Cases eligible for 100% health insurance coverage in Vietnam

Cases eligible for 100% health insurance coverage in Vietnam​ (Illustrative Photo)

According to the provisions in Decree 146/2018/ND-CP, participants of health insurance (HI) when going for medical check-ups and treatment as stipulated in Articles 26, 27, 28 and Clauses 4 and 5, Article 22 of the Amended Health Insurance Law 2014 will be covered 100% by the HI fund in the following cases:

- Subjects specified in Clauses 3, 4, 8, 9, 11, and 17, Article 3 of Decree 146/2018/ND-CP;

- 100% medical expenses without applying the payment limit ratios for drugs, chemicals, medical supplies, and technical services as regulated by the Minister of Health for:

- Revolutionaries before January 01, 1945;

- Revolutionaries from January 01, 1945, to the August 1945 uprising;

- Vietnamese Heroic Mothers;

- War invalids, policy beneficiaries like war invalids, type B war invalids, and persons with work capacity impairment of 81% or more;

- War invalids, policy beneficiaries like war invalids, type B war invalids, and sick soldiers when treated for recurring injuries or illnesses;

- Resistance activists contaminated with toxic chemicals with labor capacity impairment of 81% or more;- Children under 6 years old.

- Medical check-ups and treatment at the commune level;

- For cases where the cost of one-time medical check-up or treatment is less than 15% of the statutory pay rate;

- When the patient has participated in health insurance for 5 consecutive years or more and the co-payment costs exceed 6 months' statutory pay rate in a year, except for cases of self-referred medical check-ups or treatment not following the approved route.

Thus, in the above-mentioned cases, HI participants are entitled to 100% medical expenses coverage. For other cases, participants will still be entitled to coverage but at a lower rate, with different levels of support depending on the specific situation. HI participants should take note when seeking medical check-ups and treatment to maximize the support for medical expenses.

Thuy Tram

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