From January 1, 2015, individuals holding a health insurance card (BHYT) who have participated in health insurance (BHYT) continuously for a period of 5 years or more, and have co-payment amounts for medical examination and treatment (KCB) at the correct level exceeding six months' statutory pay rate within the year, will be entitled to 100% coverage of the KCB costs.
Article table of contents
According to the regulations in the Amended 2014 Health Insurance Law and Decree 105/2014/ND-CP, participants of health insurance (BHYT) are entitled to 100% coverage of medical examination and treatment (KCB) costs by the Health Insurance Fund if they have continuously participated in health insurance for 5 years from the time of starting participation up to the time of medical examination and treatment, and the cumulative co-payment of KCB costs in a year is greater than 6 months' statutory pay rate, calculated from the time when they have participated in health insurance for 5 consecutive years (excluding the case of self-referral in non-designated medical facilities).
This regulation took effect on January 01, 2015; however, since then, many people are not aware or do not know about the benefits they are entitled to.
According to Point d, Clause 1, Article 9 of Decision 1399/QD-BHXH, dated December 22, 2014 of Vietnam Social Security, the above medical examination and treatment cost coverage applies to the payment ratio for certain drugs, chemicals, medical supplies, and technical services as prescribed by the Minister of Health, and the patient has the responsibility to keep the receipts of the co-payment costs as a basis for the social insurance agency to issue a certificate of no co-payment within the year.
Everyone needs to note that the condition to enjoy this benefit must ensure 2 main factors:
1. The health insurance card has participated continuously for 5 years and the card indicates “Time of 5 consecutive years: from...”.
2. The co-payment amount of KCB costs at designated medical facilities in the year is greater than 6 months' statutory pay rate, and these costs are calculated within the same calendar year.
In case you have participated in health insurance for 5 consecutive years but do not have that line on the card, you can go to the social insurance agency where you participated to submit your documents and request a card replacement.
Additionally, the 100% coverage of medical examination and treatment costs also applies to the following cases:
- Subjects specified in Points d, e, g, h, and Point i, Clause 3, Article 12 of the Amended Health Insurance Law such as:- People with meritorious services to the revolution, veterans;- Children under 6 years old;- Persons receiving monthly social protection benefits;- Persons from poor households; ethnic minorities living in areas with difficult socio-economic conditions; persons living in extremely difficult socio-economic conditions; persons living in island communes and island districts;- Relatives of people with meritorious services to the revolution, including biological parents, spouses, children of martyrs; persons taking care of martyrs;- People engaged in pre-January 01, 1945 revolution; people engaged in revolution from January 01, 1945 to August Revolution 1945; Vietnamese Heroic Mothers; war invalids, persons enjoying war invalid policies, Type B war invalids, patients with a working capacity loss of 81% or more; war invalids, persons enjoying war invalid policies, Type B war invalids, patients being treated for relapse of wounds or diseases; children under 6 years old;- Persons having medical examinations and treatments at commune-level medical facilities;- Persons whose costs for a single medical examination or treatment are less than 15% of the statutory pay rate.
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