Household Health Insurance in Vietnam: Benefits and something to know

Health insurance Household: Benefits and things to know (Illustration image)

1.  The insured

Pursuant to Clause 5, Article 12 of the Law on Health Insurance, the group participating in health insurance by household includes:

- All members named in household registration book, temporary residence book or jointly registered for permanent/temporary residence at a lawful place of residence, except those eligible to participate in health insurance according to other groups and those who reported temporary absence.

- People living in social protection establishments (except for those covered by health insurance under other groups).

- Dignitaries, civil servants, monks, and people living in social protection establishments without state budget support to pay health insurance premiums.

2. The amount of payment

According to the provisions of the current Law, the household health insurance premium is calculated based on the base salary. Specifically, according to Point e, Clause 1, Article 7 of Decree 146/2018/ND-CP , the health insurance premiums of household members are as follows:

*** Monthly payment: Equal  to 4.5% of the base salary (base salary from July 1, 2019 is VND 1,490,000)

*** 1 year payment  = Base salary x 4.5% x 12 months  =  804,600 VND/year

***Deduction of premium: The State has a policy to support health insurance premiums for participating members, specifically as follows:

3. Benefits:

-  Issued a health insurance card.

- To be able to choose an initial health insurance facility according to regulations.

- To change the place of initial medical examination and treatment in the first month of each quarter.

- To be paid medical examination and treatment expenses within the scope of benefits and entitlements specified on the health insurance card

- To complain and denounce violations of the law on health insurance

4.  The amount of benefit:

The household health insurance allowance follows the general principles of health insurance enjoyment specified in Article 14 of Decree 146/2018/ND-CP in 2021. Specifically:

***Emergency case:  Get medical treatment at any medical facility (with registration for medical treatment and health insurance) and must present documents as prescribed before being discharged from the hospital.

***On-line medical examination and treatment services: Correct medical examination and treatment services at the place of initial registration stated on the health insurance card; Transfer health care health insurance according to regulations

-  If outpatient treatment: 100% of total outpatient medical expenses at all district hospitals across the country.

- If you are hospitalized for inpatient treatment and present your health insurance card, you will be entitled to benefits at the hospital at the prescribed rate of 80% times (x) with the following rate:

+ Provincial hospital: 100%

+ Central hospital: 40%

*** In case of medical examination and treatment at a medical facility that does not sign a contract for medical examination and treatment with health insurance

- In case of emergency, the social insurance agency will reimburse the patient for actual expenses within the scope of benefits and the prescribed level of entitlement is 80%.

- In case patient is not in an emergency situation, the social insurance agency will reimburse the patient under the actual expenses within the scope of benefits and the prescribed benefit rate is 80%  (if the medical treatment is at a medical facility at the district level or below) or 80% times (x) 60% rate ( provincial medical facilities ) or 40% rate ( central level medical facilities ), but maximum 01 session of medical treatment does not exceed the following:

In addition, The social insurance agency shall directly pay the costs of medical examination and treatment covered by health insurance in the following cases:​

- Health insurance card data is not provided or provided incorrectly about health insurance card information

- The patient fails to present his/her health insurance card before being discharged from the hospital or transferred on the same day due to an emergency, loss of consciousness or death.

- Persons participating in health insurance for 5 consecutive years or more and the amount of co-payment for medical treatment in the year is greater than 06 months' base salary ( currently over VND 8,940,000 ) but have not yet been paid the co-payment amount. more than 6 months base salary.

5. Some notes for household health insurance cards

- For first-time participants or intermittently for 3 months or more in a fiscal year, the health insurance card is valid for use after 30 days from the date of payment.

- Patients who participate in health insurance continuously, are valid to use the card from the date of payment of health insurance premium. The period of continuous participation in health insurance is the period of participation for the next time following the expiry date of the previous health insurance card. In case of interruption, the maximum time is not more than 3 months.

- In order for the health insurance card to be valid for continuous and uninterrupted use, before the expiry date of the health insurance card, the participant must pay the card renewal fee at the collection agent or the social insurance agency.

- Present your health insurance card and photo identification when going to the clinic.

- Use the card for the right purpose, do not lend the card to others and do not use other people's cards when providing health insurance.

6. Procedures for participating in household health insurance

To register to buy household health insurance, participants can carry out procedures at social insurance collection agents or social insurance agencies of communes, wards and townships where they reside. The order to buy household health insurance is guided in Official Dispatch 3170/BHXH-BT dated 24/8/2015

In addition to the practical benefits that people participating in household health insurance can receive, participating in household health insurance also demonstrates the responsibility of each individual and family to society, ensuring the humanity, community support, the principle of risk-sharing right from the family.

Bao Ngoc

>> CLICK HERE TO READ THIS ARTICLE IN VIETNAMESE