Vietnam: Health insurance benefits for children under 6 years old from 2021

Health insurance is a welfare regime to serve and protect the health care needs of the people, especially for children under 6 years old. So, what is the health insurance coverage for children under 6 years old from 2021 in Vietnam?

Bảo hiểm y tế cho trẻ sơ sinh: Chi tiết mức hưởng và thủ tục cấp thẻ BHYT

According to Point b Clause 1 Article 14 of the Decree No. 146/2018/NĐ-CP of Vietnam’s Government, children under 6 years of age shall be entitled to the health insurance fund’s coverage of permissible medical costs at the rate of 100% of medical costs, and no restrictions on the rate of payment of medical costs such as medicines, chemicals, medical supplies and medical technology services as regulations of the Minister of Health.

Besides, according to Clause 3 Article 22 of the Law on Health Insurance of Vietnam, in case any card holder goes to a hospital different from the registered hospital except for the insured, his or her costs shall be covered by the health insurance fund according to the benefit levels prescribed in Clause 1 this Article as follows:

- 40% of the inpatient treatment expenditures at the central hospitals.

- Total inpatient treatment costs from January 01, 2021 at all hospitals in Vietnam.

- Total medical examination and treatment expenditures at the district hospitals.

Concurrently, the insured who are poor household members or ethnics living in regions facing socio-economic difficulties, regions facing extreme socio-economic difficulties; the insured living in island communes or islands districts who go to the hospitals different from the registered hospital shall be paid for their medical examination and treatment expenditures at the commune hospitals, their inpatient treatment costs at the provincial and central hospital by the health insurance fund according to the benefit levels prescribed in Clause 1 Article 22 of the Law on Health Insurance of Vietnam.

Thus, according to the above provisions, health insurance benefits for children under 6 years old from 2021 are as follows:

- For cases of medical examination and treatment at the right level: children under 6 years old are entitled to 100% of medical examination and treatment expenses.

- For out-of-line medical examination and treatment: children under 6 years old are entitled to 40% of the treatment costs at central hospitals, 100% of the treatment costs at the provincial and district hospitals.

- For children who are poor household members or ethnics living in regions facing socio-economic difficulties, regions facing extreme socio-economic difficulties; children living in island communes or islands districts who go to the hospitals different from the registered hospital shall be paid 100% for their medical examination and treatment expenditures.

In order to enjoy the above-mentioned health insurance benefits from 2021, parents of children under 6 years old must submit 01 set of documents (according to Article 6 of the Circular No. 05/2015/TTLT-BTP-BCA-BYT) at the People’s Committees of commune for issuance of health insurance card. Documents include:

1. Birth registration form according to prescribed forms.

2. Notice of birth issued by medical facility where a child is born:

- If the child is born outside the medical facility, notice of birth can be replaced by a written confirmation by witnesses;

- In case no witness is available, the person who makes registration must give a guarantee that the birth is true;

- In case of an abandoned child, a written record of the abandoned child can be used as a substitute for notice of birth;

- In case of surrogacy, registration for birth must be added with a written proof of the surrogacy according to the law provisions.

3. Declaration form for participating in social insurance according to prescribed forms.

Note: The time limit for granting health insurance cards to children under 6 years old is no more than 15 working days from the date of submission of complete dossiers as prescribed.

Ty Na

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