Vietnam: Levels of health insurance benefits for medical care services at the right level, at level different from the registered hospital and for transferred level in 2021

1. Levels of health insurance benefits for medical care services at the right level

According to Article 22 of the Law on Health Insurance of Vietnam, levels of health insurance benefits for medical care services at the right level have been amended as follows:

* 100% of the costs:

- Commissioned officers, professional soldiers, non-commissioned soldiers on active duty;

- Commissioned police officers and non-commissioned police officers; police students, non-commissioned police officers or soldiers on fixed term contracts; 

- Ciphers whose salaries are the same as the salaries as the servicemen; 

- Cipher students whose benefits are the same as the benefits of students in military or police academies;

- Persons performing meritorious services in the wars, war veterans;

- Children under the age of 6;

- Persons receiving monthly social protection pensions;

- Poor household members, ethnics living in regions facing socio-economic difficulties, persons living in regions facing extreme socio-economic difficulties; persons living in island communes or districts.

- Relatives of persons performing meritorious services in the wars such as biology parents, husbands, wives or children of revolutionary martyrs; persons rearing revolutionary martyrs;

- Medical examination and treatment at commune hospitals whose cost is lower than the cost prescribed by the Government;

- The at least 5-year-insured whose medical examination and treatment expenditures exceed the total amount of the base salaries in 6 months, except for the insured who go to the hospitals different from the registered hospitals.

* 95% of the costs:

- Persons receiving monthly retirement pensions and compensation for loss of capacity for work;

- Relatives of persons performing meritorious services in the wars, except for relatives of persons performing meritorious services in the wars such as biology parents, husbands, wives or children of revolutionary martyrs; persons rearing revolutionary martyrs;

- Members of households living above the poverty line.

* 80 % of the medical examination and treatment expenditures with regard to other insured persons.

2. Levels of health insurance benefits for medical care services at level different from the registered hospital 

According to Article 22 of the Law on Health Insurance of Vietnam, in case any card holder goes to a hospital different from the registered hospital, his or her costs shall be covered by the health insurance fund according to the benefit levels as follows:

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

- 60% of the inpatient treatment expenditures at the provincial hospitals from the effective date of this Law to December 31, 2020; total inpatient treatment costs from January 01, 2021 at all hospitals in Vietnam;

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

Note: 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 section 1.

Particularly, the inpatient treatment expenditures of the insured who go to any provincial hospital in Vietnam different from their registered hospitals shall be paid by the health insurance fund from January 01, 2021.

3. Levels of health insurance benefits for transferred-level insured

According to Clause 3 Article 14 of the Decree No. 146/2018/NĐ-CP of Vietnam’s Government, in case where a health insurance card holder visits an inappropriate-level healthcare establishment at his/her discretion, and then is referred to another healthcare establishment by the receiving healthcare establishment, he/she shall be paid the health insurance fund’s coverage at the coverage rate as follows:

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

- 60% of the inpatient treatment expenditures at the provincial hospitals from the effective date of this Law to December 31, 2020; total inpatient treatment costs from January 01, 2021 at all hospitals in Vietnam;

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

Note: Case that the health insurance card holder is given emergency treatment services; he/she is given inpatient treatment services while being diagnosed with any other disease of which treatment is out of professional capabilities of the referring healthcare establishment; his/her pathological conditions have changed to the extent that they are out of competencies of the referring healthcare establishment.

>>> View more: 06 groups of subjects required to participate in health insurance from 2021 in Vietnam

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