From 2021, the policy for users of health insurance cards will have many notable new points. LAWNET would like to review the most prominent new regulations.
Article table of contents
1. 08 cases of medical examination and treatment under health insurance in appropriate level
(1) Health insurance participants apply for medical examination and treatment in initial medical examination and treatment establishments specified on their health insurance cards.
(2) Health insurance participants who apply for initial medical examination and treatment in medical examination and treatment establishments of communes or general clinics or district hospitals may receive medical examination and treatment covered by health insurance in other medical stations of communes or general clinics or district hospitals in the same provinces.
(3) Health insurance participants who are in state of emergency are provided with emergency medical aid in any medical examination and treatment establishment in the country.
(4) Health insurance beneficiaries who benefit from transfer of administrative levels for receiving medical examination and treatment under health insurance as per the law.
(5) Health insurance participants who obtain documents proving their stay in other administrative divisions when they go on working trips, participate in concentrated education in training programs, semi-boarding programs and apply for initial medical examination, treatment in medical examination and treatment establishments of the same or equivalent administrative level as their initial medical examination and treatment establishments specified on health insurance cards.
(6) Holders of notice of re-examination appointment in case they have been transferred.
(7) Individuals who have donated their organs and require immediate treatment after donating organs.
(8) Newborn babies who must receive treatment upon birth.
Thus, from March 2021, there are 08 cases mentioned above of medical examination and treatment under health insurance in appropriate level in accordance with the Circular No. 30/2020/TT-BYT of the Ministry of Health of Vietnam.
More details at the article: Cases of medical examination and treatment under health insurance in appropriate level in Vietnam from 2021.
2. Inter-provincial use of health insurance cards: Card holder goes to a hospital different from the registered hospital shall be paid the total inpatient treatment expenditures
According to the Article 22 of the Law on Health Insurance 2008, amended by Clause 15 Article 1 of the Law amendments to the Law on Health Insurance 2014 of Vietnam, the total 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.
However, the followings should be noted:
(1) Not everyone is entitled to 100% payment of inpatient treatment expenditures when accessing the health insurance card
The user of the health insurance card when going to the right medical examination and treatment at the right level will not in all cases be paid 100% of the cost, depending on who the user is. Because the benefit levels of the inappropriate level health insurance card will be based on the same level of benefits as going to the right medical examination and treatment, not everyone is entitled to the payment of 100% of the inpatient treatment costs when the health insurance card is passed through the province. Specifically, depending on each entity, the benefit levels of inappropriate level are based on the benefit levels of appropriate level as follows:
- 100% of inpatient treatment expenditures;
- 95% of inpatient treatment expenditures;
- 80% of inpatient treatment expenditures.
Examples:
- Children under the age of 6 shall be paid 100% of inpatient treatment expenditures when going to any hospital in Vietnam different from their registered hospitals.
- Persons receiving monthly retirement pensions shall be paid 95% of inpatient treatment expenditures when going to any hospital in Vietnam different from their registered hospitals.
- Employees working in enterprises shall be paid 80% of inpatient treatment expenditures when going to any hospital in Vietnam different from their registered hospitals.
(2) Inter-provincial use of health insurance cards is only applicable to the insured under inpatient treatment
To be specific, according to Clause 6 Article 22 of the Law on Health Insurance 2008 (amended in 2014) of Vietnam, the total 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. The health insurance fund only pays the total expenditures according to the scope of benefits for cases where the patient self-checks at a provincial hospital and has a doctor's appointment for inpatient treatment. In case people go to the outpatient clinic, they will have to pay the entire medical examination expenditures themselves.
(3) Inter-provincial use of health insurance cards is not applied to central hospitals such as Bach Mai Hospital, Viet Duc Hospital, Cho Ray Hospital, Thong Nhat Hospital, 108 Military Central Hospital
Inter-provincial use of health insurance cards is not applied to all provincial hospitals and some specialized hospitals. Central hospitals such as Bach Mai Hospital, Viet Duc Hospital, Cho Ray Hospital, Thong Nhat Hospital, 108 Military Central Hospital are not applied the inter-provincial use of health insurance cards.
3. From April 01, 2021, health insurance participants will be issued a card with a unique social insurance number
According to the Decision No. 1666/QĐ-BHXH, the new form of health insurance card will be officially applied nationwide from April 01, 2021. Specifically, according to this Decision, “Each person participating in health insurance is issued a card with a unique social insurance number”. Previously, according to the Decision No. 1313/QĐ-BHXH, “Each person participating in health insurance is issued with a card and a code that does not change during the period of participation in health insurance”.
Thus, from April 1, 2021, when the new form of health insurance card is applied, each health insurance participant will be issued a card with a unique social insurance number. Concurrently, people can use the social insurance number and register for transactions at: https://dichvucong.baohiemxahoi.gov.vn to continue participating in health insurance, re-issue, issue and change health insurance cards, check medical expenses diseases and treatment covered by health insurance.
Above are some new regulations applicable to health insurance card users from 2021 in Vietnam.
Thuy Tram
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