What benefits do citizens in Vietnam enjoy when participating in health insurance contributions for 5 consecutive years? This is a question that Lawnet has recently received quite frequently from Valued Customers and Members. Lawnet would like to provide a detailed answer in the following article.
Article table of contents
What benefits do citizens in Vietnam enjoy when participating in health insurance contributions for 5 consecutive years? (Illustration)
According to Clause 5, Article 12 of Decree 146/2018/ND-CP, the period of participating in health insurance for five consecutive years or more applies to individuals who are required to co-pay medical examination and treatment costs. The continuous participation duration in health insurance in Vietnam is calculated based on the period indicated on the health insurance card, where each subsequent card follows the previous one without a break exceeding three months.
Thus, it can be understood that individuals participating in health insurance for five consecutive years or more, with a maximum interruption of no more than three months, will have this period recorded on their health insurance card as five consecutive years. What benefits do citizens in Vietnam enjoy when participating in health insurance contributions for 5 consecutive years?
Based on Clause 15, Article 1 of the 2014 Amended Health Insurance Law, guided by Article 14 of Decree 146/2018/ND-CP, the health insurance benefits for individuals participating in health insurance for five consecutive years are as follows:
Article 14. Health insurance benefits for cases specified in Clauses 1 and 7, Article 22 of the Health Insurance Law
- Participants in health insurance when seeking medical examination and treatment as per Articles 26, 27, and 28 of the Health Insurance Law, Clauses 4 and 5, Article 22 of the Health Insurance Law, the health insurance fund will cover the medical examination and treatment costs within the covered scope with the following benefits:
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dd) 100% of medical examination and treatment costs for patients who have participated in health insurance for five consecutive years or more and have co-paid medical examination and treatment costs in the year exceeding six months’ statutory pay rate, except for cases of off-line medical examination and treatment;
Therefore, according to the above regulation, individuals who have continuously participated in health insurance for five years or more and have co-paid medical examination and treatment costs in the year exceeding six months' statutory pay rate (the current statutory pay rate is 1,490,000 VND) and seek medical treatment in line with the regulations will receive 100% coverage of medical examination and treatment costs within the health insurance coverage for subsequent treatments in the year. Participants of health insurance for five consecutive years will also receive a certificate of "no co-payment for the year" from the social insurance authority.
Example: Mr. Nguyen Thanh An has participated in health insurance for five consecutive years or more (benefit level 80%) and resides in District 10. In October 2020, Mr. An received medical treatment at Cho Ray Hospital with treatment costs of 58 million VND, requiring him to pay 11,600,000 VND (exceeding six months' statutory pay rate). Therefore, Mr. An will be reimbursed the difference exceeding six statutory pay rates (11,600,000 - 8,940,000 = 2,660,000 VND) by Vietnam Social Security and issued a certificate of no co-payment for the year. Consequently, if Mr. An returns for treatment at Cho Ray Hospital in 2020, he will be covered for 100% of the treatment costs within the health insurance benefit scope.
Upon meeting the eligibility criteria for health insurance benefits for five consecutive years, individuals must prepare one set of documents according to Notification 2298/TB-BHXH of 2018 as follows:
- A health insurance card displaying the words: "Continuous participation for five years as of..." or a certification of five consecutive years of participation;
- An identification document with a photo (copy) valid up to the time of incurring health insurance medical examination and treatment costs;
- Original invoices and payment receipts for hospital fees.
After obtaining these documents, the patient should submit the application to the social insurance agency where they participate in health insurance for processing.
Ty Na
- Key word:
- Vietnam
- Health Insurance
- 5 consecutive years
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