What is health insurance? 06 groups of persons eligible for health insurance in Vietnam

What is health insurance? 06 groups of persons eligible for health insurance in Vietnam (Internet image)

1. What is health insurance?

According to Clause 1, Article 2 of the Law on Health Insurance 2008 (amended in 2014), Health insurance is a form of compulsory insurance which is implemented by the State to look after the health of the insured according to the Law on Health Insurance 2008 (amended in 2014) for non-profit purposes.

2. 06 groups of persons eligible for health insurance in Vietnam

Specifically, in Article 12 of the Law on Health Insurance 2008 (amended in 2014), groups of subjects participating in health insurance include:

(1) The group whose insurance are paid by the employers and employees, including:

- Employees on indefinite or at least full three-month contracts; salaried business managers; officials and civil servants (hereinafter referred to as employees).

- Part-time officers in communes, wards and towns under the regulations of the law.

(2) The group of the insured whose insurance is paid by the social insurance organizations, including:

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

- Persons receiving monthly social insurance pensions due to occupational accidents or diseases or diseases needing long-term treatment; beneficiaries at the age of 80 or above;

- Officers in communes, wards and towns who have left employment and been receiving monthly social insurance benefits.

- Persons receiving unemployment benefits.

(3) The group of the insured whose insurance is paid by the State budget, including:

- 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.

- Officers in communes, wards and towns who have left employment and been receiving monthly pensions funded by the State budget.

- Persons no longer receiving compensation for loss of capacity for work and being receiving monthly pensions funded by the State budget;

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

- Incumbent deputies of the National Assembly or the People’s Councils at all levels;

- 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;

- Relatives of persons performing meritorious services in the wars, except for the insured prescribed at point i clause 3 Article 12 of the Law on Health Insurance 2008 (amended in 2014);

- Relatives of the insured prescribed in point a clause 3 Article 12 of the Law on Health Insurance 2008 (amended in 2014);

- Persons who have donated body parts under the regulations of the law;

- Foreigners studying in Vietnam that are granted scholarships funded by the Vietnam State budget.

(4) The group of the insured whose insurance are supported by the State budget, including:

- Members of households living above the poverty line;

- Students.

(5) Group of the household insured including household members except for the ones prescribed in Clauses 1, 2, 3 and 4 of Article 12 of the Law on Health Insurance 2008 (amended in 2014).

(6) The government shall prescribed the insured different from the ones prescribed in item (3), (4) and (5); regulate the issuance of the health insurance cards to the insured under the management of the Ministry of National Defense and the Ministry of Public Security and the insured prescribed in point 1 Clause 3 of Article 12 of the Law on Health Insurance 2008 (amended in 2014)

3. Rights and responsibilities of the insured in Vietnam

3.1. Rights of the insured

Rights of the insured include:

- To be granted health insurance cards if paying health insurance premiums.

- To pay the household health insurance at any health insurance agency in Vietnam; to choose any covered medical provider in accordance with Clause 1 Article 26 of the Law on Health Insurance 2008 (amended in 2014)

- To be entitled to medical care.

- To get medical care costs paid by health insurance institutions.

- To request health insurance institutions, health insurance-covered medical care providers and relevant agencies to explain and provide information on health insurance.

- To complain about or denounce violations of the health insurance law.

(Article 36 of the Law on Health Insurance 2008 (amended in 2014))

3.2. Responsibilities of the insured

Responsibilities of the insured include:

- To pay health insurance premiums fully and on time.

- To use health insurance cards for proper purposes, not to lend their cards to others.

- To abide by the provisions of Article 28 of this Law when using medical care services.

- To comply with regulations and guidance of health insurance institutions and medical establishments when using medical care services.

- To pay medical care costs to medical establishments, in addition to the costs-covered by the health insurance fund.

(Article 37 of the Law on Health Insurance 2008 (amended in 2014))

Thanh Rin

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