Amendments to regulations on numerical codes (2nd box) in health insurance card codes from December 3, 2023 in Vietnam

Amendments to regulations on numerical codes (2nd box) in health insurance card codes from December 3, 2023 in Vietnam (Internet image) 

Regarding this issue, LawNet would like to answer as follows:

On November 27, 2023, the General Director of Vietnam Social Insurance issued Decision 1697/QD-BHXH in 2023, amending the code recorded on the health insurance card in Decision 1351/QD-BHXH in 2015.

Amendments to regulations on numerical codes (2nd box) in health insurance card codes from December 3, 2023 in Vietnam

Specifically, Decision 1697/QD-BHXH will amend and supplement items a, b, c, and d, Clause 2, Article 2 of Decision 1351/QD-BHXH of 2015, as follows:

- Numerical code 1: 100% of medical examination and treatment costs covered by health insurance are paid by the health insurance fund, and no limit on payment rates for drugs, chemicals, medical supplies, and technical services is applied according to the regulations of the Minister of Health, including beneficiaries with codes: CC, TE.”

(Decision 1351/QD-BHXH 2013 stipulates:

“Numerical code 1: 100% of medical examination and treatment costs covered by health insurance are paid by the health insurance fund, and there is no limit on payment rates for some drugs, chemicals, medical supplies, and technical services according to the regulations of the Minister of Health on the list; rates and conditions for payment of technical services; expenses for transporting patients from district level to higher level in case of emergency or when undergoing inpatient treatment requiring technical and professional transfer, including beneficiaries with codes: CC, TE.”)

- Numerical code 2: 100% of medical expenses paid by the health insurance fund within the scope of health insurance coverage (limited payment rates for some drugs, chemicals, medical supplies, and technical services according to regulations of the Minister of Health); Expenses for transporting patients from district level to higher level in case of emergency or when undergoing inpatient treatment requiring technical and professional transfer, including beneficiaries with the code: CK, CB, KC, HN, DT, DK, XD, BT, TS, AK, CT.

(Decision 1351/QD-BHXH 2013 stipulates:

“Numerical code 2: 100% of health insurance costs paid by the health insurance fund within the scope of health insurance coverage (limited payment rates for some drugs, chemicals, medical supplies, and technical services according to regulations of the Minister of Health); Expenses for transporting patients from district level to higher level in case of emergency or when undergoing inpatient treatment requiring technical and professional transfer, including beneficiaries with the code:
CK, CB, KC, HN, DT, DK, XD, BT, TS.”)

- Numerical code 3: Health insurance fund pays 95% of medical expenses within the scope of health insurance coverage (limited payment rates for some drugs, chemicals, medical supplies, and technical services according to regulations of the Minister of Health); 100% of medical expenses at the commune level; and the cost for one medical examination is lower than 15% of the basic monthly salary, including beneficiaries with the codes: HT, TC, CN, PV, TG, DS, and HK.

(Decision 1351/QD-BHXH 2013 stipulates:

Numerical code 3: The health insurance fund pays 95% of medical expenses within the scope of health insurance coverage (limited payment rates for some drugs, chemicals, medical supplies, and technical services according to regulations of the Minister of Health); 100% of medical expenses at the commune level; and the cost for one medical examination is lower than 15% of the basic monthly salary, including beneficiaries with the codes: HT, TC, CN.”)

- Numerical code 4: The health insurance fund pays 80% of medical expenses within the scope of health insurance coverage (limited payment rates for some drugs, chemicals, medical supplies, and technical services according to regulations of the Minister of Health); 100% of medical examination costs at the commune level, and the cost for one medical examination is lower than 15% of the basic monthly salary, including beneficiaries with the code: DN, HX, CH, NN, TK, HC, XX, TB, NO, XB, TN, CS, XN, MS, HD, TQ, TA, TY, HG, LS, HS, SV, GB, GD, ND, TH, TV, TD, TU.

(Decision 1351/QD-BHXH 2013 stipulates:

Numerical code 4: Health insurance fund pays 80% of medical expenses within the scope of health insurance coverage (limited payment rates for some drugs, chemicals, medical supplies and technical services according to regulations of the Minister of Health); 100% of medical treatment costs at the commune level and the cost for one medical examination is lower than 15% of the basic monthly salary, including beneficiaries with the code: DN, HX, CH, NN, TK, HC, XK, TB, NO, CT, XB, TN, CS, XN, MS, HD, TQ, TA, TY, HG, LS, PV, HS, SV, GB, GD.”)

It is known that the next character (2nd box) on the health insurance card code: denoted by number (in order from 1 to 5), is the health insurance benefit level.

In case a person belongs to many subjects participating in health insurance, the health insurance benefit level recorded on the health insurance card is the benefit level of the subject with the highest benefits.

Decision 1697/QD-BHXH takes effect on December 3, 2023.

- Regulations in: sections a and g, clause 1; details a and b, clause 2; and Article 1 of Decision 1697/QD-BHXH will be applied from October 19, 2023.

- The provisions in items c and e, clause 1, and item c, clause 4, Article 1 of Decision 1697/QD-BHXH apply from February 15, 2022.

- The provisions in Clauses 1, 2, 3, and 4, Article 1 of this Decision (except for the provisions in Clauses 2 and 3, Article 2 of Decision 1697/QD-BHXH) will come into force on December 1, 2018.

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