Cases Eligible for 100% Medical Examination and Treatment Costs Covered by Health Insurance

Participants of Health Insurance (BHYT) will be covered by the BHYT Fund for 100% of medical examination and treatment costs in the following cases:

First, 100% of the medical examination and treatment costs will be covered for individuals specified in Clauses 3, 4, 8, 9, 11, and 17 of Article 3, Decree 146/2018/ND-CP, including:

- People with meritorious services to the revolution as stipulated in the Ordinance on Incentives for People with Meritorious Services to the Revolution;

- Veterans:

+ Veterans who participated in the resistance war prior to April 30, 1975;

+ Veterans participating in the resistance war after April 30, 1975, as specified in Decree 150/2006/ND-CP like soldiers, defense workers who have received allowances according to Decision 62/2011/QD-TTg; officers, professional soldiers, non-commissioned officers, soldiers, and defense workers directly involved in the war to defend the country, performing international duties in Cambodia, assisting Laos after April 30, 1975, who transferred to work at agencies, organizations, enterprises (not receiving allowances according to Decision 62/2011/QD-TTg); officers, professional soldiers who completed their active duty during the period of building and defending the country retired, retired, or transferred to agencies, organizations, enterprises; militiamen and self-defense forces who participated in combat, directly served in combat after April 30, 1975 and have received allowances according to Decision 62/2011/QD-TTg.

- Individuals eligible for monthly social protection allowances as stipulated by law on the elderly, disabled persons, and social protection subjects;

- Members of poor households; ethnic minorities residing in areas with difficult socio-economic conditions; people living in areas with special difficult socio-economic conditions; people living in island communes, island districts, and several other subjects;

- Relatives of people with meritorious services to the revolution who are the biological father, mother, spouse, or child of a martyr; people taking care of martyrs;

- Individuals aged 80 years or older who are receiving monthly survivor benefits as stipulated by the law on Social Insurance (BHXH).

Second, 100% coverage for medical examination and treatment costs and no application of the limit on the payment rate for medicines, chemicals, medical supplies, and technical services as stipulated by the Minister of Health for:

- People active in the revolution before January 1, 1945;

- People active in the revolution from January 1, 1945, to the August Revolution in 1945;

- Vietnamese Heroic Mothers; war invalids, persons entitled to policies as war invalids, category B invalids, and patients with a labor capacity decreased by 81% or more;

- War invalids, persons entitled to policies as war invalids, category B invalids, and patients when treating recurrent injuries and diseases;

- Individuals who participated in the resistance war infected with chemical toxins with a labor capacity reduction of 81% or more;

- Children under 6 years old.

Third, 100% coverage for medical examination and treatment costs at the commune level.

Fourth, 100% coverage for medical examination and treatment costs when the cost per visit is less than 15% of the statutory pay rate.

Fifth, 100% coverage for medical examination and treatment costs when the patient has participated in the BHYT continuously for 5 years or more and has co-paid medical examination and treatment costs in the year that exceed 6 months of the statutory pay rate, except in the case of self-referred medical examination and treatment that is not in line with referrals.

In addition, BHYT also supports 95% of the medical examination and treatment costs for individuals specified in Clause 1, Article 2, Clause 12, Article 3, and Clauses 1 and 2, Article 4 of Decree 146, including:

- Pensioners, monthly labor loss benefit recipients;

- Relatives of people with meritorious services to the revolution, excluding relatives of people with meritorious services to the revolution who are the biological father, mother, spouse, or child of a martyr; those taking care of martyrs, including:

+ Biological fathers, mothers, spouses, children over 6 years old and under 18 years old, or 18 years old and older if still studying or severely disabled, extremely severely disabled of the following subjects: People active in the revolution before January 1, 1945; people active in the revolution from January 1, 1945, to the August Revolution in 1945; Heroes of the People's Armed Forces, Heroes of Labor during the resistance war; war invalids, patients reduced labor capacity by 61% or more; people active in the resistance war infected with chemical toxins who have a decreased labor capacity of 61% or more.

+ Biological children aged 6 years or older of people active in the resistance war exposed to chemical toxins, having deformities, malformations due to the effects of chemical toxins, unable to self-reliantly live or having diminished self-reliant capacity, receiving monthly allowances.

- Members of near-poor households according to the near-poor criteria as stipulated by the Government of Vietnam, the Prime Minister of the Government of Vietnam;

- Members of multidimensional poor households who do not fall under the category of poor households according to income criteria, multidimensional poor individuals experiencing deficiencies in health insurance according to Decision 59/2015/QD-TTg.

The remaining support level of 80% for medical examination and treatment costs is applied to other subjects.

Participants of BHYT who register for initial medical examination and treatment at commune health stations located in border communes of contiguous provinces will be reimbursed 100% of the medical examination and treatment costs within their entitled scope and level of coverage when seeking medical services at commune health stations located in border communes of contiguous provinces.

In the case of changing the coverage level of BHYT, the new level of coverage is calculated from the time the new BHYT card becomes effective.

For more details, see: Decree 146/2018/ND-CP, effective from December 1, 2018, replacing Decree 105/2014/ND-CP.

- Nguyen Trinh -

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