Costs of Medical Examination and Treatment Covered by Health Insurance for People Infected with HIV

People living with HIV with health insurance cards shall register for medical examination and treatment under Circular 40/2015/TT-BYT.

- In cases where patients with health insurance cards within the provincial area are receiving antiretroviral (ARV) treatment at a provincial-level medical examination and treatment facility that provides initial healthcare services covered by health insurance, if there is a demand, they are allowed to register for initial healthcare services covered by health insurance at that facility.- In cases where patients undergoing HIV/AIDS treatment develop other illnesses that the healthcare facility is incapable of treating, the patients are to be referred to specialized technical levels as per legal regulations.- In cases where people undergoing ARV treatment are on business trips, working in mobile jobs, or studying in other localities for durations longer than the prescribed outpatient ARV medication period, or are temporarily residing in other localities, such individuals are entitled to receive medical examination and treatment at healthcare facilities of equivalent technical levels mentioned on their health insurance cards and provide HIV/AIDS services. If the equivalent-level healthcare facilities listed on the health insurance cards do not provide HIV/AIDS treatment, the patients are to receive medical examination and treatment at district-level facilities that offer HIV/AIDS services or be referred to specialized technical levels according to regulations.

Example: If a participant's health insurance card specifies the initial registration for medical examination and treatment at District A General Hospital, the patient can receive health insurance services or HIV/AIDS treatment at District B General Hospital (either in the same or different province) or if the initial registration is at Provincial C General Hospital, the patient can receive services or HIV/AIDS treatment at Provincial D General Hospital.

- If a healthcare facility cannot conduct certain tests or provide medical services and must send patients or samples to an authorized facility with adequate conditions to perform such tests and services, the Health Insurance Fund will reimburse the facility that sent the patients or samples at the technical service prices and within the scope and benefit level covered by health insurance as per regulations; the healthcare facility sending the patient or samples is responsible for paying the costs to the unit performing the tests and services, and then consolidating these costs into the patient's overall medical examination and treatment expenses for settlement with the social insurance agency.

See detailed information in Circular 27/2018/TT-BYT, effective from January 01, 2019.

-Thao Uyen-

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