Good news: From 2021, patients receiving off-route medical examination and treatment at provincial hospitals in Vietnam will still be entitled to 100% of the inpatient treatment costs

Illustrative Image

According to Clause 15 Article 1 Amended Law on Health Insurance 2014 amending and supplementing Article 22 Law on Health Insurance 2008, in case a person with a health insurance card goes for off-route medical examination and treatment at the wrong level, the health insurance fund will pay according to the benefit levels stipulated in Clause 1 Article 22 of the Law on Health Insurance 2008 at the following rates:

- At central-level hospitals, 40% of inpatient treatment costs;

- At provincial-level hospitals, 60% of inpatient treatment costs from the effective date of this Law until December 31, 2020; 100% of inpatient treatment costs from January 1, 2021 nationwide;

- At district-level hospitals, 70% of medical examination and treatment costs from the effective date of this Law until December 31, 2015; 100% medical examination and treatment costs from January 1, 2016.

In case of ethnic minorities and persons from impoverished households participating in health insurance living in areas with difficult socio-economic conditions and areas with particularly difficult socio-economic conditions; persons participating in health insurance living in island communes or districts who go for medical examination and treatment at the wrong level, the health insurance fund will pay medical examination and treatment costs for district-level hospitals, inpatient treatment at the provincial and central-level hospitals, and the benefit levels as stipulated in Clause 1 Article 22 of the Law on Health Insurance 2008.

The benefit levels of health insurance as stipulated in Article 22 of the Law on Health Insurance 2008 are as follows:

1. Participants in health insurance when going for medical examination and treatment as stipulated in Articles 26, 27, and 28 of this Law shall have medical examination and treatment costs covered by the health insurance fund within the benefit scope as follows:

a) 100% of medical examination and treatment costs for subjects stipulated at points a, d, e, g, h and i of Clause 3 Article 12 of this Law. Medical examination and treatment costs outside the benefit scope of health insurance for subjects stipulated at point a Clause 3 Article 12 of this Law shall be covered from the health insurance fund dedicated to medical examination and treatment for this subject group; in case this fund is insufficient, the state budget shall cover the difference;

b) 100% of medical examination and treatment costs in cases where each instance costs less than the amount stipulated by the Government of Vietnam and for medical examinations and treatments at the commune level;

c) 100% of medical examination and treatment costs when the patient has participated in health insurance for 5 continuous years or more and has co-payment for medical examination and treatment costs in a year exceeding 6 months statutory pay rate, except when going for medical examination and treatment at the wrong level;

d) 95% of medical examination and treatment costs for subjects stipulated at point a Clause 2, point k Clause 3, and point a Clause 4 Article 12 of this Law;

dd) 80% of medical examination and treatment costs for other subjects.

Nguyen Trinh

>> CLICK HERE TO READ THIS ARTICLE IN VIETNAMESE