Latest Guidelines on Medical Examination and Treatment Fees Calculation Using Health Insurance Cards Issued

1. BHYT Consultation Fees at Private Clinics Equivalent to Grade IV Hospitals

The price applicable to BHYT consultation services at private clinics is 29,000 VND (including direct costs and wages).

2. Cap for Inter-District Visits Compensated Between Inpatient and Outpatient

In cases where the patient comes for examination at a medical facility and is then admitted for inpatient treatment based on professional requirements, it is considered as one consultation for payment purposes.

3. Costs Not Included in the Cap for Inter-District Visits

Expenses such as transportation, blood and blood product costs, and costs reimbursed according to actual expenses will not be included in the cap for inter-district visits.

Among these, costs reimbursed according to actual expenses must be approved by the BHYT authority.

4. The K Coefficient for Medication Group Applied in 2017 is 1.012

The K coefficient for the medication group includes the costs of drugs, chemicals, and infusions.

5. The K Coefficient for Service Group Applied in 2017 is 1.0353

The K coefficient for the service group applies to the costs of other medical services, excluding transportation, blood, and blood product costs.

6. Average Costs Under the Cap for Inter-District Visits Adjusted According to the New Medical Service Prices

Conversions are carried out in accordance with Joint Circular 37/2015/TTLT-BYT-BTC.

If a medical facility has applied the service prices including wages for at least one month, the conversion is based on the price as of July 1.

If a medical facility has not applied service prices including wages or for less than one month, the conversion is based on the price as of March 1. The difference is paid outside the cap for inter-district visits.

This conversion method also applies to units that sign a contract for BHYT medical examinations and treatment for the first time.

7. Payments Outside the Cap for Inter-District Visits for Costs Arising Due to Changes in BHYT Consultation and Treatment Prices

The provincial Social Insurance Agency is responsible for verifying and paying these costs.

Legal basis:

- Official Dispatch 1094/BHXH-CSYT;- Official Dispatch 1142/BHXH-CSYT.

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