List of Eligible Beneficiaries and Levels of Health Insurance Benefits for 2018 in Vietnam

Duy Thinh

18:53, 10/07/2024

According to the current regulations, depending on the beneficiaries and hospital level for medical examination and treatment, the health insurance coverage rate for the patient in Vietnam will vary. To know the specific health insurance coverage rate, you can refer to the Summary Table below.

No.	Case	Beneficiaries	Benefits
1	On route	- People with meritorious service to the revolution, veterans in Vietnam; - Individuals entitled to monthly social protection allowance in Vietnam; - Members of poor households; ethnic minorities living in areas with difficult socio-economic conditions, especially difficult; people living on island communes, island districts; - Relatives of people with meritorious service to the revolution, including biological parents, spouses, children of martyrs; individuals taking care of martyrs; - Participating in medical examination and treatment at the commune level. - Subjects where the cost for one medical examination and treatment event is less than 15% of the statutory pay rate; - Patients who have participated in health insurance for 5 continuous years, counted from the time they join health insurance to the time they go for medical examination and treatment, and have a cumulative co-payment amount in the year exceeding 6 months' statutory pay rate, counted from the time of continuous 5-year participation in health insurance.	100% of medical examination and treatment costs
		- Revolutionary activists before January 01, 1945; - Revolutionary activists from January 01, 1945 to the August Revolution of 1945; - Heroic Vietnamese Mothers; - War invalids, individuals entitled to policies like war invalids, category B war invalids, seriously injured patients with a labor capacity decrease of 81% or more; - War invalids, individuals entitled to policies like war invalids, category B war invalids, severely injured patients when treating recurrent injuries or illnesses; - Children under 6 years old;	100% of medical examination and treatment costs without applying a payment limit for certain drugs, chemicals, medical supplies, and technical services
		- Retirees, individuals entitled to monthly labor loss allowance; - Relatives of people with meritorious service to the revolution, except biological parents, spouses, or children of martyrs; individuals taking care of martyrs; - Members of near-poor households.	95% of medical examination and treatment costs
		Subjects not falling into the cases mentioned above.	80% of medical examination and treatment costs
2	Off route	Inpatient treatment at Central level hospitals in Vietnam	40% of treatment costs
		Inpatient treatment at Provincial level hospitals in Vietnam	- 60% of treatment costs from January 01, 2018, to December 31, 2020; - 100% of treatment costs from January 01, 2021
		Medical examination and treatment at District level hospitals in Vietnam	100% of medical examination and treatment costs
3	Referral	Subjects and benefits are similar to in-network medical examination and treatment cases.

Legal basis:

- Health Insurance Law 2008;

- Law amending the Health Insurance Law 2014;

- Decree 105/2014/ND-CP.

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