Guidance on Payment for Participants in Health Insurance for Five Consecutive Years or More

13:14, 11/07/2024

This content is mentioned in Official Dispatch 5544/BYT-BH dated July 19, 2016, concerning direct payment of shared costs exceeding 6 months of the statutory pay rate for individuals who have participated in health insurance (HI) for 5 consecutive years or more. To be specific::

- In the case where the medical facility determines that the cumulative cost-sharing expenses for medical examination and treatment under health insurance in the year exceed 6 months of statutory pay rate (exceeding 7,260,000 VND) from the time of continuously participating in health insurance for 5 years:

- Do not collect additional cost-sharing expenses from the patient;- Provide an invoice showing cost-sharing up to the amount equivalent to 6 months of statutory pay rate to the patient so that the Social Insurance agency has the basis to issue a certificate of exemption from cost-sharing for the financial year.

- In the case where the medical facility cannot determine the cumulative cost-sharing expenses for medical examination and treatment under health insurance in the year at the time the expenses exceed 6 months of statutory pay rate:

- The patient pays the cost-sharing amount directly, then- Brings the invoice and documentation to the Social Insurance agency for direct reimbursement of the amount exceeding 6 months of statutory pay rate.

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