Cases not eligible for health insurance benefits in Vietnam 2023

Cases not eligible for health insurance benefits in Vietnam 2023 (Internet image)

1. Cases not eligible for health insurance benefits in Vietnam 2023

Cases not eligible for health insurance benefits in Vietnam in 2023 include:

- Cases specified in Clause 1 of Article 21 of the Law on Health Insurance in which costs have been paid by the state budget.

- Convalescence at sanatoria or convalescence establishments.

- Medical check-up.

- Prenatal tests and diagnosis for non-treatment purposes.

- Use of obstetric supportive techniques, family planning services or abortion services, except for cases of discontinuation of pregnancy due to fetal or maternal diseases.

- Use of aesthetic services.

- Treatment of squint, myopia and eye refraction defect except for the children under age 6.

- Use of prostheses including artificial limbs, eyes, teeth, glasses, hearing aids or movement aids in medical examination, treatment and function rehabilitation.

- Medical examination, treatment and functional rehabilitation in case of disasters.

- Medical examination and treatment for addiction to drugs, alcohol or other habit-forming substances.

- Medical assessment, forensic examination, forensic mental examination.

- Participation in clinical trials or scientific research.

(Article 23 of the Law on Health Insurance 2008, as amended in 2014)

2. Persons eligible for health insurance in Vietnam

Persons eligible for health insurance in Vietnam include:

(1) The group whose insurance are paid by the employers and employees, including:

- Employees on indefinite or at least full three-month contracts; salaried business managers; officials and civil servants (hereinafter referred to as employees).

- Part-time officers in communes, wards and towns under the regulations of the law.

(2) The group of the insured whose insurance is paid by the social insurance organizations, including:

- Persons receiving monthly retirement pensions and compensation for loss of capacity for work

- Persons receiving monthly social insurance pensions due to occupational accidents or diseases or diseases needing long-term treatment; beneficiaries at the age of 80 or above;

- Officers in communes, wards and towns who have left employment and been receiving monthly social insurance benefits.

- Persons receiving unemployment benefits.

(3) The group of the insured whose insurance is paid by the State budget, including:

- Commissioned officers, professional soldiers, non-commissioned soldiers on active duty; commissioned police officers and non-commissioned police officers; police students, non-commissioned police officers or soldiers on fixed term contracts; ciphers whose salaries are the same as the salaries as the servicemen; cipher students whose benefits are the same as the benefits of students in military or police academies.

- Officers in communes, wards and towns who have left employment and been receiving monthly pensions funded by the State budget.

- Persons no longer receiving compensation for loss of capacity for work and being receiving monthly pensions funded by the State budget;

- Persons performing meritorious services in the wars, war veterans;

- Incumbent deputies of the National Assembly or the People’s Councils at all levels;

- Children under the age of 6;

- Persons receiving monthly social protection pensions;

- Poor household members, ethnics living in regions facing socio-economic difficulties, persons living in regions facing extreme socio-economic difficulties; persons living in island communes or districts.

- Relatives of persons performing meritorious services in the wars such as biology parents, husbands, wives or children of revolutionary martyrs; persons rearing revolutionary martyrs;

- Relatives of persons performing meritorious services in the wars, except for the insured prescribed at point i this Clause;

- Relatives of the insured prescribed in point a clause 3 this Article;

- Persons who have donated body parts under the regulations of the law;

- Foreigners studying in Vietnam that are granted scholarships funded by the Vietnam State budget.

(4)  The group of the insured whose insurance are supported by the State budget, including:

- Members of households living above the poverty line;

- Students.

(5) Group of the household insured including household members except for the ones prescribed above

(Article 12 of the Law on Health Insurance 2008, as amended in 2014)

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