Health insurance benefits for each group of subjects in Vietnam

Health insurance benefits for each group of subjects in Vietnam (Internet image)

Health insurance benefits for each group of subjects are specified as follows:

1. Entitlement to 100% of medical costs in Vietnam

Participants in health insurance are entitled to 100% of medical examination and treatment costs in the following cases:

- People with meritorious services to the revolution according to the provisions of the Ordinance on incentives for people with meritorious services to the revolution.

- Veterans who participated in the resistance war from April 30, 1975, or earlier according to the provisions of Clauses 1, 2, 3, and 4 of Article 2 of Decree 150/2006/ND-CP.

- Veterans who joined the resistance after April 30, 1975, as defined in Clause 5, Article 2 of Decree 150/2006/ND-CP, include the following subjects:

+ Soldiers and defense workers who have received subsidies under Decision 62/2011/QD-TTg;

+ Officers, professional soldiers, non-commissioned officers, soldiers, and defense workers directly participating in the war to protect the Fatherland, performing international missions in Cambodia, helping Laos friends after the 30th day of April 1975, transferred to work in agencies, organizations, and enterprises (not entitled to subsidies under Decision 62/2011/QD-TTg);

+ Professional officers and soldiers who have completed active duty during the period of national construction and defense have served, retired, or been transferred to work at agencies, organizations, and enterprises;

+ Militia and self-defense forces that have participated in combat and directly served in combat after April 30, 1975, have received subsidies under Decision 62/2011/QD-TTg.

- Persons eligible for monthly social protection allowance in accordance with the law on elderly people, disabled people, and social protection beneficiaries.

- People from poor households; ethnic minorities living in areas with difficult socio-economic conditions; people living in areas with extremely difficult socio-economic conditions; people living in island communes and island districts; and some other subjects, specifically:

+ People in poor households according to income criteria, people in multidimensionally poor households with health insurance shortages specified in Decision 59/2015/QD-TTg.

+ Ethnic minorities living in areas with difficult socio-economic conditions, as prescribed by the Government and the Prime Minister;

+ People living in areas with extremely difficult socio-economic conditions as prescribed by the Government or the Prime Minister;

+ Persons currently living in island communes or island districts as prescribed by the Government or the Prime Minister.

- Relatives of martyrs include: biological father; mother tongue; martyrs' spouses and children; people who have taken care of martyrs.

- People aged 80 years or older are enjoying a monthly survivorship allowance in accordance with the law on social insurance.

- People who were active in the revolution before January 1, 1945;

- People who were active in the revolution from January 1, 1945, to the date of the August uprising, 1945;

- Vietnamese heroic Mother;

- War invalids, including class B war invalids recognized before December 31, 1993, who enjoy the same policy as war invalids with an injury rate of 81% or more;

- Patients with an injury rate of 81% or more;

- Resistance activists infected with toxic chemicals have an injury rate of 81% or more;

- War invalids, including class B war invalids who were recognized before December 31, 1993, who enjoy the same policy as wounded and sick soldiers when they are treated for recurrent wounds or illnesses;

- Children under 6 years old.

- 100% of medical examination and treatment costs at the commune level;

- 100% of medical examination and treatment expenses for cases where the cost for one medical examination and treatment is lower than 15% of the base salary;

- 100% of medical examination and treatment expenses when the patient has participated in health insurance for 5 consecutive years or more and the amount of money jointly paid for medical examination and treatment expenses in the year is greater than 6 months' basic salary, except for the case of self-diagnosis and medical treatment at the wrong line;

(Points a, b, c, d, dd, Clause 1, Article 14 of Decree 146/2018/ND-CP (amended in Decree 131/2021/ND-CP))

2. Entitlement to 95% of medical costs in Vietnam

According to point e, Article 14 of Decree 146/2018/ND-CP stipulating that health insurance participants are entitled to 95% of medical examination and treatment costs for the following subjects: 

- Persons eligible to be entitled to retirement pensions and incapacity benefits

- Relatives of persons rendering meritorious revolutionary services, except those defined in clause 11 of Article 3 of Decree 146/2018/ND-CP, including:

+ Natural parents, spouses, children aged from over 6 years to under 18 years, or 18 years or older if they are still going to school or are suffering serious disabilities or extremely serious disabilities, of the followings:

Revolutionaries carrying out activities before January 1, 1945; revolutionaries carrying out activities from January 1, 1945 to the August Uprising in 1945; heroes of the People’s Armed Forces and heroes of labor in the resistance war stage; wounded soldiers and sick soldiers suffering a reduction by 61% and more of their labor capacity; partisans infected with toxic chemicals whose labor capacity is reduced by at least 61%.

+ Natural children aged 6 years or older of partisans exposed to toxic chemicals causing deformities and disabilities due to consequences thereof, unable to be self-reliant in performing everyday life activities or suffering from reductions in capabilities for self-reliance in everyday life activities, who are entitled to monthly benefits.

- Members of near-poor family households defined according to the near-poor criteria under regulations of the Government and the Prime Minister.

- Members of multidimensional-poverty family households falling into the cases specified in point a, clause 9, Article 3 of Decree 146/2018/ND-CP.

3. Entitlement to 80% of medical costs in Vietnam

For the remaining cases of health insurance participants, the health insurance payment will be paid 80% according to the provisions at point g, clause 1, Article 14 of Decree 146/2018/ND-CP.

Nguyen Ngoc Que Anh

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