New policy on health insurance as of July 1, 2021 in Vietnam

New policy on health insurance as of July 1, 2021 in Vietnam (Internet image)

Additional subjects eligible for free health insurance cards

Decree 20/2021/ND-CP (taking effect on July 1, 2021) adds many social protection beneficiaries eligible for monthly social benefits as follows:

- Individuals who live in poor, near-poverty households and have not married; individuals who are married to spouses that are deceased or missing as per the law and raising children under 16 years of age or children from 16 to 22 years of age that are pursuing formal education, vocational education, professional secondary education, college education or first higher education degrees according to Clause 2 of this Article (hereinafter referred to as “poor single parent”).

(Currently, there is no regulation that near-poverty households are eligible to receive monthly social benefits).

- Elderly from 75 years old to 80 years old living in poor or near-poor households, not specified under Point a of this Clause and living in ethnic minorities in communes, hamlets and mountainous regions

-  Children under 3 years of age, living in poor households or near-poor households, not specified under Clauses 1, 3, and 6 of Article 5 of Decree 20/2021/ND-CP and living in ethnic minorities in communes, hamlets and mountainous regions.

- Individuals contracted HIV/AIDS, living in poor households and having no stable monthly income namely salary, wage, pension, social security benefit, monthly social security.

According to Clause 1, Article 9 of Decree 20/2021/ND-CP, Social protection beneficiaries receiving monthly social benefits shall be issued with health insurance card according to regulations and law on health insurance. At the same time, Clause 8, Article 3 of Decree 146/2018/ND-CP stipulates: Persons eligible to be entitled to monthly social protection benefits under laws on the elderly, the disabled and subject of social protection programs.

Thus, from July 1, 2021, more subjects will be issued free health insurance cards.

Matters that need to be disclosed in a timely and open manner by public hospital in Vietnam

According to Article 10 of Circular 05/2021/TT-BYT of the Ministry of Health regulating implementation of practices of democracy in activities of public medical establishments, matters that need to be disclosed in a timely and open manner by public hospital in Vietnam include:

Prices of medical examination and treatment services applied to patients with health insurance cards;  prices of unsolicited medical examination and treatment services applied to patients without health insurance cards; relief of prices of medical examination and treatment services; implementation of health insurance benefits; health insurance coverage of  medical examination and treatment costs according to the provisions of law.

Regarding public announcement approaches

- Posting public notices and displaying information on electronic billboards

• Written documents, drawings, diagrams and directional markings or signs showing way to zones, wards, departments or subordinate units;
• Boards of internal rules, regulations or prices of medical examination and treatment services and prices of patient’s services at public places where a lot of patients walk. Posting notices at public places must be regular, continuous and timely.

- Information, communication and counseling activities

Disseminating, communicating and counseling regulations, policies and issues related to medical examination and treatment activities when patients arrive at clinics, emergency rooms and wards.

- Directly notifying patients, patient's legal representatives; organizing activities of patient councils of departments, wards and units..

Thus, starting from July 1, 2021, public hospitals must publicize the fees for medical examination and treatment services covered by health insurance in prescribed forms, mainly to make it easier for patients to see and understand.

Payment of medical examination and treatment costs covered by health insurance according to capitation fund

Below is the content of Circular 04/2021/TT-BYT providing guidance on capitation payment of costs of covered healthcare services, which will take effect on July 1, 2021.

According to this Circular, capitation fund means a predetermined amount of money which is allocated to a health facility providing covered healthcare services for covering costs of outpatient services provided for health insurance card holders in the scope of capitation within a given period.

The scope of capitation does not include the following costs of healthcare services:

+ Costs of healthcare services provided for health insurance card holders who are soldiers (code: QN), cipher officers (code: CY), or police officers (code: CA);

+ Costs of transporting patients who have health insurance cards;

+ Total costs of healthcare services with use of regular hemodialysis or peritoneal dialysis technique or peritoneal dialysis solutions;

+ Total costs of healthcare services with use of anticancer drugs or medical interventions for cancer treatment provided for patients who are diagnosed with cancer of codes C00-C97 and codes D00-D09 according to the International Classification of Diseases, Tenth Revision (hereinafter referred to as “ICD-10”);

+ Total costs of healthcare services with use of drugs for treatment of Haemophilia or blood or blood samples provided for patients who are diagnosed with Haemophilia of codes D66, D67, D68 according to ICD-10;

+ Total costs of healthcare services with use of immunosuppressive drugs provided for organ transplant patients;

+ Total costs of healthcare services with use of hepatitis C medicines provided for hepatitis C patients;

+ Total costs of healthcare services with use of antiretroviral drugs or HIV viral load tests provided for patients who have health insurance cards and are diagnosed with HIV.

Amendments to the health insurance policy for individuals with meritorious services to the revolution in Vietnam

This is the content of Ordinance 02/2020/UBTVQH14 on incentives for people with meritorious services to the revolution, which will officially take effect on July 1, 2021.

According to this Ordinance, the subjects entitled to health insurance are the personal identities of people who have contributed to the revolution since July 1, 2021, with changes, for example:

- Spouses and children from 6 years old to under 18 years old or 18 years old or older if they continue to go to school or have severe disabilities or especially severe disabilities of revolutionary activists before January 1, 1945 (no longer subject to biological father or biological mother compared to current regulations).

- Spouses and children from 6 years old to under 18 years old or 18 years old or older if they continue to go to school or have severe disabilities or especially severe disabilities of revolutionary activists since January 1, 1945, to the day of the August 1945 uprising (no longer subject to biological father or biological mother compared to the present).

- The martyr's spouse marries another husband or wife and raises the martyr's children to adulthood or takes care of the martyr's biological father or mother while they are still alive, or because of revolutionary activities, they cannot take care of their biological father or mother while they are still alive (currently, there is no such regulation).

Bao Ngoc

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