What are the benefits for people participating in the health insurance for a consecutive period of at least 5 years in Vietnam?

What are the benefits for people participating in the health insurance for a consecutive period of at least 5 years in Vietnam? (Internet image) 

Regarding this issue, LawNet would like to answer as follows:

1. Benefits for people participating in the health insurance for a consecutive period of at least 5 years in Vietnam

According to Point dd, Clause 1, Article 14 of Decree 146/2018/ND-CP, regulations on benefits for people participating in the health insurance for a consecutive period of at least 5 years are as follows:

100% of medical costs if a patient participates in the health insurance for a consecutive period of at least 5 years and has made the co-payment of medical costs in a year which is greater than total base pay amount received during 6 months, except self-referrals to inappropriate-level healthcare establishments;

2. Payment of medical costs of a patient participating in the health insurance for a consecutive period of at least 5 years in Vietnam

Pursuant to Clause 3, Article 27 of Decree 146/2018/ND-CP, with respect to payment of medical costs of a patient participating in the health insurance for a consecutive period of at least 5 years and has made the co-payment of medical costs in a year which is greater than total base pay amount received during 6 months in accordance with Section 1:

- If a patient makes co-payment for each visit or multiple visits for medical care at the same healthcare establishment which is greater than the base pay amount received during 6 months, that healthcare establishment shall not be allowed to collect the patient’s co-payment which is greater than the base pay amount that he/she has received during 6 months.

The healthcare establishment shall be responsible for providing an invoice for the co-payment amount equal to the base pay amount during 6 months so that the patient can use it as a basis for requesting the health insurance agency to give its certification of exemption from making any co-payment in that year;

- In case where the patient's accrued amount of co-payments in a financial year at different healthcare establishments or at the same healthcare establishment is greater than 6 months’ base pay amount, that patient may present evidencing documents to the social insurance agency issuing his/her health insurance card to pay the amount of co-payment greater than 6 months’ total base pay amount and receive the certification of exemption from co-payment in that year;

- In case where the patient's co-payment amount is greater than the 6 months’ total base pay amount as from January 1, the health insurance fund shall cover 100% of costs incurred from healthcare services falling within the scope of a patient’s interests from the anniversary date of 5 consecutive years of health insurance participation to the end of December 31 in that year.

3. What are stated on the health insurance cards in Vietnam?

According to Article 12 of Decree 146/2018/ND-CP, health insurance cards shall be issued by competent social insurance agencies and contain the following information:

- Personal information of a policyholder, including full name, gender, date of birth, permanent residence or workplace address.

- Health insurance coverage rate stipulated in Article 14 of Decree 146/2018/ND-CP.

- Start date of a health insurance card.

- Name of the primary healthcare establishment.

- The consecutive 5-year or longer period of health insurance participation of policyholders making co-payment of healthcare costs. The consecutive period of health insurance participation refers to the date subsequent to the previous date of issue inscribed on a health insurance card; in case of an interval, it must be less than 03 months.

With respect to persons dispatched by competent authorities to go on an educational or business trip; spouses, natural children, or legally adopted children aged under 18 years, accompanying their parents serving terms of office at Vietnam’s overseas missions, their overseas stay period shall be accepted as the period of health insurance participation.

With respect to employees working abroad, the period of their health insurance participation before their overseas work shall be assumed as the period of health insurance participation if they resume participating in the health insurance within duration of 30 days from the date of their entry.

If employees await completion of required procedures for entitlement to unemployment benefits as provided by the Law on Employment, the period of the previous health insurance participation shall be assumed as the period of health insurance participation.

With respect to policyholders, referred to in point a of clause 3 of Article 12 of the Law on Health Insurance, who retire, are demobilized, transfer to other business or resign, if they have not yet participated in the health insurance during the period of their study or military service in the people’s army, the people’s public security force or a cryptographic body, that period shall be assumed as the consecutive period of health insurance participation.

- Photo of the policyholder (not applicable to children under 6 years of age) in case where he/she does not have any photo personal identification document issued by competent bodies or authorities, or any certificate issued by commune-level police authorities or other documents endorsed by educational institutions or vocational education establishments in charge of management of pupils or students, or other legitimate personal identity documents.

Nguyen Ngoc Que Anh

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