What do insurance companies say about buying health insurance but not getting full payment when moving to another province?

How people with health insurance cards are paid when going to see a doctor or get medical treatment is a matter of concern for many people - Photo: NAM TRAN

Voters in Bac Giang province believe that currently, people buy health insurance in their locality, but when they go on business trips or do business in other provinces and get sick and have to go to medical facilities for examination and treatment, they are not fully paid for health insurance costs according to regulations because they are not in the right area.

Therefore, voters suggest reviewing and adjusting the health insurance coverage nationwide to avoid disadvantages for insurance participants.

Responding to this problem, the representative of the Health Insurance Policy Implementation Board, Vietnam Social Security, also said that the current regulations have opened up the district-level medical examination and treatment system; people with health insurance cards can receive medical examination and treatment at district-level medical facilities nationwide.

In case of studying or working in another locality for less than 12 months, you can go to a medical facility at the same level as the initial medical facility registered for medical examination and treatment in the locality where you live.

For example, if the initial medical examination and treatment facility at the place of residence is a provincial general hospital, when going to another province to work or study for less than 12 months, the patient can still be examined and treated at the provincial hospital and paid as if they were in the right hospital.

Responding to the question of why there is still this problem of connecting health insurance with provincial-level medical facilities since 2021, this representative said that the provincial-level health insurance connection is only for inpatient treatment, while medical examination and other outpatient services are not yet connected at provincial-level medical facilities.

According to our research, the current regulations on health insurance payment mentioned above still have shortcomings for some groups of people participating in insurance. In which, the current regulations have mentioned people studying or working for less than 12 months, but there are no regulations for retirees moving to other provinces with their children while the number is quite large.

This problem leads to retirees living in other provinces and cities who need to go to the hospital for medical treatment, either not being paid enough, or having to go back to the place that issued the card to transfer to another hospital, which is very cumbersome.

In addition, there are opinions that retirees from other provinces come to live in Hanoi because many districts of Hanoi do not have district hospitals (accompanied by regulations on health insurance coverage at district-level medical facilities nationwide).

Therefore, when they need medical examination and treatment, they must go to a provincial or equivalent medical facility and pay an out-of-network fee.

There have been many suggestions that the Ministry of Health and Vietnam Social Security should soon review this regulation and correct existing shortcomings.

Source: https://tuoitre.vn/co-quan-bao-hiem-noi-gi-ve-viec-mua-bao-hiem-y-te-nhung-sang-tinh-khac-khong-duoc-tra-du-phi-20240220213103711.htm