If you have paid health insurance for 5 consecutive years, what level will you receive under the new law?

According to the latest regulations, people who participate in health insurance for 5 consecutive years will enjoy more preferential benefits than usual.

Enjoy 100% coverage of medical examination and treatment costs in many cases, including out-of-network cases.
Pursuant to Clause 17 of the 2024 amended Law on Health Insurance, the condition for patients who have participated in health insurance for 5 consecutive years or more is to enjoy 100% of medical examination and treatment costs when:

Firstly, the amount of co-payment for medical examination and treatment costs during the year for medical examination and treatment visits as prescribed below is greater than 6 times the reference level.

Second, when examining and treating patients at a place other than the place registered for initial health insurance examination and treatment.

Third, going to see a doctor or get medical treatment at a facility not registered for initial health insurance examination and treatment, not at the place registered for initial health insurance examination and treatment, not following the procedure for transferring patients between health insurance examination and treatment facilities in the following cases:

- Medical examination and treatment at basic or specialized medical examination and treatment facilities in cases of definitive diagnosis and treatment of certain rare diseases, serious diseases, diseases requiring surgery or using advanced techniques as prescribed by the Minister of Health ;

- Ethnic minorities and people from poor households living in areas with difficult socio -economic conditions, areas with especially difficult socio -economic conditions, people living in island communes and island districts when receiving inpatient examination and treatment at specialized medical examination and treatment facilities;

- Medical examination and treatment at primary medical examination and treatment facilities;

- Inpatient examination and treatment at basic medical examination and treatment facilities;

- Medical examination and treatment at basic and specialized medical examination and treatment facilities that, before January 1, 2025, have been identified by competent authorities as district level;

Fourth, when examining and treating patients at any medical facility in an emergency.

Fifth, when registering for initial health insurance examination and treatment.

Sixth, transfer patients between health insurance medical examination and treatment facilities.
Thus, to enjoy 5 consecutive years of health insurance, the following conditions must be met at the same time: Having participated in health insurance for 5 consecutive years or more; Having the amount of co-payment for medical examination and treatment costs in the year greater than 6 times the reference level; Going to the right medical examination and treatment facility, following the procedure of transferring patients between health insurance medical examination and treatment facilities or going to the wrong medical examination facility in the cases mentioned in (3) above or emergency care in all cases.

The amended law specifically stipulates that cases of continuous health insurance participation for 5 years are entitled to 100% health insurance (including cases of out-of-network coverage).

Eliminate the 180-day waiting period to enjoy high-tech service benefits
Previously, according to Clause 3, Article 16 of the 2008 Law on Health Insurance: “For those who participate in health insurance for the first time or do not pay health insurance continuously, the health insurance card is valid after 30 days from the date of payment; the benefits of high-tech services are valid after 180 days.”

However, currently, according to Point c, Clause 3, Article 16 of the Amended Law No. 51/2024/QH15: "For those who participate in health insurance under Clauses 4 and 5, Article 12 for the first time or for an interruption of more than 90 days, the health insurance card is valid after 30 days from the date of full payment".

Thus, the new regulation has removed the 180-day waiting period to enjoy high-tech service benefits.

What are the regulations on groups whose employees pay health insurance?
According to the provisions of Article 12 of the Law on Health Insurance 2008, amended Clause 10, Article 1 of the Law on Health Insurance 2024, on the subjects participating in health insurance as follows:

- Employees working under indefinite-term labor contracts or fixed-term labor contracts with a term of at least 01 month, including cases where the employee and the employer agree on a different name but with content showing the paid work, salary and management, operation and supervision of one party; enterprise managers, controllers, representatives of state capital, representatives of enterprise capital as prescribed by law; members of the Board of Directors, General Directors, Directors, members of the Board of Supervisors or controllers and other elected management positions of cooperatives and cooperative unions as prescribed by the Law on Cooperatives 2023 who receive salaries;

- Enterprise managers, controllers, representatives of state capital, representatives of enterprise capital as prescribed by law; members of the Board of Directors, General Directors, Directors, members of the Board of Supervisors or controllers and other elected management positions of cooperatives and cooperative unions as prescribed by the Law on Cooperatives 2023 do not receive salaries;

- Employees who are foreign citizens working in Vietnam when working under a fixed-term labor contract with a term of 12 months or more with an employer in Vietnam, except for those who are transferred within the enterprise according to the provisions of the law on foreign employees working in Vietnam or at the time of signing the labor contract, have reached the retirement age according to the provisions of Clause 2, Article 169 of the 2019 Labor Code or international treaties to which the Socialist Republic of Vietnam is a member have other provisions;

- Employees working under indefinite-term labor contracts, fixed-term labor contracts with a term of 01 month or more, including cases where the employee and the employer agree on a different name but with content showing the paid work, salary and management, operation and supervision of one party, agree with the employer to work part-time, with monthly salary equal to or higher than the salary used as the basis for the lowest compulsory social insurance payment according to the provisions of the law on social insurance;

- Business owners of registered business households are subject to compulsory social insurance according to the provisions of the law on social insurance;

- Cadres, civil servants, public employees;

- Non-professional workers at the commune level according to the provisions of law;

- Defense workers and civil servants serving in the army, police workers working in the people's police; people working in other key organizations as prescribed in the 2011 Law on Key;

- Relatives of defense workers and civil servants serving in the army, relatives of police workers working in the people's police are not eligible to participate in health insurance according to the provisions at points a, b, c, d, dd, e, g and h, Clause 1, Clause 2 and Clause 3, Article 12 of the Law on Health Insurance 2008 (amended Clause 10, Article 1 of the Law on Health Insurance amended in 2024).

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Source: https://baolaocai.vn/dong-bhyt-du-5-nam-lien-tiep-ban-duoc-huong-muc-nao-theo-luat-moi-post649332.html