The Law amending and supplementing a number of articles of the Law on Health Insurance will take effect from July 1. Master Hoang Trung Tuan, Deputy Director of the Department of Health Insurance, said that the Law has expanded the scope of payment of the health insurance fund.
Accordingly, health insurance participants are paid for costs including remote medical examination and treatment; remote medical examination and treatment support; family medical examination and treatment; home medical examination and treatment; rehabilitation, periodic pregnancy examinations, and childbirth.
Health insurance also covers the cost of patient transportation between medical facilities, whereas previously it only covered transportation from district level to higher level. The costs of medical technical services, drugs, equipment, blood, blood products, medical gases, supplies, tools, instruments, and chemicals used in medical examination and treatment are now also covered by the Fund.
In addition, the cost of treating strabismus and refractive errors of the eyes for people under 18 years old will be covered by health insurance while the current regulations only cover children under 6 years old. Thus, from July 1, the age of health insurance coverage for treatment of these health problems will be raised from 6 to 18 years old.
These are some new points that health insurance participants have expanded coverage. The level, rate, and payment conditions for the above costs will be specifically regulated by the Government and the Ministry of Health .
Many changes in health insurance benefits
Accordingly, health insurance participants are entitled to 100% of the benefits when examining and treating at primary health care facilities; inpatient treatment at basic health care facilities; 100% of the benefits when examining and treating at any basic or specialized health care facility that, before January 1, 2025, has been determined by a competent authority to be at the district level.
In addition, health insurance participants are entitled to 100% of the cost of a medical examination and treatment lower than the level prescribed by the Government . According to regulations, the cost of a medical examination and treatment covered by 100% health insurance is lower than 15% of the basic salary. Currently, the basic salary is 2.34 million VND. Thus, health insurance participants will be entitled to full medical examination and treatment costs in cases where the cost of a medical examination and treatment is lower than 351,000 VND.
To enjoy 100% coverage of medical examination and treatment costs from July 1, health insurance participants need 3 principles:
- Have participated in health insurance continuously for 5 years or more (interruption not exceeding 3 months).
- The total amount of co-payments in the year exceeds 6 times the reference level. The reference level is a concept prescribed by the Government as the basis for calculating health insurance contributions and benefits, replacing the previous "minimum wage". Currently, the current basic wage is 2.34 million VND. Therefore, people who have participated in health insurance for 5 consecutive years or more must have the amount of medical examination and treatment expenses paid in the year greater than 14.04 million VND (6 months of basic wage).
This is the first time the concept of "reference level" as above has been applied as a basis for calculating health insurance.
- At the same time, people who receive medical examination and treatment at the right level, are transferred to the right level according to the procedure, or are in cases where they are allowed to receive medical examination and treatment at the wrong level as prescribed, such as having some rare or serious diseases, will be transferred directly to a specialized level while still enjoying maximum benefits.
VN (according to VnExpress)Source: https://baohaiduong.vn/kham-chua-benh-tu-xa-tai-nha-duoc-bao-hiem-y-te-thanh-toan-tu-1-7-413865.html
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