How much does the family health insurance premium increase when the basic salary increases?

Pursuant to Decree 146/2018/ND-CP guiding the Law on Health Insurance.

At Point e Clause 1 Article 7 Decree 146/2018/ND-CP stipulates the monthly health insurance contribution level for the subjects as follows:

The health insurance contribution rate for the subjects specified in Article 5 of this Decree is as follows: The first person pays 4.5% of the basic salary; the second, third, and fourth persons pay 70%, 60%, and 50% of the first person's contribution rate, respectively; from the fifth person onwards, the contribution rate is 40% of the first person's contribution rate.

Accordingly, the health insurance premium for family health insurance is determined as follows:

First person: 4.5% of basic salary;

Second person: 70% of the first person's contribution (3.15% of basic salary);

Third person: 60% of the first person's contribution (2.7% of basic salary);

4th person: 50% of the first person's contribution (2.25% of basic salary);

5th person onwards: 40% of the first person's contribution (1.8% of basic salary).

Specifically, when the basic salary increases to 1.8 million VND/month according to Decree 24/2023/ND-CP, the family health insurance contribution level increases as follows:

First person: 81,000 VND/month.

Second person: 56,700 VND/month.

Third person: 48,600 VND/month.

Fourth person: 40,500 VND/month.

Fifth person onwards: 32,400 VND/month.

Will the cost of medical examination and treatment increase to be covered 100% by health insurance?

Pursuant to Point d, Clause 1, Article 14 of Decree 146/2018/ND-CP, in case the cost of one medical examination and treatment is lower than 15% of the basic salary, the health insurance participant will be paid 100% of the cost.

Currently, health insurance participants are paid 100% of the cost when the cost for one medical examination is lower than VND 223,500 (15% of the basic salary).

When the basic salary increases, the cost for one medical examination as mentioned above will change to 270,000 VND. Specifically, if the cost for one medical examination of a patient is lower than 270,000 VND, the Health Insurance Fund will pay 100% of the cost.

Do I have to pay additional health insurance premiums when the basic salary increases from July 1 for family health insurance?

Article 10 of Decree 146/2018/ND-CP stipulates the determination of the amount of contribution and support for a number of subjects when the State adjusts the health insurance contribution rate and adjusts the basic salary as follows:

Determining the amount of contributions and support for certain subjects when the state adjusts health insurance contributions and basic salary levels

1. For the group of subjects specified in Article 4 of this Decree that are supported by the State budget for 100% of the health insurance premium:

a) The amount of money the State budget contributes and supports monthly is determined by multiplying the health insurance contribution rate (x) by the basic salary. When the State adjusts the health insurance contribution rate or the basic salary, the amount of money the State budget contributes and supports monthly is adjusted from the date of application of the new health insurance contribution rate or the new basic salary;

b) The health insurance premium for children under 6 years old is calculated from the date of birth to the date the child turns 72 months old. In case the child is a Vietnamese citizen born abroad, the health insurance premium is calculated from the date the child returns to reside in Vietnam according to the provisions of law.

2. For the group of subjects receiving partial support from the State budget for health insurance premiums as prescribed in Clauses 3 and 4, Article 4 of this Decree:

a) The monthly contribution amount of the participant and the State budget support is determined by multiplying the health insurance contribution level (x) by the basic salary at the time the participant pays the health insurance;

b) When the State adjusts the health insurance premium level and the basic salary level, participants and the State budget do not have to pay additional amounts or are not refunded the difference due to the adjustment of the health insurance premium level and the basic salary level for the remaining period that the participant has paid health insurance.

3. For the group of subjects participating in family health insurance as prescribed in Article 5 of this Decree:

a) The monthly contribution amount of the participant is determined by multiplying the health insurance contribution level (x) by the basic salary at the time of health insurance contribution;

b) When the State adjusts the health insurance premium level or the basic salary level, participants do not have to pay additional amounts or receive a refund of the difference due to the adjustment of the health insurance premium level or the basic salary level for the remaining period during which the participant has paid health insurance.

4. For subjects participating on any day of the month, the health insurance payment amount is determined by month from the date of health insurance payment.

Thus, according to the above regulations, in case the household health insurance participant has paid health insurance, there is no need to pay additional for the increase when the basic salary increases.

Minh Hoa (t/h)

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