People present their health insurance cards when seeking medical treatment - Illustration photo: NAM TRAN
3 cases of health insurance refund
According to the regulations of Vietnam Social Security, there are 3 cases in which health insurance participants will be refunded.
Case 1: Participants are issued health insurance cards according to the new group of subjects, now reporting a reduction in the value of the previously issued card.
The condition for getting a refund of health insurance premiums is that people are then issued health insurance cards according to a different group of subjects.
For example: When a member of a household participates in family health insurance, is then hired by a company and is issued a health insurance card paid by the company. In this case, the previously paid family health insurance card will be reduced in value (because the health insurance card for the new subject has a higher priority). At this time, people will be refunded the amount paid for the unused period.
Case 2: The state budget adjusts to increase the support for health insurance premiums
Cases of health insurance refund when the policy changes and a certain group of subjects enjoys a higher level of health insurance contribution support than before.
Case 3: The participant died before the health insurance card became valid.
In case the person who purchased the health insurance card dies before the card becomes effective, the family of the deceased will be refunded the entire amount paid for the unused health insurance card.
Subjects participating in health insurance
According to the 2024 Health Insurance Law, effective from July 1, there are 5 groups of subjects participating in health insurance,
First: The group is paid by the employer or paid by the employee or jointly paid.
Second: Group paid by social insurance agency.
Third: Group funded by the state budget.
In this group, 4 more subjects are added, including regular militia; people aged 75 and over and people aged 70-75 from near-poor households receiving monthly survivor benefits; people receiving monthly social pension benefits; workers who are not eligible for pensions and are not old enough to receive social pension benefits.
Fourth: Groups whose contribution levels are supported by the state budget.
In addition to the subjects under the old regulations, the new Law on Health Insurance adds support for the contribution level for medical staff in villages and hamlets; midwives in villages and hamlets; non-professional workers in villages and residential groups according to the provisions of law; people awarded the title of People's Artist, Meritorious Artist and victims according to the provisions of the Law on Prevention and Combat of Human Trafficking 2011.
Thursday: Group pays for health insurance themselves.
Previously, the group participated in health insurance as a household. According to the amended Law on Health Insurance, the group that self-pays for health insurance includes people in households participating in health insurance as a household; people living and working, people being raised and cared for in organizations, charitable and religious establishments; employees on unpaid leave or having their labor contracts suspended...
Accordingly, depending on the priority as guided by the law, health insurance participants can choose the appropriate contribution level.
Principles for calculating the refund amount
According to the instructions of Vietnam Social Security, for the above 3 cases, the refund amount is calculated based on the health insurance premium and the period of time the premium has been paid but the card has not been used. Specifically:
Case 1: The time of not using the card is calculated from the time the health insurance card for the new group of subjects takes effect.
Case 2: The time the card has not been used is calculated from the time the decision to increase the support level takes effect.
Case 3: The time the card has not been used is calculated from the time the health insurance card becomes valid.
To get a refund of health insurance premiums, participants need to follow the steps as prescribed:
Step 1: Prepare and submit documents to the social insurance agency. Participants complete the TK1-TS declaration form.
In case a health insurance participant dies, his/her relatives will complete the TK1-TS declaration form.
Step 2: The application will be received by the social insurance agency.
Step 3: The resolved results will be sent to the participant.
The participant's profile can be received by the social insurance agency in many different forms. Participants may not have to come directly but submit their profile online through the Vietnam Social Security Public Service Portal or through the I-VAN organization.
In addition, participants can send paper documents by post or submit documents directly to the document reception department of the social insurance agency where they are managed, or at public administrative service centers at all levels.
WILLOW
Source: https://tuoitre.vn/nguoi-tham-gia-bao-hiem-y-te-se-duoc-hoan-tra-tien-khi-nao-20250708170637577.htm
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