Health insurance is a type of insurance in the field of public health care. Accordingly, the buyer of health insurance will be paid part or all of the cost of medical examination, treatment, rehabilitation, etc. in case of an accident or illness.
However, according to Article 23 of the 2008 Law on Health Insurance (amended and supplemented in Clause 16, Article 1 of the 2014 amended Law on Health Insurance), there are 12 cases that are not entitled to health insurance even though they receive medical treatment at the right facility.
Cases that are not covered by health insurance even though they go to the right medical facility for examination and treatment include:
1. Medical examination and treatment costs (in the cases specified in Clause 1, Article 21, Law on Health Insurance 2008, amended and supplemented by Clause 14, Article 1, Law on Health Insurance 2014) have been paid by the State budget.
2. Nursing and convalescence at nursing and convalescent facilities.
3. Health check.
4. Pregnancy testing and diagnosis are not for treatment purposes.
5. Use of assisted reproductive techniques, family planning services, abortion, except in cases where pregnancy must be terminated due to pathological causes of the fetus or the mother.
6. Treatment of strabismus, myopia and refractive errors of the eye, except for children under 6 years old.
7. Medical examination, treatment, and rehabilitation in case of disaster.
8. Use of cosmetic services.
9. Use of replacement medical supplies including artificial limbs, artificial eyes, dentures, eyeglasses, hearing aids, and mobility aids in medical examination, treatment, and rehabilitation.
10. Medical examination and treatment of drug addiction, alcoholism or other addictive substances.
11. Medical examination, forensic examination, forensic psychiatric examination.
12. Participate in clinical trials and scientific research.
Thus, people who go to the hospital in the above cases will not be covered by health insurance, which means that the patient must pay the entire cost of medical examination and treatment.
Many benefits of participating in health insurance
Health insurance is implemented according to the provisions of law, not for profit, organized by the State. By participating in health insurance, people will enjoy many benefits. Specifically, the benefits are as follows:
- Partially funded by the state when participating.
- Enjoy 80-100% of medical examination and treatment costs within the scope of payment when going to the right medical facility for examination and treatment.
- Get better medical care.
-Reduce financial burden when sick or encounter risks due to accidents or occupational diseases.
According to information from Vietnam Social Security, in 2022, there will be 150.6 million people nationwide using health insurance for medical examination and treatment, with a proposed payment amount of more than 106.6 trillion VND.
Of these, 64 patients had their medical examination and treatment costs paid by the Health Insurance Fund for more than 1 billion VND. And in the first quarter of 2023, nationwide, 99 patients had their medical examination and treatment costs paid by the Health Insurance Fund for more than 500 million VND. 8 patients had their medical examination and treatment costs paid by the Health Insurance Fund for more than 1 billion VND.
Minh Hoa (t/h)
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