Cases where health insurance costs are paid directly, know this or you will lose out.

According to the provisions of Article 31 of the 2008 Law on Health Insurance, amended and supplemented in 2014 and the guidance in Clause 1, Article 4 of Circular 09/2019/TT-BYT, patients participating in health insurance will be directly paid by the social insurance agency for health insurance examination and treatment costs if they fall into one of the following cases:

- Going to a medical facility that does not have a health insurance contract for medical examination and treatment.

+ Emergency.

+ Outpatient and inpatient examination and treatment at district-level medical examination and treatment facilities and equivalent;

+ Inpatient examination and treatment at provincial and equivalent medical facilities.

+ Inpatient examination and treatment at central and equivalent medical examination and treatment facilities.

For example, in an emergency, the patient's house is right next to a hospital but the hospital has not signed a health insurance contract, the patient still has the right to go there and the social insurance agency must pay.

- Going to a medical facility that has a contract for medical examination and treatment under health insurance but does not follow the regulations on medical examination and treatment procedures under health insurance.

+ Patients coming for examination cannot present health insurance card and identification documents, children under 6 years old cannot present health insurance card.

+ In case of emergency, if you cannot present your health insurance card and identification documents before leaving the hospital.

+ Transferring treatment without transfer records.

+ Re-examination as required for treatment but unable to present re-examination appointment paper.

- Patients who have participated in health insurance for 5 consecutive years or more and have co-paid medical examination and treatment costs in the year greater than 6 months of basic salary (except for cases of self-examination and treatment outside the prescribed medical facility) but have not yet received co-paid amounts exceeding 6 months of basic salary.

- In case the health insurance card data is not provided or incorrect information about the patient's health insurance card is provided.

- Patients cannot present their health insurance card before being discharged from the hospital, transferred to another hospital during the day due to emergency, loss of consciousness or death, or lost their health insurance card but have not been reissued.

If the patient falls into one of the above cases, the Social Insurance agency will refund a portion of the hospital fees that the patient paid to the medical facility when going for medical examination and treatment.

Based on hospital fees and benefits within the scope of the patient's health insurance benefits, the Social Insurance agency will pay the corresponding insurance amount.

Three ways to replace paper health insurance cards in medical examination and treatment

According to Vietnam Social Security, the implementation of Project 06 of the Government has brought many benefits to participants and beneficiaries of social insurance and health insurance; including the replacement of paper health insurance cards in medical examination and treatment.

Three ways to replace health insurance cards in medical examination and treatment include:

1- Use VssID application

+ VSSID Login

+ Select "Health Insurance Card".

2- Use chip-embedded CCCD

+ Present CCCD card at medical examination and treatment facility

3- Use VNeID level 2 account

+ Login VNeID

+ Select the health insurance card item

Minh Hoa (t/h)

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