Cases where health insurance does not cover medical examination and treatment costs

(Dan Tri) - The 2024 Law on Health Insurance (HI) adjusts a number of regulations on cases where people are not entitled to health insurance even though they go to the right medical facility for examination and treatment.

In many cases, patients are not entitled to health insurance (Illustration: Hoang Le).

When using a valid health insurance card, the patient will have most of the medical examination and treatment costs covered by the health insurance fund. However, there are cases where the patient is not covered by health insurance even though he or she goes to the right medical facility for examination and treatment.

Cases not eligible for health insurance are specifically regulated in Article 23 of the Law on Health Insurance.

In the 2008 Law on Health Insurance, Article 23 stipulates 14 cases where patients are not entitled to health insurance.

In the 2014 Law on Health Insurance, Article 23 reduces 2 cases, leaving 12 cases where patients are not entitled to health insurance.

Recently, the 2024 Health Insurance Law maintains 12 cases of patients not entitled to health insurance, only amending and supplementing the 7th and 8th cases.

In the 8th case, the 2024 Law on Health Insurance only adjusts the wording to clarify and detail the content of the regulations.

In the 7th case, the 2024 Health Insurance Law expands the group of patients with strabismus and refractive errors who are entitled to health insurance.

Specifically, the 2014 Law on Health Insurance stipulates that patients being treated for these disabilities are not entitled to health insurance, except for children under 6 years old.

The 2024 Health Insurance Law stipulates that only patients aged 18 and over who are treated for these disabilities are not entitled to health insurance.

12 cases are not covered by health insurance (Graphic: Tung Nguyen).

Source: https://dantri.com.vn/an-sinh/nhung-truong-hop-khong-duoc-bhyt-thanh-toan-chi-phi-kham-chua-benh-20250211110013649.htm