Unprecedented benefits for people participating in health insurance for 5 consecutive years

5 consecutive years of health insurance is when the health insurance participant has paid for 5 consecutive years, with a maximum interruption of 3 months allowed.

From July 1, if going to a different health facility, people who have participated in health insurance for 5 consecutive years or more can enjoy 100% of medical examination and treatment costs in some cases.

Visiting patients at K Hospital.

According to current regulations, people who have participated in health insurance for 5 consecutive years (allowed to have a 3-month interruption) are entitled to 100% of medical examination and treatment costs when meeting the following conditions: Having the amount of money to co-pay for medical examination and treatment costs in the year greater than 6 months of basic salary; going to the right medical facility for examination and treatment.

Currently, the health insurance coverage for patients is 80 - 95 and 100%, equivalent to the co-payment of patients being 5 - 20%. The current 6-month basic salary is 14.04 million VND.

When the total co-payment amount of medical examinations and treatments during the year exceeds this amount, the patient does not have to pay any additional money for subsequent medical examinations and treatments (still within the year and within the correct treatment area).

However, the 2024 amended Law on Health Insurance has many changes that are more beneficial to patients. Accordingly, according to Clause 17 of the 2024 amended Law on Health Insurance, patients who have participated in health insurance for 5 consecutive years or more are entitled to 100% of medical examination and treatment costs if they meet the following 3 conditions:

First, the period of continuous participation in health insurance is from 5 years or more.

Second, the co-payment amount during the year exceeds 6 times the prescribed reference level.

Third, go to the right hospital, follow the transfer process, or go to the wrong hospital in special cases such as: Treatment of rare diseases, serious diseases, surgery, high technology; ethnic minorities, poor households living in difficult areas, island communes, island districts receiving inpatient treatment at specialized medical examination and treatment facilities; examination at facilities that were district-level before January 1, 2025; emergency examination at any facility.

Changes in the 2024 revised Law on Health Insurance help expand benefits, creating more favorable conditions for patients to enjoy 100% of medical examination and treatment costs under health insurance, especially those with serious illnesses, illnesses requiring surgery or using high technology.

According to Vietnam Social Security, by early 2025, the whole country will have about 95.52 million people participating in health insurance, reaching a coverage rate of 94.2% of the population.

It is estimated that by the end of May, the Social Insurance has paid health insurance examination and treatment costs for nearly 80 million people, an increase of 8.59% over the same period in 2024. The total amount paid is estimated at VND 63,324 billion, an increase of 15.59% over the same period last year.

According to nld.com.vn

Source: https://baolaocai.vn/quyen-loi-chua-tung-co-cho-nguoi-tham-gia-bhyt-5-nam-lien-tuc-post402738.html