Participate in health insurance for 5 consecutive years, what benefits do you receive for medical examination and treatment?

Question:

If you participate in health insurance for 5 consecutive years, what benefits will you receive when you go for medical examination and treatment? - Mr. Nguyen Van Duy (Hoan Kiem, Hanoi)

Hanoi Social Insurance replied:

Clause 3, Article 27 of Decree 146/2018/ND-CP stipulates the level of payment of medical examination and treatment costs for patients who have participated in health insurance for 5 consecutive years or more and have the amount of co-payment of medical examination and treatment costs in the year greater than 6 months of basic salary as follows:

The doctor examined the patient.

a) In case the patient has a co-payment amount for one or more medical examinations at the same medical examination and treatment facility that is greater than 6 months of basic salary, the medical examination and treatment facility shall not collect a co-payment amount greater than 6 months of basic salary from the patient. The medical examination and treatment facility shall be responsible for providing a receipt for the co-payment amount equal to 6 months of basic salary so that the patient has a basis to request the Social Insurance agency to confirm that there is no co-payment required in that year;

b) In case the patient has a cumulative co-payment amount in the fiscal year at different medical facilities or at the same medical facility greater than 6 months of basic salary, the patient shall bring the documents to the Social Insurance agency that issued the health insurance card to pay the co-payment amount greater than 6 months of basic salary and receive a certificate of no co-payment in that year;

c) In case the patient's co-payment amount exceeds 6 months of basic salary calculated from January 1, the Health Insurance Fund will pay 100% of the medical examination and treatment costs within the patient's benefits from the time the patient participates for 5 consecutive years until December 31 of that year.

Source: https://kinhtedothi.vn/tham-gia-bhyt-5-nam-lien-tuc-kham-chua-benh-duoc-huong-quyen-loi-gi.html