According to Article 14 of Decree 146/2018/ND-CP, only a few policy groups are entitled to 100% of health insurance examination and treatment costs such as: people with revolutionary contributions, Vietnamese Heroic Mothers, people aged 80 and over receiving monthly pensions, children under 6 years old...
Some other groups are entitled to 95% of health insurance medical examination and treatment costs such as: pensioners, people receiving monthly disability allowances, near-poor households, etc.
The remaining health insurance participants such as family health insurance, students... are only covered 80% of medical examination and treatment costs by the health insurance fund.
Health insurance will have many changes from July 1, 2024 (Illustration: Tung Nguyen).
However, there are 3 specific cases in which all groups participating in health insurance are covered 100% of medical examination and treatment costs by the health insurance fund.
The first case covered 100% by the Health Insurance Fund is when the Health Insurance participant goes to a commune-level medical facility for examination and treatment.
The second case covered 100% by the Health Insurance Fund is when the health insurance participant goes for medical examination and treatment and the cost for one medical examination and treatment is lower than 15% of the basic salary.
Before July 1, the basic salary was 1,800,000 VND, the 15% rate was 270,000 VND. That is, when a health insurance participant goes to see a doctor and the cost for one medical examination and treatment is less than 270,000 VND, the health insurance will cover 100%.
From July 1st onwards, the new basic salary will be 2,340,000 VND, the 15% rate is 351,000 VND. That is, when a health insurance participant goes to see a doctor and the cost for one medical examination and treatment is less than 351,000 VND, the health insurance will cover 100%.
The third case covered by the Health Insurance Fund is 100% when the patient has participated in Health Insurance for 5 consecutive years or more and the amount of co-payment for medical examination and treatment costs in the year is greater than 6 months of basic salary.
That is, during the year, from the time the patient's co-payment amount is greater than 6 months of basic salary, the remaining medical examination and treatment costs will be 100% paid by the Health Insurance Fund.
Before July 1, the basic salary was 1,800,000 VND, the co-payment amount of the patient as the basis for enjoying 100% health insurance was 10,800,000 VND.
From July 1st onwards, the basic salary is 2,340,000 VND, the co-payment amount of the patient as the basis for enjoying 100% health insurance is 14,040,000 VND.
The complicated thing is that in 2024 there will be a transition period, applying two different basic salaries: VND 1,800,000/month (from the beginning of 2024 to June 30) and VND 2,340,000/month (from July 1 to December 31).
The co-payment amount as prescribed above is calculated for the whole year, so it is difficult to calculate the 100% health insurance benefit level using the figure of 10,800,000 VND or 14,040,000 VND.
To calculate during this transition period, the Ministry of Health has issued instructions in Official Dispatch No. 3687/BYT-BH dated July 1, 2024 on the application of the basic salary level as prescribed in Decree No. 73/2024/ND-CP of the Government in payment of health insurance medical examination and treatment costs.
According to the above document, the amount of co-payment for health insurance examination and treatment costs in a year is greater than 6 months of basic salary to determine the non-co-payment benefits according to the above regulations, determined according to the following formula.
This formula applies to patients who are admitted to the hospital from July 1 or start treatment before July 1 but are discharged (or finish treatment) from July 1 until the end of 2024.
From 2025, the basic salary will be 2,340,000 VND, the co-payment amount of the patient as the basis for enjoying 100% health insurance is 14,040,000 VND.
Readers can refer to the detailed adjustments HERE.
Source: https://dantri.com.vn/an-sinh/thay-doi-ve-dieu-kien-huong-bao-hiem-y-te-100-20240702140536650.htm
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