More benefits for patients using health insurance

(Dan Tri Newspaper) - Circular 39 of the Ministry of Health, effective from 2025, amends and supplements many regulations to facilitate patients' use of health insurance.

The Ministry of Health has just issued Circular No. 39/2024/TT-BYT amending and supplementing a number of articles of Circular No. 35/2016/TT-BYT on the issuance of the list and rates, and payment conditions for medical technical services within the scope of benefits for health insurance participants.

Accordingly, Clause 2, Article 1 of Circular 39 amends and supplements the list of medical technical services covered by health insurance by simplifying the conditions to expand the scope of implementation for lower-level medical facilities, giving patients more choices.

The eligibility criteria for CT scans have been expanded to include cases such as chest or abdominal scans for children under 6 years old, and craniofacial scans for congenital craniofacial deformities.

Many advanced medical services that support the diagnosis and treatment of cancer are also covered by health insurance, such as PET/CT scans for cancer diagnosis, metastatic cancer of unknown primary tumor, staging, recurrence or metastasis identification, and treatment response assessment…

Readers can find detailed information on the list and rates, and payment conditions for medical technical services covered by health insurance, as issued with Circular 39, HERE.

Cancer patients will receive more support from health insurance (Illustrative image: Ho Chi Minh City Social Insurance).

In addition, Circular 39 adds Articles 4a, 4b, 4c, and 4d after Article 4 of Circular 35 (which regulates the guidance on health insurance payment).

Article 4a of Circular 39 stipulates that the cost of various supplies not included in the daily bed rate will be reimbursed based on the patient's actual usage, such as: medications, blood, blood products, intravenous fluids, syringes, needles, etc.

Article 4a stipulates that costs not included in the price of technical services shall be reimbursed based on actual usage by the patient; medical examination and treatment facilities shall not charge patients for the costs of medicines, consumables, and replacement materials that are covered by the Health Insurance Fund.

According to Article 4b of Circular 39, if a patient, after being examined by one specialist, needs to be examined by other specialists during a single visit to the same medical facility, then from the second visit onwards, only 30% of the price of one examination will be charged.

If a patient consults multiple specialists simultaneously, the maximum reimbursement for their medical expenses shall not exceed twice the price of a single consultation.

If a patient has been examined and prescribed medication but later experiences unusual symptoms and returns for a follow-up examination on the same day, this follow-up will be counted as the second examination of the day, and will only be charged at 30% of the price of a single examination.

Article 4c of Circular 39 stipulates the method for determining the number of hospital bed days, applying the price levels, and settling hospital bed payments between social insurance agencies and medical examination and treatment facilities; many of these provisions are beneficial to patients.

Specifically, if a patient is transferred between two departments on the same day, each department will only be counted as half a day.

The daily hospital bed service fee is calculated based on a standard of 1 person/1 bed. If two people share one bed at the same time, only half the service fee will be reimbursed. If three or more people share a bed, only one-third of the fee will be reimbursed. If the patient is lying on a stretcher or folding bed, 50% of the standard fee will apply.

Circular 39 officially takes effect from January 1, 2025.

Source: https://dantri.com.vn/an-sinh/them-quyen-loi-cho-nguoi-benh-su-dung-bao-hiem-y-te-20241123055255011.htm