Good news for people when 3 new regulations on health insurance are applied from January 1, 2025

Some new regulations on health insurance (HI) will be applied from January 1, 2025 to facilitate people.

3 quy định mới về BHYT tạo thuận lợi cho người dân từ 1/1/2025

From January 1, 2025, the list of drugs covered by health insurance will not be divided by hospital class.

From January 1, 2025, some cases of rare diseases, serious diseases... will be taken directly to specialized medical examination and treatment facilities and will be 100% covered by health insurance; Hospitals do not have medicine, health insurance patients will be refunded when buying outside, along with some other regulations to facilitate people with health insurance cards...

Rare and serious diseases are directly upgraded to specialized level, 100% covered by health insurance

The Law amending and supplementing a number of articles of the Law on Health Insurance (HI) recently passed by the National Assembly has 8 new points, including regulations on the level of health insurance when implementing universal health insurance examination and treatment in the direction of not distinguishing administrative boundaries, maintaining the rate of health insurance benefits according to the provisions of the current Law and expanding it to a number of cases.

According to the representative of the Ministry of Health, the list of rare and critical diseases of the Ministry of Health includes 42 diseases, including serious diseases such as cancer, lupus erythematosus, organ transplants, severe burns, multiple sclerosis, heart valve replacement surgery, stroke, Alzheimer's disease, dementia, kidney failure, permanent disability...

Patients who have been diagnosed with rare diseases, serious diseases, or diseases requiring high technology on the list issued by the Ministry of Health can go directly to specialized hospitals without needing to request a referral letter as is currently the case.

However, the Ministry of Health is currently developing a specific list of rare and serious diseases that do not require a referral letter. In addition, the Ministry of Health is integrating referral letters electronically to reduce administrative procedures for patients.

To ensure health insurance benefits, the new regulations of the 2024 Health Insurance Law also affirm that patients will enjoy 100% of health insurance benefits when treated at upper-level medical facilities, if their illness exceeds the treatment capacity of lower-level medical facilities.

Hospital has no medicine, health insurance patients get refund when buying outside

This is one of the notable contents stipulated in Circular 22/2024/TT-BYT of the Ministry of Health which will take effect from January 1, 2025.

Accordingly, from January 1, 2025, according to Article 3 of Circular 22/2024/TT-BYT, in case a doctor prescribes a drug that is on the insurance list but the hospital does not have the drug at that time, the patient must buy the drug outside, the Social Insurance will refund the patient if the following conditions are met:

At the time of prescribing medicine or ordering the use of medical equipment without medicine or medical equipment due to the process of selecting a contractor according to an approved plan in one of the following forms.

Accordingly, the Social Insurance agency will pay directly to the patient according to the quantity and unit price stated on the invoice purchased by the patient at the pharmaceutical business establishment.

Regarding direct cost payment, according to the guidance of Circular 22, the Social Insurance agency shall pay directly to the patient according to the following regulations:

For drugs, the basis for calculating the payment level is the quantity and unit price stated on the invoice purchased by the patient at the pharmaceutical business establishment. In case the drug has regulations on payment rates and conditions, the payment rates and conditions shall be implemented;

For medical equipment (including reusable medical equipment), the basis for calculating the payment level is the quantity and unit price stated on the invoice purchased by the patient at the medical equipment trading facility. In case the medical equipment has a payment level regulation, it must not exceed the payment level prescribed for that medical equipment.

The unit price of drugs and medical equipment used as the basis for determining the payment level must not exceed the unit price paid at the most recent time for cases where drugs and medical equipment have won bids at the medical examination and treatment facility where the patient was examined and treated.

Do not divide the list of drugs covered by health insurance by hospital class.

Currently, according to the Appendix issued with Circular 20/2022/TT-BYT, drugs in the list of health insurance payments are classified according to hospital class and professional level, including: Special class, class I, class II, class III and class IV hospitals; Technical professional level includes: Central, provincial, district and communal levels.

However, from January 1, 2025, this regulation will be abolished in Circular 37/2024/TT-BYT of the Ministry of Health. Specifically, the columns for classifying hospitals using drugs; notes on payment rates and payment conditions of drugs will be abolished.

This means that the list of drugs covered by health insurance will not be divided according to hospital class. At that time, medical examination and treatment facilities will be able to use all drugs in the list, in accordance with the scope of professional activities, diagnosis and treatment guidelines, regardless of hospital class or technical expertise level.

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