From January 1, 2025, health insurance participants may have their costs for purchasing medicines and medical equipment outside of insurance policies reimbursed.

The Ministry of Health has just issued Circular No. 22/2024/TT-BYT regulating the direct payment of costs for medicines and medical equipment for people with health insurance cards who go for medical examination and treatment. This Circular stipulates that people participating in health insurance who go for medical examination and treatment may have their costs for medicines and medical equipment covered by the health insurance fund directly reimbursed.

From January 1, 2025, health insurance participants may be reimbursed for the cost of medicines and medical equipment purchased outside of insurance plans.

Specifically, the cases eligible for reimbursement include: drugs on the list of drugs covered by health insurance (issued with Circular No. 26/2019/TT-BYT dated August 30, 2019, of the Ministry of Health). Medical devices of type C or D, excluding in vitro diagnostic medical devices, personal specialized medical devices, and medical devices on the list of medical devices issued by the Minister of Health, which can be bought and sold as ordinary goods.

Patients are reimbursed if, at the time of prescribing medication or ordering medical equipment, the following conditions are met: firstly, the medication or medical equipment is unavailable because it is currently in the bidding process according to the approved bidding plan; secondly, the medical facility does not have any commercially available medication containing the active ingredient prescribed to the patient, or the same active ingredient but at a different concentration, dosage, pharmaceutical form, or route of administration that cannot be substituted; and thirdly, the medical equipment prescribed to the patient is unavailable and there is no alternative medical equipment available.

Secondly, patients should not be transferred to other medical facilities in any of the following cases: The patient's health condition or illness is determined to be unsuitable for transfer; the medical facility where the patient is being examined and treated is under medical quarantine as prescribed by law on the prevention and control of infectious diseases; the medical facility where the patient is being examined and treated is a specialized medical facility.

Thirdly, it is not possible to transfer medicines and medical equipment between medical examination and treatment facilities in accordance with the law.

Fourthly, prescribed medications and medical devices must be within the scope of expertise of the medical facility and the medical examination and treatment costs must have been covered by health insurance at one of the medical facilities nationwide.

Fifthly, the medicines and medical devices prescribed and indicated for use must be within the scope of benefits covered by health insurance.

Payment for medication: The basis for calculating the payment is the quantity and unit price recorded on the invoice purchased by the patient at the business establishment. If the medication has regulations regarding payment rates and conditions, those rates and conditions will be followed.

For medical devices (including reusable medical devices): The basis for calculating the payment amount is the quantity and unit price recorded on the invoice issued by the patient at the medical device retailer. In cases where a medical device has a specified payment limit, the payment must not exceed the limit stipulated for that device.

Documents required for direct payment include: Health insurance card, identity card, discharge papers, medical examination form or medical record book (submit photocopies along with the original for verification), and invoices and documents related to the purchase of medicines and medical equipment.

Patients, their relatives, or their legal representatives, as stipulated by law, must directly submit their applications to the district-level social insurance agency where they reside. The social insurance agency will receive the application and issue a receipt (if the application is incomplete, the patient will be guided to supplement it).

Within 40 days from the date of receiving all necessary documents for payment, the health insurance assessment must be completed and the costs of medical examination and treatment paid to the patient, their family member, or their legal representative. In case of non-payment, a written response must be provided stating the reasons.

Source: https://thoidai.com.vn/tu-112025-nguoi-tham-gia-bao-hiem-y-te-co-the-duoc-thanh-toan-chi-phi-mua-thuoc-thiet-y-te-ben-ngoai-206898.html