People make health insurance payment procedures at Thanh Nhan Hospital, Hanoi - Illustration photo: NAM TRAN
This is a group of people who have maintained health insurance (HI) payments for at least 5 years, allowing a maximum interruption of 3 months.
3 outstanding benefits for people participating in health insurance for 5 consecutive years
Millions of people across the country will enjoy new policies when participating in health insurance for 5 consecutive years.
100% coverage of medical examination and treatment costs in many cases, including out-of-network cases
One of the important new points of the revised Law on Health Insurance is that people who have participated in health insurance for 5 consecutive years or more will have their entire medical examination and treatment costs paid by the health insurance fund if the total amount of co-payments in a year exceeds 6 times the reference level (the level prescribed by the Government , replacing the previous minimum wage).
Patients can also be paid 100% of the cost even when they go to a different hospital in the following cases:
Examination at a specialized hospital to diagnose serious illnesses, rare diseases, requiring surgery or high technology.
Being an ethnic minority, a poor household living in a disadvantaged area, an island commune, or an island district; receiving inpatient treatment at a basic facility; receiving emergency care at any medical facility; and following the correct referral process between medical facilities.
No more waiting 180 days for high tech benefits
According to the 2008 Law on Health Insurance, for those who participate in health insurance for the first time or pay health insurance intermittently, the health insurance card is valid after 30 days from the date of payment; the benefits of high-tech services are valid after 180 days.
The new regulation has eliminated this waiting period.
Specifically, from July 1, people participating in health insurance for the first time or having an interruption of more than 90 days only need to wait 30 days for the card to be valid - regardless of basic or high-tech services.
This is a major improvement, helping patients access modern medical services faster in times of emergency.
Change the way co-payments are calculated
Previously, the minimum wage was the basis for calculating the portion of costs that patients had to pay themselves. From July, the new law will apply the "reference level", a concept regulated by the Government as the basis for calculating health insurance contributions and benefits, replacing the previous "minimum wage".
This helps the health insurance policy become flexible, while encouraging people to maintain continuous participation so that the health insurance fund can cover all costs when they exceed the threshold of 6 times the reference level.
Conditions to enjoy full benefits
To enjoy full benefits of 100% of medical examination and treatment costs from July 1, health insurance participants need to ensure:
- Have participated in health insurance continuously for 5 years or more (interruption not exceeding 3 months).
- The total amount of co-payment in the year exceeds 6 times the reference level. Currently, the current basic salary is 2.34 million VND. Therefore, people who have participated in health insurance for 5 consecutive years or more must have the amount of co-payment for medical examination and treatment costs in the year greater than 14.04 million VND (6 months of basic salary).
- Perform medical examination and treatment in the correct line, transfer to the correct line according to the procedure or in cases of examination in the wrong line as prescribed.
Remote medical examination and treatment is covered by health insurance
According to the new Health Insurance Law, from July 1, patients who receive medical examination and treatment at home will still be covered by health insurance. This is a new content that the current law does not stipulate.
Medical examination and treatment, including remote medical examination and treatment, support for remote medical examination and treatment, family medical examination and treatment, medical examination and treatment at home, rehabilitation, periodic pregnancy examination, childbirth; patient transportation for subjects specified in the case of inpatient or emergency treatment must be transferred to a medical examination and treatment facility.
In addition, health insurance participants are also paid for the costs of using medical technical services, drugs, medical equipment, blood, blood products, medical gases, supplies, tools, instruments, and chemicals used in medical examination and treatment within the scope of payment of the health insurance fund.
Source: https://tuoitre.vn/tu-1-7-dong-bao-hiem-y-te-5-nam-lien-tuc-co-them-nhieu-quyen-loi-gi-20250606201308044.htm
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