Health insurance payment area of Thanh Nhan Hospital (Hanoi) - Illustration photo: NAM TRAN
The amended Law on Health Insurance (HI) clearly stipulates special cases in which people will be paid 100% of their HI benefits.
In which cases is the maximum payment still paid when going out of line?
Specifically, some cases of self-examination and treatment outside the health insurance coverage area are entitled to 100% of the benefit level. (In which, the benefit level is 100%, 95% or 80% of the medical examination and treatment costs depending on the benefit level specified on the health insurance card of the participant. 100% of the benefit level does not mean 100% of the cost level - PV):
- Medical examination and treatment at basic or specialized facilities with confirmed diagnosis to treat certain serious diseases, rare diseases, requiring surgery or advanced techniques according to regulations of the Ministry of Health . (List of diseases issued by the Ministry of Health).
- Ethnic minorities and poor households living in economically and socially disadvantaged areas, especially disadvantaged areas, and people living in island communes and island districts when receiving inpatient treatment at specialized facilities.
- Medical examination and treatment at primary level, inpatient treatment at basic level.
- Basic and specialized medical examination and treatment facilities that before January 1, 2025 have been identified by competent authorities as district level.
- Inpatient medical examination and treatment at a specialized medical examination and treatment facility that, before January 1, 2025, has been identified by a competent authority as a provincial level.
In addition, one of the notable changes is the regulation on groups of subjects entitled to 100% of health insurance examination and treatment costs.
Including armed forces such as officers, non-commissioned officers, cadets in the army and people's police; people working in secret work; regular militia; people with meritorious services to the revolution and veterans; children under 6 years old; relatives of martyrs and people who have contributed to raising martyrs.
Notably, people from poor households, ethnic minorities living in extremely difficult areas, island communes, island districts... are also on the list of people entitled to full medical examination and treatment costs.
In addition, people receiving monthly social benefits, people aged 75 and over receiving survivor benefits, or people aged 70 to under 75 from near-poor households are also significantly expanded their health insurance benefits.
Under 351,000 VND/visit, patients do not need to pay co-payment
The revised Law on Health Insurance also clearly stipulates special cases in which people will have 100% of the costs covered by the Health Insurance Fund, including:
- One-time medical examination and treatment costs are lower than the Government's prescribed level.
Accordingly, the cost for a medical examination and treatment covered by 100% health insurance is 15% lower than the basic salary. (The current basic salary is 2,340,000 VND).
Therefore, health insurance participants will enjoy 100% of medical examination and treatment costs in case the cost for one medical examination and treatment is lower than 351,000 VND.
- Medical examination and treatment at primary health care facilities including: Health stations; family medicine examination and treatment facilities; military-civilian medical stations, military-civilian medical clinics.
District-level medical centers with medical examination and treatment activities are licensed to operate in the form of clinics; medical agencies, units, and organizations as prescribed by the Minister of Health.
Medical examination and treatment facilities at the level of initial medical examination and treatment in the military and police are regulated by the Minister of National Defense and the Minister of Public Security. 100% of the cost of outpatient medical examination and treatment at regional polyclinics.
- People who have participated in health insurance for 5 consecutive years or more and the amount of co-payment for medical examination and treatment in the year is 6 times greater than the basic salary.
- Emergency medical examination and treatment at any medical facility.
Source: https://tuoitre.vn/tu-1-7-truong-hop-nao-tu-di-kham-chua-benh-trai-tuyen-duoc-huong-100-bao-hiem-y-te-2025060918003568.htm
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