BENEFITS FOR MEDICAL EXAMINATION AND TREATMENT UNDER HEALTH INSURANCE AT APPROPRIATE MEDICAL FACILITIES

Health insurance benefits will be guaranteed at the highest level when health insurance participants receive medical treatment at appropriate medical facilities. How is this benefit level currently regulated?

1. Medical examination and treatment under health insurance at appropriate medical facilities

Cases of receiving medical examination and treatment under health insurance at appropriate medical facilities include:

– Health insurance participants apply for medical examination and treatment in initial medical examination and treatment establishments specified on their health insurance cards.

– Health insurance participants who apply for initial medical examination and treatment in medical examination and treatment establishments of communes or general clinics or district hospitals may receive medical examination and treatment covered by health insurance in other medical stations of communes or general clinics or district hospitals in the same provinces.  Children who have not obtained health insurance cards since birth declaration procedures have not been adopted may use birth certificates to receive medical examination and treatment in medical examination and treatment establishments specified.

– Health insurance participants who are in state of emergency are provided with emergency medical aid in any medical examination and treatment establishment in the country.

– Health insurance beneficiaries who benefit from transfer of administrative levels for receiving medical examination and treatment under health insurance.

– Health insurance participants who obtain documents proving their stay in other administrative divisions when they go on working trips, participate in concentrated education in training programs, semi-boarding programs and apply for initial medical examination, treatment in medical examination and treatment establishments of the same or equivalent administrative level as their initial medical examination and treatment establishments specified on health insurance cards.

– Holders of notice of re-examination appointment in case they have been transferred.

– Individuals who have donated their organs and require immediate treatment after donating organs.

– Newborn babies who must receive treatment upon birth.

>> PROCEDURE FOR TRANSFER OF MEDICAL EXAMINATION AND TREATMENT TO INFERIOR FACILITY https://linconlaw.vn/procedure-for-transfer-of-medical-examination-and-treatment-to-inferior-facility/

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2. Benefits for medical examination and treatment under health insurance at appropriate medical facilities

For health insurance participants, the level of health insurance benefits for medical examination and treatment at appropriate medical facilities is as follows:

a. 100% of the medial examination and treatment expenditures for:

– The group of the insured whose insurance is paid by the State budget:

+ Commissioned officers, professional soldiers, non-commissioned soldiers on active duty; commissioned police officers and non-commissioned police officers; police students, non-commissioned police officers or soldiers on fixed term contracts; ciphers whose salaries are the same as the salaries as the servicemen; cipher students whose benefits are the same as the benefits of students in military or police academies.

+ Persons performing meritorious services in the wars, war veterans;

+ Children under the age of 6;

+ Persons receiving monthly social protection pensions;

+ Poor household members, ethnics living in regions facing socio-economic difficulties, persons living in regions facing extreme socio-economic difficulties; persons living in island communes or districts.

+ Relatives of persons performing meritorious services in the wars such as biology parents, husbands, wives or children of revolutionary martyrs; persons rearing revolutionary martyrs;

– Any medical examination and treatment at commune hospitals whose cost is lower than the cost prescribed by the Government.

– Total medical examination and treatment expenditures with regard to the at least 5-year-insured whose medical examination and treatment expenditures exceed the total amount of the base salaries in 6 months, except for the insured who go to the hospitals different from the registered hospitals.

b. 95% of the medial examination and treatment expenditures for:

– Persons receiving monthly retirement pensions and compensation for loss of capacity for work;

– Relatives of persons performing meritorious services in the wars;

– Members of households living above the poverty line;

c. 80% of the medial examination and treatment expenditures for:

The remaining objects.