WHAT IS MEDICAL EXAMINATION AND TREATMENT UNDER HEALTH INSURANCE AT APPROPRIATE MEDICAL FACILITIES

Health insurance participants have the right to choose a medical examination and treatment facility and transfer appropriate to their actual situation when undergoing medical examination and treatment. When meeting the conditions according to regulations on medical examination and treatment and transfer, it will be considered as medical examination and treatment under health insurance at appropriate medical facilities, thereby ensuring the patient’s health insurance benefits. So, specifically, how to determine “medical examination and treatment under health insurance at appropriate medical facilities”?

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

The cases considered as 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.

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2. Transfer of medical examination and treatment under health insurance at appropriate medical facilities

Transfer of medical examination and treatment under health insurance at appropriate medical facilities

Chuyển đúng tuyến khám bệnh, chữa bệnh is transferring patients between medical examination and treatment facilities in accordance with regulations on conditions and procedures corresponding to each case, including:

– Transfer from inferior facilities to superior facilities;

– Transfer from superior facilities to inferior facilities;

– Transfer patients between medical examination and treatment facilities at the same level;

– Transfer between medical facilities in neighboring areas.

The transfers of patients uncomfortable with regulations above are considered off-line transfer.

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