Compulsory health insurance: What you need to know about medical examination and treatment with a health insurance card

• You must produce a valid health insurance card and photo identification when going for a medical examination and treatment. Only a valid health insurance card is required for children under the age of six.
• In the event of an emergency: Received at any medical examination and treatment institution , and must provide a valid ID card as well as a health insurance card before being released from the hospital. If some diseases are discovered during treatment and must be treated, the treatment at the medical institution will be estimated at the appropriate level.
• In the event of a referral for treatment, the patient will be transferred to a professional and technical hospital in accordance with regulations if the health care facility's treatment capacity is exceeded or the unit's technical services are not provided. Patients must produce a valid health insurance card (HI), valid picture identification, and a referral facility hospital transfer letter.
• In case of payment of transportation costs for patients, subjects are: non-commissioned officers, those conducting cipher work, and people who have rendered outstanding service to the revolution. Relatives of revolutionaries who have rendered outstanding service (parents, mothers). giving birth, children, and people who have done good deeds to care for martyrs); Children under the age of six; monthly patrons; in the event of a technical transfer, the health insurance fund will cover the expense of two-way transportation.
• In the event of a re-examination, the following guidelines should be followed: The insured must receive a note from the medical facility confirming their appointment. The re-examination appointment letter can only be used once for medical examination and treatment.

2.1. Payment at hospitals and medical facilities with health insurance coverage

Medical examination and treatment according to regulations

• Participants going for medical treatment who present their health insurance card and valid identification documents at the original medical facility or another health care facility with health insurance will be paid as follows:

a/ Using regular medical examination and treatment services:

• 100% of medical treatment costs for the following subjects: officers, professional non-commissioned officers and officers and non-commissioned officers; People with revolutionary merits; Children under 6 years old; the cost of medical treatment in case the cost of one-time medical treatment is lower than 15% of the base salary (common minimum wage) and medical treatment at the commune level; Persons eligible for monthly social protection allowance; People from poor households; ethnic minorities are living in areas with difficult or extremely difficult economic conditions.
• 95% of medical treatment costs for the following subjects: People who are enjoying monthly pensions or benefits for loss of working capacity; People from near-poor households; Relatives of people with meritorious services to the revolution.
• 80% of medical expenses for other subjects.

b/ When using high-tech services, large costs are paid as follows:

• 100% of medical expenses with no limit on payment rates for: Children under 6 years old; People who were active in the revolution before 1945; revolutionary activists from January 1, 1945 to before August 19, 1945; Vietnamese heroic mothers; War invalids and beneficiaries of policies such as war invalids, class B invalids and sick soldiers when they are treated for recurrent injuries or injuries.
• 100% of expenses for: Officers, professional non-commissioned officers and officers and non-commissioned officers working in the People's Public Security force but not exceeding 40 months' basic salary (general minimum salary) for an employee. use of technical services. The rest shall be paid by the agency or unit managing the subject.
• 100% of the cost for: People with meritorious services to the revolution, but not exceeding 40 months' basic salary (general minimum salary) for one time using technical services specified in Joint Circular No. 41/2014/TTLT /BYT-BTC.
• 95% of expenses for: People receiving monthly pensions and social insurance benefits; Relatives of people with meritorious services to the revolution, except for the group of subjects specified at Point i, Clause 3, Article 12 of the Law on Social Insurance No. 46/2014; People from near-poor households.
• 80% of the cost goes to other audiences and target groups.

Medical examination and treatment not at the original registered medical facility or not according to professional and technical lines (except for emergency cases) will be paid as follows:

• 60% of the cost for medical treatment at provincial medical facilities;
• 40% of the cost for medical treatment at a central-affiliated medical facility.

2.2. Value of using the card

• For participants who are the first time, if they stop participating in health insurance for 3 months or more, the card will be valid 30 days after the payment date.
• For those who participate continuously, renew the card, or have a break for no more than 3 months, the card will take effect from the date of payment of health insurance premiums to the collection agency or agent.

2.3. Direct payment of health insurance premiums at the social insurance agency

• Medical care at a medical facility that does not sign a contract with health insurance; go to a medical facility that has signed a contract for medical care and health insurance, but does not have enough medical procedures: The patient pays the cost of medical treatment with the medical facility, then brings the document to the social insurance agency for payment. Based on the technical services provided to the patient, the medical facility's professional and technical lines, and valid documents, the social insurance agency shall pay the patient actual expenses but must not exceed the prescribed amount in the Appendix attached to Joint Circular 37/2015/TTLT-BYT-BTC.

See more instructions at: https://baohiemxahoidientu.vn/bhxh/kham-benh-chua-benh-khong-co-the-bhyt.html

• The specific amount of direct payment is specified in the Appendix of Joint Circular 37/2015/TTLT-BYT-BTC of the Ministry of Health - Ministry of Finance regarding:
• Price of medical examination and treatment services
• Bed day service price
• Prices for technical and testing services

Download the detailed appendix of Circular 37/2015/TTLT-BYT-BTC here.

Note: In case of medical treatment abroad, medical expenses are not paid according to Article 14 and Appendix 04 of Joint Circular 41/2014/TTLT-BYT-BTC.

Excerpt from Article 23 of Law on Health Insurance, cases not entitled to health insurance include:

• Expenses in cases already covered by the state budget.
• Nursing and convalescence at nursing and convalescent establishments.
• Physical examination.
• Pregnancy testing and diagnosis is not intended for treatment.
• Using assisted reproductive technology, family planning services, abortion, abortion, except in cases where the pregnancy must be terminated due to the medical causes of the fetus or the mother.
• Use beauty services.
• Treatment of strabismus, myopia and refractive errors of the eye. Except for the treatment of strabismus, myopia and refractive errors for children under 6 years old.
• Using alternative medical supplies including prosthetic limbs, artificial eyes, dentures, eyeglasses, hearing aids, mobility aids in medical examination, treatment and rehabilitation.
• Medical examination, treatment and rehabilitation for occupational diseases, occupational accidents and disasters.
• Medical examination and treatment in case of suicide, self-injury. (revoked)
• Medical examination and treatment for addiction to drugs, alcohol or other addictive substances.
• Medical examination and treatment for physical and mental injuries caused by such person's law-breaking acts. (revoked)
• Medical assessment, forensic examination, forensic psychiatric assessment.
• Participate in clinical trials and scientific research.

• The first box (first 2 characters): Code of participants in health insurance is denoted by letters. In case a person belongs to many different beneficiaries of health insurance, the object code written on the health insurance card is the code of the person paying health insurance premium determined first according to the provisions of Clause 7, Article 1 of the Law amending and supplementing the Law on Health Insurance.
• The second box (1 next letter): The level of health insurance benefits and is denoted by a number (in order from 1 to 5). In case a person belongs to many subjects participating in health insurance, the level of health insurance benefit stated on the health insurance card is the benefit level of the person with the highest benefits.
• 3rd box (next 2 characters): Code of province, city directly under the Central Government, where the health insurance card is issued is denoted by a number (from 01 to 99) (according to the code of the province or city issued together with the Decision). No. 124/2004/QD-TTg on the announcement of the new administrative list code). Particularly, the code of the Social Security of the Ministry of National Defense is denoted by number 97, of the Social Security of the People's Public Security is denoted by number 98.
• 4th cell (next 2 characters): District code, district. town, city directly under the province, where the focal point of health insurance participants is managed (In the order of districts specified in Decision No. 124/2004/QD-TTg and Official Letter No. 628/TCTK-PPCD). Particularly, objects directly collected by the province have the symbol 00.
• Box 5 (next 3 characters): Code of management unit, by administrative boundary and by object type. In which, the subjects managed by the commune (including employees working in cooperative groups, individual production and business households), take the first letter with the number 9 (901, 999).
• Box 6 (last 5 characters): The ordinal number of the insured person in 1 unit, denoted by a number (according to a natural number from 00001 to 99999).

Note: If the health insurance card has the words "Full 5 consecutive years from ....", you will enjoy the benefit of 100% of the cost of medical examination and treatment covered by health insurance if the following conditions are met:

• On-line medical examination and treatment;
• Having a co-payment of medical examination and treatment expenses in the cumulative year is greater than 6 months' basic salary (current base salary is 1,210,000 VND. By July 1, 2017, the base salary will increase to 1,300,000 VND. ). The base salary in 2019 increased to 1,490,000 VND/month according to the provisions of Resolution 70/2018/QH14.

Details and help:

• North: 1900 6142 | ebhxh@efy.com.vn
• Central: 1900 6134 | mtebhxh@efy.com.vn
• South: 1900 6139 | mnebhxh@efy.com.vn

(Source: Vietnam Social Insurance)

''I have a health insurance card to register for initial medical examination and treatment at Vinmec, so when I go to Vinmec for medical examination and treatment, how will I receive health insurance premiums?'' is one of the most frequently asked questions about Medical Insurance benefits at Vinmec International Hospital. To learn more about your rights, please read more HERE.