Ensuring the rights of health insurance participants

Health insurance participants receive medical examination and treatment at Can Tho University Hospital.

According to the Law on Amending and Supplementing a Number of Articles of the Law on Health Insurance, health insurance participants enjoy more benefits. Mr. Nguyen Tan L in Truong Lac Ward, O Mon District, shared: “Recently, my child was injured and had to be hospitalized for many days at Can Tho Central General Hospital. Thanks to participating in health insurance, my child's treatment costs were paid by the Health Insurance Fund, which only cost us about 10 million VND. Without a health insurance card, the treatment process would have cost tens of millions of VND, which would have been very difficult for the family…”.

One of the new points of the Law amending and supplementing a number of articles of the Law on Health Insurance is that health insurance participants will have their medical examination and treatment costs paid by the Health Insurance Fund at primary health care facilities nationwide. The list of covered medical examinations includes: remote examination, family medicine examination, home examination, rehabilitation, periodic pregnancy examination and childbirth. In addition, health insurance participants will also be paid for the costs of patient transportation according to regulations; medical technical services, drugs, blood, medical gases, medical supplies; instruments and chemicals within the scope of payment of the Health Insurance Fund.

According to the new regulations, health insurance participants are entitled to 100% of the cost of medical examination and treatment at any primary health care facility nationwide; and 100% of the inpatient cost at basic health care facilities nationwide. In particular, health insurance participants are paid 100% of the cost when examining at any basic or specialized health care facility, if this facility was identified as a district level before January 1, 2025.

According to the Social Insurance of Region III (Can Tho), patients are covered 100% of medical examination and treatment costs if they fall into the following cases: the total cost for one medical examination and treatment is lower than the level prescribed by the Government (currently 15% of the basic salary, equivalent to 351,000 VND); have participated in health insurance continuously for 5 years or more and have the co-payment amount in the year exceeding 6 times the reference level. The Law on Amendments and Supplements to a Number of Articles of the Law on Health Insurance stipulates that medical examination and treatment facilities are allowed to receive drugs, medical equipment or paraclinical services from other medical examination and treatment facilities to serve treatment, in case at the designated time, that facility does not have them available.

Not only that, from 2025, people with rare or serious diseases on the list of 62 diseases issued by the Ministry of Health will be transferred directly to specialized facilities while still enjoying 100% health insurance, without the need for a referral.

Ms. Le Thi Tuyet Trinh, Head of the Front Working Committee of Hoa Thanh A area, Thoi Hoa ward, O Mon district, said: “This policy not only demonstrates profound humanitarian meaning but also helps patients access high-quality medical services quickly, equally and fairly. Thanks to that, we can promote and mobilize people to participate in health insurance more conveniently; people agree and boldly continue to participate when their health insurance cards expire.”

Article and photos: CHAN HUNG

Source: https://baocantho.com.vn/-am-bao-quyen-loi-cua-nguoi-tham-gia-bao-hiem-y-te-a185390.html