Mr. Dinh had a sore throat and went to a general clinic (registered for health insurance). The doctor ordered an endoscopy and Dinh had to pay 220,000 VND.
Mr. Dinh asked: "I have participated in health insurance for over 5 years and am eligible for 100% coverage of medical examination and treatment costs. May I ask if the clinic is charging me for endoscopy services as stated above, is it correct?"
Private medical examination and treatment facilities have the right to decide the price of medical examination and treatment services (Illustration: Truong Thinh).
Vietnam Social Security said that according to the provisions of the Law on Medical Examination and Treatment, private medical examination and treatment facilities have the right to decide and must declare prices and publicly post prices for medical examination and treatment services. Meanwhile, patients participating in health insurance are obliged to pay for medical examination and treatment costs beyond the scope of benefits and benefits according to the provisions of the law on health insurance.
Thus, in the case of Mr. Dinh, who is eligible for 100% of the cost of health insurance examination and treatment when going to a private clinic for examination and treatment, and fully completing the procedures for health insurance examination and treatment (presenting the health insurance card and photo identification), the health insurance fund will fully pay the cost of health insurance examination and treatment within the scope of health insurance benefits.
However, patients must pay for costs outside the scope of health insurance benefits (if any) and the difference between the price of health insurance medical examination and treatment services paid by the health insurance fund and the price of medical examination and treatment services declared by private medical examination and treatment facilities.
The insurance agency also noted that the right to 100% payment of medical examination and treatment costs for health insurance participants for 5 consecutive years is conditional.
In addition to some groups participating in health insurance paid by the state budget, the contribution support is entitled to health insurance covering 95%-100% of medical examination and treatment costs, the remaining groups are only covered by health insurance covering 80% of medical examination and treatment costs.
However, these groups still have the opportunity to have 100% of medical examination and treatment costs covered by health insurance when meeting 2 conditions.
Firstly, the person must have participated in health insurance for at least 5 consecutive years (from the time the person participates in health insurance to the time of medical examination and treatment).
Second, the amount of co-payment for medical examination and treatment costs in the year is greater than 6 months of basic salary (calculated from the time of participating in health insurance for 5 consecutive years).
That is, during the year, from the time the co-payment amount for medical examination and treatment costs of a person participating in health insurance for 5 consecutive years is greater than 6 months of basic salary (10.8 million VND), the health insurance fund will pay 100% of the medical examination and treatment costs until the end of the year.
Source: https://dantri.com.vn/an-sinh/dieu-kien-duoc-bao-hiem-y-te-chi-tra-100-khi-tham-gia-tren-5-nam-20240524134913869.htm
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