Conditions for 100% health insurance when participating for 5 consecutive years in 2024

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 participating in health insurance for 5 consecutive years.

Article 14 of Decree No. 146/2018/ND-CP provides detailed guidance on the application of health insurance benefits. According to Point d, Clause 1 of this Article, when a health insurance participant goes to the right medical facility for examination and treatment, the health insurance fund will pay 100% of the medical examination and treatment costs within the scope of benefits when the patient has participated in health insurance for 5 consecutive years or more and the amount of co-payment for medical examination and treatment costs in the year is greater than 6 months of basic salary.

Thus, to have 100% of medical examination and treatment costs covered by the Health Insurance Fund, health insurance participants must meet 2 conditions:

- Have participated in health insurance for 5 consecutive years or more (from the time the person participates in health insurance to the time of medical examination and treatment).

-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).

This means that during the year, if the amount of medical examination and treatment that the patient co-pays is greater than 6 months of basic salary, the portion exceeding 6 months of basic salary will be paid by the health insurance fund.

In case the patient's co-payment amount exceeds 6 months of basic salary calculated from January 1, the health insurance fund will pay 100% of the medical examination and treatment costs within the patient's benefits from the time the patient participates for 5 consecutive years until December 31 of that year.

Medical examination and treatment facilities are responsible for providing receipts for the co-payment amount of 6 months of basic salary so that patients have a basis to request the social insurance agency to confirm that they do not have to co-pay in that year.

In 2024, the basic salary is 1.8 million VND, 6 months of basic salary is 10.8 million VND. During the year, from the time the amount of co-payment for medical examination and treatment costs of a person participating in health insurance for 5 consecutive years is greater than 10.8 million VND, the health insurance fund will pay 100% of the medical examination and treatment costs until the end of the year.

Health insurance application for 5 consecutive years

According to Notice 2298/TB-BHXH in 2018, people who are eligible for payment must submit the following documents to the Social Insurance agency to receive the benefits:

- Health insurance card with the words "Time of 5 consecutive years: from dd/mm/yy" and ID card with photo (copy).

- Hospital bill (original).

Minh Hoa (t/h)

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