According to the new health insurance policy in Decree 75/2023, how is the conversion of health insurance card codes guided?
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Latest instructions on converting health insurance card codes according to Decree 75/2023
Vietnam Social Security issued Official Dispatch 3452/BHXH-CSYT in 2023 to implement Decree 75/2023/ND-CP amending a number of policies on health insurance.
Accordingly, the new content on converting health insurance card codes is instructed as follows:
(1) Convert the health insurance benefit level code according to the provisions of Clause 5, Article 1 of Decree 75/2023/ND-CP, specifically:
- Change the health insurance benefit level from code 4 to code 2 for people participating in the resistance war and defending the Fatherland (with subject code KC) as prescribed in Clause 5, Article 3 of Decree 146/2018/ND-CP.
- Change the health insurance benefit level from code 4 to code 3 for people serving people with revolutionary contributions living in their families (with subject code PV) as prescribed in Clause 19, Article 3 of Decree 146/2018/ND-CP.
(2) Supplementing the subject code and health insurance benefit level code recorded on the health insurance card for new health insurance participants as prescribed in Decree 75/2023/ND-CP and Decree 131/2021/ND-CP
While waiting for amendments and supplements to Decision 1351/QD-BHXH dated November 16, 2015 of the General Director of Vietnam Social Security regulating the codes on health insurance cards, provincial social insurance agencies coordinate with the subject management units to review, make a list and issue health insurance cards to subjects added in Decree 75/2023/ND-CP, as follows:
- The wife or husband of a martyr who marries another person or wife is receiving a monthly allowance according to the provisions of Point a, Clause 10, Article 16 of the Ordinance on preferential treatment for people with revolutionary contributions: the object code is TG and the benefit level code is number 3; the management block code is WG, the statistical block code is 37.
- People in safe zone communes and revolutionary safe zone areas during the resistance war against France and the US who are currently residing in safe zone communes during the resistance war against France and the US have had their information updated in the National Population Database and the Residence Database: the object code is AK and the benefit level code is number 2; the management block code is WK, the statistical block code is 61.
- Ethnic minorities living in communes in regions II, III, and extremely disadvantaged villages in ethnic minority and mountainous areas in the period 2016-2020, but these communes are no longer on the list of communes in regions II, III, and extremely disadvantaged villages in ethnic minority and mountainous areas in the period 2021-2025 according to the Prime Minister's decision: the object code is DS and the benefit level code is number 3; the management block code is WS, and the statistical block code is 62.
(3) In case a health insurance participant belongs to many different categories at the same time, the provincial Social Insurance will review and compare the data being managed with the cases whose names are in the benefit level change file and the list of subjects changing to the new card. If the old health insurance card issued to another category has a lower benefit level than the new regulation, then the highest benefit level will be followed.
The health insurance card codes listed above are understood as follows:
The first two characters are denoted by letters (according to the Latin alphabet) which are the code for the health insurance participant.
- KC: People who directly participated in the resistance war against the US to save the country; people who participated in the war to protect the Fatherland, performed international duties in Cambodia, and helped Laos after April 30, 1975; youth volunteers during the resistance war against France and youth volunteers who completed their duties during the resistance war; frontline laborers participating in the resistance war against France, against the US, the war to protect the Fatherland and performing international duties according to the regulations in the Decisions of the Prime Minister, except for subjects granted codes CC, CK and CB;
- PV: People serving people with revolutionary contributions, including: people serving Vietnamese Heroic Mothers living in their families; people serving war invalids and sick soldiers with a labor capacity reduction of 81% or more living in their families; people serving resistance fighters infected with toxic chemicals with a labor capacity reduction of 81% or more living in their families.
Current health insurance benefit code
The next character (after the first 2 characters) on the card is marked by a number (in order from 1 to 5) which is the health insurance benefit level. In case a person belongs to many health insurance participants, the health insurance benefit level recorded on the health insurance card is the benefit level of the subject with the highest benefits.
- Symbol number 1: 100% of medical examination and treatment costs within the scope of health insurance payment are paid by the Health Insurance Fund and there is no limit on the payment rate for some drugs, chemicals, medical supplies and technical services according to the regulations of the Minister of Health on the list and rate, conditions for payment of technical services; costs of transporting patients from district level to higher level in emergency cases or when being treated as inpatients and having to transfer to a technical specialist level, including beneficiaries with symbols: CC, TE.
- Symbol number 2: 100% of medical examination and treatment costs within the scope of health insurance payment are paid by the health insurance fund (with a limit on the payment rate for some drugs, chemicals, medical supplies and technical services according to regulations of the Minister of Health); costs of transporting patients from district level to higher level in emergency cases or when inpatient treatment requires technical transfer, including beneficiaries with symbols: CK, CB, KC, HN, DT, DK, XD, BT, TS.
- Symbol number 3: The Health Insurance Fund pays 95% of the medical examination and treatment costs within the scope of health insurance payment (with a limit on the payment rate for some drugs, chemicals, medical supplies and technical services according to regulations of the Minister of Health); 100% of the medical examination and treatment costs at the commune level and the cost for one medical examination and treatment is lower than 15% of the basic monthly salary, including beneficiaries with symbols: HT, TC, CN.
- Symbol number 4: The Health Insurance Fund pays 80% of the medical examination and treatment costs within the scope of health insurance payment (with a limit on the payment rate for some drugs, chemicals, medical supplies and technical services according to regulations of the Minister of Health); 100% of the medical examination and treatment costs at the commune level and the cost for one medical examination and treatment is lower than 15% of the basic monthly salary, including beneficiaries with the symbols: DN, HX, CH, NN, TK, HC, XK, TB, NO, CT, XB, TN, CS, XN, MS, HD, TQ, TA, TY, HG, LS, PV, HS, SV, GB, GD.
- Symbol number 5: 100% of medical examination and treatment costs are paid by the Health Insurance Fund, including medical examination and treatment costs outside the scope of health insurance benefits; transportation costs, including beneficiaries with symbols QN, CA, CY.
Above is the latest information on converting health insurance card codes according to Decree 75/2023/ND-CP that health insurance participants need to pay attention to.
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