Latest guidelines on converting health insurance card codes according to Decree 75/2023.

According to the new health insurance policy in Decree 75/2023, what are the instructions for converting health insurance card codes?

Latest guidelines on converting health insurance card codes according to Decree 75/2023.

The Vietnam Social Security issued Official Letter 3452/BHXH-CSYT in 2023 to implement Decree 75/2023/NĐ-CP amending some policies on health insurance.

Accordingly, the new guidelines for converting health insurance card codes are as follows:

(1) Convert the health insurance benefit 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 those who participated in the resistance war and defended the Fatherland (with the KC target code) as stipulated in Clause 5, Article 3 of Decree 146/2018/NĐ-CP.

- Change the health insurance benefit level from code 4 to code 3 for caregivers of people with meritorious services to the revolution living at home (with subject code PV) as stipulated in Clause 19, Article 3 of Decree 146/2018/NĐ-CP.

(2) Supplementing the subject code and health insurance benefit level code recorded on the health insurance card for new health insurance participants as stipulated in Decree 75/2023/ND-CP and Decree 131/2021/ND-CP

While awaiting the amendment and supplementation of Decision 1351/QD-BHXH dated November 16, 2015, of the Director General of Vietnam Social Security, which regulates the codes recorded on health insurance cards, provincial Social Security offices, in coordination with the units managing beneficiaries, will review, compile lists, and issue health insurance cards to the beneficiaries added in Decree 75/2023/ND-CP, as follows:

- For the widow or widower of a fallen soldier who is remarrying and receiving a monthly allowance as stipulated in point a, clause 10, Article 16 of the Ordinance on Preferential Treatment for People with Meritorious Contributions to the Revolution: the beneficiary code is TG and the benefit level code is 3; the management block code is WG, and the statistical block code is 37.

- Residents of safe zones and revolutionary safe zones during the resistance against the French and American forces, who are currently residing in these safe zones, 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 2; the management block code is WK, and the statistical block code is 61.

- Ethnic minority people living in communes in areas II and III, and particularly difficult villages in ethnic minority and mountainous regions during the 2016-2020 period, where these communes are no longer on the list of communes in areas II and III, and particularly difficult villages in ethnic minority and mountainous regions for the 2021-2025 period according to the Prime Minister 's decision: the beneficiary code is DS and the benefit level code is 3; the management block code is WS, and the statistical block code is 62.

(3) In cases where a person participating in health insurance simultaneously belongs to many different categories, provincial social insurance agencies review and compare the data they are managing with the cases named in the benefit level change records and the list of beneficiaries who have new cards. If the old health insurance card issued under a different category has a lower benefit level than the new regulations, then the highest benefit level will be applied.

The health insurance card codes listed above are understood as follows:

The first two characters, represented by letters (according to the Latin alphabet), are the code for the health insurance participant.

- KC: Individuals who directly participated in the resistance war against the US to save the country; individuals who participated in the war to defend the Fatherland, performed international duties in Cambodia, and assisted Laos after April 30, 1975; youth volunteers during the resistance war against France and youth volunteers who completed their duties during the resistance war; civilian laborers who participated in the resistance war against France and the US, the war to defend the Fatherland, and performed international duties as stipulated in the Prime Minister's Decisions, excluding those who were granted CC, CK, and CB codes;

- PV: Those who serve people who have rendered meritorious services to the revolution include: those who serve Heroic Vietnamese Mothers living in their families; those who serve wounded soldiers and sick soldiers with a disability of 81% or more living in their families; and those who serve resistance fighters exposed to chemical toxins with a disability of 81% or more living in their families.

Current health insurance benefit code

The next character (after the first two characters) on the card is indicated by a number (in sequential order from 1 to 5) representing the level of health insurance coverage. If a person belongs to multiple health insurance categories, the level of coverage recorded on the health insurance card is the level corresponding to the category with the highest benefits.

- Symbol number 1: 100% of the costs of medical examination and treatment covered by health insurance are reimbursed by the health insurance fund, and there are no payment limits on certain drugs, chemicals, medical supplies, and technical services as stipulated by the Minister of Health regarding the list and payment rates and conditions for technical services; transportation costs for patients from district level to higher levels in case of emergency or when undergoing inpatient treatment requiring transfer to a higher level of specialized medical care, including beneficiaries with the symbols: CC, TE.

- Number 2: Covers 100% of medical examination and treatment costs within the scope of health insurance coverage (with limitations on the reimbursement rate for certain drugs, chemicals, medical supplies, and technical services as stipulated by the Minister of Health); covers the cost of transporting patients from district-level to higher-level facilities in case of emergency or when undergoing inpatient treatment requiring transfer to a higher level of specialized medical care, including beneficiaries with the following symbols: CK, CB, KC, HN, DT, DK, XD, BT, TS.

- Number 3: Covered by the health insurance fund for 95% of medical examination and treatment costs within the scope of health insurance coverage (with limitations on the reimbursement rate for certain drugs, chemicals, medical supplies, and technical services as stipulated by the Minister of Health); 100% of medical examination and treatment costs at the commune level and costs for a single medical examination and treatment less than 15% of the basic monthly salary, including beneficiaries with the symbols: HT, TC, CN.

- Number 4: Covered 80% of medical examination and treatment costs within the scope of health insurance coverage (with limitations on the reimbursement rate for certain drugs, chemicals, medical supplies, and technical services as stipulated by the Minister of Health); 100% of medical examination and treatment costs at the commune level and costs for a single medical examination and treatment less than 15% of the basic monthly salary, including beneficiaries with the following 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.

- Number 5: 100% of medical examination and treatment costs are covered by the health insurance fund, including costs outside the scope of health insurance coverage; transportation costs, including beneficiaries with the symbols QN, CA, CY.

The above is the latest information regarding the conversion of health insurance card codes according to Decree 75/2023/ND-CP that health insurance participants need to pay attention to.

Source: https://baoquocte.vn/huong-dan-moi-nhat-ve-chuyen-doi-ma-the-bhyt-theo-nghi-dinh-752023-248834.html