Health insurance benefits for 5 consecutive years

According to Article 12 of Decree 146/2018/ND-CP, 5 consecutive years of health insurance is when the participant has paid for 5 consecutive years, with a maximum interruption of 3 months allowed.

The time when a person participates in health insurance for 5 consecutive years is recorded directly on the health insurance card.

According to Decision 1666/QD-BHXH on health insurance card form, the recording of 5 consecutive years is regulated, people who have had 5 years of continuous health insurance participation as of January 1, 2015 will print from January 1, 2015.

From January 1, 2015 onwards, health insurance participants who have not participated in enough or started participating in 5 consecutive years will be printed from the first day of the sixth year.

Health insurance is of particular importance in reducing the financial burden on patients. The level of health insurance benefits for 5 consecutive years is stipulated in Point c, Clause 1, Article 22 of the Health Insurance Law No. 25/2008/QH12, amended by Law No. 46/2014/QH13.

Specifically, when health insurance participants go for medical examination and treatment according to the provisions of Articles 26, 27 and 28 of this Law, the health insurance fund will pay for medical examination and treatment costs within the scope of benefits at a rate of 100% of medical examination and treatment costs 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, except in cases of self-examination and treatment at the wrong medical facility.

Accordingly, the health insurance benefit for 5 consecutive years is 100% of medical examination and treatment costs within the scope of benefits.

To be paid 100% of medical examination and treatment costs according to the health insurance benefit level for 5 consecutive years, the patient must meet the conditions for participating in health insurance for 5 consecutive years or more; the time of eligibility is recorded on the health insurance card.

The amount of co-payment for medical examination and treatment costs in a year is greater than 6 months of basic salary. The co-payment amount is understood as the amount that the patient must pay with the social insurance agency according to the % rate on the health insurance card.

Currently, the basic salary is applied at 1.8 million VND/month, so the co-payment amount must be greater than 6 x 1.8 million VND = 10.8 million VND.

Regarding medical examination and treatment in the right place, according to Notice 2298/TB-BHXH dated November 14, 2018, the application file for health insurance benefits for 5 consecutive years includes: Health insurance card, photo identification (copy); invoices, hospital fee payment documents (original).

After having all these documents, the patient submits the application to the social insurance agency where he/she participates in health insurance for settlement.

This regulation shows that when going to see a doctor or get treatment, patients should carefully keep their invoices and documents to have a basis for the social insurance agency to resolve the regime to ensure their rights.

Source