Health insurance benefits for medical examination and treatment from July 1

On June 30, the Ministry of Health issued Official Dispatch No. 4082 on the application of the basic salary level as prescribed in Decree No. 24/2023/ND-CP of the Government in the payment of health insurance medical examination and treatment costs to Vietnam Social Security.

The dispatch clearly stated that, in response to dispatch No. 1914 of Vietnam Social Security requesting guidance on applying the basic salary level in payment of health insurance examination and treatment costs according to the provisions of Decree No. 24 of the Government, the Ministry of Health guides the implementation in the transition period from July 1, 2023 to December 31, 2023 specifically:

Regarding the level of health insurance benefits as prescribed in Point d, Clause 1, Article 14 of Decree No. 146 of the Government detailing and guiding measures to implement a number of articles of the Law on Health Insurance from July 1, 2023 or in the case of a patient admitted to the hospital or starting treatment before July 1, 2023 but discharged from the hospital or ending treatment from July 1, 2023: The cost for one medical examination and treatment is lower than 15% of the basic salary: equivalent to less than VND 270,000.

Policy - Health insurance benefits for medical examination and treatment from July 1 — Latest guidance from the Ministry of Health on health insurance benefits when going to the doctor for medical examination and treatment from July 1.

Regarding the direct payment level as prescribed in Article 30 of Decree No. 146 from July 1, 2023 or in the case of a patient admitted to the hospital or starting treatment before July 1, 2023 but discharged from the hospital or ending treatment from July 1, 2023:

At point a, clause 1, the maximum amount is not more than 0.15 times the basic salary: equivalent to a maximum of not more than 270,000 VND.

At point b, clause 1, the maximum amount is not more than 0.5 times the basic salary: equivalent to a maximum of not more than 900,000 VND.

In Clause 2, the maximum amount is not more than 1.0 times the basic salary: equivalent to a maximum of not more than VND 1,800,000.

In Clause 3, the maximum amount is not more than 2.5 times the basic salary: equivalent to a maximum of not more than VND 4,500,000.

The total payment level for medical supplies for one use of technical services shall not exceed 45 months of basic salary as prescribed in Point b, Clause 2, Article 3 of Circular No. 04 of the Ministry of Health promulgating the List and rates, payment conditions for medical supplies within the scope of benefits of health insurance participants:

In case of patients admitted to hospital from July 1, 2023: equivalent to not exceeding 81 million VND.

In case the patient is admitted to the hospital or starts treatment before July 1, 2023 but is discharged or ends treatment from July 1, 2023: The total payment level for medical supplies for one use of technical services is determined according to the time of completion of the technical service, specifically:

Before July 1, 2023, the basic salary prescribed in Decree No. 38 of the Government shall apply, stipulating the basic salary for cadres, civil servants, public employees and armed forces, equivalent to not exceeding VND 67,050,000;

From July 1, 2023, the basic salary prescribed in Decree No. 24 of the Government will apply, stipulating the basic salary for cadres, civil servants, public employees and armed forces, equivalent to not exceeding 81 million VND.

From July 1, 2023 and in the case of a patient being hospitalized or starting treatment before July 1, 2023 but being discharged or ending treatment from July 1, 2023, the amount of co-payment for health insurance medical examination and treatment costs in the year is greater than 6 months of basic salary to determine the non-co-payment benefit according to the provisions of Point d, Clause 1, Article 14 of Decree No. 146 is greater than the amount determined as follows: 6 months - total amount co-paid from January 1, 2023 to before July 1, 2023 divided by 1,490,000 VND) multiplied by 1,800,000 VND .

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