Want to register for health insurance at a hospital near home but can't?

Mr. Loi has just moved from his hometown to Ho Chi Minh City to live with his children. To make it easier for him to get medical treatment at the right place near where he lives, Mr. Loi wants to change his initial medical registration location.

However, when he chose the initial medical facility from the list of hospitals in his place of residence, he could not transfer because the place he registered was overloaded and could not accept any more patients.

Similar to Mr. Loi, Ms. My registered for health insurance treatment at Thong Nhat Hospital (Tan Binh District) according to her work contract, which is near her home. Later, Ms. My was informed by the company that Thong Nhat Hospital was full, and her initial treatment place was transferred to Binh Thanh Hospital. The inconvenience is that this hospital is very far from her home.

Ms. My asked: "Is it correct for the insurance to transfer my medical examination and treatment registration location like this case? If so, what benefits will I receive when I go to another hospital, out of line?"

Muốn đăng ký BHYT ở bệnh viện gần nhà mà không được - 1 — Patients can choose where to register for initial health insurance examination and treatment, but it also depends on the receiving capacity of the medical facility (Illustration: Hoang Le).

According to Vietnam Social Security, initial registration for health insurance examination and treatment and referral for health insurance examination and treatment are regulated in Circular No. 40/2015/TT-BYT.

Accordingly, health insurance participants have the right to initially register at a commune/district health facility appropriate to their workplace, place of residence and the response capacity of the medical examination and treatment facility.

Therefore, the acceptance of health insurance participants' registration depends on the response capacity of the medical examination and treatment facility.

However, Vietnam Social Security instructed Ms. My: "In case Binh Thanh District Hospital is not convenient to your workplace or residence, at the beginning of each quarter, we recommend that you bring your health insurance card to the Social Security agency that issued the card to be instructed on the procedure to change the initial medical examination and treatment registration location and choose a suitable medical facility."

In case the health insurance participant goes to the wrong medical facility for examination and treatment and completes all health insurance examination and treatment procedures (presenting health insurance card and photo identification), the health insurance fund will pay depending on the medical facility.

Firstly, at district-level hospitals, patients will be paid 100% of their health insurance examination and treatment costs within the scope of the health insurance fund and the benefit level stated on the card.

Second, at provincial hospitals, patients are paid 100% of inpatient treatment costs by the health insurance fund within the scope of payment of the health insurance fund and the benefit level stated on the card. In case the patient only receives outpatient treatment, he/she will not be entitled to health insurance benefits.

Third, at central hospitals, patients are paid 40% of inpatient treatment costs by the health insurance fund within the scope of payment of the health insurance fund and the benefit level stated on the card. In case the patient only receives outpatient treatment, he/she will not enjoy health insurance benefits.