If I am admitted to the emergency room but forget my health insurance card, will I still be entitled to benefits?

On this issue, Vietnam Social Security advises:

Article 28 of the Law on Health Insurance stipulates that health insurance participants must present their health insurance card and photo identification when going for medical examination and treatment. Children under 6 years old only need to present their health insurance card.

In case of emergency, health insurance participants can be examined and treated at any medical facility (both public and private) and must present their health insurance card and photo identification before being discharged from the hospital.

Note: Determining the patient's emergency status upon admission is under the authority of the treating physician and the medical facility that receives the patient.

When the emergency phase is over, the medical facility will transfer the patient to another department or treatment room at that facility for continued monitoring and treatment or transfer to another facility, which will be determined to be in the correct line and paid according to the level of benefit stated on the card.

If a health insurance participant goes to an emergency room at a medical facility that does not have a health insurance contract, the facility must provide the patient with valid documents and certificates related to the cost of medical examination and treatment upon discharge so that the patient can pay directly to the social insurance agency according to regulations.

If the patient goes to the emergency room at a place with a health insurance contract but upon discharge from the hospital, he/she still cannot present the health insurance card and photo identification, the patient will only be directly paid a portion of the cost by the Health Insurance Fund according to regulations.

Specifically: For outpatients, the Health Insurance Fund will pay according to actual costs within the scope of benefits and the patient's benefit level, but not exceeding 0.15 times the basic salary at the time of medical examination and treatment (currently 233,500 VND).

For inpatients, the maximum is not more than 0.5 times the basic salary at the time of discharge (currently 745,000 VND).

Thus, if the patient does not bring the health insurance card when admitted to the emergency room, he/she is still entitled to full benefits related to health insurance, as long as he/she presents the health insurance card before leaving the hospital. However, if he/she still cannot present the health insurance card upon discharge, the patient will only receive a portion of the cost directly paid by the health insurance fund.

Minh Hoa (t/h)

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