Many policies are beneficial for health insurance participants from July 1

How do out-of-network patients benefit from health insurance?

Speaking at the workshop on implementing some new regulations of the Law on Health Insurance and contributing opinions to the draft decree, Deputy Minister of Health Tran Van Thuan said that the Law amending and supplementing some articles of the Law on Health Insurance is an important milestone, demonstrating the determination to reform administration, reduce paperwork, and create convenience for people...

With many policy changes that benefit health insurance participants, the Ministry of Health is finalizing a draft Decree guiding the implementation of the Health Insurance Law, aiming to resolve practical problems in health insurance examination and treatment and payment of health insurance examination and treatment costs...

Regarding the new points of the Law amending and supplementing a number of articles of the Law on Health Insurance, Mr. Doan Quoc Dan, senior expert of the Department of Health Insurance (Ministry of Health) said that in addition to the subjects participating in health insurance according to current regulations, from July 1, the amended Law on Health Insurance stipulates 7 more groups of subjects required to participate in health insurance.

These are: Employees with labor contracts of at least 1 month; business owners of registered business households who are subject to compulsory social insurance according to the provisions of the law on social insurance; employees who are foreign citizens in some cases; employees working under labor contracts agreed with employers for part-time work; people taking sick leave or maternity leave for 14 days or more; medical staff in villages and hamlets; victims of human trafficking, folk and excellent artisans... and some other subjects.

Deputy Minister Tran Van Thuan spoke at the workshop.

For health insurance participants who go to medical examination and treatment at a facility not registered for initial health insurance examination and treatment, or not in accordance with regulations on patient transfer, the health insurance fund will pay a percentage of the benefit level such as: 100% of the benefit level when examining and treating at a basic or specialized medical examination and treatment facility in case of confirmed diagnosis and treatment of some rare diseases, serious diseases, diseases requiring surgery or using high technology.

100% of the benefits for ethnic minorities and poor households living in areas with difficult socio-economic conditions, areas with especially difficult socio-economic conditions, people living in island communes and island districts when receiving inpatient treatment at specialized medical facilities.

Receive 100% of the benefits when examining and treating at a primary medical facility; 100% of the benefits when examining and treating inpatients at a basic medical facility; 100% of the benefits when examining and treating at a basic or specialized medical facility that, before January 1, 2025, has been determined by a competent authority to be a district-level medical facility.

From 50% to 100% of the benefit level when examining and treating outpatients at basic medical facilities based on the results of technical expertise ranking according to the roadmap and specific benefit level rate prescribed by the Government.

Health insurance participants receive 40% of the benefit when receiving inpatient treatment at a specialized medical facility. 50% of the benefit when receiving outpatient treatment according to the Government's roadmap and 100% of the benefit when receiving inpatient treatment at a specialized medical facility that has been identified by a competent authority as a provincial level before January 1, 2025.

Medical examination less than 351,000 VND enjoys 100% health insurance

According to Mr. Doan Quoc Dan, the revised Law on Health Insurance also stipulates that health insurance participants will be paid by the health insurance fund for medical examination and treatment costs, including remote medical examination and treatment, support for remote medical examination and treatment, family medical examination and treatment, medical examination and treatment at home, rehabilitation, periodic pregnancy examinations, and childbirth.

Be paid for the cost of patient transportation according to regulations and pay for the costs of using technical services, medicine, blood, blood products, medical gases, supplies, tools, instruments, and chemicals used within the scope of payment of the health insurance fund.

Mr. Dan also said that patients will be covered 100% of medical examination and treatment costs in cases where the cost for one medical examination and treatment is lower than the level prescribed by the Government. Currently, this benefit is equal to 15% of the basic salary, equivalent to 351,000 VND. In particular, from 2025, with 62 rare and serious diseases, patients will be able to go directly to specialized medical examination and treatment facilities for treatment without a referral form, and will still enjoy 100% health insurance.

The workshop at the Hanoi bridge point was attended by representatives of many ministries, branches and hospitals.

In addition, health insurance participants are covered 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 of medical examination and treatment according to regulations is 6 times greater than the reference level.

The representative of the Ministry of Health also said that to ensure the rights of patients, the amended Law on Health Insurance has added regulations that in cases where a patient is prescribed to use drugs, medical equipment or paraclinical services but the medical examination and treatment facility is not available, the medical facility is allowed to receive drugs and medical equipment transferred from another health insurance medical examination and treatment facility to treat the patient, and is allowed to transfer the patient or specimen to another facility that is qualified to perform paraclinical services.

Mr. Dan also added that for those who register for initial health insurance examination and treatment at specialized and basic medical examination and treatment facilities, if the medical examination and treatment is not at the place where they initially registered for health insurance examination and treatment due to a change in temporary residence or stay, they will be examined and treated at a basic medical examination and treatment facility suitable for the new temporary residence or stay and will be paid by the health insurance fund.

Source: https://cand.com.vn/y-te/nhieu-chinh-sach-co-loi-cho-nguoi-tham-gia-bhyt-tu-1-7-i763211/