(Dan Tri) - When the revised Law on Health Insurance takes effect, the conditions for receiving 100% of medical examination and treatment costs for people participating in health insurance for 5 consecutive years will also be adjusted.
The biggest benefit for people who have participated in health insurance for 5 consecutive years is that they can have 100% of their medical examination and treatment costs paid (Illustration: Minh Nhat).
Before 1/7/2025
In 2025, health insurance regulations will be applied in two different phases.
The period before July 1, 2025 will apply according to the current Law on Health Insurance, namely the Social Insurance Law 2008, amended in 2014 and supplemented by a number of other laws (referred to as the Law on Health Insurance 2014).
According to the current Law on Health Insurance, except for some special groups that are entitled to health insurance benefits covering 95-100% of medical examination and treatment costs, the majority of health insurance participants are only covered by health insurance for 80% of medical examination and treatment costs.
However, people who participate in health insurance continuously for 5 years will enjoy greater benefits such as having health insurance pay 100% of medical examination and treatment costs (with conditions attached).
Specifically, according to Article 22 of the current Law on Health Insurance, which stipulates the level of health insurance benefits and is guided in detail in Article 14 of Decree No. 146/2018/ND-CP, health insurance participants will be paid 100% of medical examination and treatment costs when the patient has participated in health insurance for 5 consecutive years or more and has the amount of co-payment for medical examination and treatment costs in the year greater than 6 months of basic salary, except in cases of self-examination and treatment not in the right line.
Thus, to have 100% of medical examination and treatment costs covered by the health insurance fund, health insurance participants must meet 3 conditions.
Firstly, the person must have participated in health insurance for at least 5 consecutive years (from the time the person participates in health insurance to the time of medical examination and treatment).
Second, go to the right medical facility for treatment.
Third, the amount of co-payment for medical examination and treatment costs in the year is greater than 6 months of basic salary (calculated from the time of participating in health insurance for 5 consecutive years).
That is, during the year, if the amount of medical examination and treatment that the patient co-pays is greater than 6 months of basic salary, the portion exceeding 6 months of basic salary will be paid by the health insurance fund.
From January 1, 2025 to before July 1, 2025, the basic salary is 2.34 million VND, 6 months basic salary is 14.04 million VND.
Thus, from the time the co-payment amount for medical examination and treatment costs of a health insurance participant for 5 consecutive years is greater than 14.04 million VND and the patient goes to the right medical facility for examination and treatment, the health insurance fund will pay 100% of the medical examination and treatment costs.
From 1/7/2025 onwards
On November 27, at the 8th session, the 15th National Assembly passed Law No. 51/2024/QH15 amending and supplementing a number of articles of the Law on Health Insurance (referred to as the 2024 Law on Health Insurance). This Law will take effect from July 1, 2025.
Thus, from July 1, 2025, the regulation on enjoying 100% of medical examination and treatment costs for people participating in health insurance for 5 consecutive years will change according to the 2024 Health Insurance Law.
Specifically, the 2024 Law on Health Insurance has made some adjustments to Article 22 regulating the level of health insurance benefits for health insurance participants.
At Point d, Clause 1, Article 22, the Law on Health Insurance 2024 stipulates that health insurance participants will enjoy 100% of medical examination and treatment costs when the patient has participated in health insurance for 5 consecutive years or more and has the amount of co-payment for medical examination and treatment costs in the year of correct medical examination and treatment is 6 times greater than the reference level.
Thus, to have the Health Insurance Fund cover 100% of medical examination and treatment costs from July 1, 2025 onwards, health insurance participants must meet 3 conditions.
Firstly, the person must have participated in health insurance for at least 5 consecutive years (from the time the person participates in health insurance to the time of medical examination and treatment).
Second, go to the right medical facility for treatment.
Third, the amount of co-payment for medical examination and treatment costs in the year is 6 times greater than the reference level. This is an important milestone to calculate the time when health insurance participants are entitled to health insurance benefits covering 100% of medical examination and treatment costs.
Clause 9, Article 2 of the 2024 Law on Health Insurance stipulates: "The reference level is the amount decided by the Government to calculate the contribution and benefit levels of a number of cases participating in health insurance prescribed in this Law".
Thus, when the Government decides on the reference level, the Ministry of Health will base on the reference level to provide guidance on calculating the amount of co-payment for medical examination and treatment costs as a milestone for calculating the time when health insurance participants are entitled to health insurance benefits to pay 100% of medical examination and treatment costs.
Source: https://dantri.com.vn/an-sinh/thay-doi-dieu-kien-huong-100-chi-phi-kham-chua-benh-trong-nam-2025-20241216123721040.htm
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