More benefits for health insurance participants

The revised Law on Health Insurance, effective from July 1, expands the right to pay medical expenses for patients; many new forms of medical examination and treatment will be covered by the Health Insurance Fund.

The conference to deploy new regulations on health insurance and collect opinions on the draft decree detailing and guiding the implementation of a number of articles of the Law on Health Insurance was held by the Ministry of Health on March 27.

Medical examination and treatment regardless of geography

At the conference, Deputy Minister of Health Tran Van Thuan commented that the Law on Amending and Supplementing a Number of Articles of the Law on Health Insurance is an important milestone in administrative reform, creating convenience for people, reducing paperwork, promoting digital transformation and improving the effectiveness of implementing health insurance policies.

From July 1, health insurance participants will have more benefits. In particular, the provision of health insurance examination and treatment regardless of administrative geography at the provincial level will create conditions for patients to have their entire medical expenses covered by the health insurance fund in many situations. Patients will be paid 100% of the benefit when receiving medical examination and treatment at the initial level nationwide (the first registered medical examination and treatment facility), 100% of the benefit when receiving inpatient medical examination and treatment at the basic level, 100% of the benefit when receiving medical examination and treatment at any basic or specialized medical facility that was identified as a district level before January 1, 2025.

In particular, from January 2025, the Ministry of Health has stipulated that in 62 cases of rare diseases and serious diseases, patients can go directly to specialized medical facilities and enjoy 100% health insurance without having to request a referral. The Health Insurance Fund also pays 100% of the benefits for ethnic minorities and people from poor households living in difficult or extremely difficult areas, island communes, and island districts when receiving inpatient medical treatment at specialized facilities.

Affirming that patient rights continue to be expanded, Ms. Tran Thi Trang, Director of the Department of Health Insurance - Ministry of Health, said that the new points in the revised Law on Health Insurance will fundamentally resolve the urgent problems and difficulties after 15 years of implementing the Law on Health Insurance, ensuring social security, rights and interests of health insurance participants.

Previously, the Ministry of Health expanded the technical services covered by health insurance for patients. With the revised Law on Health Insurance, more forms of medical examination and treatment will be covered by health insurance: remote medical examination and treatment, remote medical examination and treatment support, family medicine medical examination and treatment, home medical examination and treatment, rehabilitation, periodic pregnancy check-ups, childbirth; payment of costs for patient transportation between medical facilities (previously transportation between lower and upper levels).

According to Ms. Tran Thi Trang, currently, patients are 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. This benefit is equal to 15% of the basic salary, equivalent to 351,000 VND/visit. In addition, patients who have participated in health insurance for 5 consecutive years or more and have the amount of co-payment for medical examination and treatment costs in the year greater than 6 months of the basic salary (except for cases of self-treatment at the wrong facility) will have 100% of the medical examination and treatment costs covered by health insurance. Health insurance participants who self-treat at a facility not registered for treatment at the original facility or not in accordance with regulations on patient transfer will be paid by the health insurance fund according to the percentage of the benefit level.

"The provision of health care services regardless of administrative boundaries by province is a mechanism to help health insurance participants access high-quality health services, creating favorable conditions for people when they encounter complex health problems that require specialized treatment. These regulations gradually contribute to reducing the rate of direct out-of-pocket expenditure of health insurance participants," Ms. Trang emphasized.

Health insurance participants will have more benefits when examining and treating diseases.

Proposal to increase health insurance support level for students

New in this draft, the Ministry of Health proposes to increase the level of health insurance support from the state budget to at least 50% instead of the current 30%, for high school students from grades 1 to 12.

Explaining the above proposal, Ms. Vu Nu Anh, Deputy Director of the Health Insurance Department - Ministry of Health, said that the department has received many opinions that the support level for students is lower than the deduction level when participating with households. Currently, the health insurance contribution level for students after receiving 30% support is 884,520 VND.

"The Ministry of Health proposes to increase the support level to at least 50% to ensure benefits. This support level applies to high school students from grades 1 to 12, while university students will still receive 30%. With this support level, the budget will spend an additional 3,700 billion VND" - Ms. Vu Nu Anh analyzed.

To increase the health insurance coverage rate, the Ministry of Health also proposed to support 50% of the health insurance premium for the following groups: village health workers; village midwives; part-time workers in villages and residential groups; people participating in security and order protection forces at the grassroots level; victims of bombs, mines and explosives after the war; people awarded the title of People's Artisan, Meritorious Artisan according to the provisions of the Law on Cultural Heritage...

Health Insurance Fund surplus of 40,000 billion VND

Mr. Duong Tuan Duc, Head of the Health Insurance Policy Implementation Department - Vietnam Social Insurance, said that by the end of 2024, the whole country had more than 95.5 million people participating in health insurance, reaching a health insurance coverage rate of 94.29%. Of these, 24% of participants had support from the state budget (including students); the largest number were households (28%). In 2024, the whole country had more than 183.7 million health insurance visits.

Over the years, the Health Insurance Fund has always balanced its revenue and expenditure. With 5% of revenue for the reserve fund, the Health Insurance Fund currently has a surplus of about 40,000 billion VND.

Source: https://nld.com.vn/them-quyen-loi-cho-nguoi-tham-gia-bhyt-196250327213919851.htm