Some notable new points in the Draft Law amending and supplementing a number of articles of the Law on Health Insurance are about to be submitted to the National Assembly for approval at the 8th Session.
In which cases can one enjoy health insurance regardless of "administrative boundaries"?
Some notable new points in the Draft Law amending and supplementing a number of articles of the Law on Health Insurance are about to be submitted to the National Assembly for approval at the 8th Session.
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| Many health insurance regulations will be more flexible. |
Health insurance participants can still be paid by the Health Insurance Fund when examining and treating at primary and basic medical examination and treatment facilities when changing their place of residence or temporary residence.
That is a notable new point in the Draft Law amending and supplementing a number of articles of the Law on Health Insurance (HI) which is about to be submitted to the National Assembly for approval at the 8th Session.
As reported by the Investment Electronic Newspaper - Baodautu.vn , the draft law stipulates that the level of health insurance benefits is designed on the basis of eliminating "administrative boundaries" in medical examination and treatment under the direction of the National Assembly Standing Committee, maintaining the level of health insurance benefits according to the provisions of current law and expanding to some cases, such as rare diseases, serious diseases... to go directly to specialized medical examination and treatment facilities.
This content was also stated by the Ministry of Health in the report dated November 14, 2024, expected to receive and explain the opinions of National Assembly deputies and the examination opinions of the National Assembly's Social Committee on the Draft Law amending and supplementing a number of articles of the Law on Health Insurance.
Accordingly, the Draft adds that the regular militia will enjoy the same level and scope of benefits as non-commissioned officers and soldiers on active duty according to the provisions of the Law on Militia and Self-Defense Forces.
Notably, the Draft stipulates that cases of medical examination and treatment are considered appropriate to the initial health insurance medical examination and treatment registration facility to facilitate people when changing their place of residence or temporary residence, regardless of administrative boundaries.
Article 26 of the draft stipulates that health insurance participants have the right to register for initial health insurance examination and treatment at primary and basic level medical examination and treatment facilities (basic medical examination and treatment facilities perform the tasks of general outpatient and inpatient examination and treatment; general practical training, and organize continuous medical knowledge updates for practitioners - PV).
Article 27 stipulates that the transfer of patients between medical examination and treatment facilities is carried out according to professional requirements and the response capacity of the medical examination and treatment facility.
Clause 3, Article 22 (health insurance benefits) stipulates that health insurance participants are paid by the health insurance fund according to the provisions of Clause 1 of this Article (scope of benefits and benefits - PV) when receiving medical examination and treatment not according to the provisions of Articles 26 and 27 of this Law in the following cases:
a) Medical examination and treatment at primary and basic medical examination and treatment facilities when changing residence or temporary residence.
b) Health insurance participants register for initial health insurance examination and treatment at specialized medical examination and treatment facilities when receiving health insurance examination and treatment at basic and initial medical examination and treatment facilities.
c) Health insurance participants register for initial health insurance examination and treatment at a basic level medical examination and treatment facility when receiving health insurance examination and treatment at a primary level medical examination and treatment facility".
The Ministry of Health also agreed to accept the revised content of the Social Committee and the opinions of some National Assembly deputies to revise the regulations on payment rates for cases where patients go to medical examination and treatment under health insurance at basic and specialized medical examination and treatment facilities that are classified as district and linear before January 1, 2025, and assign the Government to prescribe a specific roadmap for outpatient medical examination and treatment costs at a payment rate of 50% - 100%.
Specifically, Clause 4, Article 22 stipulates that health insurance participants who go to medical examination and treatment at a facility other than the one initially registered for health insurance examination and treatment, as stipulated in Clauses 3 and 5 of this Article, Clause 3, Article 28 of this Law (regulations on procedures for health insurance examination and treatment - PV) and regulations on transferring medical examination and treatment facilities are paid by the health insurance fund according to the benefit level stipulated in Clause 1 of this Article as follows:
a) 100% of the benefit level at basic or specialized medical examination and treatment facilities in cases of definitive diagnosis and treatment of certain rare diseases, serious diseases, diseases requiring surgery or using high technology according to regulations of the Minister of Health;
b) 100% of the benefit level 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 medical examination and treatment at specialized medical examination and treatment facilities;
c) 100% of the benefit level at the initial medical examination and treatment facility;
d) 100% of the benefit level for inpatient examination and treatment at basic medical examination and treatment facilities;
d) From 50% to 100% of the benefit level for outpatient medical examination and treatment at basic medical examination and treatment facilities according to the roadmap and regulations of the Government based on the results of technical expertise ranking;
e) 40% of the benefit level for inpatient examination and treatment at specialized medical examination and treatment facilities, except for the cases specified in Point e and Point g of this Clause;
g) 100% of the benefit level prescribed in Point d and dd, Clause 4, Article 22 of this Law in case of medical examination and treatment at a medical examination and treatment facility classified as specialized and before January 1, 2025, the competent authority has assigned the provincial and district levels.
Source: https://baodautu.vn/truong-hop-nao-co-the-duoc-huong-bao-hiem-y-te-khong-phan-biet-dia-gioi-hanh-chinh-d230245.html
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