In which cases are health insurance medical examination and treatment costs directly paid?

Question:

I would like to ask in which cases are medical examination and treatment costs directly paid by health insurance? What are the documents and procedures for payment, and where to submit them? – Nguyen Ngan Hoa (Ung Hoa, Hanoi).

Hanoi Social Insurance replied:

Pursuant to Article 31 of the Consolidated Law on Health Insurance and Articles 28, 29, 30 of Decree 146/2018/ND-CP, cases eligible for direct payment include: cases of medical examination and treatment at medical examination and treatment facilities that do not sign a health insurance medical examination and treatment contract; cases of medical examination and treatment that do not comply with the provisions of Article 28 of the Law on Health Insurance (medical examination and treatment without presenting a health insurance card and/or related documents such as citizen identification card, referral form, re-examination appointment form).

In what cases are medical examination and treatment costs directly paid by health insurance?

Regarding the documents required for payment, pursuant to Article 28, Decree 146/2018/ND-CP, the documents are photocopies (with originals for comparison) including: health insurance card, identity card as prescribed in Clause 1, Article 15 of this Decree; hospital discharge papers, medical examination form or medical examination book of the medical examination and treatment for which payment is requested. In addition, invoices and related documents are required.

Payment request documents are submitted to the district-level social insurance agency where you reside (pursuant to Article 29, Decree 146/2018/ND-CP).

Source: https://kinhtedothi.vn/truong-hop-nao-duoc-thanh-toan-truc-tiep-chi-phi-kham-chua-benh-bhyt.html