From January 1, 2025, health insurance participants can be paid for the cost of purchasing medicine and medical equipment outside.

The Ministry of Health has just issued Circular No. 22/2024/TT-BYT regulating the direct payment of medicine and medical equipment costs for people with health insurance cards who go for medical examination and treatment. This Circular stipulates that people participating in health insurance who go for medical examination and treatment can have their medicine and medical equipment costs directly paid for within the scope of benefits from the health insurance fund.

From January 1, 2025, health insurance participants can be paid for the cost of purchasing medicine and medical equipment from outside.

Specifically, cases of drugs and medical equipment that are paid for include: drugs on the list of health insurance drugs (issued with Circular No. 26/2019/TT-BYT dated August 30, 2019 of the Ministry of Health). Medical equipment of type C or D, except for in vitro diagnostic medical equipment, personal medical equipment, medical equipment on the list of medical equipment issued by the Minister of Health are bought and sold like ordinary goods.

Patients are paid if at the time of prescribing drugs or ordering the use of medical equipment, the following conditions are met: first, there are no drugs or medical equipment because the contractor is being selected according to the approved contractor selection plan and at that medical examination and treatment facility there are no commercial drugs containing the active ingredient that the patient is prescribed or the same active ingredient but with different concentrations or content or dosage form or route of administration and cannot be replaced for prescribing to the patient, there is no medical equipment that the patient is prescribed to use and there is no medical equipment to replace it.

Second, the patient shall not be transferred to another medical examination and treatment facility in one of the following cases: The patient's health condition or illness is determined to be unsuitable for transfer; the medical examination and treatment facility where the patient is being examined and treated is under medical isolation according to regulations of the law on prevention and control of infectious diseases; the medical examination and treatment facility where the patient is being examined and treated is a specialized medical examination and treatment facility.

Third, it is impossible to transfer drugs and medical equipment between medical examination and treatment facilities according to the provisions of law.

Fourth, the prescribed and indicated drugs and medical equipment must be consistent with the scope of expertise of the medical examination and treatment facility and the medical examination and treatment costs have been paid for by health insurance at one of the medical examination and treatment facilities nationwide.

Fifth, prescribed and indicated drugs and medical equipment must be within the scope of benefits of health insurance participants.

Payment level for drugs: The basis for calculating the payment level is the quantity and unit price stated on the invoice purchased by the patient at the business establishment. In case the drug has regulations on payment rates and conditions, the payment rates and conditions shall be implemented.

For medical equipment (including reusable medical equipment): The basis for calculating the payment level is the quantity and unit price stated on the invoice purchased by the patient at the medical equipment trading facility. In case the medical equipment has a payment level regulation, it must not exceed the payment level prescribed for that medical equipment.

Documents for direct payment request include: Health insurance card, identity card, hospital discharge papers, medical examination form or medical examination book (submit a photocopy with the original for comparison) and invoices and documents related to the purchase of medicine and medical equipment.

The patient or the patient's relative or legal representative as prescribed by law directly submits the application to the district-level social insurance agency where they reside. The social insurance agency will receive the application and issue a receipt (if the application is incomplete, the patient will be instructed to supplement it).

Within 40 days from the date of receipt of the complete payment request, the health insurance assessment must be completed and the medical examination and treatment costs paid to the patient or the patient's relatives or legal representative must be paid. In case of non-payment, a written response must be given stating the reason.

Source: https://thoidai.com.vn/tu-112025-nguoi-tham-gia-bao-hiem-y-te-co-the-duoc-thanh-toan-chi-phi-mua-thuoc-thiet-bi-y-te-ben-ngoai-206898.html