Six new health insurance policies take effect from July 1st.

First: Change the concept of households participating in health insurance.

On November 13, 2020, the National Assembly passed the 2020 Law on Residence, which came into effect on July 1, 2021. This law amends and supplements the content of several other related laws, including the Law on Health Insurance. Specifically, Clause 2, Article 38 of the Law on Residence amends Clause 7, Article 2 of the Law on Health Insurance as follows: A household participating in health insurance consists of individuals who are jointly registered as permanent residents or temporary residents at the same legal dwelling in accordance with the law on residence.

Meanwhile, the current Health Insurance Law stipulates that a household participating in health insurance includes all individuals whose names are listed in the Household Registration Book or Temporary Residence Book.

Providing advice to residents on participating in social insurance and health insurance at the collection agency in Le Loi ward (Vinh City). Photo: Duc Anh.

Therefore, according to the new regulations, those eligible to participate in family health insurance must be people who: are registered as permanent residents or temporary residents at the same legal residence, instead of sharing the same household registration book or temporary residence book as before.

The above adjustments are due to the 2020 Residence Law, which stipulates that from January 1, 2023, household registration books and temporary residence books will be officially abolished, replaced by management on the National Population Database. At the same time, from July 1, 2021, residence registration agencies will no longer issue new or reissue household registration books or temporary residence books, but will instead adjust and update citizens' information on the residence database.

Secondly: To add more categories of people whose health insurance cards are purchased by the State budget.

This content is addressed in Government Decree No. 20/2021/ND-CP dated March 15, 2021, on regulations regarding social assistance policies for social protection beneficiaries.

Specifically, compared to the current regulations in Decree No. 136/2013/ND-CP dated October 21, 2013, Article 5 of Decree No. 20 has added the following category: “Individuals belonging to near-poor households who are unmarried; or who have a spouse but that spouse has died or is missing according to the law and are raising children under 16 years old or raising children aged 16 to 22 years old who are studying at a general education school, vocational school, professional secondary school, college, or university for their first degree (these children are receiving social welfare benefits)” are eligible for health insurance cards purchased by the State budget.

According to previous regulations, this group was only eligible for state budget support for purchasing.health insurance cardat least 70%.

Thirdly: Changes in the list of meritorious individuals and their relatives eligible for health insurance benefits.

From July 1, 2021, the Ordinance on Preferential Treatment for People Who Have Rendered Meritorious Services to the Revolution No. 02/2020/UBTVQH14 officially came into effect.

According to the new Ordinance, "The spouse of a fallen soldier who remarries and raises the fallen soldier's children until adulthood, or cares for the fallen soldier's parents while they are alive, or who, due to revolutionary activities, are unable to care for the fallen soldier's parents while they are alive," will have their health insurance cards purchased by the State budget. Previously, there was no such provision.

Fourthly: Payment of health insurance costs for examination and treatment based on fixed rates.

Fixed-rate payment is a method of payment between the Social Insurance agency and health insurance-covered medical facilities based on a predetermined fee according to the scope of services for each registered cardholder at the medical service provider over a specific period of time.

Front view of the new health insurance card. Photo by PV.

Back view of the new health insurance card. Photo by PV.

On April 29, 2021, the Ministry of Health issued Circular No. 04/2021/TT-BYT guiding the payment of health insurance medical examination and treatment costs according to the fixed rate. The Circular takes effect from July 1, 2021.

Accordingly, the Circular defines: The fixed-rate fund is a predetermined amount of money allocated to health insurance medical examination and treatment facilities to provide outpatient medical examination and treatment for patients with health insurance cards within the fixed-rate limit, for a specific period of time.

At healthcare facilities at the district level and below, a fixed-rate payment method will be applied to the entire outpatient medical examination and treatment cost within the scope of coverage for health insurance participants. At provincial and central-level healthcare facilities, this will be applied only to facilities that have signed initial health insurance contracts and will only apply to the portion of outpatient medical examination and treatment costs incurred at that initial healthcare facility for the registered patient...

Fifthly: Publicly disclose the service fees for medical examination and treatment covered by health insurance to patients and their legal representatives.

This is the content stated in Circular No. 05/2021/TT-BYT dated May 5, 2021, on regulations for implementing democracy in the operation of public medical examination and treatment facilities.

Social insurance officials in Nghe An province advise people on participating in social insurance and health insurance. Photo: Duc Anh.

This includes regulations requiring healthcare facilities to promptly and publicly inform patients and their legal representatives about the fees for healthcare services, including: fees for healthcare services for patients with health insurance cards; fees for non-requested healthcare services for patients without health insurance cards; fees for healthcare services requested by patients; and fees for other services at the facility.

In addition, the regulations stipulate that medical facilities must publicly disclose exemptions and reductions in the cost of medical examination and treatment services, and implement health insurance policies, paying for medical examination and treatment costs covered by health insurance in accordance with the law.

Sixth: Pregnant women who are tested for HIV are entitled to health insurance benefits.

This is the content of the Law amending and supplementing a number of articles of the Law on Prevention and Control of Infection with the Human Immunodeficiency Virus (HIV/AIDS), which came into effect on July 1, 2021.

According to this Law, pregnant women who undergo HIV testing as prescribed by a healthcare professional will have their testing costs covered by the Health Insurance Fund and the State budget as follows:

The health insurance fund pays for health insurance cardholders according to the benefit levels stipulated by health insurance law.

The State budget covers the portion of the costs not covered by the health insurance fund mentioned above and pays for those without health insurance cards according to the health insurance service price list.