6 new policies on health insurance take effect from July 1

One is: Changing the concept of households participating in health insurance

On November 13, 2020, the National Assembly passed the Law on Residence 2020, effective from July 1, 2021. This Law amends and supplements the contents of a number of 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: Households participating in health insurance are those who are registered for permanent residence or temporarily registered at a legal residence according to the provisions of the law on residence.

Meanwhile, the current Law on Health Insurance stipulates: Households participating in health insurance include all people whose names are listed in the Household Registration Book or Temporary Residence Book.

Consulting people to participate in social insurance and health insurance at the collection agency in Le Loi ward (Vinh city). Photo: Duc Anh

Thus, according to the new regulations, people eligible to participate in family health insurance must be those who: Have the same permanent residence registration or temporary residence registration at a legal residence, instead of having the same household registration book or temporary residence book as before.

The reason for the above adjustment is that the 2020 Law on Residence stipulates that from January 1, 2023, the Household Registration Book and Temporary Residence Book will be officially abolished, replaced by management on the National Population Database. At the same time, from July 1, 2021, the residence registration agency will not issue new or reissue Household Registration Books and Temporary Residence Books, but will adjust and update citizens' information on the Residence Database.

Second: Add subjects that are eligible to purchase health insurance cards from the State budget.

This content is mentioned in Decree No. 20/2021/ND-CP dated March 15, 2021 of the Government on regulations on 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, Decree No. 20 has added the following subjects: "People belonging to near-poor households who are not married; have a husband or wife but have died or are missing according to the provisions of law and are raising children under 16 years old or are raising children from 16 to 22 years old and that child is studying culture, vocational training, professional secondary school, college, university with a first degree (this child is receiving social security benefits)" are entitled to purchase health insurance cards from the State budget.

According to previous regulations, this group of subjects was only supported by the State budget to buyhealth insurance cardminimum 70%.

Third: Changes in the list of meritorious people and relatives entitled to health insurance policy

From July 1, 2021, Ordinance on preferential treatment for people with revolutionary contributions No. 02/2020/UBTVQH14 officially takes effect.

According to the new Ordinance, "The wife or husband of a martyr who marries another person and raises the martyr's children to adulthood or takes care of the martyr's biological father or mother while they are still alive or because of revolutionary activities, does not have the conditions to take care of the martyr's biological father or mother while they are still alive" will have the State budget buy health insurance cards. Previously, there was no such provision.

Four: Payment of health insurance examination and treatment costs according to the quota

Capitation payment is a payment method between the Social Insurance agency and the Health Insurance medical examination and treatment facility at a predetermined fee according to the scope of service for a card registered at the medical service provider within a certain period of time.

New health insurance card front. Photo: PV

The back of the new health insurance card. Photo: 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 cap. The Circular takes effect from July 1, 2021.

Accordingly, the Circular defines: The capitation fund is a predetermined amount of money, assigned to health insurance medical facilities to provide outpatient medical care for patients with health insurance cards within the capitation range, within a certain period of time.

At medical facilities from the district level down, the payment method will be applied according to the rate for all outpatient medical examination and treatment costs within the scope of benefits of health insurance participants. At medical facilities at the provincial and central levels, the method will be applied at facilities that have signed initial health insurance medical examination and treatment contracts and the payment method will only be applied according to the rate for the outpatient medical examination and treatment costs of the initial health insurance registrant arising at that initial medical examination and treatment facility...

Five: Publicly disclose the price of health insurance services for patients and their legal representatives.

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

Nghe An Social Insurance officers advise people to participate in social insurance and health insurance. Photo: Duc Anh

In which, it is stipulated that medical examination and treatment facilities must promptly and publicly inform patients and their legal representatives about the prices of medical examination and treatment services, including: Prices of medical examination and treatment services for patients with health insurance cards, prices of medical examination and treatment services not requested by patients without health insurance cards; prices of medical examination and treatment services requested by patients; prices of other types of services at the unit.

In addition, it is stipulated that medical facilities must publicize the exemption and reduction policies for medical examination and treatment services and implement the health insurance policy, and pay the prices and costs of health insurance medical examination and treatment according to the provisions of law.

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

This is the content of the Law on Amendments and Supplements to a number of articles of the Law on Prevention and Control of Human Immunodeficiency Virus (HIV/AIDS), effective from July 1, 2021.

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

The Health Insurance Fund pays to people with health insurance cards according to the benefits prescribed by the law on health insurance.

The State budget covers the above-mentioned unpaid health insurance fund costs and pays for people without health insurance cards according to the health insurance service prices.