Nghe An Provincial Social Insurance responds to voters' opinions regarding benefits when participating in Health Insurance

The provincial Social Insurance reports on the settlement of the voters' reflection content according to its authority, as follows:

Content:Voter Nguyen Thi Nguyet, residing in Block 7, Quynh Xuan Ward, Hoang Mai Town, requested the authorities to inform what benefits people who have participated in health insurance for 5 consecutive years will enjoy. For students from average households, when participating in health insurance, they still have to pay at the student rate, not at the average household rate; requested the Social Insurance agency to create conditions for students from average households to participate in health insurance at the average household rate. Currently, there is a policy of examining and treating diseases using citizen identification cards, but in reality, when people go to see a doctor or get treatment, the hospital requires a health insurance card. Requested to have an agreement between the hospital and the Social Insurance to make it convenient for people to examine and treat diseases.

Response content:

1. What benefits will people who participate in Health Insurance for 5 consecutive years enjoy?

According to the provisions of the Law amending and supplementing a number of articles of the LawHealth insuranceFrom January 1, 2015, people who have participated in Health Insurance for 5 consecutive years or more and have the amount of co-payment for medical examination and treatment costs in the year greater than 6 months of basic salary, except for cases of self-examination and treatment at the wrong medical facility, will enjoy 100% of the cost of medical examination and treatment under Health Insurance.

Therefore, not all cases that have participated in Health Insurance continuously for 5 years or more are entitled to 100% of the cost of medical examination and treatment under Health Insurance. To be covered 100% of the cost of medical examination and treatment under Health Insurance, the Health Insurance participant must meet the following 2 conditions: First: Having participated in Health Insurance for 5 consecutive years or more from the time the person participates in Health Insurance to the time of medical examination and treatment; Second: Having the amount of money to co-pay for medical examination and treatment costs in the year greater than 6 months of basic salary calculated from the time of participating in Health Insurance for 5 consecutive years, except in cases of self-examination and treatment outside the prescribed health facility.

The benefit of a health insurance participant for the next 5 consecutive years is that in case the patient has a cumulative co-payment amount in the fiscal year at different medical examination and treatment facilities or at the same medical examination and treatment facility greater than 6 months of basic salary, the patient brings the documents to the Social Insurance agency that issued the health insurance card to pay the co-payment amount greater than 6 months of basic salary and receive a confirmation of no co-payment in that year. (The medical examination and treatment facility is responsible for providing a receipt for the co-payment amount equal to 6 months of basic salary so that the patient has a basis to request the Social Insurance agency to confirm no co-payment in that year). In case the patient's co-payment exceeds 6 months of basic salary calculated from January 1, the Health Insurance Fund will pay 100% of the medical examination and treatment costs within the patient's benefits from the time the patient has participated for 5 consecutive years until December 31 of that year.

2. For students from average households, when participatingHealth insurancestill have to pay according to student rate, not average household rate; request Social Insurance agencycreate conditions for students from average households to participate in health insuranceby average household

In Clause 2, Article 13 of the Law on Health Insurance No. 25/2008/QH12, amended by Law No. 46/2014/QH13 amending and supplementing a number of articles of the Law on Health Insurance, it is stipulated: "In case a person simultaneously belongs to many different health insurance participants specified in Article 12 of this Law, he/she shall pay health insurance according to the first subject that the person is identified in the order of the subjects specified in Article 12 of this Law".

In Article 4 of Decree No. 146/2018/ND-CP dated October 17, 2018 of the Government detailing and guiding measures to implement a number of articles of the Law on Health Insurance, it stipulates that the Group supported by the state budget for the contribution level includes:

1. People belonging to near-poor households according to near-poor criteria as prescribed by the Government and the Prime Minister.

2. People belonging to multidimensionally poor households not falling under the cases specified in Point a, Clause 9, Article 3 of this Decree.

3. Students.

4. People in households engaged in agriculture, forestry, fishery and salt production with an average living standard according to regulations of the Government and the Prime Minister".

Thus, according to the above regulations, students are ranked before those in households engaged in agriculture, forestry, fishery, and salt production with an average standard of living. Therefore, if a participant in Health Insurance is a student studying at an educational institution in the national education system, except for those who have participated in Health Insurance according to the groups of subjects identified as ranked before students as prescribed in Article 12 of the Law on Health Insurance, it is mandatory to register for Health Insurance for students at school in accordance with the regulations.

3. Currently, there is a policy of health insurance examination and treatment using citizen identification cards, but in reality, when people go for medical examination and treatment, hospitals require a health insurance card. It is recommended that there be a consensus between hospitals and social insurance to make it convenient for people to go for medical examination and treatment.

Using a chip-embedded citizen identification card to replace the Health Insurance card when going to see a doctor or get medical treatment under Health Insurance is a big step forward in reforming administrative procedures. Instead of spending time on paperwork, people will have faster access to medical services, improving the quality of health insurance examination and treatment services.

Currently, in Nghe An province, 100% of health insurance examination and treatment facilities have deployed the use of chip-embedded citizen identification cards in health insurance examination and treatment. People only need to present their chip-embedded citizen identification cards to scan the code. (In 2023, health examination and treatment facilities in Nghe An province have conducted citizen identification lookups when people with health insurance cards go for medical examination and treatment, with the number of successful implementations being 1.8 million times).

The case where a health insurance medical examination and treatment facility requires people to provide their health insurance card when going for medical examination and treatment (when the person with a health insurance card has used a chip-embedded citizen identification card) is not in accordance with regulations. We hope that voters will specifically report which health insurance medical examination and treatment facility requires it when people have complied with regulations so that the Social Insurance agency can coordinate with the Department of Health to verify, clarify, and correct./.