If you participate in health insurance for 5 consecutive years, you can go to the hospital without paying?

Illustration: Internet

According to the amended Law on Health Insurance from January 1, 2015, those who have a health insurance card and have participated in health insurance for 5 consecutive years from the date of participation and have the amount of co-payment for medical examination and treatment costs in the right line in the year exceeding 6 months of basic salary need to contact the card issuer to be issued a "Certificate of exemption from co-payment in the year" and enjoy 100% of health insurance medical examination and treatment costs for the next medical examinations and treatments.

Explaining this issue further, a leader of the Social Insurance agency said that this "5 consecutive years" regulation is calculated from January 1, 2015 when the amended and supplemented Law on Health Insurance comes into effect.

Thus, from January 1, 2015, continuous health insurance participation without interruption for more than 3 months is called "continuous time", and there is absolutely no distinction between business purchase or voluntary purchase at the household level.

To enjoy this “5 consecutive years” benefit will depend on two factors:

- One, 5 consecutive years.

- Second, after participating for 5 consecutive years and within a fiscal year (from January 1 to December 31), if the health insurance participant goes for medical examination and treatment, the co-payment cost for one or more treatment sessions must be spent (20%) exceeding 6 months of basic salary (1,210,000 x 6 months = 7,260,000 VND), for subsequent examinations, the health insurance participant does not have to pay and will be paid 100% by the health insurance fund. And in the following fiscal year, the calculation will continue like that.

To understand what a “Certificate of Non-Copayment in the Year” is, it is important to understand the principle of “copayment”. Medical examination and treatment costs are paid according to the principle of copayment, meaning that social insurance will pay a portion and the person receiving the examination and treatment will also have to pay a portion.

Once a Certificate of Non-Co-Payment has been issued in a year, the co-payment principle will no longer apply in that year, meaning that the person seeking medical treatment will not need to continue to pay for medical examination and treatment costs with social insurance until the end of the calendar year.

To be granted a Certificate of non-co-payment in the year, the person receiving medical examination and treatment must satisfy the condition of having 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 right line in the year greater than 6 months of basic salary (the basic salary applied from May 1, 2016 is 1,210,000 VND/month).

In short, the phrase “5 consecutive years” comes into play when you have a high-tech medical condition, for example, the cost of a surgery can exceed 7,260,000 VND. For subsequent medical examinations and treatments in the year, the health insurance will cover the entire cost.

All people participating in health insurance who meet the above conditions should immediately go to the social insurance agency to apply for a Certificate of non-co-payment within the year to enjoy the benefit of 100% exemption of medical examination and treatment costs at the right place. The application documents include:

- Original invoices.

- Receipt of co-payment for medical examination and treatment costs under health insurance from the beginning of the year.

- Valid health insurance card.