Ensuring the rights of health insurance participants according to Decree No. 75/2023/ND-CP

To promptly implement Decree No. 75,Social insuranceVietnam requests the Social Insurance of provinces to: Issue and change health insurance cards according to the provisions of Decree No. 75, including converting the health insurance benefit level code according to the provisions of Clause 5, Article 1 of Decree No. 75 (people participating in the resistance war and defending the Fatherland; people serving people with revolutionary contributions living at home).

At the same time, supplement the subject code and health insurance benefit level code recorded on the Health Insurance card for new health insurance participants as prescribed in Decree No. 75 and Decree No. 131/2021/ND-CP.

Vietnam Social Security requires provincial Social Security to proactively coordinate with the subject management unit to review, make a list and issue health insurance cards to the subjects added in Decree No. 75 as follows: Wives or husbands of martyrs who marry other men or women who are receiving monthly allowances according to the provisions of Point a, Clause 10, Article 16 of the Ordinance on Preferential Treatment for People with Meritorious Services to the Revolution; people in safe zone communes and revolutionary safe zone areas during the resistance war against France and the US who are currently residing in safe zone communes during the resistance war against France and the US whose information has been updated in the National Population Database and the Residence Database; Ethnic minorities living in communes in regions II, III, and extremely disadvantaged villages in ethnic minority and mountainous areas in the period 2016-2020, but these communes are no longer on the list of communes in regions II, III, and extremely disadvantaged villages in ethnic minority and mountainous areas in the period 2021-2025 according to the Prime Minister's decision.

In case a health insurance participant belongs to many different subjects at the same time, the Social Insurance of the provinces will review and compare the data being managed with the cases named in the benefit level change file and the list of subjects to change the new card. If the old health insurance card issued to another subject has a lower benefit level than the new regulation, then the highest benefit level will be followed.

Regarding the procedures for medical examination and treatment under health insurance, it is implemented according to the amended and supplemented provisions in Clause 6, Article 1, Decree No. 75 as follows: When examining and treating, health insurance participants must present a health insurance card with a photo or citizen identification card; in case of presenting a health insurance card without a photo, they must present one of the following identification papers with a photo issued by a competent agency or organization or a certificate from the commune-level police, or other papers certified by the educational institution where the student is managed; other legal identity papers or level 2 electronically identified papers as prescribed in Decree No. 59/2022/ND-CP dated September 5, 2022 of the Government regulating electronic identification and authentication.

For cases where health insurance participants enter medical examination and treatment facilities for treatment before the effective date of this Decree but are discharged from the effective date of this Decree, the health insurance fund shall pay within the scope of benefits and benefit levels according to the provisions of the Law on Health Insurance, according to the provisions of Article 14, Decree No. 146/2018/ND-CP and the provisions of Clause 5, Article 1 of this Decree.

Decree No. 75 amending and supplementing a number of articles of Decree No. 146/2018/ND-CP detailing and guiding measures to implement a number of articles of the Law on Health Insurance, effective from December 3, 2023, has created favorable conditions for medical examination and treatment under health insurance, ensuring the rights of health insurance participants. With many important new points such as: adding a number of groups of subjects supported by the state budget to pay health insurance, increasing the level of health insurance benefits for a number of groups of subjects; strengthening the role and responsibility of ministries, branches, medical examination and treatment facilities in managing and effectively using the Health Insurance Fund./.