Out-of-network medical examination and treatment will enjoy 100% health insurance for inpatient costs

This content is specifically regulated in Clause 15, Article 1 of the Law amending and supplementing a number of articles of the Law on Health Insurance.

Accordingly, in case a person with a health insurance card goes to a provincial hospital for medical examination and treatment that is not in the right line, the health insurance fund will pay 100% of the inpatient treatment costs from January 1, 2021 nationwide.

For example:Ms. Nguyen Thi C has a health insurance card and her initial medical examination and treatment registration place is at Nong Cong District General Hospital, Thanh Hoa Province. She will be paid 100% of her inpatient treatment costs by the health insurance fund if she receives medical examination and treatment at Dong Nai General Hospital, Dong Nai Province from January 1, 2021.

Currently, if a patient receives medical treatment at a provincial hospital, the health insurance fund will only pay 60% of the inpatient treatment costs.

This new policy somewhat reduces financial difficulties for patients with health insurance.

Conditions for health insurance

1. When going to see a doctor or get treatmentMust present valid Health Insurance Card and valid photo ID. For children under 6 years old, only present valid Health Insurance Card.

2. Emergency cases:Admitted to any medical examination and treatment facility and must present health insurance card along with valid identification before leaving the hospital. During the treatment process, if certain diseases are discovered and treated, treatment at the medical examination and treatment facility is considered to be in the right line.

3. In case of treatment transfer:Be referred to a specialized technical facility according to regulations in case the health insurance facility exceeds the treatment capacity or the technical services are not provided by the unit. The patient must present a valid health insurance card and a valid photo identification and a referral letter from the referring health care facility.
4. In case of payment of patient transportation costs:The subjects are "non-commissioned officers, people working in secretarial work...; People with revolutionary contributions; Relatives of people with revolutionary contributions (biological father, biological mother, children, people who raised martyrs); Children under 6 years old; People under monthly sponsorship;" will be paid by the Health Insurance Fund for two-way transportation costs in case of technical transfer.

5. In case of re-examination:According to treatment requirements: Health insurance participants must have a re-examination appointment from the medical facility. The re-examination appointment is only used for one medical examination and treatment.