How is cancer covered by health insurance?
Cancer patients in Vietnam are getting younger. Many people with health insurance are unaware of the coverage levels if they are unfortunately diagnosed with the disease.
My sister was diagnosed with colorectal cancer earlier this year and is receiving treatment at the provincial hospital. She has been paying social insurance continuously for 20 years. Therefore, will her medical expenses and treatment be covered by health insurance? If she goes to a central-level hospital for examination and treatment on her own, how will her expenses be reimbursed? (Quynh Huong, Phu Tho).
According to information from the Vietnam Social Security:
If enrolled in health insurance, all patients (including cancer patients) will have their medical examinations and treatments covered by the Health Insurance Fund according to the scope and benefit levels specified in Clause 15, Article 1 of the amended and supplemented Health Insurance Law of 2014.
If you go for a medical examination at the designated facility as prescribed.Cancer patients who present complete medical examination and treatment documents under health insurance will have 80-100% of their costs covered by the Health Insurance Fund, depending on their health insurance coverage status.
Specifically, for patients with a health insurance coverage level of 95% or 80%, the Health Insurance Fund will cover 100% of their costs (within the coverage limits) if they simultaneously meet all three of the following conditions:
- Must have participated in health insurance continuously for 5 years or more.
- Having a higher co-payment amount when receiving medical examination and treatment under health insurance at designated facilities during the year.6 times the base salary(The current base salary is 1,490,000 VND, 6 times the base salary is equivalent to 8,940,000 VND, increasing to 10,800,000 VND from July 1st).
- Seek medical treatment at the designated healthcare facility.
When the above conditions are met, cancer patients will not have to pay the co-payment portion (5% or 20%) of their health insurance medical examination and treatment costs for that year at the medical facility. The medical facility will be responsible for providing a receipt for the co-payment amount equivalent to 6 months of the basic salary, so that the patient has a basis to request reimbursement from the social insurance agency.Certificate of exemption from co-payment of health insurance costs for medical examination and treatment.during that year.
Currently, medical services used in the diagnosis and treatment of colorectal cancer, as well as many other cancers (tests, imaging, surgery, procedures, medications, chemotherapy) are all covered by health insurance.
Since your sister has been covered by health insurance for 20 years, if she has to pay more than 6 months' basic salary as co-payments, when she receives medical examination and treatment under health insurance as prescribed, she will be entitled to additional benefits, including exemption from co-payments for medical expenses covered by the Health Insurance Fund.
Cases of self-diagnosis and treatment for cancer that are not within the designated network.If a patient is referred to a higher-level hospital, they will only be reimbursed for the cost of treatment at a central-level hospital.40% of inpatient treatment costsWithin the scope of benefits and coverage levels specified on the health insurance card, outpatient medical examinations and treatments are not covered. For health insurance participants with an 80% coverage level, the health insurance fund will reimburse 40% of 80% of the inpatient treatment costs (equivalent to 32% of the health insurance examination and treatment costs).
