Things you need to know about health insurance payments.

According to Dr. Le Van Kham, Deputy Director of the Health Insurance Department (Ministry of Health), regulations on health insurance payments exist, but in reality, many patients are unaware of them or do not fully understand them, leading to questions when health insurance payments are processed.

Therefore, the Ministry of Health recently organized training to promote communication activities about health insurance at medical examination and treatment facilities. Doctors, hospital staff, and health insurance inspectors will act as communicators, helping patients better understand the procedures and benefits of health insurance.

According to Mr. Kham, the following information related to health insurance will be actively disseminated to help patients better understand their rights when seeking medical treatment: procedures and processes for medical examination and treatment; what medical services are included; what benefits are covered by health insurance, and which services, medications, and tests are not covered by health insurance and must be paid for by the patient; and how much they have to pay…

Below is a detailed guide on medical examinations covered by health insurance:

When going for a medical check-up

Patients must present a valid health insurance card and a valid photo ID. For children under 6 years old, only a valid health insurance card is required.

Emergency cases: Patients can be admitted to any medical facility and must present their health insurance card along with a valid photo ID before discharge.

Patients are referred to a higher-level medical facility for specialized treatment as per regulations when the health insurance-covered medical facility exceeds its treatment capacity or does not provide the necessary technical services. In such cases, the patient must have valid health insurance, a valid photo ID, and a referral letter from the referring medical facility.

For follow-up examinations as required by treatment: the health insurance participant must have a follow-up appointment slip from the medical facility.

How is it covered by health insurance?

When medical examinations and treatments are conducted according to regulations, patients using regular medical services will be entitled to 100% reimbursement of medical expenses for the following groups: officers and non-commissioned officers; people with meritorious service to the revolution; children under 6 years old; and medical expenses for cases where the cost of a single medical examination or treatment is less than 15% of the basic salary (general minimum wage) and medical treatment is provided at the commune level.

Health insurance covers 95% of medical examination and treatment costs for the following groups: those receiving monthly pensions or disability benefits; those receiving monthly social welfare benefits; those from poor households; and ethnic minorities living in economically disadvantaged or extremely disadvantaged areas. The coverage is 80% for other groups.

When using high-tech medical services, 100% of the costs are covered for: Children under 6 years old; Revolutionary activists before 1945; Heroic Vietnamese Mothers; War invalids, those receiving benefits similar to war invalids, war invalids of type B, and sick soldiers when treating recurring wounds or injuries.

100% of the cost is covered for: Professional officers and non-commissioned officers, and technical officers and non-commissioned officers currently serving in the People's Public Security Force, but not exceeding 40 times the basic salary (general minimum wage) for each use of technical services. The remaining portion is paid by the agency or unit managing the individual.

Health insurance covers 100% of the costs for: People with meritorious service to the revolution, but not exceeding 40 times the basic salary (general minimum wage) for each use of technical services.

The reimbursement rates decrease to 95%, 80%, 70%, 50%, and 30% for specific groups, depending on the hospital's category.

Dr. Kham also noted that those participating in voluntary health insurance who are entitled to high-tech, high-cost services must ensure that their health insurance card is valid for 180 days from the date of payment.

Specifically for cancer patients, the 50% reimbursement of costs according to the benefit level applies to those who have continuously participated in health insurance for 36 months or more.

Individuals injured in traffic accidents are entitled to health insurance benefits if they did not violate traffic laws. This excludes cases of traffic accidents that fall within the scope of payment under the law on occupational accidents.

According to dantri.com.vn