Cases of medical examination and treatment outside the health insurance coverage area are entitled to 100% of the cost.
In some cases, health insurance participants who go to a medical facility other than the one initially registered for will still be paid 100% of the cost as if they were at the correct facility.
I registered for initial health insurance examination and treatment at the commune health station. If I want to go to the district or provincial hospital but cannot get a referral letter, will I be covered by health insurance and at what level? (Le Nam, Phu Cu district, Hung Yen).
Mr. Nguyen Tri Dung, Deputy Director of Health Insurance Department, Ministry of Health, replied:
According to the provisions of Clause 3,4, Article 22 of the Law on Health Insurance, if you register for initial medical examination and treatment at a commune-level health station, you have the right to receive medical examination and treatment at commune-level health stations, polyclinics or district-level hospitals in the same province or district-level hospitals nationwide. You will still enjoy health insurance benefits as if you received medical examination and treatment at the initial registration place stated on your card.
In addition, from 2021, when going to provincial hospitals for medical examination and treatment, the health insurance fund will cover the costs.inpatient treatmentaccording to the level of benefits as going to the right medical facility for examination and treatment.
This means that the health insurance fund will pay 100% of the treatment costs (inpatient and outpatient) for people with health insurance cards (according to the scope of benefits) who go to district-level hospitals nationwide for examination and treatment.
The Health Insurance Fund pays 100% of inpatient treatment costs within the scope of benefits (does not pay 100% of outpatient costs) for people with a Health Insurance card.self-treatmentoff-line at medical facilitiesprovincial linenationwide
In case of ethnic minorities or people from poor households living in areas with difficult or especially difficult economic and social conditions; living in island communes or island districts, whenself-examination and treatment at central hospitalThe health insurance fund will pay for inpatient treatment costs at the same level as going to the right hospital.
8 cases of health insurance examination and treatment are considered to be in line
According to the regulations of the Ministry of Health in Circular 30/2020, 8 cases of medical examination and treatment under the correct health insurance scheme will be paid 100% of the medical examination and treatment costs according to the scope of benefits of the health insurance card, including:
- Go to the correct initial medical examination and treatment facility listed on the health insurance card.
- Health insurance card registered for initial medical examination and treatment at commune-level medical examination and treatment facilities, or polyclinics, or district-level hospitals to go to other commune-level medical stations, polyclinics, or district-level hospitals in the same province.
In case children do not have health insurance cards because they have not completed birth registration procedures, they can use their birth certificates to go to the doctor for examination and treatment.
- Health insurance participants in emergency situations can receive emergency treatment at any medical facility nationwide.
- Be transferred to health insurance treatment according to regulations, including:
+ Be transferred according to regulations in Article 10 and Article 11 of Circular 40/2015 of the Ministry of Health
+ Transferred according to regulations in Clause 3, Article 14 of Decree 146/2018 of the Government
+ Transferred according to regulations in Clause 2, Article 6, Circular 04/2016 of the Ministry of Health
- Have documents proving that you are staying in another locality during the time of business trip, mobile work, concentrated study in training forms, training programs, temporary residence and initial medical examination and treatment at a medical examination and treatment facility at the same level or equivalent to the initial registration facility recorded on the health insurance card.
- People with a re-examination appointment in case of referral.
- People who donate their organs must seek treatment immediately after donating their organs.
- Newborns must be treated immediately after birth.
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