In which cases is the cost of medical examination and treatment under Health Insurance increased from 80% to 100%?
From December 3, a series of new policies on Health Insurance stipulated in Decree 75 amending and supplementing a number of articles of Decree No. 146 of the Government, detailing and guiding measures to implement a number of articles of the Law on Health Insurance took effect.
The Government has issued Decree 75/2023/ND-CP amending and supplementing a number of articles of Decree No. 146/2018/ND-CP dated October 17, 2018 of the Government detailing and guiding measures to implement a number of articles of the Law on Health Insurance. This Decree has many new points in the direction of increasing benefits for health insurance participants, but also sets high requirements for relevant agencies, especially the Vietnam Social Insurance sector, in managing and effectively using the health insurance fund according to regulations.
More subjects are granted health insurance cardsfree of charge
Decree 75/2023/ND-CP has supplemented and adjusted regulations on a number of subjects in the group participating in Health Insurance paid by the state budget, including:
- New addition: 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 have had their information updated in the National Population Database and the Residence Database but are not subject to the provisions of Clauses 1, 2 and 3, Article 12, Law on Health Insurance.
Decree 146/2018/ND-CP stipulates that people are eligible for monthly social protection benefits according to the provisions of law on the elderly, people with disabilities, and social protection beneficiaries.
Decree 146/2018/ND-CP stipulates that people are poor households according to income criteria, people are multidimensionally poor households with a lack of health insurance as prescribed in Decision No. 59/2015/QD-TTg and other Decisions of competent authorities to amend, supplement or replace.
According to Vietnam Social Security, Decree No. 75's addition of ethnic minority groups living in communes that have just escaped from difficult and especially difficult areas in ethnic minority and mountainous areas in the 2021-2025 period according to the Prime Minister's decision to the group receiving state budget support for health insurance contributions is extremely important in creating favorable conditions for all people, especially disadvantaged groups, to have the opportunity to participate in and benefit from health insurance policies, thereby contributing to maintaining and developing health insurance coverage.
The regulation that the state budget continues to support for a period of time after escaping poverty so that people can accumulate and have enough economic conditions to participate in health insurance demonstrates the Government's policy of ensuring social security and sustainable poverty reduction.
Supplement and increase the level of health insurance benefits
Decree 75 also added and increased the level of health insurance benefits, including increasing the benefit level from 80% to 100% of medical examination and treatment costs for health insurance for a number of groups of people with revolutionary contributions.
People serving people with revolutionary contributions living at home have their benefits increased from 80% to 95% of the cost of medical examination and treatment under Health Insurance; Spouses of martyrs who remarry but are receiving monthly allowances according to the provisions of the Ordinance on preferential treatment for people with revolutionary contributions (code TG): have a benefit level of 95% of the cost of medical examination and treatment under Health Insurance.
Supplementing the benefit level for the group of ethnic minorities escaping poverty according to Decision 861/QD-TTg dated June 4, 2021 of the Prime Minister and a group of subjects according to the Ordinance on Preferential Treatment for People with Revolutionary Contributions.
Amending regulations on the level of support for health insurance contributions from the state budget
Decree 75/2023/ND-CP stipulates 100% support for health insurance premiums for people in near-poor households residing in poor districts according to the Prime Minister's decision and other documents of competent authorities.
Meanwhile, Decree 146/2018/ND-CP only stipulates 100% support for health insurance premiums for people in near-poor households living in poor districts according to Resolution No. 30a/2008/NQ-CP and districts applying mechanisms and policies according to Resolution No. 30a/2008/NQ-CP.
These are 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.
Regulations on medical examination and treatment procedures for health insurance
Decree 75 allows the presentation of citizen identification cards in place of health insurance cards with photos; other legal identity documents or documents that have been electronically identified at level 2 on VNeID when going for medical examination and treatment.
Regulations on the duration of the Re-examination Appointment: Decree 75 clearly states that in case the re-examination appointment time is overdue, within 10 days from the date of the re-examination appointment, the patient must contact the medical staff to register for a suitable appointment or come for a re-examination himself/herself./.
