How is cancer covered by health insurance?
Cancer patients in Vietnam are getting younger. Many people with health insurance do not know the payment level when they are unfortunately diagnosed with this disease.
My sister was diagnosed with colorectal cancer at the beginning of this year and is currently receiving treatment at the provincial hospital. She has been paying social insurance for 20 years. Will her medical insurance cover her medication and treatment? If she goes to the central hospital for examination and treatment, how will she be paid? (Quynh Huong, Phu Tho).
According to information from Vietnam Social Security:
If participating in health insurance, all patients (including cancer patients) when going for medical examination and treatment will be paid by the Health Insurance Fund according to the scope and level of benefits according to Clause 15, Article 1, Law on Health Insurance amended and supplemented 2014.
If you go to the right clinic according to regulationsCancer patients who present complete medical examination and treatment procedures under health insurance will have their costs paid by the Health Insurance Fund from 80 - 100% depending on the health insurance participant.
Particularly for patients with health insurance coverage of 95% or 80%, the Health Insurance Fund will pay 100% (within the coverage range) if they simultaneously meet the following 3 conditions:
- Participate in health insurance continuously for 5 years or more.
- The co-payment amount when going to the right health insurance clinic or treatment center in the year is larger6 times the base salary(The current basic salary is 1,490,000 VND, 6 times the salary equivalent to 8,940,000 VND, from July 1 it will increase to 10,800,000 VND).
- Go to the right hospital for treatment.
When meeting all the above conditions, cancer patients will not have to pay the co-payment portion (5% or 20%) of the cost of health insurance examination and treatment in that year at the medical examination and treatment facility. The medical examination and treatment facility will be responsible for providing receipts for the co-payment amount of 6 months of basic salary, so that the patient has a basis to request the social insurance agency to issueCertificate of exemption from co-payment of health insurance examination and treatment coststhat year.
Currently, medical services used in the diagnosis and treatment of rectal cancer as well as many other cancers (tests, diagnostic imaging, surgery, procedures, drugs, chemicals) are all covered by the health insurance fund.
Because your sister has participated in health insurance for 20 years, if she has to pay a co-payment amount greater than 6 months of basic salary, when going to see a doctor or get medical treatment under health insurance according to regulations, your sister will enjoy the additional benefit of not having to pay co-payment for medical examination and treatment costs within the scope of payment of the Health Insurance Fund.
In case of self-examination and treatment of cancer at the wrong place, when going to the Central level, the patient is only paid40% of inpatient treatment costsWithin the scope of benefits and benefit levels specified on the health insurance card, no payment is made for outpatient examination and treatment. In the case of health insurance participants with a benefit level of 80%, the health insurance fund will pay 40% of 80% of inpatient treatment costs (equal to 32% of health insurance examination and treatment costs).