Regulations beneficial for health insurance patients from December 1, 2018

From December 1, 2018, when Decree 146/2018 takes effect, health insurance patients will have many new benefits.

*According to Decree 146, patients with health insurance cards who are being treated as inpatients and whose cards have expired will be paid for medical examination and treatment costs for no more than 15 days from the date the card expires.

Illustration: Internet

*Health insurance patients who do not follow proper procedures for medical examination and treatment or who do not have a health insurance contract with a facility that does not have a health insurance contract will still receive direct payment from the social insurance agency with the following benefits: At district-level medical examination and treatment facilities and equivalents, the payment is no more than 0.15 times the basic salary for outpatient treatment; inpatient treatment is no more than 0.5 times. For provincial-level medical examination and treatment facilities and equivalents, the payment is no more than one time the basic salary for inpatient treatment; at central-level medical examination and treatment facilities, the payment is no more than 2.5 times the basic salary for inpatient treatment.

*In case a health insurance patient goes to the wrong medical facility and is then transferred to another medical facility by the receiving facility, the health insurance fund will pay as if the patient was sent to the wrong medical facility; except in cases of emergency or the patient's condition exceeds the facility's professional capacity.

*In case the medical examination and treatment facility cannot perform paraclinical tests, diagnostic imaging, functional testing and must transfer the patient or specimen to another health examination and treatment facility covered by health insurance or a facility approved by a competent authority as qualified to perform such services, the health insurance fund will still pay for the cost of performing the service within the scope of benefits.

*According to the old regulations, all family members had to participate in health insurance at the same time to be able to buy this insurance package. Decree 146 does not stipulate that all members must participate in health insurance at the same time, but only stipulates that family members participating in health insurance in the same fiscal year will have their contributions reduced from the second member onwards.

*According to Decree 146, people aged 80 and over who are receiving monthly pension benefits have their health insurance paid for by the state budget and are entitled to 100% of medical examination and treatment costs within the scope of benefits (previously they were only entitled to 80%).

*The Decree also adds a number of subjects participating in health insurance such as: frontline workers, youth volunteers, people's artisans, excellent artisans, relatives of national defense workers and civil servants, relatives of police workers and civil servants, dignitaries, monks and nuns, and people living in social protection facilities.

*In addition, Decree 146 also mentions a number of cases that do not have to pay health insurance but are still entitled to health insurance benefits such as:

• Employees on sick leave for 14 days or more per month;

• Children who are 72 months old but born before September 30 of the year they turn 72 months old.

• Children 72 months old born after September 30 but on any day of the month will have their card issued until the end of the month of birth.

• People with health insurance cards who are receiving inpatient treatment but whose health insurance cards have expired will be paid for medical examination and treatment costs within the scope of benefits and benefit levels until they are discharged from the hospital, but no more than 15 days from the date the card expires.