Regulations beneficial to patients with health insurance from December 1, 2018.

Since December 1st, 2018, when Decree 146/2018 came into effect, patients covered by health insurance will have many new benefits.

*According to Decree 146, patients with health insurance cards who are receiving inpatient treatment and whose cards have expired are entitled to reimbursement for medical examination and treatment costs for a maximum of 15 days from the date the card expires.

Illustration photo: Internet

*Patients covered by health insurance who receive medical treatment without following proper procedures or at facilities not contracted with the health insurance agency will still be reimbursed directly by the social insurance agency at the following rates: At district-level and equivalent medical facilities, the reimbursement rate is no more than 0.15 times the basic salary for outpatient treatment; and no more than 0.5 times for inpatient treatment. At provincial-level and equivalent facilities, the reimbursement rate is no more than one time the basic salary for inpatient treatment; and at central-level facilities, no more than 2.5 times the basic salary for inpatient treatment.

*Patients covered by health insurance who seek treatment outside their designated network and are subsequently referred to another healthcare facility will have their treatment costs reimbursed by the health insurance fund as if it were an out-of-network case; except in cases of emergency or when the patient's condition exceeds the facility's professional capabilities.

*In cases where a healthcare facility is unable to perform paraclinical tests, diagnostic imaging, or functional examinations and must transfer the patient or specimen to another healthcare facility covered by health insurance or a facility approved by the competent authority as qualified to perform those services, the health insurance fund will still reimburse the cost of the services within the scope of coverage.

*According to the old regulations, all family members had to participate in health insurance at the same time to be eligible for this insurance package. Decree 146 does not require all members to participate in health insurance simultaneously, but only stipulates that family members participating in health insurance in the same fiscal year are eligible for a reduced contribution rate from the second member onwards.

*According to Decree 146, people aged 80 and above who are receiving monthly survivor's benefits have their health insurance premiums paid by the state budget and are entitled to 100% coverage of medical examination and treatment costs within their benefit entitlement (previously only 80%).

*The Decree also adds several groups to the list of those eligible for health insurance, such as: civilian workers on the front lines, volunteer youth, people's artisans, distinguished artisans, relatives of defense workers and civil servants, relatives of police workers and civil servants, religious dignitaries, monks and nuns, and people living in social welfare institutions.

*In addition, Decree 146 also mentions some cases where individuals are not required to pay health insurance contributions but are still entitled to health insurance benefits, such as:

• Employees who are on sick leave for 14 days or more in a month;

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

• Children who are 72 months old and were born after September 30th but on any day of the month will have their cards issued until the end of the birth month.

• Individuals with health insurance cards who are receiving inpatient treatment but whose cards have expired will have their medical expenses reimbursed within the scope and limits of their benefits until discharge, but for a maximum of 15 days from the date the card expires.