What will change in the benefits of people whose medical examination and treatment costs are covered by Health Insurance when their salary increases from July 2023?

People whose medical examination and treatment costs are 100% covered by health insurance is information that many people participating in health insurance are interested in and need to know to ensure their rights.

5 groups of people are covered 100% by health insurance when going to the right medical facility for examination and treatment

Group 1:People with revolutionary contributions as prescribed in the Ordinance on preferential treatment of people with revolutionary contributions; War veterans; People eligible for monthly social security benefits; People from poor households; Ethnic minorities living in areas with difficult socio-economic conditions; People living in areas with especially difficult socio-economic conditions; People living in island communes and island districts; Relatives of people with revolutionary contributions who are biological fathers, biological mothers, wives or husbands, and children of martyrs; people who have raised martyrs; People aged 80 or older who are receiving monthly benefits...

Group 2 - The following subjects are paid 100% of medical examination and treatment costs and there is no limit on the payment rate for drugs, chemicals, medical supplies and technical services:Revolutionary activists before January 1, 1945; Revolutionary activists from January 1, 1945 to the August 1945 uprising; Vietnamese heroic mothers; War invalids, people enjoying policies like war invalids, war invalids of type B, sick soldiers with a labor capacity reduction of 81% or more; War invalids, people enjoying policies like war invalids, war invalids of type B, sick soldiers when treating recurrent wounds or illnesses; Resistance fighters infected with toxic chemicals with a labor capacity reduction rate of 81% or more; Children under 6 years old.

Many cases will have 100% of medical examination and treatment costs covered by health insurance in 2023.

Group 3:Health insurance participants go to the commune health center for medical examination and treatment.

Group 4:The cost of one medical examination is less than 15% of the basic salary.

Group 5:Have participated in health insurance for 5 consecutive years or more and have the amount of co-payment for medical examination and treatment costs in the year greater than 6 months of basic salary.

Change in conditions for 100% coverage of medical examination and treatment costs from July 1, 2023

Many conditions and benefits for 100% health insurance payment when examining and treating diseases are related to the basic salary. Therefore, from July 1, 2023, when the basic salary increases from 1.49 million VND to 1.8 million VND, some conditions for 100% payment of medical examination and treatment costs will also change.

As mentioned above, one of the 5 groups of subjects is covered by health insurance for 100% of the cost of medical examination and treatment at the right facility when the cost for one medical examination and treatment is lower than 15% of the basic salary.

Accordingly, 15% of the current basic salary is 223,500 VND; from July 1, 2023, this figure will be 270,000 VND. Thus, from July 1, people participating in health insurance who go to medical examination and treatment in accordance with the provisions of the Law on Health Insurance with a one-time cost of less than 270,000 VND will be covered 100% by health insurance, and patients will be examined and treated for free.

Similar to above, for group 5, when the basic salary increases, the conditions for receiving 100% of medical examination and treatment costs for people participating in health insurance for 5 consecutive years or more also change accordingly.

Specifically, from the beginning of 2023 until June 30, people who have participated in health insurance for 5 consecutive years or more and have the amount of co-payment for medical examination and treatment costs in the year greater than 8.94 million VND (6 months of basic salary of 1.49 million VND/month), the excess of 6 months of basic salary will be paid by the health insurance fund and the patient will be paid 100% of the medical examination and treatment costs from this time until the end of the year.

From July 1, 2023, when the basic salary increases to 1.8 million VND/month, people who have participated in health insurance for 5 consecutive years or more must have an amount of co-payment for medical examination and treatment costs in the year greater than 10.8 million VND (6 months of basic salary) to enjoy the above benefits.

Cases identified as being in the correct health insurance treatment line include:

- Medical examination and treatment at the original registered place;

- Medical examination and treatment at the connected place;

- Medical examination and treatment with referral letter from the initial medical examination and treatment facility;

- Emergency;

- Medical examination and treatment during business trips, mobile work, or concentrated study must be performed at a medical examination and treatment facility at the same level or equivalent to the facility registered for initial medical examination and treatment./.