The latest benefits that people participating in 5 consecutive years of health insurance need to know

Benefits of Health Insurance participants for 5 consecutive years

According to point c, clause 1, Article 22 of the Lawhealth insuranceRegulations on the rights of health insurance participants for 5 consecutive years, patients are paid 100% of medical examination and treatment costs within the scope of benefits by the health insurance fund if they meet the conditions in section 2.

Specifically, Decree 146/2018/ND-CP guides the payment of medical examination and treatment costs for patients who have participated in Health Insurance for 5 consecutive years or more as follows: In case the patient has a co-payment amount at one or more times of medical examination and treatment at the same medical examination and treatment facility greater than 6 months of basic salary, the medical examination and treatment facility will not collect the co-payment amount greater than 6 months of basic salary of the patient.

Medical examination and treatment facilities are responsible for providing receipts for the co-payment amount of 6 months of basic salary so that patients have a basis to request the Social Insurance agency to confirm that they do not have to co-pay in that year.

People who participate in health insurance for 5 consecutive years enjoy many benefits when examining and treating diseases.

The benefit of a health insurance participant for the next 5 consecutive years is that in the case where the patient has a cumulative co-payment amount in the fiscal year at different medical examination and treatment facilities or at the same medical examination and treatment facility greater than 6 months of basic salary, the patient brings the documents to the Social Insurance agency that issued the health insurance card to pay the co-payment amount greater than 6 months of basic salary and receive a certificate of no co-payment in that year.

In case the patient's co-payment amount exceeds 6 months of basic salary calculated from January 1, the health insurance fund will pay 100% of the medical examination and treatment costs within the patient's benefits from the time the patient participates for 5 consecutive years until December 31 of that year.

Conditions for receiving Health Insurance for 5 consecutive years

According to current regulations, the conditions for patients to enjoy Health Insurance for 5 consecutive years include:

- Have participated in health insurance for 5 consecutive years or more;

- The amount of co-payment for medical examination and treatment costs in the year is greater than 6 months of basic salary (equivalent to 8,940,000 VND).

Co-payment amount/co-payment cost is the amount that a patient with health insurance must pay together with the social insurance agency according to the % rate of the health insurance card type.

For example: If the health insurance card has a benefit level of 80%, the patient must co-pay 20% of the total cost covered by the health insurance.

- Go to the right hospital for treatment.

Consulting people to participate in health insurance. Photo courtesy of Dinh Tuyen

Health Insurance application for 5 consecutive years

According to Notice 2298/TB-BHXH in 2018, people who are eligible for payment of Health Insurance benefits for 5 consecutive years must submit the following documents to the Social Insurance agency to have their benefits resolved:

- Health Insurance card with the words "Time of 05 consecutive years: from dd/mm/yy" and ID card with photo (copy).

- Hospital bill (original)./.