Ms. Duong Thi Minh Chau - Head of the Department of Propaganda and Support for Participants (Hanoi Social Insurance) said about the health insurance (HI) level of HSSV as follows:
a) Medical examination and treatment (KCB) at a medical facility with a signed health insurance medical examination and treatment contract
First, in the case of health insurance medical examination and treatment in accordance with regulations: Right place of initial registration on the card or transfer to medical examination and treatment level in accordance with regulations and complete all procedures.
- Receive 100% of medical examination and treatment costs in the following cases:
+ KCB at initial-level medical examination and treatment facilities includes: medical stations, family medicine medical examination and treatment facilities, military - civilian health stations, military - civilian health clinics, district-level medical centers with medical examination and treatment activities licensed to operate in the form of clinics, health agencies, units, and organizations as prescribed by the Minister of Health; medical examination and treatment facilities under initial medical examination and treatment levels in the army and police as prescribed by the Minister of National Defense and the Minister of Public Security.
+ Outpatient medical examination and treatment at the regional general clinic.
+ If the cost of medical examination and treatment is 15% lower than the basic salary at the time of medical examination and treatment.
+ When participating in health insurance for 5 consecutive years or more and having the same amount of money to pay for medical examination and treatment costs during the year for medical examinations according to the provisions of the Law on Health Insurance greater than 06 months of basic salary.
- Receive 80% of the cost of health insurance medical examination and treatment in other cases.
Second, the case of health insurance medical examination and treatment is not in accordance with regulations: self-treatment of medical examination and treatment is not in accordance with the original medical examination and treatment registration facility; transferring patients between health insurance medical examination and treatment facilities is not in accordance with regulations.
- Receive 80% of health insurance medical examination and treatment costs in the following cases:
+ KCB at basic or specialized medical facilities for people with some rare diseases, serious diseases, diseases requiring surgery or using high technology.
+ Medical examination and treatment at initial medical examination and treatment facilities
+ Boarding medical examination and treatment at basic medical examination and treatment facilities
+ KCB at basic or specialized medical facilities that are determined to be district-level before January 1, 2025.
+ Boarding medical examination and treatment at a specialized medical examination and treatment facility that before January 1, 2025, is determined by a competent authority as a provincial level.
- Receive 40% of the cost of health insurance treatment in the case of inpatient treatment at a specialized health insurance facility. Third, in case the patient has a health insurance card and submits card information late when coming to the health insurance facility, the health insurance fund will pay the cost of health insurance within the scope of benefits and the benefit level from the time of presentation of health insurance card information, except in emergency cases. The cost of medical examination and treatment during the period when the patient has not presented health insurance card information will be paid directly by the health insurance fund according to regulations.
b) Medical examination and treatment at medical facilities without health insurance medical examination and treatment contracts
The Social Insurance agency will directly pay the cost of health insurance medical examination and treatment for the following cases:
- Basic medical examination and treatment facilities (under 50 points as prescribed) or have been identified by competent authorities as district-level facilities or have been temporarily classified as basic facilities before January 1, 2025:
+ Outpatient medical examination and treatment, receive a maximum of 0.15 times the basic salary at the time of medical examination and treatment (2,340,000 VND x 0.15 = 351,000 VND).
+ Boarding medical examination and treatment, receive a maximum of 0.5 times the basic salary at the time of discharge (2,340,000 VND x 0.5 = 1,170,000 VND).
- Basic-level medical examination and treatment facilities (from 50 points to less than 70 points as prescribed) or before January 1, 2025, have been identified by competent authorities as provincial level:
Boarding medical examination and treatment, receives the maximum of 1 time of basic salary at the time of discharge from the hospital (2,340,000 VND).
- Specialized medical examination and treatment facilities:
Boarding medical examination and treatment, receive a maximum of 2.5 times the basic salary at the time of discharge (2,340,000 VND x 2.5 = 5,850,000 VND).
c) Social insurance agencies directly pay for other special cases within the scope of benefits of health insurance participants
- In case the health insurance card data is not provided or the health insurance card information is not provided accurately.
- In case the patient cannot present a health insurance card before the end of the treatment period, transferred to the hospital on the same day due to emergency situation, loss of consciousness or death or loss of card but has not been reissued.
In these cases, patients need to contact the social insurance agency for specific instructions on direct payment procedures.
d) Emergency cases
Receive medical examination and treatment at any medical examination and treatment facility and must present information about the health insurance card, identification documents with photos before the end of the treatment period to enjoy full health insurance benefits.
