In the draft Circular detailing the implementation of a number of articles of the Law amending and supplementing a number of articles of the Law on Health Insurance, the Ministry of Health proposes cases that are paid in accordance with the scope of health examination and treatment benefits under health insurance.
Accordingly, cases that are paid according to the scope of health insurance examination and treatment benefits include:
People with health insurance cards who register for initial medical examination and treatment at a facility under the initial medical examination and treatment level are entitled to receive health insurance examination and treatment at any medical examination and treatment facility under the initial medical examination and treatment level nationwide.
People with health insurance cards who register for initial medical examination and treatment at a facility at the initial medical examination and treatment level will be transferred to a basic, specialized, or high-tech specialized medical examination and treatment facility and will be paid according to the correct benefit level within the payment scope.
People with health insurance cards are transferred from basic-level medical examination and treatment facilities to specialized or high-tech specialized medical examination and treatment facilities.
Cases of transfer according to the level of examination and treatment, some of the following cases: transfer beyond the level, transfer to a lower level.
In case of emergency, health insurance participants can go to any medical examination and treatment facility. The doctor or nurse who receives the patient will assess, determine the emergency situation and record it in the medical record. After the emergency treatment phase, the patient will be transferred to inpatient treatment at the medical examination and treatment facility where the emergency was received or transferred to another medical examination and treatment facility for continued treatment according to professional requirements or transferred back to the place of initial medical examination and treatment registration after treatment has stabilized.
In case a patient is transferred to a medical examination and treatment facility with other accompanying diseases, diseases discovered or arising other than the diseases recorded on the transfer form, the medical examination and treatment facility receiving the patient shall examine and treat those diseases within the scope of its expertise.
In case the health insurance participant goes on a business trip, studies, works on the move or resides temporarily for less than 12 months in another locality, he/she shall be examined and treated at a medical examination and treatment facility in that locality equivalent to the level of the initial facility recorded on the health insurance card. In case the locality does not have an equivalent medical facility, the health insurance participant shall be allowed to choose another medical examination and treatment facility that organizes initial health insurance examination and treatment.
