The Ministry of Health proposes to amend and supplement the benefits of health insurance participants in Clause 1, Clause 3 and Clause 4, Article 14 of Decree No. 146/2018/ND-CP, amended and supplemented by Decree No. 75/2023/ND-CP, to ensure compliance with the new provisions of the Law on Medical Examination and Treatment 2023 and Decree No. 96/2023/ND-CP on the right to pay 100% of medical examination and treatment fees for one medical examination and treatment.
The Ministry of Health proposes to amend that health insurance participants, when going for medical examination and treatment according to the provisions of Articles 26, 27 and 28 of the Law on Health Insurance; Clauses 4 and 5, Article 22 of the Law on Health Insurance, will have 100% of the medical examination and treatment costs paid by the Health Insurance Fund for the subjects specified in Clauses 3, 4, 5, 8, 9, 11, 17 and 20, Article 3 of this Decree.
100% coverage of medical examination and treatment costs and no limit on payment rates for drugs, chemicals, medical supplies and technical services as prescribed by the Minister of Health for:
- Revolutionary activists before January 1, 1945 and from January 1, 1945 to the August 1945 uprising
- Vietnamese heroic mother
- War invalids, people enjoying policies like war invalids, war invalids of type B, sick soldiers with reduced working capacity of 81% or more; sick soldiers during treatment of wounds, and recurrent illnesses.
- Resistance fighters infected with toxic chemicals with a labor capacity reduction rate of 81% or more; Children under 6 years old.
- 100% of medical examination and treatment costs at commune, ward and town health stations; infirmaries; health stations, health rooms of agencies, units and organizations; family medicine clinics; military-civilian health stations, military-civilian health clinics and a number of other outpatient medical examination and treatment facilities in the army according to regulations of the Minister of National Defence.
- Some other outpatient medical examination and treatment facilities in the police according to the regulations of the Minister of Public Security. (According to current regulations: 100% of medical examination and treatment costs at the commune level).
- 100% of medical examination and treatment costs in cases where the cost for one medical examination and treatment is lower than 15% of the basic salary.
- 100% of medical examination and treatment costs when the patient has participated in health insurance for 5 consecutive years or more and has the amount of co-payment for medical examination and treatment costs during the year of medical examination and treatment as prescribed in Articles 26 and 27 of the Law on Health Insurance greater than 6 months of basic salary.
Current regulations clearly state: 100% of medical examination and treatment costs when the patient has participated in health insurance for 5 consecutive years or more and the amount of co-payment for medical examination and treatment costs in the year is greater than 6 months of basic salary, except in cases of self-examination and treatment at the wrong medical facility.
