Rights of household health insurance participants:
household health insurance participants enjoy many important incentives and benefits:
Reduced the contribution level for members participating in the same household.
Is granted an electronic health insurance card, convenient for lookup and use during medical examination and treatment.
To be paid for medical examination and treatment costs within the scope of benefits and benefits stated on the card.
Choose and change the place of initial medical examination and treatment registration within the first 15 days of each quarter.
Explained and provided information about the health insurance regime from the Social Insurance agency and the medical examination and treatment facility.
Have the right to complain and denounce violations of the law on health insurance.
Health insurance benefits when going to the doctor
1. In case of emergency care: Patients are treated at any facility and need to present health insurance card information, identification documents with photos before the end of the treatment period to enjoy full benefits.
2. Health insurance medical examination and treatment in accordance with regulations:
Check the correct registration location as stated on the card.
Transferring routes between health insurance medical facilities according to regulations.
The expenses will be paid according to the prescribed benefit rate.
3. Health insurance medical examination and treatment is not in accordance with regulations:
self-treatment for medical examination and treatment at an unregistered facility.
Failure to properly implement the referral process.
Patients are paid at a lower rate.
The Social Insurance Agency will directly pay the cost of health insurance medical examination and treatment according to the benefit level within the scope of benefits when:
Outpatient medical examination and treatment is not in accordance with regulations: the maximum is 0.15 times the basic salary (2,340,000 VND x 0.15 = 351,000 VND).
Resident medical examination and treatment is not in accordance with regulations: the maximum is 0.5 times the basic salary (2,340,000 VND x 0.5 = 1,170,000 VND).
For medical facilities that do not sign health insurance contracts:
District route: maximum outpatient fee 351,000 VND, maximum inpatient fee 1,170,000 VND.
Provincial route: maximum boarding 2,340,000 VND.
specialized route: maximum boarding of 5,850,000 VND.
Other special cases are also guaranteed benefits, such as when the health insurance card data is inaccurate, the patient loses the card or cannot present due to emergency care, loss of consciousness, or death.
Notes when using a health insurance card:
First-time participants or participants with interruptions of 90 days or more: The card is valid after 30 days from the date of full payment of health insurance.
Do not lend cards to others or use cards from others.
Timely renewal of cards through collection service organizations, social insurance agencies, Public Service portals or banking applications to ensure continuous value.
