Reader Luong Thi Thanh Phuong said: "My father registered for initial medical examination and treatment at the ward health station. In March 2024, my father suffered a stroke (hemiplegia), so he asked for a transfer to a provincial hospital, then the provincial hospital transferred my father to a traditional medicine hospital for long-term inpatient treatment. Every month, my father had to be discharged from the hospital and readmitted after 2 days.
At the time of hospitalization, my father had difficulty walking, so the hospital only required him to bring his old discharge papers and health insurance card. Therefore, my family did not ask for a transfer paper and continued to be hospitalized again.
"In November 2024, the treatment fee is eligible for 100%, but the Social Insurance agency did not resolve it because my father was transferred to the wrong hospital and requested to contact the Traditional Medicine Hospital again. May I ask, can my father be reconsidered to receive 100% health insurance?" - a reader asked.
Regarding this issue, Vietnam Social Security responds as follows:
According to Article 22 of the Law on Health Insurance, health insurance participants are entitled to a non-co-payment regime during the year when meeting the following conditions:
- Participate in health insurance for 5 consecutive years or more;
- The amount of money to co-pay for medical examination and treatment costs of visits to the right medical facility during the year is greater than 6 months of basic salary (currently the basic salary is 2,340,000 VND);
- Go to the right hospital for examination and treatment.
In addition, according to the provisions of Article 22 of the Law on Health Insurance, in case a health insurance participant goes to a provincial hospital for examination and treatment (without a referral paper for health insurance examination and treatment) and fully performs the procedures for health insurance examination and treatment (presenting the health insurance card and photo identification), he/she will be entitled to 100% of the inpatient treatment costs within the scope of payment of the health insurance fund and the level of benefit specified on the health insurance card.
However, due to the fact that the health insurance examination and treatment is not in the right line, the co-payment cost of this medical examination and treatment (if any) is not determined as a condition for issuing a certificate of non-co-payment in the year and the health insurance participant is not exempted from co-payment of medical examination and treatment costs in the case of having participated in health insurance for 5 consecutive years and the co-payment amount in the year of the correct medical examination and treatment exceeds 6 months of basic salary.
After talking with Ms. Luong Thi Thanh Phuong via the phone number she provided and checking the information, in 2024, Ms. Phuong's father went to the Traditional Medicine and Rehabilitation Hospital of Khanh Hoa province for health insurance examination and treatment:
- Treatment period from April 1, 2024 to May 3, 2024: Because the patient went to the right medical facility for examination and treatment (was transferred to the health insurance facility for examination and treatment according to regulations), the co-payment costs of this inpatient treatment were accumulated to determine the regime of not having to co-pay for health insurance examination and treatment costs.
- Treatment sessions from May 6, 2024 to June 4, 2024, from June 7, 2024 to July 5, 2024, from July 8, 2024 to August 6, 2024, from August 9, 2024 to August 29, 2024, from September 4, 2024 to October 2, 2024, from October 7, 2024 to November 5, 2024, because the patient went to the wrong medical examination and treatment line (not transferred to the health insurance examination and treatment line according to regulations), the co-payment costs of these treatments are not determined as a condition for issuing a certificate of non-co-payment in the year and the patient is not entitled to the benefit of exemption from co-payment for medical examination and treatment costs in case he/she has participated in health insurance for 5 consecutive years and has the co-payment amount During the year, the number of times of medical examination and treatment at the right place exceeds 6 months of basic salary.
