Updated at 22/06/2022 - 10:11 am
Currently, when going to the wrong level of medical examination and treatment (health care) by the health insurance card, in some cases the patient will be paid by the health insurance fund (health insurance) at the rate of 40% -100% of the cost. KCB.
However, From 01/01/2021, the holder of the health insurance card, when providing at the wrong level at the provincial hospital, is covered by the health insurance fund 100% of the cost of inpatient medical care. According to the entitlement level of the health insurance card specified in Clause 15, Article 1 of the Law on Health Insurance, amended 2014 as follows:Note: Provisions above Not applicable to ethnic minorities and household members poor people with health insurance are living in areas with difficult socio-economic conditions With difficulties and extreme difficulties, people participating in health insurance are living in island communes and districts island when self-service medical examination is not at the correct route
Gland | Year 2020 | Year 2021 |
Central hospital | 40% of the cost of inpatient treatment | 40% of the cost of inpatient treatment |
Line Hospital | 60% of the cost of inpatient treatment | 100% of the cost of inpatient treatment |
District Hospital | 100% of medical expenses | 100% of medical expenses |
The rate of entitlement to health insurance when providing services at the right level from 2021
A participant of health insurance, when going to medical examination according to Articles 26, 27 and 28 of the Law on Health Insurance 2008, shall be entitled to the health insurance fund to pay his medical expenses within the entitlement to the following rate:
- 100% of the medical examination and treatment costs for the subjects specified at Points a, d, e, g, h and i, Clause 3, Article 12 of the Law on Health Insurance 2008 (This is amended by Clause 6, Article 1 of the Law on Health Insurance. 2014).
- 100% of the curative care cost for the case that the cost for a medical examination is lower than the level prescribed by the Government and the curative care cost at the commune level;
- 100% of the medical care costs when the patient has been enrolled in health insurance for 5 consecutive years or more and has the co-pay for medical care costs in the year greater than the 6-month base salary, except the case of self-care at the wrong level ;
- 95% of the medical examination and treatment costs for the subjects specified at Point a, Clause 2, Point k, Clause 3 and Point a, Clause 4, Article 12 of the Law on Health Insurance 2008;
- 80% of medical examination and treatment costs for other subjects.
Note:
- In case a person belongs to many subjects participating in health insurance, he / she is entitled to the health insurance benefit according to the subject with the highest benefits.
- A participant of health insurance who registers initial medical care at a commune health station or a polyclinic or a district hospital is entitled to give medical care covered by health insurance at a commune health station or a polyclinic or district hospital in the same area. province and have the same benefit level as above.
- Ethnic minority people and poor households participating in health insurance are living in areas with difficult socio-economic conditions, areas with extremely difficult socio-economic conditions; Participants
Health insurance who is living in island commune, island district, when taking medical care by themselves at the wrong level, is covered by the health insurance fund for medical care costs for district hospitals, inpatient treatment for provincial and central hospitals and with the benefit rate. as above
