Today, health has become an issue that many people are concerned about. They take care of their life and health. So about the matter “Regulations on health insurance under Vietnam law”. Let’s find out with LSX in the article below.
Legal grounds
- Law on health insurance 2008 amended and supplemented 2014
- Decree 146/2018/ND-CP
What is health insurance?
Health insurance (HI) is a form of compulsory insurance that is applied to the subjects prescribed by the Law on Health Insurance for health care, not for profit, organized by the State. . Participating in health insurance is both a responsibility, an obligation and a right of people, agencies and organizations.
Health insurance is implemented based on the principles of ensuring risk sharing among the participants of health insurance. The health insurance fund is managed centrally, uniformly, openly and transparently, ensuring a balance between revenues and expenditures and is protected by the State. In addition, the principles of payment rates, benefits, medical examination and treatment costs are also strictly regulated.
Regulations on health insurance under Vietnam law
• The health insurance premium is determined according to the percentage of the salary used as the basis for payment of compulsory social insurance according to the provisions of the Law on Social Insurance, pension, allowance or base salary.
• The level of health insurance benefits is based on the severity of illness, the group of subjects within the scope of benefits and the duration of health insurance participation.
• Medical examination and treatment expenses covered by health insurance are jointly paid by the health insurance fund and the participants of health insurance.
According to regulations, participants of health insurance will be divided into several groups of subjects including:
1. Groups played by employees and employers
2. Group paid by the social insurance agency
3. The group paid by the state budget
4. Groups supported by the state budget
5. Health insurance group by household
6. The group is closed by the employer.
Depending on the different groups of subjects, there will be different premiums and benefits for health insurance. For those in the group paid by the social insurance agency, the group paid by the state budget and the group paid by the employer, they will be granted a free health insurance card according to regulations.
Benefits of joining health insurance
When participating in health insurance, you will enjoy a lot of benefits such as the cost of participating in health insurance (Depending on different subjects according to the provisions of the Law); health insurance coverage.
The state is aiming to universalize health insurance for all people, therefore, it sets regulations on health insurance premiums, who are supported by the state to buy, who are free, etc. to support people. People participating in health insurance have the opportunity to access health insurance.
At that time, the performance of medical examination and treatment activities will be partially paid by the Vietnam Health Insurance Fund based on the benefits of the participants in the list of medical examination and treatment prescribed by law.
What is the health insurance benefit for 5 consecutive years?
– Health insurance for five consecutive years
This is a mechanism to encourage people to participate in health insurance. In other target groups, health insurance participants will be paid at different percentages from 80% to 100%.
But when a person participates in health insurance for five consecutive years, but the interval is not more than three months, they will receive health insurance benefits for five consecutive years.
Participants of health insurance will receive 100% of medical examination and treatment costs when they have participated in health insurance for 5 consecutive years or more and have the same amount to pay medical examination and treatment expenses in the year. more than 06 months’ basic salary, except for the case of self-diagnosis and medical treatment at the wrong line;
Thus, the law stipulates two conditions at the same time, that the participants of health insurance must participate for 5 consecutive years or more according to the provisions of the Law on Insurance and the amount of medical examination and treatment in the year must not exceed 6 months. monthly base salary unless otherwise stated.
If you are in the beneficiaries of 80% or 95% of health insurance benefits, when recognized as health insurance for five consecutive years, you will be entitled to 100% of health insurance coverage. This provision will greatly benefit those who participate in health insurance for a long time. Especially for those with diseases that require long and expensive treatment.
What are the benefits of infant health insurance?
Children under 6 years old are a special subject of the Law on Health Insurance. Instead of other subjects having to consider conditions or pay fees to participate in health insurance, children under 6 years old are entitled to free health insurance paid by the state budget.
Therefore, children under 6 years old will be listed by local state agencies and enjoy free health insurance cards until the end of 72 months.
This subject’s health insurance benefit is 100% of the health insurance card value.
What are the benefits of household health insurance?
Health insurance benefits of households are prescribed as follows:
First: About the health insurance premium
When participating in household health insurance, the participants will follow the household registration book or temporary residence book. And the contribution rate of each member is regulated as follows:
+ The first person of the household participating in health insurance will pay 4.5% of the basic salary/month;
+ The second person of the household pays 70% of the payment rate of the first household;
+ The third person of the household pays 60% of the salary of the first person;
+ The fourth person pays 50% of the premium of the first person.
+ From the fifth person onward, the payment is equal to 40% of the contribution rate of the first person
Currently, the base salary is set at 1,490,000 VND. The formula for paying for health insurance is as follows:
The first person’s contribution rate = 4.5% x base salary x number of months (by payment method)
From the second person onwards will follow that result and multiply by the percentages of 70%; 60%; 50%; 40% respectively.
Because it will have to be purchased according to the household registration book or temporary residence book, so to buy health insurance according to the household, members who have not yet joined health insurance will have to buy it. Therefore, the law stipulates a gradual reduction in the health insurance premiums of households to reduce costs and help people access health insurance.
Second: Benefit level
– In case of medical examination and treatment at the right level
Health insurance participants who are households will enjoy the following benefits:
+ 100% of medical examination and treatment costs at the commune level
+ 100% of medical examination and treatment costs in case the cost for a medical examination and treatment is lower than 15% of the base salary (Current base salary is VND 1,490,000)
+ 80% of medical examination and treatment costs for the remaining cases
– In case of medical examination and treatment of off-line diseases
+ From January 1, 2016, health insurance participants who register for initial medical examination and treatment at commune health stations or general clinics or district hospitals are entitled to medical examination and treatment covered by insurance health care services at commune health stations or general clinics or district hospitals in the same province have the benefit rates according to the beneficiaries at the right levels.
+ From January 1, 2021, the health insurance fund will pay inpatient treatment expenses according to the level of benefits according to the beneficiaries at the right line for health insurance participants when they go for medical examination and treatment at the wrong level at the provincial medical examination and treatment establishments nationwide.
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Frequently asked questions
People belonging to near-poor households according to the near-poor criteria as prescribed by the Government and the Prime Minister.
Persons belonging to multidimensional poor households are not included in the case of Persons belonging to poor households according to income criteria, persons belonging to multi dimensional poor households with health insurance deficits specified in Decision No. 59/2015/QD- TTg dated November 19, 2015 of the Prime Minister promulgating the multi-dimensional poverty line applied for the period 2016 – 2020 and other decisions of competent agencies to amend, supplement or replace the applied poverty line. used for each stage.
Students, students.
People of households engaged in agriculture, forestry, fishery and salt production have an average standard of living as prescribed by the Government or the Prime Minister.
The time when the health insurance card is valid is specified as follows:
a) Subjects “Groups paid by employees and employers, Groups paid by the state budget, Groups paid by social insurance organizations, according to the provisions of the Law on Health Insurance” participating in health insurance for the first time, health insurance cards are valid. use value from the date of payment of health insurance premiums;
b) For those who participate in health insurance continuously from the second time onwards, the health insurance card is valid for consecutive use with the expiry date of the previous card;
c) Subjects “Group with state budget support, group participating in health insurance by household, according to the provisions of the Law on Health Insurance” who participate in health insurance for 3 months or more in a fiscal year, the health insurance card valid for use after 30 days from the date of payment of health insurance premiums;
d) For children under 6 years old, the health insurance card is valid until the child is full 72 months old; Children born before September 30
In case a person concurrently belongs to many different beneficiaries of health insurance as prescribed in Article 12 of the Law on Health Insurance, he/she shall pay health insurance premiums according to the first subject that he or she is identified in the order of the subjects specified in Article 12 of this Law. Law on Health Insurance. In case an employee has one or more indefinite-term labor contracts or labor contracts with a term of full 3 months or more, he/she shall pay health insurance premiums according to the labor contract with the highest salary. In case subjects who are part-time active in communes, wards and townships and belong to many different beneficiaries of health insurance as prescribed in Article 12 of the Law on Health Insurance, the health insurance premiums shall be paid in the following order: paid by the social insurance organization , paid by the state budget, by the subjects and the commune-level People’s Committees.
Conclusion: So the above is Regulations on health insurance under Vietnam law. Hopefully with this article can help you in life, please always follow and read our good articles on the website: lsxlawfirm.com
