“Hello, Lawyer. Since childhood, my teeth have been uneven and misaligned, making me very self-conscious. Now I have a desire to have beautiful braces. I have a question braces are covered by health insurance? What item does oral and maxillofacial health insurance cover? Looking forward to being answered by a lawyer, I sincerely thank you!”. Thank you for sending us your question. To answer this question, today, LSX Lawfirm will give you an article about “Are braces in Vietnam covered by health insurance?”, as follows:
Legal grounds
- Law on health insurance 2008 amended and supplemented 2014
- Circular 30/2020/TT-BYT
Where is health insurance examined?
Check online health insurance
Pursuant to Article 6 of Circular 30/2020/TT-BYT stipulating cases of medical examination and treatment covered by medical insurance at the right level include:
– Health insurance participants come for medical examination and treatment at the same medical facility as originally stated on the health insurance card.
– Health insurance participants who register for initial medical treatment at commune medical examination and treatment establishments or general clinics or district hospitals are entitled to medical examination and treatment for diseases covered by health insurance at commune health stations or clinics. general or other district hospitals in the same province.
Children who do not have health insurance cards because they have not yet carried out birth registration procedures can use their birth certificates to go to the medical examination and treatment establishments mentioned above.
Health insurance participants in an emergency situation can receive emergency treatment at any medical examination and treatment facility nationwide.
– Participants of health insurance may be referred to health insurance providers according to regulations
– The person who has an appointment for a follow-up examination in case he has been transferred…
Off-line health insurance check
Pursuant to Article 11, Circular 40/2015/TT-BYT and Clause 7, Article 15, Decree 146/2018/ND-CP, out-of-network medical examination, and treatment are cases that are not covered by the right-line health insurance according to regulations. provisions of the Law on Health Insurance as well as other relevant legal documents.
Cases of medical examination and treatment of off-line health insurance include:
– Registering for initial health insurance medical examination and treatment facility in this district/province, but self-diagnosing and treating health insurance covered by health insurance in another district/province
– Patients who come for medical examination and treatment at central hospitals
– The patient transferred treatment from the district hospital to the provincial hospital but did not have a referral from the doctor/
Health insurance check-ups at private clinics
Accordingly, to Article 24 of the Law on Health Insurance 2008, amended and supplemented in 2014, a medical examination and treatment facility covered by health insurance is defined as a medical facility under the Law on Medical Examination and Treatment that has signed a contract for medical examination and treatment. with the health insurance organization.
If a private hospital signs a contract for medical examination and treatment with health insurance, it is also considered a medical examination and treatment facility with insurance coverage. And when people with health insurance cards visit these medical facilities, they are also paid by the Health Insurance Fund at the same rate as public medical facilities.
If the private medical facility has not signed a medical examination and treatment contract with a health insurance organization, the patient must pay the cost of medical examination and treatment to the private hospital in advance, then carry out procedures for the insurance fund. post-paid medical care.
In Clause 2, Article 31 of the Law on Health Insurance, the health insurance organization pays the costs of medical examination and treatment covered by the insurance premium directly to the holders of the health insurance card who go for medical examination and treatment at a medical facility that does not have a contract for medical examination and treatment then. health insurance or improper medical examination and treatment…
What items does dental health insurance cover?
Pursuant to the provisions of Article 21, the Law on Health Insurance, as amended and supplemented in Clause 14, Article 1 of the Law on Health Insurance 2014, clearly states that the scope of benefits for participants of health insurance includes:
- Expenses for medical examination, treatment, rehabilitation, periodical antenatal care, and childbirth.
- Participants of health insurance are paid expenses when: transporting patients from the district level to a higher level for the specified subjects in case of emergency or during inpatient treatment who must be transferred to a professional and technical hospital.
In addition, according to Article 23 of the Law on Health Insurance, amended and supplemented in Clause 16, Article 1 of the Law on Health Insurance 2014), it is clear that 12 cases are not entitled to health insurance such as:
- Expenses in the above cases have been paid by the State budget.
– Nursing and convalescence at nursing and convalescent establishments
- Physical examination
Pregnancy testing and diagnosis are not intended for treatment.
Using assisted reproductive technology, family planning services, abortion, and abortion, except in cases where the pregnancy must be terminated due to the medical causes of the fetus or the mother.
– Using beauty services
- Participate in clinical trials, scientific research…
Thus, on the basis of the above provisions, depending on each case consider the benefit of dental health insurance.
Are braces covered by health insurance?
Article 23 of the Law on Health Insurance 2008 stipulates cases in which health insurance is not eligible as follows:
- Expenses in the case specified in Clause 1, Article 21 have been paid by the state budget.
- Nursing and convalescence at convalescent and convalescent establishments.
- Health examination.
- Pregnancy testing and diagnosis are not for treatment purposes.
- Using assisted reproductive technology, family planning services, abortion, and abortion, except for cases where the pregnancy must be terminated due to medical causes of the fetus or the mother.
- Use beauty services.
- Treatment of strabismus, myopia, and refractive errors of the eyes, except for children under 6 years old.
- Use of alternative medical supplies including prosthetic limbs, artificial eyes, dentures, eyeglasses, hearing aids, and mobility aids in medical examination, treatment, and rehabilitation then.
According to the above regulations, braces are considered cosmetic services. Therefore, in case you have braces, you will not be covered by health insurance.
Do private general hospitals pay for health insurance?
Clause 17, Article 1 of the 2014 Amended Health Insurance Law provides for medical examination. And treatment establishments covered by health insurance as follows:
A medical examination and treatment facility covered by health insurance means a medical facility prescribed by the Law on Medical Examination. And Treatment that has signed a medical examination and treatment contract with a health insurance organization then.
According to that regulation, in case a private general hospital has signed a medical examination. And treatment contract with a health insurance organization, medical insurance will be paid for the patient.
In which case, tooth extraction is covered by health insurance?
When tooth extraction, it also depends on the case to consider whether to enjoy health insurance or not.
– If the tooth is extracted, the tooth is extracted to treat dental-related diseases. As prescribed by the doctor such as gingivitis, tooth decay; tooth extraction due to fracture; Wisdom tooth extraction. If teeth are extracted due to misalignment … affecting health, you will be entitled to health insurance
- If the tooth is extracted to do cosmetic services, extracted teeth not according to the doctor’s prescription, or extracted teeth to participate in trials and scientific research. It will not be covered by health insurance then.
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Related questions
To be paid for health insurance during a dental examination, the patient needs to: bring a full range of personal documents such as an identity card, driver’s license, and health insurance card, … to present when receiving medical treatment. requested by the medical staff. Children under 6 years old only need to present their health insurance card. An identity card or driver’s license are additional documents to prove identity in case the health insurance card does not have a photo.
Accordingly, to new regulations, from 01/01/2016 onwards. When people want to participate in voluntary health insurance, people must register as a household. In addition, voluntary health insurance will not be sold at medical examination and treatment facilities, but only registered in the locality of residence.
According to Article 18 of Decision No. 595/QD-BHXH, the monthly health insurance premium payment is equal to 4.5% of the monthly salary, in which:
– The employer pays 3%;
– Employees pay 1.5%.
Conclusion: So the above is Are braces in Vietnam covered by health insurance?. Hopefully with this article can help you in life, please always follow and read our good articles on the website: lsxlawfirm.com
