How long before birth to buy health insurance in Vietnam to enjoy the insurance scheme?

“Hello, Lawyer, I am currently 8 months pregnant and expect to have a baby in 2 months. So if I buy voluntary health insurance now, is it still time to buy health insurance before giving birth? will be entitled to the insurance regime? Please advise.” Hello, first of all, need to clarify the term “Medical insurance” here. According to Paragraph 1, Clause 1, Article 1 of the Law on Health Insurance 2014, “Medical insurance is a form of compulsory insurance applicable to the subjects specified in this Law for health care, not for profit purposes organized by the State”. So how long before you buy health insurance before giving birth, you will be entitled to the insurance policy? To answer this question, today, LSX Lawfirm will give you an article about “How long before birth to buy health insurance in Vietnam to enjoy the insurance scheme?“, as follows:

Legal grounds

• Law on Health Insurance Amendment 2014
• Law on Social Insurance 2014

What is health insurance?

How long before birth to buy health insurance in Vietnam to enjoy the insurance scheme? Health insurance, also known as health insurance, is one of the forms of insurance applied in the field of health care in which the policyholder will be paid by the insurance agency for part or all of the cost. medical examination and treatment as well as the cost of buying medical examination and treatment drugs.

Health insurance is carried out not for profit, organized by the State and the participants are responsible for participating in accordance with the provisions of the Law on Health Insurance. Often public health organizations will be forced to participate in order to help people get the best health care, while private health agencies will be encouraged to participate without coercion.

Health insurance aims to serve and protect people’s health care needs. In case of illness, disease, unexpected incidents, or accidents, health insurance provides effective support to help pay some or all of the hospital fees so that you can get the best health care.

Health insurance in our country is provided by the state and is not for profit, but it is a social policy regulated by the Law on Health Insurance, so people will have responsibilities and benefits when participating. prescribed insurance.

Benefits when participating in health insurance if the mother participates in health insurance

1. Giving birth at the right medical examination and treatment facility (KCB)

Based on the health insurance card number of each individual, there are different benefits, specifically:

– Number 1: 100% of the cost of childbirth is covered by health insurance and no limit on the payment rate applies.
– No. 2: 100% of the cost of childbirth is covered by health insurance (with limited payment rates for some drugs, chemicals, medical supplies, and technical services); Transportation costs from the district level to the upper level in case of emergency or during inpatient treatment must be transferred to a professional and technical level.
– Number 3: 95% of the cost of childbirth is covered by health insurance (with limited payment rates for some drugs, chemicals, medical supplies, and technical services); 100% of the cost if giving birth at the commune level but the total cost is less than 15% of the basic monthly salary.
– No. 4: 80% of the cost of childbirth covered by health insurance (with limited payment rates for some drugs, chemicals, medical supplies, and technical services); 100% of the cost of giving birth at the commune level.
– Number 5: 100% of the cost of childbirth, including expenses outside the scope of health insurance benefits, trand ansportation costs.

2. Giving birth at an off-line medical facility

Will paid according to the prescribed rate for the case of giving birth on the right line as above according to the following rate:
– Firstly, At the central hospital is 40% of the cost of inpatient treatment.
– Secondly, At the provincial hospital is 60% of the cost of inpatient treatment.
– Thirdly, At the district hospital, 100% of the total cost of giving birth.

Benefits when participating in compulsory social insurance

In case only the mother participates in social insurance

Mothers who have paid social insurance contributions for full 06 months or more during the 12 months before giving birth entitled to:
– One-time allowance when giving birth: One-time allowance = Number of children x 02 times the base salary in the month of childbirth.

• Leave on maternity leave:
• Taking maternity leave before and after giving birth is 06 months. In the case of twins or more, from the second child onwards, for each child, the mother entitled to an extra month of leave. The maximum period of maternity leave before giving birth is not more than 02 months.
• The maternity benefit rate is equal to 100% of the average monthly salary on which social insurance premiums are based for the 06 months before taking leave to enjoy the maternity regime.
• If you have paid social insurance premiums for a full 12 months or more when you are pregnant, you must take a leave of absence to take care of your pregnancy under the direction of a competent medical examination, and the treatment facility must pay social insurance premiums for full 03 months or more within 12 months before giving birth.

In addition

• Convalescence and health rehabilitation after maternity: Female employees after enjoying the maternity regime, within the first 30 days of working, but their health has not yet recovered, entitled to convalescence and health rehabilitation from 05 days to 10 days (including public holidays, New Year holidays, weekly holidays). The number of days of convalescence and rehabilitation shall decided by the employer and the grassroots trade union. In case the employer has not yet established a grassroots trade union, the decision shall made by the employer. The time for convalescence and rehabilitation prescribed as follows:
• Up to 10 days for female employees who give birth once with two or more children;
• Then Up to 07 days for female employees who have to undergo surgery;
• Up to 5 days for other cases.

In case only the father participates in social insurance

Fathers who have paid social insurance contributions for the full 06 months or more during the 12 months before the birth of their children entitled to:

• One-time allowance when giving birth (like mother’s).
  – Leave to enjoy the maternity regime: 05 working days if the wife gives birth naturally; 07 working days when the wife gives birth to a child requiring surgery or gives birth to a child under 32 weeks old; In case the wife gives birth to twins, she entitled to 10 working days off, from the birth of triplets or more, for each additional child, she entitled to an additional 03 working days; In case the wife has twins or more and needs surgery. She entitled to 14 working days off.
  The time off work to enjoy the maternity regime specified in this Clause calculated within the first 30 days from the date the wife gives birth.
• Fathers who have paid social insurance premiums for less than 6 months at the time of giving birth entitled to a leave of absence from work to enjoy the maternity regime as in the case of paying the full 6 months or more but not entitled to a lump-sum allowance when giving birth.

In case both parents participate in social insurance

The mother entitle to the maternity regime as in Section 1, Part II, and at the same time, the father will entitled to maternity leave as in Section 2, Part II above.

In case of obstetric complications

In case of miscarriage, curettage, abortion, stillbirth, or pathological abortion, female employees entitled to take maternity leave as prescribed by competent medical examination and treatment establishments. The maximum time off work regulated as follows:

• 10 days if the pregnancy is under 05 weeks;
• 20 days if the pregnancy is from 05 weeks to under 13 weeks;
• 40 days if the pregnancy is from 13 weeks to under 25 weeks;
• 50 days if the pregnancy is 25 weeks or more.
  The time off work to enjoy the maternity regime specified in this article includes public holidays, New Year holidays, and weekly rest days.

In case both parents participate in social insurance and the mother dies after giving birth, the father entitled to a leave of absence to enjoy the maternity regime for the remaining time of the mother. The level of maternity benefits will calculated as the average of 06 months adjacent to the salary paid for social insurance before leaving work to enjoy the maternity regime of the father. In case, the father has just joined the social insurance but has not paid the full 6 months, the benefit rate will calculated on the average salary paid for social insurance for the months of paying social insurance the father.

How long before birth to buy health insurance?

According to the 2008 Law on Health Insurance, amended in 2014, it states: “Medical insurance is a form of compulsory insurance that applied to the subjects specified in this Law for health care, not for the purpose of health care. for-profit purposes organized by the State.”

Article 21 of the Law on Health Insurance 2008 amended in 2014 stipulates the scope of benefits of health insurance participants as follows: “ 1. Health insurance participants covered by the health insurance fund. the following fees: a Medical examination, treatment, rehabilitation, periodical antenatal care, childbirth;”

Conclusion: According to the law, Health Insurance does not stipulate how long the mandatory period of participating in health insurance before giving birth will entitled to the health insurance regime.

This regulation is different from the regulations on the time to participate in social insurance to enjoy the maternity regime. Therefore, when participating in Health Insurance, when giving birth to a child, the Health Insurance will paid in accordance with current regulations.

In addition

Regarding the level of health insurance enjoyment specified in Clause 15, Article 1 of the Law on Health Insurance Amending and Supplementing 2014, the allowance levels are as follows:

“ 1. Health insurance participants who go for medical examination and treatment according to the provisions of Articles 26, 27, and 28 of this Law shall reimbursed by the health insurance fund within the scope of medical examination and treatment. entitled to the following benefits:

a) 100% of medical examination and treatment expenses for the subjects specified at Points a, d, e, g, h, and i, Clause 3, Article 12 of this Law. Expenses for medical examination and treatment outside the health insurance coverage of the subjects specified at Point a, Clause 3, Article 12 of this Law shall paid from the health insurance funds for medical examination and treatment of the patients. this target group; if this funding source is insufficient, the state budget shall ensure;

b) 100% of medical examination and treatment costs, for cases where the cost of a medical examination and treatment is lower than the level prescribed by the Government and medical examination and treatment at the commune level;

c) 100% of medical examination and treatment expenses when the patient has participated in health insurance for 5 consecutive years or more and the amount of money jointly paid for medical examination and treatment expenses in the year is greater than 6 months’ salary. establishments, except for the case of going to medical examination and treatment at the wrong line;

d) 95% of medical examination and treatment expenses for the subjects specified at Point a, Clause 2, Point k, Clause 3 and Point a, Clause 4, Article 12 of this Law;

đ) 80% of medical examination and treatment expenses for other subjects.

Can I buy health insurance when I’m 8 months pregnant?

How long before birth to buy health insurance in Vietnam to enjoy the insurance scheme? In case people voluntarily want to participate in health insurance to enjoy benefits at birth, they can participate in health insurance in the form of household participation.

Pursuant to the provisions of Clauses 1 and 2, Article 5 of Decree 146/2018/ND-CP on the group of households participating in health insurance:

“ 1. Persons whose names are in the household registration book, except those who fall into the categories specified in Articles 1, 2, 3, 4, and 6 of this Decree.

2. Persons named in temporary residence books, except for those specified in Articles 1, 2, 3, 4, and 6 of this Decree and those who have already participated in health insurance as prescribed in Clause 1 of this Article.”

According to the above regulations, when participating in voluntary household health insurance, the buyer will register at the place where the household registration book or the temporary residence book is available.

And

The time for issuance of health insurance cards is specified in Clause 2, Article 17 of the Law on Health Insurance Amended and Supplemented in 2014 as follows:

“ 2. Within 10 working days from the date of receipt of a complete dossier specified in Clause 1 of this Article, the health insurance organization must transfer the health insurance card to the agency or organization managing the subject or for health insurance participants.”

Thus, after 10 days from the date of receipt of a complete dossier, the health insurance organization must transfer the health insurance card to the agency or organization that will transfer the health insurance participant’s card.

The time when the health insurance card is valid is specified at Point c, Clause 3, Article 15 of the Law on Health Insurance Amended and Supplemented in 2014 as follows:

“The subjects specified in Clauses 4 and 5, Article 12 of this Law who participates in health insurance from the effective date of this Law or for 3 consecutive months or more in a fiscal year, the health insurance card health insurance is valid for use after 30 days from the date of payment of health insurance;”

According to the above regulations, for the first time participating in health insurance after 8 months of pregnancy, the insurance card is valid for use after 30 days from the date of payment of health insurance.

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