“Hello, Lawyer, I bought a strip to test 2 lines, so I went to the hospital for an ultrasound to find out if I was pregnant and how many weeks it has been. However, I have health insurance, but I still have to pay for it. Because the cashier in the hospital said that the pregnancy ultrasound is not covered by the insurance. So, is it true? Is the pregnancy ultrasound in Vietnam covered by health insurance? I would like to sincerely thank Lawyer.”.
Whether the pregnancy ultrasound is covered by insurance is one of the issues that pregnant women are especially concerned about. Social insurance for childbirth plays a very important role, but many pregnant women are confused and do not fully understand the benefits that they are entitled to? Is pregnancy ultrasound covered by health insurance? To better understand this, today, LSX Lawfirm will give you an article about “Is pregnancy ultrasound in Vietnam covered by health insurance?”, as follows:
Legal grounds
Health Insurance Law 2008
Law on Health Insurance Amendment 2014
What is health insurance?
Health insurance is 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 of medical examination and treatment as well as cost of buying medical treatment. sick.
Health insurance is made not for profit; implemented 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 to help people get the best health care, while private health agencies will be encouraged to participate without coercion.
Medical insurance serves; to protect the health care needs of the people. When sick; diseases; when incidents occur; or Unintentional accidents health insurance provides effective support to help pay part 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.
Is pregnancy ultrasound covered by health insurance?
Pursuant to Article 21 of the Law on Health Insurance 2008 (amended by Clause 14, Article 1 of the Law on Health Insurance Amendment 2014), the scope of benefits of health insurance participants is as follows:
The health insurance participants covered by the health insurance fund for the following expenses:
+ Medical examination; Healing; Rehabilitation; periodical antenatal care; birth;
+ Transporting patients from the district level to a higher level for the subjects specified at Point a; d; e; g; h and I, Clause 3, Article 12 of this Law, in case of emergency or during inpatient treatment, must referred to a professional and technical hospital.
– The Minister of Health presides over; coordinates with ministries; The relevant sector promulgates the list and rate; payment conditions for drugs; chemistry; medical supplies; medical-technical services within the scope of benefits of the participants of health insurance.
According to the above provisions; Periodic antenatal check-ups are eligible for health insurance.
As for whether a pregnancy ultrasound covered by insurance, you need to see if this service is on the list of covered by health insurance. Since you did not say specifically what the name of the ultrasound service you use is, you need to review the documents to determine exactly. Afterward; you check with the appendix of Circular 39/2018/TT-BYT to know if you entitled to health insurance or not.
How much is the health insurance coverage?
Pursuant to Clause 15, Article 1 of the 2014 Amended Health Insurance Law, the benefit rates are as follows:
+ Firstly, 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 scope of health insurance entitlement; 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 subjects; specified in Point a, Clause 3, Article 12 of this Law. this target group; if this funding source is insufficient, the state budget shall ensure;
+ Secondly, 100% of medical examination and treatment expenses in case the cost for one medical examination and treatment is lower than the level prescribed by the Government and medical examination and treatment at the commune level;
+ Thirdly, 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’ basic salary. the facility, except for the case of self-diagnosis and medical treatment at the wrong line;
+ Fourthly, 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;
+ Finally, 80% of medical examination and treatment costs for other subjects.
– In case a person belongs to many subjects participating in health insurance, he/she entitled to health insurance benefits according to the subject with the highest benefits.
Benefits when participating in health insurance if the mother participates in health insurance
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 covered by health insurance; no limit on the payment rate applies.
– No. 2: 100% of the cost of childbirth 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 transferred to a professional and technical level.
– Number 3: 95% 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 but the total cost is less than 15% of the basic monthly salary.
– Number 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, and transportation costs.
Giving birth at an off-line medical facility
Will paid according to the prescribed level of benefits 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 when giving birth
Are illegitimate births covered by health insurance?
When participating in health insurance, participants required to register the place of initial medical examination and treatment. Depending on the subject, the initial medical examination and treatment may be at the commune level, district level, provincial level, or central level.
Giving birth to an unborn child means a woman giving birth; at a medical facility that is not a primary care facility. Cases of childbirth that not identified as medical examination and treatment routes covered by health insurance; prescribed in Article 11, Circular 40/2015/TT-BYT, it considered giving birth to an illegitimate child.
Pursuant to the provisions of Clause 15, Article 1 of the Law on Health Insurance, which amended and supplemented in 2014, stipulates the level of health insurance benefits in cases of medical examination and treatment covered by health insurance. Accordingly, in case the holders of the health insurance card go to the wrong medical examination and treatment by themselves, they will paid by the health insurance fund at the rate specified in Clause 1, Article 22 of the Law on Health Insurance.
Consulting service of LSX Lawfirm
Above is LSX Lawfirm’s advice on the content of the problem “Is pregnancy ultrasound in Vietnam covered by health insurance?”. And all the above knowledge to use in work and life. If you have any questions and need more advice and help, please contact the hotline for the reception. Lawyer X is a place that provides reputable and fast business services at reasonable prices. Customers will be extremely satisfied when using our services.
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Related questions
To apply for health insurance, participants need to prepare the following documents: Household book (original). Photocopy of the health insurance card of the people in the household registration to determine the deduction of the premium rate Declaration of participation in health insurance (Form TK1-TS).
Step 1: Submit your application for health insurance to the Social Insurance Agency of the commune/ward/town where you live or the insurance purchasing agent
And Step 2: Pay the insurance premium
Step 3: Receive an appointment to pick up the insurance card.
By the time on the appointment letter, you go to the insurance agency to get the card. Within 10 working days from the date the health insurance agency receives the valid documents, you will receive your health insurance card.
In case of emergency, the health insurance participants are entitled to a medical examination; medical treatment at any medical examination facility; any medical treatment and must present a health insurance card as prescribed. In case of referral for treatment, together with the transfer record of the medical facility then.
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