Question: I am a person with a mild disability who buys household health insurance. May I ask, according to current legal regulations, when I go to a medical examination and treatment at a provincial hospital by myself, am I still entitled to 100% of the treatment cost? Thank you!
Law Department - ACDC advises:
Clauses 3 and 5, Article 22 of the Law on Health Insurance 2008 (amended and supplemented in 2014) stipulate the level of health insurance benefits as follows:
“3. For a health insurance card holder who receives medical care at a hospital of an improper level, the health insurance benefits prescribed in Clause 1 of this Article shall be paid by the health insurance fund at the following levels, except for the case prescribed in Clause 5 of this Article:
…b) At provincial-level hospitals, 60% of the costs for inpatient treatment from the effective date of this Law to December 31, 2020; and 100% of the costs for inpatient treatment from January 1, 2021, nationwide;
…5. When receiving medical care at hospitals of improper levels, the insured being ethnic minority people and members of poor households who are living in areas with difficult or exceptionally difficult socio-economic conditions; and the insured who are living in island communes or districts may be paid by the health insurance fund for medical care costs at district-level hospitals, and for inpatient treatment costs at provincial-level hospitals at the benefit levels prescribed in Clause 1 of this Article.”
Based on the foregoing:
Case 1: If you receive medical care at hospitals of improper levels and inpatient treatment, you are paid 100% of inpatient treatment expenses by the health insurance fund according to your benefit level when you receive medical care at a hospital of a proper level.
In this case, you participate in household health insurance, and you are entitled to 80% of medical examination and treatment expenses according to Point dd, Clause 1, Article 22 of the Law on Health Insurance 2008 (amended and supplemented). year 2014). Therefore, when receiving medical care at provincial-level hospitals, inpatient treatment will be entitled to 80% of the costs.
Case 2: If you receive medical care at hospitals of improper levels and outpatient treatment (not hospitalized), you are not covered by the Health Insurance Fund for this medical care costs.
