Regulations on health insurance plan for 5 consecutive years in Vietnam – Laws and insurance products

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When discussing the advantages of continued participation in the social insurance scheme as well as the disadvantages of abolishing flat-rate social insurance, one often hears about the advantages of the 5-year health insurance scheme. However, people do not get clear explanation about the information about this benefit, which makes them hesitant and confused about the social insurance scheme. So, what is the regulation on health insurance plan for 5 consecutive years in Vietnam?

To enjoy the benefits of the 5-year health insurance plan, it is obvious that the insured person will have to pay health insurance contributions for at least 5 years.

However, for the continuous part, it is not a word-for-word condition. If the members of the health insurance have a break not exceeding 3 months, they will still be able to benefit from the benefits of the health insurance plan for 5 years.

That is, if for some reason an employee participating in health insurance has to stop paying social insurance, primarily by quitting or changing jobs from one company to another, but that the duration of the temporary stoppage does not exceed 3 months, then they can continue to pay social insurance until they reach 5 years old to benefit from the health insurance plan for 5 years in a row.

This is clearly stated in article 12 of decree 146/2018/ND-CP. People who subscribe to health insurance will be able to see whether or not they meet the conditions to join the scheme by mentioning “Period of 5 consecutive years: From …./…./…..”. printed at the end of the health insurance card (clause 1, article 3 of decision 1313/QD-BHXH)

Benefits in case of eligibility for 5 consecutive years of health insurance

According to clause 15, article 1 of the law on health insurance, amended and supplemented in 2014, patients will be reimbursed 100% of the costs of medical examination and treatment by the health insurance fund within the framework of their rights if they have participated in health insurance for 5 consecutive years or more and have a contribution to the cost of medical examination and treatment in the year exceeding 6 months of basic salary, except in the case of self-diagnosis and offline medical treatment.

This provision means that for cases where the employee goes to the medical examination center of the prescribed health insurance institution (online medical insurance) and uses the services of the prescribed health insurance package, if the total cost that the employee must pay is more than 6 months of basic salary, then he will only have to pay an amount equal to exactly 6 months of basic salary. The balance will be covered 100% by health insurance.

Currently, the basic salary is 1,490,000 VND/month (in accordance with Article 3 of Decree 38/2019/ND-CP). The basic salary for 6 months will be: 1,490,000 x 6 = 8,940,000 VND.

The amount of the co-payment for medical examination is here the amount that the employee participating in the health insurance must pay. Employees who still contribute to social insurance will be covered up to 80% of hospitalization costs, which means that the amount of the moderating ticket will be 20% of hospitalization costs.

Accordingly, the amount of 20% that the employee must pay must exceed 6 months of basic salary of 8,940,000 VND to be eligible for the health insurance scheme for 5 consecutive years. In other words, if the total hospitalization costs while using online medicines and services exceeds 44,700,000 VND, the employee will only have to pay 8,940,000 VND for the whole year without having to worry about excess amounts.

This plan is particularly advantageous for employees who unfortunately have to pay significant medical expenses with hospitalization costs that can reach tens of millions of VND per year. In other words, no matter what the patient’s illness is or how long he stays in the hospital, if he receives medical care online, it will only cost him nearly 9 million per year, and he will receive the best care and support overall. health insurance system.

Note on the 5-year continuous health insurance policy

In the event that a patient receives a medical examination and treatment in one or more establishments and the hospitalization costs accumulated during the year exceed 6 months of basic salary, the patient must still pay the full hospitalization costs at the medical examination and treatment facility. However, the patient will be reimbursed by the social insurance agency for hospitalization costs over 6 months’ basic salary if he can bring enough related documents to the social insurance agency.

This means that at the beginning, the patient and his family will still have to pay the medical expenses out of pocket, but at the end of the year, they will have to prepare a document to be submitted to the social insurance agency where the participant the insurance participates in order to receive the benefits and receive the difference to be paid.

According to Notice 2298/TB-BHXH of November 14, 2018, participants who receive the benefits of the health insurance plan for 5 consecutive years will be required to prepare a set of documents including a health insurance card; Photo ID (copy); Invoices for payment of hospitalization costs (original).

The content of this article is intended to provide a general guide on the subject. Specialist advice should be sought regarding your particular situation.

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