SKDS – People who participate in health insurance for 5 consecutive years enjoy many benefits when examining and treating diseases.
Benefits of health insurance participants for 5 consecutive years
According to Point c, Clause 1, Article 22 of the Health Insurance Law, regulations on the benefits of health insurance participants for 5 consecutive years, patients receive Health Insurance (Health insurance) pays 100% for medical examination and treatment costs within the scope of entitlement if the conditions in section 2 are met.
Specifically, Decree 146/2018/ND-CP guides payment of medical examination and treatment costs for patients who have participated in health insurance for 5 consecutive years or more as follows: In case the patient has an amount of money If the same payment at one or more times of medical examination and treatment at the same medical examination and treatment facility is greater than 6 months' base salary, the medical examination and treatment facility will not collect the same payment for more than 6 months. The patient's base salary.
Medical examination and treatment facilities are responsible for providing receipts for the full 06-month base salary so that the patient has a basis to request the social insurance agency to confirm that they do not have to pay together in that year.
The benefits of health insurance participants for the next 5 consecutive years are in cases where the patient has accumulated payments in the fiscal year at different medical examination and treatment facilities or at the same medical examination facility. If the medical treatment is greater than 6 months of base salary, the patient brings documents to the social insurance agency where the health insurance card is issued to pay the co-payment amount greater than 6 months of base salary and receive a certificate confirming that no co-payment is required during the year. there.
In case the patient has a co-payment amount that exceeds 6 months of base salary calculated from January 1, the health insurance fund will pay 100% for medical examination and treatment costs within the patient's benefits from the date of payment. Patient participation points for 5 consecutive years until December 31 of that year.
Conditions for receiving health insurance for 5 consecutive years
According to current regulations, conditions for patients to receive health insurance for 5 consecutive years include:
– Have participated in health insurance for 5 consecutive years or more;
– Have an amount of money to cover medical examination and treatment costs during the year that is greater than 6 months of base salary (corresponding to 8,940,000 VND).
The co-payment amount/co-payment cost is the amount of money that patients with health insurance must pay with the social insurance agency according to the % rate of the health insurance card type.
For example, if a health insurance card has a benefit level of 80%, the patient must co-pay 20% of the total cost within the payment scope of health insurance.
– Go for proper medical examination and treatment.
Application for health insurance benefits for 5 consecutive years
According to Notice 2298/TB-BHXH in 2018, people who are eligible to receive health insurance benefits for 5 consecutive years must submit the following documents to the social insurance agency to have the benefits processed:
– Health insurance card with the words "Time of full 05 consecutive years: from dd/mm/yy" and ID document with photo (copy).
– Hospital bill (original).
Source: Ministry of Health
