Is medical examination and treatment at private clinics covered by health insurance?

Question:

I have a health insurance card issued by the company, but I do not want to go to the medical facility registered on the health insurance card but want to go to another private clinic. May I ask if I am covered by health insurance? - Mr. Nguyen Hanh Phuc (Ung Hoa, Hanoi)

Hanoi Social Insurance replied:

Because the information you provided is not complete, there is no basis to specifically answer your question. However, there are some regulations on medical examination and treatment at private clinics that are covered by the Health Insurance Fund as follows:

People see a doctor at Dong Da General Hospital (Hanoi).

- In case a private clinic has signed a contract for health insurance: according to the provisions of Clause 4, Article 22 of the Law on Health Insurance, health insurance participants who register for initial health insurance at a commune health station or a polyclinic or a district hospital are entitled to health insurance at a commune health station or a polyclinic or a district hospital in the same province with the same benefits as receiving health insurance in accordance with regulations.

- In case the private clinic does not sign a health insurance contract: according to the provisions of Clause 1, Article 30 of Decree No. 146/2018/ND-CP dated October 17, 2018 of the Government detailing and guiding the implementation of a number of articles of the Law on Health Insurance, in case the patient comes to a district-level health insurance facility or equivalent without a health insurance contract (except in emergency cases), the health insurance fund will directly pay the health insurance costs as follows:

In case of outpatient medical examination and treatment: payment is based on actual costs within the scope of benefits and health insurance benefits according to regulations, but not exceeding 0.15 times the basic salary at the time of medical examination and treatment.

In case of inpatient medical examination and treatment: payment is based on actual costs within the scope of benefits and health insurance benefits according to regulations, but not exceeding 0.5 times the basic salary at the time of medical examination and treatment.

Source: https://kinhtedothi.vn/kham-chua-benh-o-phong-kham-tu-co-duoc-thanh-toan-bhyt-khong.html