The Law amending and supplementing a number of articles of the Law on Health Insurance (HI) will take effect from July 1. Ms. Tran Thi Trang, Director of the Department of Health Insurance ( Ministry of Health ), said that compared to the old Health Insurance Law, this amended Law has many new points, and the rights of health insurance participants are expanded.
The highlight is the elimination of "administrative boundaries" in medical examination and treatment, effective from July 1. Health insurance participants enjoy 100% insurance coverage when examining and treating at all initial registration facilities nationwide. Some rare and serious cases are taken directly to specialized medical examination and treatment facilities.
Specifically, the Law allows some cases of medical examination and treatment outside the designated area to still enjoy 100% of the health insurance benefits. Currently, the health insurance benefits for patients are 80-95% and 100% depending on the benefits specified on the health insurance card of the participant.
The first group that will enjoy 100% of the health insurance benefits are those who are examined and treated at basic or specialized facilities and are diagnosed to treat certain serious diseases, rare diseases, requiring surgery or high technology according to regulations of the Ministry of Health . This list of diseases has been issued by the Ministry of Health, including 62 types of serious and rare diseases, such as infectious diseases, cancers, metabolic disorders, lysosomal storage disorders, neurological diseases, cardiovascular diseases, lung diseases, skin diseases, congenital malformations and special conditions such as anti-tuberculosis drug resistance, war sequelae, or organ transplant conditions.
People with these diseases, when diagnosed at the initial level, can go directly to a specialized facility for examination and treatment without a referral letter, and still enjoy 100% of health insurance benefits according to regulations.
If you go to a specialist for a check-up and are diagnosed with the above diseases, health insurance benefits will also be applied from the first visit.
The second group is those who receive medical examination and treatment at primary level facilities and inpatient treatment at basic level. Accordingly, health insurance participants are entitled to 100% of the insurance coverage in the following situations: Medical examination and treatment at the initial registered facility nationwide; inpatient treatment at a facility with basic health insurance nationwide; medical examination and treatment at any facility with basic health insurance or specialized health insurance before January 1, 2025 that has been identified by competent authorities as district level.
In addition, ethnic minorities and poor households living in economically and socially disadvantaged areas, and people living in island communes and island districts, when receiving inpatient treatment at specialized facilities, are also entitled to 100% of health insurance benefits.
Currently, the whole country has more than 95.5 million people participating in health insurance, reaching a health insurance coverage rate of 94.29%.
HA (according to VnE)Source: https://baohaiduong.vn/tu-1-7-kham-chua-benh-trai-tuyen-duoc-huong-100-bao-hiem-y-te-413778.html
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