What to know about health insurance – Term 3

Term 3: What is going to medical examination and treatment for health insurance right on the right hand, benefits?

  1. Examining and treating medical insurance for health insurance at the right level

Article 11, Circular 40/2015 / TT-BYT regulates the cases identified as true medical examination and treatment lines for health insurance:

  • Health insurance card holders who register for initial medical examination and treatment at commune-level medical examination and treatment establishments or district-level clinics or district-level hospitals are entitled to medical examination and treatment with medical insurance at medical stations International commune or polyclinic, or district level hospital in the same province.
  • People with health insurance cards register for initial medical examination and treatment at commune health care facilities, referring to district hospitals, including district hospitals which have been rated I, II and disease. Traditional medicine institute of the province (in case the district hospital does not have a traditional medicine department).
  • People with health insurance cards are district-level hospitals, including hospitals rated No. I, class II and general hospitals, specialized hospitals, specialized hospitals, specialized provincial-level hospitals transferred to provincial-level specialized centers or general hospitals, specialized hospitals, provincial-level specialized hospitals of the same or lower grade.

In case of emergency:

  • Patients are given first aid at any medical examination and treatment facility. The doctor or physician receives the patient to assess, determine the emergency situation and record in the records and medical records.
  • After the emergency treatment period, the patient is transferred to inpatient treatment at the medical examination and treatment facility where the patient has been granted emergency treatment or transferred to another medical examination and treatment facility for continued treatment. according to professional requirements or transferred to the place of initial medical examination and treatment after stable treatment.
  • In case the patient is transferred to the medical examination and treatment line with other diseases, the disease is detected or arises outside the disease and written on the referral paper, the medical examination and treatment facility where the patient receives the examination. diseases and diseases for such diseases within the scope of expertise.
  • In cases where health insurance participants go to work, study or work in mobile or temporary residence for less than 12 months in other localities, they shall be entitled to medical examination and treatment at such medical examination and treatment establishments in such localities. equivalent to the route of the initial medical examination and treatment facility recorded on the health insurance card. In cases where such localities do not have equivalent medical establishments, health insurance participants may select other medical examination and treatment establishments with medical examination and treatment organizations initially providing medical insurance.

         * In addition, the Health Insurance Law stipulates that people with health insurance cards have codes where the living people (denoted by K1, K2, K3) when they go to the health care center on their own will be paid by the health insurance fund for district and hospital hospitals. Inpatient treatment for provincial and central hospitals (without the need for KCB referral), 100% of medical care costs are paid.

        2. Benefits for medical services at the Military Hospital 175

          Health insurance entitlements are based on the second box – the third character from left to right will know how much health insurance is entitled to (Based on Decision 1351 / QD-BHXH dated November 16, 2015 on the code listed above). Health insurance card issued by the General Director of Vietnam Social Insurance. Specifically:

         a) Notation by number 1: To be covered by the health insurance fund 100% of the cost of medical examination and treatment (medical examination and treatment) under the scope of health insurance coverage and not apply the limit on payment of some drugs, chemicals and supplies medical and technical services according to the Minister of Health’s regulations on lists and rates and conditions for payment of technical services; expenses for transporting patients from the district level to the higher level in case of emergency or when being treated as inpatients must transfer technical and professional routes, including beneficiaries with the symbols: CC, TE.

        b) Notation by number 2: To be covered by the health insurance fund 100% of medical examination and treatment expenses covered by the health insurance coverage (there is a limit on the rate of payment of certain drugs, chemicals, medical supplies and technical services according to regulations) Minister of Health; The cost of transporting patients from the district level to the higher level in case of emergency or while inpatient treatment must refer to the technical and professional routes, including beneficiaries with the symbols: CK, CB, KC, HN , DT, DK, XD, BT, TS.

       c) Notation by number 3: To be paid by the health insurance fund 95% of medical examination and treatment costs covered by the health insurance coverage (there is a limit on the rate of payment of certain drugs, chemicals, medical supplies and technical services according to regulations) Minister of Health; 100% of the medical examination and treatment costs at the commune level and the cost of one medical examination is lower than 15% of the base salary, including beneficiaries with the symbols: HT, TC, CN.

       d) Notation by number 4: To be paid by the health insurance fund 80% of medical examination and treatment expenses covered by the health insurance coverage (there is a limit on the rate of payment of certain drugs, chemicals, medical supplies and technical services according to regulations) Minister of Health; 100% of the medical examination and treatment costs at the commune level and the cost for one medical examination is lower than 15% of the base salary, including beneficiaries with symbols such as: DN, HX, CH, NN, TK, HC, Export, TB , NO, CT, XB, TN, CS, XN, MS, HD, TQ, TA, TY, HG, LS, PV, HS, SV, GB, GD.

      đ) Notation by number 5: To be covered by the health insurance fund 100% of medical examination and treatment costs, including medical examination and treatment costs outside the scope of health insurance coverage; Shipping costs, including beneficiaries with the symbol QN, CA, CY.

          III. Benefits of medical examination and treatment left at the Military Hospital 175

  1. For out-patient outpatient clinics: Not entitled to health insurance
  2. For inpatient treatment on the contrary:

          Benefit level = Benefit by card code * 40%

          Specifically according to each type of health insurance card code as follows

          – If the third character of the symbol is equal to 1,2,5: The amount of reward = 100 * 40% = 40%

          – If the third character of the symbol is equal to the number 3: The benefit level = 95 * 40% = 38%

          – If the third character of the symbol card is equal to 4: The level of reward = 80 * 40% = 32%

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