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| People receiving medical treatment at the Thai Binh Traditional Medicine Hospital__Photo: VNA |
Passed by the National Assembly in November 2024, the Law Revising a Number of Articles of the Law on Health Insurance (the 2024 Law) aims to increase healthcare benefits for the insured and improve the quality of medical examination and treatment services in health facilities nationwide, thereby contributing to assurance of social security.
The 2024 Law introduces numerous amendments to the 2008 Law on Health Insurance (the 2008 Law) with a focus on key issues mentioned below.
Removal of restriction on “administrative boundaries” in registration for medical examination and treatment
Under the 2024 Law, health insurance participants are allowed to register for health insurance-covered primary healthcare at any primary-level or basic-level healthcare facility within the national health insurance system, regardless of where they reside or work. This marks a significant change as compared to the 2008 Law under which the insured may register for medical care only at health facilities in their places of residence or workplaces.
If a person has registered for health insurance-covered primary healthcare at a basic-level or specialized medical facility but does not receive medical services at such facility because he changes his place of temporary residence or stay, he may receive medical examination and treatment at a basic-level healthcare facility in the new place of residence or stay. Examination and treatment costs will be covered by the health insurance fund.
For a health insurance participant who seeks medical care not at the registered health facility, he may still have medical expenses covered by the health insurance fund at a rate ranging from 40 percent to 100 percent of the benefit level.
In particular, full coverage of medical expenses will be granted for:
(i) Persons taking medical examination and treatment at a basic-level or specialized healthcare facility in case they wish to receive diagnosis for identification and treatment of rare or dangerous diseases or diseases requiring operation or use of high techniques as specified by the Minister of Health;
(ii) Ethnic minority people and members of poor households living in areas with difficult socio-economic conditions or areas with extremely difficult socio-economic conditions, and persons living in island communes or districts and taking inpatient medical examination and treatment at specialized healthcare facilities;
(iii) Persons taking medical examination and treatment at primary healthcare facilities;
(iv) Persons taking inpatient medical examination and treatment at basic-level healthcare facilities; and,
(v) Persons taking medical examination and treatment at basic-level or specialized healthcare facilities that have been designated as district-level healthcare facilities by competent authorities before January 1, 2025.
Expansion of health insurance coverage
As provided in the 2024 Law, the health insurance fund will pay for a wider range of medical examination and treatment covering also telehealth, family medicine, home-based medical care, functional rehabilitation, pregnancy checkups, and childbirth services.
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| Nurse caring for premature babies at the Neonatal Department, Hung Vuong Hospital, Ho Chi Minh City__Photo: VNA |
Persons undergoing inpatient treatment or intensive care and in need of transferal to other healthcare facilities will also have transport costs covered by the health insurance fund. The health insurance fund will also pay charges for use of technical services, drugs, medical equipment, blood, blood preparations, medical gas, supplies, and chemicals for medical examination and treatment.
Notably, the health insurance fund will also cover treatment costs for squint and eye refractive defects for patients aged under 18 years. The use of prostheses, including artificial limbs, prosthetic eyes, dentures, glasses, hearing aids or mobility aids in medical examination and treatment and functional rehabilitation will also be covered by health insurance.
A key update in the 2024 Law is the introduction of payment mechanisms for drugs and medical equipment transferred between healthcare facilities and for para-clinical services. If a health facility lacks essential drugs, medical equipment or para-clinical services and cannot provide appropriate alternatives at the time of providing care to patients, it may use such drugs or equipment from another facility covered by health insurance or transfer the patients or their disease specimens to another qualified health establishment. In this case, the facility will sum up the costs of drugs, medical equipment or para-clinical services and get them paid by social insurance agencies.
Adjustment of health insurance premium levels and payment methods
The 2024 Law provides more flexible methods for payment of health insurance premiums, aiming to meet the diverse needs of various groups of the insured.
It states that employers and employees are responsible for paying health insurance premiums on a monthly basis. Employers will make deductions from salaries of employees for paying premiums to the health insurance fund.
For enterprises, groups of cooperatives, cooperatives, unions of cooperatives and business households engaged in agriculture, forestry, fisheries or salt making that make piece rate pay or contract-based pay, health insurance premiums may be paid on a monthly, quarterly or biannual basis.
For those with health insurance premiums wholly or partly paid by the state budget, the premiums will be paid to the health insurance fund on a quarterly basis.
The deadline for employers to pay health insurance premiums is the last day of the month following the designated month, if the premiums are paid on a monthly basis, or the last day of the month following the premium payment cycle, in case of quarterly or biannual payment.
Regarding premium levels, the 2024 Law sets out specific premium amounts for different groups of health insurance participants, ensuring fairness and conformity with their financial capacity. Health insurance premiums will be determined in percentage of the base salary or monthly income of the insured in accordance with the Law on Social Insurance. The state budget will cover part of health insurance premiums for vulnerable groups.- (VLLF)
