What is 5 years continuous health insurance (BHYT)?
Currently, the health insurance card will record the information on the time of participating in continuous health insurance for the subjects who have to contribute to medical examination and treatment costs.
According to Article 12 of Decree 146/2018/ND-CP, continuous participation in health insurance is the period of use recorded on the health insurance card next time after the previous time, and the maximum interruption period is not more than 3 months.
Specifically, according to Decision 1666/QD-BHXH dated December 3, 2020, the time for 5 consecutive years of participation in health insurance is printed from … / … / … participating in health insurance for 5 consecutive years according to current regulations, specifically:
– People who have participated in health insurance for at least 5 years until January 1, 2015, start from January 1, 2015.
– From January 1, 2015 onwards, people who participate in health insurance that is not enough or start to meet the requirements of 5 consecutive years will start from the first day of the sixth year.
Therefore, 5 years of continuous health insurance refers to when a person has a period of participating in health insurance for 5 consecutive years or more, in case of interruption, the maximum period is not more than 3 months.
Benefits of 5 years continuous health insurance
Health insurance is of special significance in reducing the financial burden on patients. The benefits of 5 years of continuous health insurance are regulated in point c, clause 1 Article 22 of Health Insurance Law No. 25/2008/QH12, amended by Law No. 46/2014/QH13 as follows:
1. Insured persons when going for medical examination and treatment as prescribed in Articles 26, 27, and 28 of this Law will have the health insurance fund pay the costs of medical examination and treatment within the scope of benefits with the following benefits:
…
c) 100% of medical examination and treatment costs when the insured person has participated in health insurance for 5 consecutive years or more and has the same amount of healthcare expenses in a year greater than 6 times the basic salary, except for cases of self-examination and treatment not in the right place;
Accordingly, the benefits of 5 years of continuous health insurance are 100% of medical examination and treatment costs within the scope of benefits.
In order to be paid 100% of medical examination and treatment costs according to the benefits of 5 years of continuous health insurance, patients must meet the following conditions:
(1) Participate in health insurance for 5 consecutive years or more:
Be recorded as meeting the condition right on the health insurance card. That is, the health insurance card has the line: “Time of reaching 05 consecutive years: From … / … / …”.
Note: If there is an interruption time, it is allowed to be interrupted for a maximum of 03 months.
(2) Have the same amount of healthcare expenses greater than 6 times the basic salary within the year
The amount of money jointly paid means the amount of money that the patient must jointly pay with the Social Insurance Agency at the percentage rate enjoyed on the health insurance card.
Currently, when applying the basic salary of VND 1.8 million per month, the amount of money jointly paid must be greater than 6 x VND 1.8 million = VND 10.8 million.
(3) Have medical examination and treatment in the right place.
Based on Announcement 2298/TB-BHXH dated November 14, 2018, the documents for claiming benefits of 5 consecutive years of health insurance include:
– Health insurance card;
– Personal identification documents with photos (copies);
– Invoices, payment receipts for hospital fees (originals).
After having enough of these documents, patients submit their applications to the Social Insurance Agency where they participate in health insurance for resolution.
With this regulation, when going for medical examination and treatment, patients should keep invoices and other documents carefully to have a basis for the Social Insurance Agency to settle the guarantee regime for their benefits.
Benefits of people participating in 5 years of continuous health insurance in 2024
According to point c, clause 1 of Article 22 of the Health Insurance Law:
Patients are paid 100% of medical examination and treatment costs within the scope of benefits if they meet the conditions at item 2.
Specifically, according to Decree 146/2018/ND-CP guiding the payment of medical examination and treatment costs for patients with 5 years of continuous health insurance, as follows:
– In case the patient has the same amount of joint payment in a single or multiple medical examination and treatment at the same medical facility that is greater than 6 months of the basic salary, that medical facility will not charge more than 6 months of the basic salary of the patient.
The medical facility is responsible for providing an invoice for the amount of joint payment of 6 months the basic salary so that patients have a basis to request the Social Insurance Agency to confirm that they are not required to jointly pay in that year;
– In case the patient has the cumulative amount of joint payment in one fiscal year at different medical facilities or at the same medical facility that is greater than 6 months of the basic salary, the patient brings documents to the Social Insurance Agency that issued the health insurance card to settle the amount of joint payment greater than 6 months of the basic salary and receive a certificate confirming that they are not required to jointly pay in that year;
– In case the amount of joint payment by the patient exceeds 6 months of the basic salary calculated from January 1st, the health insurance fund will pay 100% of medical examination and treatment costs within the scope of the patient’s benefits from the time the patient has participated for 5 consecutive years until the end of December of that year.
