What is continuous 5-year health insurance?
Currently, the health insurance card will record the information on the time of continuous 5-year participation in health insurance for people who must share the cost of medical examination and treatment.
According to Article 12 of Decree No. 146/2018 / NĐ-CP, continuous health insurance participation time is the time of use recorded on the health insurance card between subsequent uses; in case of interruption, it does not exceed 3 months.
Specifically, according to Decision No. 1666 / QD-BHXH dated December 3, 2020, the time to complete 5 years of continuous health insurance from … / … / … is completed according to the current regulations, specifically:
– People who have completed 5 continuous years of health insurance participation as of 1/1/2015, it will be completed from 1/1/2015.
– From January 1, 2015 onwards, those who participate in health insurance but have not yet completed 5 continuous years, it will be completed from the first day of the 6th year.
Thus, continuous 5-year health insurance refers to a person who has participated in health insurance for 5 continuous years or more, in case of interruption, it does not exceed 3 months.
Benefits of continuous 5-year health insurance
Health insurance has special significance in reducing the financial burden for patients. The level of benefits for continuous 5-year health insurance is determined under clause 1 of Article 22 of the Health Insurance Law No. 25/2008 / QH12, amended by Law No. 46/2014 / QH13 as follows:
1. People participating in health insurance when going for medical examination and treatment according to the provisions in Articles 26, 27 and 28 of this Law, the health insurance fund will pay for the medical examination and treatment costs within the eligible range with the following benefits:
…
c) 100% of the medical examination and treatment costs when the patient has participated in health insurance for 5 continuous years or more and the amount paid jointly with the medical examination and treatment costs in a year exceeds 6 times the basic salary, except for cases where the patient goes for medical examination and treatment outside the network;
Accordingly, the benefit level of continuous 5-year health insurance is 100% of the eligible medical examination and treatment costs.
To be eligible for the 100% payment of medical examination and treatment costs according to the benefit level of continuous 5-year health insurance, patients must meet the following conditions:
(1) Participate in health insurance for 5 continuous years or more:
The moment of eligibility will be recorded on the health insurance card. That is, the health insurance card will have the line: “The moment of 05 continuous years: From … / … / …”.
Note: If there is an interruption, it must not exceed 03 months.
(2) The joint payment of medical examination and treatment costs in a year exceeds 6 times the basic salary
The joint payment amount is understood as the amount that patients have to pay jointly with the social insurance agency at the % rate enjoyed on the health insurance card.
Currently, with a basic salary of 1.8 million VND/month, the joint payment amount must be greater than 6 x 1.8 million VND = 10.8 million VND.
(3) Receive medical examination and treatment within the network.
Based on Announcement No. 2298 / TB-BHXH dated November 14, 2018, the documents for claiming continuous 5-year health insurance benefits include:
– Health insurance card;
– Personal identification document with photo (copy);
– Invoices, payment vouchers (original copies).
After having all these documents, patients submit the documents to the social insurance agency where they participate in health insurance for processing.
With this regulation, when going for medical examination and treatment, patients should carefully keep the invoices and vouchers as evidence for the social insurance agency to resolve their rights and benefits.
Rights of people participating in continuous 5-year health insurance in 2024
According to clause 1, Article 22 of the Health Insurance Law:
Patients will be reimbursed 100% of the medical examination and treatment costs within the eligible range if they meet the conditions in section 2.
Specifically, according to Decree No. 146/2018 / NĐ-CP guiding the payment of medical examination and treatment costs for patients who have participated in health insurance for 5 continuous years or more as follows:
– In case the patient has already paid jointly for one time or multiple times for medical examination and treatment at the same facility, and the total payment amount exceeds 6 times the basic salary, that facility will not charge the jointly payment amount greater than 6 times the basic salary of the patient.
The facility is responsible for providing an invoice for the payment amount jointly paid for 6 times the basic salary so that patients have the basis for requesting the social insurance agency to confirm that they do not have to jointly pay in that year;
– In case the patient has a cumulative jointly payment amount within the fiscal year at different healthcare facilities or at the same healthcare facility, greater than 6 times the basic salary, the patient brings the supporting documents to the social insurance agency that issued the health insurance card to receive payment for the jointly payment amount greater than 06 times the basic salary and receive a certificate confirming that they do not have to jointly pay in that year;
– In case the patient has a payment amount greater than 6 times the basic salary calculated from January 1, the health insurance fund will pay 100% of the medical examination and treatment costs within the patient’s eligible benefits from the time the patient has participated continuously for 5 years until the end of December of that year.
