Guidelines for 5-year continuous health insurance in 2024
Currently, according to Article 22 of the Health Insurance Law on conditions for enjoying 5-year continuous health insurance, the following conditions are stipulated:
Health insurance participants are reimbursed for medical examination and treatment costs according to regulations in Articles 26, 27, and 28 of the Health Insurance Law. The reimbursement rates are as follows:
100% of medical examination and treatment costs when the patient has participated in health insurance for 5 consecutive years and has the same amount of payment for medical examination and treatment costs in a year exceeding 6 months of the base salary, except for cases where the patient seeks medical examination and treatment at a non-designated facility.
This content is guided by Decree 146/2018/ND-CP as follows:
– Have participated in health insurance for 05 consecutive years.
– Have the same amount of payment for medical examination and treatment costs in a year exceeding 6 months of the base salary.
The same amount of payment/Co-payment is the amount that a health insurance recipient must co-pay with the Social Insurance Agency based on the rate% of the health insurance card type.
For example: If the health insurance card has a 80% rate, the patient must co-pay 20% of the total medical examination and treatment costs covered by health insurance.
– Seek medical examination and treatment at a designated facility.
Conditions for enjoying 5-year continuous health insurance from January 1, 2024, to June 30, 2024
From January 1, 2024, to June 30, 2024, the base salary is VND 1,800,000 per month. Health insurance participants who have participated for 5 consecutive years or more must have the same amount of payment for medical examination and treatment costs in a year exceeding VND 10,800,000 (6 months of the base salary) to enjoy the benefits of 5-year continuous health insurance.
In addition, health insurance participants who seek medical examination and treatment at a designated health facility and the costs for one visit are below VND 270,000 will be fully reimbursed by health insurance, and the patient will be exempt from medical examination and treatment fees.
How will the conditions for enjoying 5-year continuous health insurance change from July 1, 2024?
It is expected that from July 1, 2024, public servant salary reforms, including the abolition of base salary, will be implemented.
As mentioned, the current conditions for enjoying 5-year continuous health insurance are based on the base salary. If the base salary is abolished from July 01, 2024, what will be the basis for the conditions for enjoying 5-year continuous health insurance?
Regarding this issue, Clause 13 of Article 1 of the Draft Law Amending the Health Insurance Law states:
“13. Amend and supplement Article 22 as follows:
1. Health insurance participants are reimbursed for medical examination and treatment costs according to regulations in Articles 26, 27, and 28 of this Law. The reimbursement rates are as follows:
… d) 100% of medical examination and treatment costs when the patient has participated in health insurance for 5 consecutive years or more and has the same amount of payment for medical examination and treatment costs in a year exceeding the Government’s prescribed amount, except for cases where the patient seeks medical examination and treatment at a non-designated facility;…”
Thus, according to the proposal above, the same amount of payment for medical examination and treatment costs covered by health insurance in a year will no longer be based on the base salary but will be based on the amount prescribed by the Government.
It can be seen that the reform of public servant salaries also has an impact on the conditions for enjoying 5-year continuous health insurance.
