Can Health Insurance Claims Be Reimbursed for Medical Check-ups on Holidays or Weekends?

Mr. H.H.M, a resident of Ho Chi Minh City, shared that due to his work schedule, he can only visit healthcare facilities on weekends. However, some hospitals do not provide health insurance (BHYT) services on Saturdays and Sundays. After reviewing the regulations, he learned that healthcare facilities have the autonomy to decide whether to offer BHYT services on holidays and weekends. Mr. M questioned whether this regulation remains appropriate in the current context and suggested a review.

Vietnam Social Security (BHXH Vietnam) addressed Mr. M’s concern. According to Clause 10, Article 27 of Decree No. 146/2018/NĐ-CP dated October 17, 2018, issued by the Government, which details and guides the implementation of certain provisions of the Law on Health Insurance, the following regulations apply:

Reimbursement of healthcare costs for facilities providing BHYT services on holidays and weekends is as follows:

Individuals with BHYT cards receiving healthcare services will have their costs covered by the BHYT fund within the scope and level of benefits they are entitled to.

Healthcare facilities are responsible for ensuring adequate staffing and professional conditions, transparently disclosing any additional costs patients must bear beyond the scope and level of BHYT benefits, and informing patients in advance. They must also notify the social security agency in writing to supplement the healthcare service contract before providing services on holidays and weekends, serving as the basis for reimbursement.

Therefore, healthcare facilities, based on their service capacity and the actual demand for healthcare on holidays and weekends from BHYT participants, will sign a supplementary agreement with the social security agency to provide BHYT services during these times.