Tiếng Việt
If one has contributed to health insurance (BHYT) for 5 consecutive years, they all have the opportunity to enjoy 100% payment coverage. So, what is the correct understanding of the BHYT 5-year continuous scheme?
1. What is the BHYT 5-year continuous scheme?
It refers to a situation where the participant has consistently paid into BHYT for 5 years, with a maximum allowable interruption of 3 months.
The moment someone achieves 5 consecutive years is directly recorded on their health insurance card. According to Decision No. 1666/QĐ-BHXH dated 2020, the recognition of the 5-year continuous period is stipulated as follows:
– For those who have completed 5 continuous years of BHYT participation by January 1, 2015, the date is printed from January 1, 2015.
– From January 1, 2015 onwards, for those who have not yet completed or have just completed 5 consecutive years, the date is printed from the first day of the sixth year.
2. Conditions for enjoying the BHYT 5-year continuous scheme:
According to Article c, Clause 1 of the Health Insurance Law of 2008, as amended in 2014, beneficiaries must meet the following conditions:
1 – Have participated in BHYT for a continuous 5-year period, as recorded on the health insurance card.
2 – Having the same amount of co-payment for medical expenses within the year exceeding 6 months of the base salary.
The co-payment amount is understood as the sum that patients must jointly contribute with the Social Insurance Agency at the percentage rate specified on the Health Insurance Card.
3 – Seeking medical treatment at the correct facility.
According to Article 6 of Circular No. 30/2020/TT-BYT, seeking medical treatment at the correct facility includes the following cases:
+ Insured individuals visit the medical facility listed on their Health Insurance Card.
+ Registering for initial medical treatment at the commune or district level and seeking treatment at facilities within the same level in the same province.
+ Emergency medical treatment.
+ Insured individuals are referred to another facility…
3. Benefits of continuous 5-year Health Insurance:
When meeting the aforementioned conditions, participants of the Health Insurance Scheme (BHYT) will enjoy 100% coverage of medical expenses within the scope of the BHYT fund.
Specifically, Article 3 of Decree No. 146/2018/NĐ-CP stipulates the following:
* Patients who co-pay for medical treatments, either in a single instance or multiple instances at the same medical facility, exceeding 6 months of the base salary:
– Are not required to pay co-payment amounts exceeding 6 months of the base salary.
– Are issued invoices with co-payment amounts equivalent to 6 months of the base salary, ensuring they are not required to co-pay for medical expenses within that year.
* Patients who accumulate co-payment amounts for medical treatments across different medical facilities within a fiscal year, or at the same facility, exceeding 6 months of the base salary:
– Must still settle the entire co-payment amount for the medical facility.
– Are reimbursed directly by the Social Insurance Agency for co-payment amounts exceeding 6 months of the base salary.
Note: If a patient’s co-payment amount exceeds 6 months of the base salary, calculated from January 1st, the BHYT fund will only cover 100% of medical expenses within the benefit entitlement period, starting from the date the individual completed 5 consecutive years of participation until December 31st of that year.
4. Procedures for Enjoying Continuous 5-Year Health Insurance
In accordance with Clause 3 of Article 27 of Decree No. 146/2018/NĐ-CP and Circular No. 2298/TB-BHXH, to fully enjoy the benefits of participating in 5 consecutive years of Health Insurance, patients need to follow these steps:
Case 1: When the co-payment for medical treatments, either in a single instance or multiple instances at the same medical facility, exceeds 6 months of the base salary.
Simply follow the correct procedures for medical treatment without having to pay the co-payment amount exceeding 6 months of the base salary.
Case 2: When the accumulated co-payment amount for medical treatments across different medical facilities within a fiscal year, or at the same facility, exceeds 6 months of the base salary.
– Visit the Social Insurance Agency where the Health Insurance Card was issued to request reimbursement for the co-payment amount exceeding 6 months of the base salary.
– Bring the following documents:
+ Health Insurance Card.
+ Copy of personal identification with photo.
+ Original invoice for medical expenses.
5. Procedures for Replacing Continuous 5-Year Health Insurance Card in Case of Errors
Despite the direct printing of the 5-year continuous participation period on the Health Insurance Card, many individuals encounter errors during the card replacement process.
In Circular No. 238/BHXH-CNTT issued in 2018, the Social Insurance Agency of Vietnam instructed provincial branches as follows:
Replace Health Insurance Cards on the same working day when the managing unit or Health Insurance participant applies for a card replacement due to errors in the participation period.
Therefore, if there are errors regarding the completion of 5 consecutive years of participation on the Health Insurance Card, individuals only need to visit the Social Insurance Agency where the card was issued to request a replacement.
Processing time: Within the same working day.
This information about continuous 5-year Health Insurance participation is essential for everyone to fully enjoy their benefits.
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Source: Vietnamese Law
