New regulations on health insurance: People benefit

From December 1, 2018, Decree 146/2018/ND-CP officially takes effect and replaces the Government's Decree detailing and guiding the implementation implementing a number of articles of the Law on Health Insurance and the Joint Circular of the Ministry of Health and Finance guiding the implementation of health insurance.

According to this Decree, the rights of medical examination and treatment (KCB) BHYT Specifically guided: In case the patient is diagnosed, prescribed treatment by a higher level medical facility, and transferred back for management, monitoring and treatment, Dispensing drugs at commune health care facilities are entitled to benefits as prescribed.

Additional regulations to the health insurance fund to pay in case the medical facility sends patient samples or transfers the patient to another facility for testing and diagnostic imaging services photo.

In case a person with a health insurance card is undergoing inpatient treatment but his health insurance card has expired, he/she will be entitled to payment of medical expenses within the scope of entitlement and benefit level until he/she is discharged. hospital but not exceeding 15 days from the expiry date of the card.

The social insurance agency is responsible for granting or renewing cards for patients while they are being treated at medical facilities.

The representative of the Ministry of Health also said: In case the person with the health insurance card goes to the wrong medical center by themselves, then they will be transferred to the medical facility by the receiving facility. otherwise, the health insurance fund will pay medical expenses according to the wrong route, except for the following cases: Emergency; are undergoing inpatient treatment and are diagnosed with other diseases outside the scope of expertise of the medical facility; The condition of the disease is developing beyond the professional capacity of the medical facility.

The Decree also adjusts the benefit level when going to medical facilities at a facility that does not sign a contract for medical care, health insurance, or medical treatment that is not in accordance with the procedure, the payment will be in proportion to the base salary. applies to each hospital line where the patient goes to medical care, instead of specifying a specific amount like now.

Accepting people's opinions on forcing all household members to participate in health insurance at the same time to be deducted, Decree 146 loosens when it is not compulsory for all household members to participate in health insurance at the same time, but deduct the premium when the second member joins in the financial year.

This regulation is convenient for people participating in health insurance by household, contributing to expanding the beneficiaries of health insurance.

On determining the duration of continuous participation in health insurance for participants of health insurance, Decree supplementing and adjusting some cases defined as continuous participation in health insurance, include: Persons who are sent by competent agencies to work, study, work or follow the regime of wives, husbands or natural children, lawfully adopted children under 18 years old accompanying their father or mother to work at the agency for a term of office. overseas Vietnamese agencies; employees who go to work abroad have already participated in health insurance before leaving, if they participate in health insurance when they return home within 30 days from the date of entry; subjects in the armed forces and ciphers upon retirement, demobilization, change of profession or job termination, if the period of study and work in the People's Army, People's Public Security and cipher organizations has not yet participated in health insurance. .

New regulation on prices of medical services covered by health insurance payment from 15/1/2019

In order to ensure fairness in the implementation of social preferential policies, not to miss the beneficiaries of health insurance, contributing to the rapid increase in the rate of health insurance coverage, This Decree adds the subjects participating in health insurance paid by the State budget, including civilians participating in the resistance wars against France, the US, the war to protect the Fatherland and performing international missions; youth volunteers in the period 1965-1975; People's artisans, elite artisans conferred by the State have an average monthly income lower than the base salary.

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The new point of the Decree stipulates not to allocate funds to establishments with initial medical registration based on the current health insurance revenues of cardholders registered here .

This will ensure the shareability of the health insurance fund, consistent with the availability of medical services, and at the same time do not put pressure on medical facilities that may affect the rights of health insurance. benefit of the patient.

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Apply the calculation of the total payment of medical expenses of the units based on the total medical expenses of the previous year calculated for the cost of drugs, medical supplies, blood , blood products, medical examination and treatment services (taking into account the adjustment coefficient on drug prices and medical supplies), plus expenses incurred during the year due to changes in the scope of expertise of the unit, changes in medical treatment subjects, changes in disease patterns,...