Find out the scope and levels of health insurance benefits in detail | iGuide

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How are the scope and level of health insurance benefits for health insurance participants regulated?

This article provides detailed information on the scope and level of health insurance benefits for participants. It helps readers better understand the benefits they are entitled to as well as the limits of health insurance according to the law. Understanding this information will help health insurance participants manage and optimize their benefits effectively.

1. According to Article 21 of the Law on Health Insurance, health insurance participants are paid the following expenses by the health insurance fund:

+ Medical examination, treatment, rehabilitation, periodic pregnancy check-ups, childbirth;

+ Medical examination to screen and diagnose some diseases early;

+ Transporting patients from district level to higher level for subjects specified in Clauses 9, 13, 14, 17 and 20, Article 12 of the Law on Health Insurance in emergency cases or when inpatient treatment requires technical transfer.

2. According to the provisions of Article 22 of the Law on Health Insurance, when health insurance participants go for medical examination and treatment as prescribed in Articles 26, 27 and 28 of the Law on Health Insurance, the health insurance fund shall pay the cost of medical examination and treatment within the scope of benefits as follows:

+ 100% of medical examination and treatment costs for subjects specified in Clauses 2, 9 and 17, Article 12 of the Law on Health Insurance;

+ 100% of medical examination and treatment costs in cases where the cost for one medical examination and treatment is lower than the level prescribed by the Government and the medical examination and treatment is at the commune level;

+ 95% of medical examination and treatment costs for subjects specified in Clauses 3, 13 and 14, Article 12 of the Law on Health Insurance;

+ 80% of medical examination and treatment costs for other subjects.

In case a person belongs to many health insurance categories, he/she will enjoy health insurance benefits according to the category with the highest benefits.