Medical benefits while waiting for health insurance card | iGuide

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What benefits are available for medical examination and treatment while waiting for a health insurance card?

This article provides detailed information about medical benefits while waiting for a health insurance card. It helps readers better understand the benefits they can enjoy during this period, as well as the necessary procedures to ensure that their health benefits are not interrupted. Knowing this information will help health insurance participants feel more secure during the waiting period.

Clause 3, Article 8 of Circular 41/2014/TTLT-BYT-BTC dated November 24, 2014 on procedures for medical examination and treatment under health insurance:

“3. Health insurance participants waiting for re-issuance or exchange of health insurance cards when going to see a doctor or receive medical treatment must present an appointment paper for re-issuance or exchange of health insurance cards issued by the Social Insurance organization that receives the application for re-issuance or exchange of cards and a type of document proving the person's identity.”

Thus, in case the patient is waiting for a reissued card, he/she can still go for medical examination and treatment under the normal health insurance by presenting the appointment paper for reissuance of the card (this appointment paper is issued by the Social Security agency where the application for reissuance of the card is submitted) and a type of identification document with a photo such as an identity card.

In case of failure to present the appointment letter for re-issuance of the card, according to Article 14 of Joint Circular 41/2014/TTLT-BYT-BTC on cases of direct payment of medical examination and treatment costs to the social insurance agency:

“Article 14. Direct payment of medical examination and treatment costs

Cases of direct payment of medical examination and treatment costs as prescribed in Clause 2, Article 31, amendments and supplements of the Law on Health Insurance include:

Medical examination and treatment not in accordance with the procedures for medical examination and treatment under health insurance as prescribed in Article 8 of this Circular".

Thus, if the appointment for reissuance of the health insurance card is not obtained, the patient must pay the medical examination and treatment costs to the hospital. Then, when the card is issued, he brings the hospital's invoice and documents along with the health insurance card and photo identification to the district-level social insurance agency where he participated in health insurance to request payment of the medical examination and treatment costs within the scope of benefits.