The Law amending and supplementing some articles of the Health Insurance Law, passed by the National Assembly last November, takes effect from 1/7/2025. Compared to the current Health Insurance Law, this amended law has many new points, reflecting the spirit of administrative reform, medical examination and treatment procedures, and reducing paperwork. The amended Law also enhances the application of information technology, decentralization, and maximum delegation of authority, creating favorable conditions for the people.
Removal of "administrative boundaries" in medical examination and treatment.
The amended Health Insurance Law stipulates the level of insurance benefits when implementing general medical examination and treatment regardless of provincial administrative boundaries. Benefit levels are kept stable according to the current Law and expanded in some cases.
Accordingly, health insurance participants are entitled to 100% insurance coverage in the following situations: Examination and treatment at the initially registered facility or inpatient treatment at a basic-level facility; examination and treatment at any basic-level or specialized insurance facility before 1/1/2025 that has been identified as a district level by competent authorities.
Some cases of rare and serious diseases can be directly referred to specialized medical examination and treatment facilities. This list has been issued by the Ministry of Health, including 62 types of serious and rare diseases, such as infectious diseases, cancer, metabolic disorders, lysosomal storage disorders, neurological, cardiovascular, pulmonary, skin, and congenital diseases, and special conditions such as multi-drug resistant tuberculosis, war sequelae, or organ transplantation.
People with these diseases diagnosed at the primary level can go directly to specialized facilities for treatment without a referral and still enjoy 100% of their health insurance benefits.
Remote and home healthcare covered by health insurance.
From 1/7, health insurance participants have expanded healthcare benefits, including home and remote treatment.
Accordingly, health insurance participants will be reimbursed for costs including remote healthcare, remote healthcare support, family medicine, home healthcare, rehabilitation, periodic prenatal checkups, and childbirth.
Insurance also covers the cost of transporting patients between medical facilities, whereas previously it only covered transportation from the district level to higher levels. The costs of medical technical services, medicine, equipment, blood, blood products, medical gases, supplies, tools, instruments, and chemicals used in medical examination and treatment are now also covered by the Fund.
In addition, the cost of treating strabismus and refractive errors for people under 18 will be covered by insurance, while current regulations only cover children under 6. Thus, from 1/7, the age eligible for health insurance coverage for these health issues is raised from 6 to 18.
These are some new points where health insurance coverage is expanded. The levels, rates, and payment conditions for the above costs will be specifically regulated by the Government and the Ministry of Health.
Transferring health insurance medications between hospitals.
Currently, there are no regulations on the transfer of medicine between facilities. Therefore, the amended Health Insurance Law adds a mechanism for paying for medicines and medical equipment transferred between medical examination and treatment facilities, and for paying for paraclinical services transferred to other facilities in cases of medicine or medical equipment shortages.
The Law stipulates the mechanism for the insurance fund to pay for these cases. For example, patients treated at the highest levels, such as Viet Duc Hospital or Bach Mai Hospital, cannot be transferred anywhere else. When these facilities lack certain medicines, they need to transfer medicines from other hospitals to treat patients.
Updating participants and cases eligible for premium support.
The Law adds village health workers and village midwives to motivate, encourage, and provide appropriate policies for the healthcare workforce in remote areas. It adjusts the responsibility and method, the insurance payment deadline, and the card's validity period.
At the same time, the Law also adds 4 groups whose health insurance will be paid by the state from 1/7. : People over 75 years old receiving pensions; people of retirement age but without enough years of contributions receiving monthly allowances; and regular militia - a force ready to participate in unexpected tasks such as natural disaster prevention and epidemic control.
Handling late or evading health insurance payments.
The amended Health Insurance Law has many provisions focusing on strengthening discipline and responsibility in fulfilling insurance obligations, reflected in new regulations on late payment, evasion, and handling violations.
Accordingly, the Law stipulates stronger sanctions for acts of violating the health insurance law, especially late payment and evasion. Remedial measures include: requiring full payment of late and evaded insurance amounts; calculating interest equal to 0.03%/day of the amount and number of days late or evaded.
Depending on the severity of the violation, in addition to being administratively sanctioned, one can also be held criminally liable.
In addition, the Law also adjusts the rate of expenditure for health insurance examination and treatment, increasing the allocation for examination and treatment activities to 92%; reducing the amount allocated to the reserve fund and fund operation to 8%, allocating a minimum of 4% to the reserve fund. The Law clearly stipulates the time limit for notifying the results of medical examination and treatment cost appraisal to overcome the problem of prolonged payment and settlement.
Adding responsibilities of the Ministry of Health.
The Ministry of Health has been assigned additional responsibilities in regularly reviewing and updating treatment regimens to ensure convenient medical examination and treatment and health insurance payment. Hospitals are encouraged to apply information technology to improve management efficiency. Interconnection and use of interconnected paraclinical results between medical examination and treatment facilities.
The Law promulgates principles and criteria for developing the list of medicines, medical equipment, and medical services covered by insurance to ensure transparency and publicity. The Law also adds regulations on issuing electronic health insurance cards, and auditing the annual settlement reports of social insurance agencies to synchronize with the Social Insurance Law.
The leader of the Health Insurance Department, Ministry of Health, assessed that with the above new points, the amended Law will fundamentally address the urgent existing problems and obstacles after 15 years of implementing health insurance, ensuring social security, the rights and interests of insured participants and medical examination and treatment facilities.
"The goal is to gradually reduce out-of-pocket expenses for health insurance participants and strengthen the management and effective use of the insurance fund," a representative of this agency said.
The national health insurance coverage rate has increased sharply over the years, reaching 93.35% of the population by 2023.
Le Nga
