(Yeni) – In case of changing the health insurance benefit code, the social insurance agency automatically updates the health insurance benefit code data but does not re-issue the health insurance card to the participant.
Who is eligible for increased health insurance benefits?
Firstly, for those participating in the resistance war and defending the country (with the target code being KC), the health insurance benefit code will be changed from 80% to 100%.
Increase health insurance benefits to 100% for some subjects
Second, for those who serve people with meritorious services to the revolution and live at home (with subject code PV), the health insurance benefit code will be changed from 80% to 95%.
Participants use the VssID application to check their health insurance benefits according to the above regulations, and use old health insurance cards or CCCDs with chips to go for medical examination and treatment.
Regarding the addition of a number of groups of people whose health insurance premiums are supported by the state, Ho Chi Minh City Social Insurance requests the subject management agency to urgently coordinate with the social insurance agency to check, review, and make a list to issue health insurance cards to these people. added person.
First, the martyr’s spouse marries another husband or wife who is receiving a monthly allowance according to the provisions of the Ordinance on preferential treatment for people with meritorious services to the revolution. This group has an object code denoted by TG and an object code denoted by the number 3.
Second, the people of the safe zone communes and the revolutionary safe zone during the resistance war against the French and the Americans who are currently residing in the safe revolutionary zone communes during the resistance war against the French and the Americans have been updated. information in the National Population Database and Residence Database. This group has an object code denoted by AK and an object code denoted by the number 2.
Third, ethnic minorities are living in communes of Region II, Region III, and extremely difficult villages in ethnic minority and mountainous plains in the 2016-2020 period, but these communes do not also on the list of regions II, region III, and extremely difficult villages in ethnic minority and mountainous areas in the period 2021-2025. This group has an object code denoted by DS and an object code denoted by the number 3.
For people participating in compulsory health insurance in Article 1 and Article 2 of Decree 146/2018/ND-CP (group paid by employees and employers, group paid by social insurance agency) but also belonging to the following groups: In case the above health insurance benefit level is increased, the employer and subject management agency shall guide participants to submit documents to have the social insurance agency adjust the health insurance benefit code.
In case of participating in health insurance as a group of students, or household health insurance, instruct participants to contact the school or collection service organization to submit the application for refund of overpayment according to regulations.
Conditions for health insurance to cover 100% of medical examination and treatment costs
According to Point d, Clause 1, Article 14 of Decree 146/2018/ND-CP, when a person has a health insurance card when going for medical examination and treatment, the cost of medical examination and treatment is less than 15% of the salary. The facility is covered by health insurance for 100% of medical examination and treatment costs.
From July 1, 2023, the base salary will be adjusted to 1.8 million VND/month according to Decree 24/2023/ND-CP.
Health insurance benefits are also adjusted in accordance with the new regulations.
If calculated based on the base salary of 1.49 million VND, the cost for a medical examination and treatment is 15% lower than the base salary (lower than 223,500 VND), then health insurance participants will be paid 100% of the cost.
When the base salary increases to 1.8 million VND, the cost for 1 medical examination mentioned above will change to 270,000 VND.
Accordingly, people with health insurance cards who go for medical examination and treatment according to regulations and whose total cost for one medical examination and treatment is less than 270,000 VND do not have to pay together.
Thus, the one-time medical examination and treatment cost covered 100% by health insurance increases by 46,500 VND from July 1, 2023.
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