Is payment of health insurance at private hospitals?

Payment of health insurance at the private hospital
Your knowledge:

     Payment of health insurance at the private hospital

Lawyer's knowledge:

   Hello, Ha Thi Law Thank you for your trust and your question about paying for health insurance at private hospitals. With your questions we would like to offer the following advice:

Legal basis:

Revised Health Insurance Law 2014
Joint Circular No. 41/2014 / TTLT-BYT-BTC
Advisory content on health insurance payment at private hospitals
     1. Payment for health insurance at the private medical examination and treatment contract with medical examination and treatment contract
     Under Point a, Clause 3, Article 16 of Joint Circular No. 41/2014 / TTLT-BYT-BTC stipulating the payment of health insurance premiums for medical examination and treatment at private hospitals with medical examination and treatment contracts as follows: The patients coming to medical examination and treatment at medical establishments with contracts for medical examination and treatment of health insurance shall pay patients within the scope of their benefits and health insurance benefits according to regulations. "

     And the level of health insurance is defined in Clause 15, Article 1 of the Law on Health Insurance amended 2014 as follows:

     "1. When participating in health insurance for medical examination and treatment as provided for in Articles 26, 27 and 28 of this Law, the medical insurance fund shall pay medical examination and treatment expenses within the scope of shall be entitled to the following benefits:
     a) 100% of medical examination and treatment expenses for the subjects defined at Points a, d, e, g, h and i, Clause 3, Article 12 of this Law. Expenses for medical examination and treatment beyond the scope of eligibility for medical insurance of persons defined at Point a, Clause 3, Article 12 of this Law shall be covered by medical insurance funds reserved for medical examination and treatment. this object group; In cases where the funding source is insufficient, it shall be covered by the state budget;
     b) 100% of the medical examination and treatment costs, for cases where the expenses for a medical examination and treatment are lower than the levels prescribed by the Government and medical examination and treatment at the commune level;
     c) 100% of medical examination and treatment costs when patients have paid health insurance premiums for 5 consecutive years or more and co-pay medical examination and treatment expenses in the year, which are larger than 6 months' except for medical examination and treatment at the same level;
     d) 95% of medical examination and treatment expenses for subjects defined at Point a, Clause 2; Point k of Clause 3 and Point a, Clause 4, Article 12 of this Law;
     e) 80% of the costs of medical examination and treatment for other subjects. "

     Accordingly, the level of payment for health insurance at private hospitals with medical examination and treatment contracts will depend on the health insurance card holder who is in charge of medical examination and treatment on the right or left of the line to determine get the corresponding rate.

     2. Payment of health insurance at medical examination at private hospitals without medical examination and treatment contract for medical insurance
     In cases where the health insurance card holders have medical examination and treatment contracts for medical care without medical examination and treatment contracts, medical insurance organizations shall pay medical examination and treatment costs directly It is also necessary for health insurance card holders to go to medical examination and treatment. And the level of payment of health insurance at private hospitals without medical examination and treatment contract shall be based on Point b, Clause 3, Article 16 of Joint Circular No. 41/2014 / TTLT-BYT-BTC as follows: "In cases where patients come for medical examination and treatment at health establishments without medical examination and treatment contracts, they shall pay according to actual expenses within the scope of benefits and health insurance benefits but not exceed the maximum level See Appendix 4 attached to this Circular. "

     And the maximum benefit will be limited to Appendix 4 of Circular 41/2014 / TTLT-BYT-BTC as follows:

     - Outpatient treatment at district-level health facilities and equivalent: VND 60,000

     - Inpatient treatment at district-level health facilities and equivalent: VND 500,000

     - Inpatient treatment at provincial level and equivalent: 1,200,000 VND

     - Inpatient treatment at central level and equivalent: 3,600,000 VND.