5 NEW POLICIES AFFECTING HEALTH INSURANCE BENEFITS EFFECTIVE FROM 01/07/2021

From 01/07/2021, there are a number of documents officially coming into effect that directly affect the benefits of the participants of health insurance (HI) are listed below:

            1. Changing the concept of “Household participating in health insurance”

The Law on Residence 2020 takes effect on 01/07/2021, this Law amends the regulations on households participating in HI under the HI law.

In detail: Households participating in HI are those who jointly register for permanent residence or temporary residence at a lawful residence as prescribed by law (previously, the HI law stipulates that a household participating in HI is all the people named in the household registration book or temporary residence book).

The reason for this change is because the new Residence Law has officially eliminated the household registration book.

            2. More subjects are granted free health insurance cards

Decree 20/2021/ND-CP on social assistance policies for beneficiaries of social protection will also take effect from 01/07/2021, this decree adds a number of cases where free HI cards are granted such as:

• The poor or near-poor households who are single and are raising children under 16 years old or are raising children aged between 16 and 22 years old and that child is studying culture, vocational training, professional secondary school, college or university (previously, only their children were supported to issue HI cards).
• People infected with HIV/AIDS belong to poor households without stable monthly income sources such as salary, wages, pension, social insurance allowance, monthly social allowance.

-> According to this Decree, in case a person is eligible for multiple types of HI cards, only one HI card with the highest benefits will be issued.

            3. Health insurance policy for relatives of war invalids and sick soldiers

The Ordinance on Incentives for people with merit No. 02/2020/UBTVQH14 also takes effect from 01/07/2021, according to this ordinance, not only war invalids and sick soldiers but their relatives are also entitled to this policy. In detail:

• Natural parents, spouse, children from full 6 years old to under 18 years old or 18 years old or older, if they continue to go to school or are severely disabled, policy beneficiaries such as war invalids and sick soldiers with an injury rate of 61% or more;
• Servicemen, war invalids, beneficiaries of policies like invalids, and servicemen of war invalids with a body injury rate of 81% or more live in the same house.

            4. Paying for medical examination and treatment costs

Date 01/07/2021 is the time to apply Circular 04/2021/TT-BYT guiding the payment of medical examination and treatment expenses with HI according to the capitation rate.

According to this circular, the capitation fund is a predetermined amount of money assigned to a healthcare facility with HI for outpatient medical examination and treatment for patients with HI cards within the quota within a certain period of time.

• The scope of capitation for hospitals at the district level and below is the entire cost of outpatient medical examination and treatment within the scope of benefits of the insured, minus a number of other expenses.
• The scope of capitation for provincial and central hospitals is the entire cost of outpatient medical examination and treatment within the quota of patients registering for initial medical examination and treatment incurred at the facility, minus a number of other expenses.

            5. The price of medical examination and treatment services must be publicized for holders of health insurance cards

Also from 01/07/2021, Circular 05/2021/TT-BYT – implementing democracy in medical examination and treatment activities at public hospitals will be applied.

This circular specifies that public hospitals need to disclose:

• Fees for medical examination and treatment services for patients with HI cards;
• Fees for unsolicited medical examination and treatment services for patients without HI cards;
• The regime of exemption and reduction of medical examination and treatment services;
• Implement HI policies, pay prices and costs of medical examination and treatment covered by HI.

In addition, patients are also entitled to participate in:

• Contribute ideas and supervise the implementation of health regimes and policies related to their legitimate rights and interests;
• HI policy;
• Service attitude of the doctor.

References:

1. Residence Law 2020:
   https://thuvienphapluat.vn/van-ban/Quyen-dan-su/Luat-68-2020-QH14-cu-tru-435315.aspx 
2. Decree 20/2021/ND-CP:
   https://thuvienphapluat.vn/van-ban/van-hoa-xa-hoi/Nghi-dinh-20-2021-ND-CP-chinh-sach-tro-giup-xa-hoi-doi-voi-doi-tuong-bao-tro-xa-hoi-467723.aspx
3. Ordinance No: 02/2020/UBTVQH14:
   https://thuvienphapluat.vn/van-ban/Van-hoa-Xa-hoi/Phap-lenh-02-2020-UBTVQH14-uu-dai-nguoi-co-cong-voi-Cach-mang-460718.aspx
4. Circular 04/2021/TT-BYT:
   https://thuvienphapluat.vn/van-ban/bao-hiem/Thong-tu-04-2021-TT-BYT-thanh-toan-chi-phi-kham-chua-benh-bao-hiem-y-te-theo-dinh-suat-384208.aspx 
5. Circular 05/2021/TT-BYT:
   https://thuvienphapluat.vn/van-ban/bo-may-hanh-chinh/Thong-tu-05-2021-TT-BYT-thuc-hien-dan-chu-trong-hoat-dong-co-so-kham-chua-benh-cong-lap-465922.aspx