Benefits of participating in health insurance for 5 consecutive years in Vietnam

When participating in health insurance (HI) continuously for 5 years, participants will enjoy higher and more special benefits when going for medical examination and treatment. So, what does 5 consecutive years of health insurance mean? What are the benefits that participants receive? How to get the most out of this mode? To help you better understand this issue, in the article below, Viet An Tax Agent will provide detailed information and answer all questions related to health insurance for 5 consecutive years, helping you grasp the great benefits that you can receive when fully and continuously participating in the health insurance regime during the long time.

What is health insurance for 5 consecutive years in Vietnam?

Health insurance (HI) for 5 consecutive years is a form of insurance participation that participants must pay for 5 consecutive years. During this process, participants can be interrupted for a maximum of 3 months without affecting benefits. When the time of participation in health insurance of people is full 5 consecutive years, this will be clearly recorded on the person’s health insurance card, making it easy to identify and identify the benefits they are entitled to.

According to Decision No. 1666/QD-BHXH issued in 2020, the recording of the time of participation in health insurance for 5 consecutive years is specified in detail as follows:

This helps ensure that everyone participating in health insurance receives full and accurate benefits when participating in long-term health insurance, and is more convenient in tracking and managing the participation time of each individual.

Conditions for enjoying health insurance for 5 consecutive years in Vietnam

The conditions for enjoying health insurance for 5 consecutive years are clearly stipulated, including the following basic requirements:

• Participating in health insurance for 5 consecutive years: To be eligible for health insurance for 5 consecutive years, participants must have time to participate in uninterrupted health insurance within 5 consecutive years. When the participant completes this time, the information will be recorded and displayed directly on their health insurance card, making it easy to check and confirm benefits.
• The amount of co-payment for medical examination and treatment in the year is greater than 06 months of base salary: One of the important conditions to receive health insurance benefits for 5 consecutive years is that the participant has paid a sum of money together with the social insurance agency (SSI) for medical examination and treatment. Specifically, this amount must exceed 6 months of base salary in a year. This co-payment is the part of the cost that the patient must pay together with social insurance, according to the percentage specified on their health insurance card.
• Medical examination and treatment on the right line: To ensure health insurance benefits, participants must carry out medical examination and treatment on the right line. This means that they need to go to the medical facilities listed on the health insurance card, or if it is a case of registering for initial medical examination and treatment at the commune or district level, they need to continue to be examined at medical facilities in the same line and the same province. Cases such as emergency or referral are also recognized and counted as medical examination and treatment on the right line.

With the above three conditions, health insurance participants can rest assured that they will receive full and legal benefits when participating in health insurance for 5 consecutive years. These regulations help ensure fairness and transparency in the allocation of health insurance benefits to the people.

Changing conditions for health insurance for 5 consecutive years from 01/07/2024 in Vietnam

From July 1, 2024, the base salary will be adjusted from 1.8 million VND/month to 2.34 million VND/month, based on Decree No. 73/2024/ND-CP. This change not only affects welfare regimes, but also directly impacts the conditions for enjoying health insurance for 5 consecutive years in 2024. Specifically, the new base salary will lead to adjustments in regulations, in order to suit the actual situation and ensure the benefits of health insurance participants.

Accordingly, one of the notable changes is that the limit on the cost of co-payment for medical examination and treatment in the year will be adjusted according to the new base salary. Concrete:

• Before June 30, 2024, health insurance participants who want to be considered for 5 consecutive years of health insurance benefits need to have a co-payment cost for medical examination and treatment on the right line in the year greater than VND 10.8 million.
• From July 1, 2024, with the adjustment to increase the base salary, health insurance participants considering benefits for 5 consecutive years will have to have a co-payment cost for on-line medical examination and treatment in the year greater than VND 14.4 million. This means that patients will have to pay a higher amount than before, but in return, they will be paid 100% of the cost of medical examination and treatment within the scope of the Health Insurance Fund, according to current regulations.

This adjustment helps to rebalance the interests of health insurance participants, and at the same time ensures fairness in the allocation of resources of the Health Insurance Fund, in line with the increase in the base salary and the actual situation of the economy. Health insurance participants will continue to have their medical interests protected comprehensively, helping to reduce the burden of medical costs when sick.

Benefits of health insurance participants for 5 consecutive years

According to the provisions of Article 22, Clause 1, Point c of the Law on Health Insurance, participants in health insurance for 5 consecutive years will enjoy special benefits from the Health Insurance Fund. Specifically, when the participant meets certain conditions, the Health Insurance Fund will pay 100% of the cost of medical examination and treatment within the scope of insurance without the patient having to pay more. This ensures that long-term health insurance participants will have maximum protection of medical benefits, helping to reduce the financial burden of contracting diseases.

To better understand these benefits, Decree 146/2018/ND-CP has detailed the payment of medical examination and treatment costs for people who have participated in health insurance for 5 consecutive years or more. Specifically, if the patient has co-payment expenses during medical examination and treatment at the same medical facility greater than 6 months of base salary, this medical examination and treatment facility is not allowed to collect additional amounts in excess of 6 months of the patient’s base salary. This means that patients only need to pay a certain amount of money, not exceeding the prescribed amount, and the rest will be paid by the Health Insurance Fund.

In order to ensure the interests of participants, medical examination and treatment facilities must also be responsible for providing invoices for the co-payment amount paid by patients, with the total amount not exceeding 6 months of base salary. This invoice will be an important basis for patients to request the social insurance agency to confirm that they do not have to pay extra in that year, thereby ensuring that the interests of health insurance participants are fully protected.

In addition, if the patient has a cumulative co-payment amount in the fiscal year at different medical examination and treatment establishments or at the same medical examination and treatment facility in excess of 6 months of base salary, the patient also has the right to request the social insurance agency where the health insurance card is issued to pay the co-payment in excess of this amount. After having all the documents on the payments, the patient will receive a certificate of non-co-payment for amounts in excess of the prescribed amount in that fiscal year.

Through these regulations, health insurance participants will be protected in a reasonable and fair way, helping them not to bear too much financial burden during the medical examination and treatment process, and at the same time ensuring transparency and clarity in the payment of costs from the Health Insurance Fund.

Dossier of health insurance entitlement for 5 consecutive years

According to the provisions of Notice No. 2298/TB-BHXH in 2018, health insurance participants who are eligible to enjoy health insurance benefits for 5 consecutive years need to prepare and submit a complete set of dossiers to the social insurance agency to be eligible for the regime. This dossier plays an important role in confirming the health insurance benefits of participants, ensuring that they are fully entitled to health protection regimes in accordance with the law.

Specifically, the dossier to enjoy health insurance for 5 consecutive years includes the following necessary documents:

• Health insurance card: Health insurance participants need to submit a health insurance card with the words “Time of full 05 consecutive years: from dd/mm/yy”, certifying that the participant has participated in health insurance for 5 consecutive years. This is an important document, accurately recording the time when the participant is eligible for health insurance benefits for 5 consecutive years.
• Photo ID (copy): Health insurance participants also need to submit a copy of a photo ID, such as ID card/ID card or passport, to verify their identity and serve as a basis for linking with the information on the participant’s health insurance card. This document helps the social insurance agency accurately determine who the beneficiaries of health insurance benefits are, avoiding confusion in the process of settling benefits.
• Hospital bill (original): To prove the cost of medical examination and treatment, the participant needs to submit the hospital bill (original) that they have paid during the treatment. This invoice must be the original, not a copy, and must contain full information about the medical examination and treatment expenses paid by the participant at the medical facility. The submission of hospital bills is necessary to confirm the amount co-paid by the participant, thereby calculating the amount of health insurance that will be paid for medical examination and treatment expenses.

When these documents are fully prepared, participants can submit a dossier to the social insurance agency where their health insurance card is issued to carry out procedures for payment of health insurance benefits for 5 consecutive years. The social insurance agency will base on the documents in the dossier to confirm the conditions and settle health insurance benefits for participants quickly and accurately.

It is very important to prepare a complete dossier, as it ensures that health insurance participants will not experience delays or difficulties in the process of receiving benefits from the Health Insurance Fund. Therefore, health insurance participants need to carefully check the documents in their dossier before submitting to ensure that their benefits are resolved in a timely and accurate manner.

If you have any difficulties or questions related to benefits when participating in health insurance for 5 consecutive years, please contact Viet An Tax Agent for the most specific advice.