January 1, 2025, the Government issued Decree No. 02/2025/ND-CP (“Decree No. 02”) on the amendment, supplementation of several articles of Decree No. 146/2018/ND-CP (“Decree No. 146”) dated October 17, 2018, detailing and guiding measures to implement the Law on Health Insurance (amended and supplemented several articles by Decree No. 75/2023/ND-CP dated October 19, 2023). According to ATA's assessment, Decree 02 will make an important contribution to information transparency, procedure simplification, and optimization of people's rights when performing medical examinations and treatment at medical facilities nationwide, including the following main points:
1. Medical examination and treatment on request are still covered by health insurance
People with health insurance cards receive medical examination and treatment on request and will be paid a portion of the medical examination and treatment costs within the scope of benefits (if any) as prescribed by the Law on Health Insurance.
The patient shall pay the difference in cost between the price of medical examination and treatment services on request and the corresponding payment paid by the insurance fund to the medical examination and treatment facility.
2. Regulations on implementation roadmap and health insurance benefit rates for outpatient medical examination and treatment
According to the provisions of Point e, Clause 4, Article 22 of the Law on Health Insurance, people, receiving outpatient medical examination and treatment at medical examination and treatment facilities, will receive health insurance at the following rates:
e) From 50% to 100% of the health insurance benefit rates when receiving outpatient medical examination and treatment at basic-level medical examination and treatment facilities based on the results of technical expertise ranking according to the roadmap and specific health insurance benefit rates prescribed by the Government, except for the cases prescribed in Point a and Point dd of this Clause;
h) 50% of the health insurance benefit rates when receiving outpatient medical examination according to the roadmap prescribed by the Government and 100% of the health insurance benefit rates when receiving inpatient medical examination in the case of receiving medical examination and treatment at specialized medical examination and treatment facilities determined to be provincial level by competent authorities before January 1, 2025.
Clause 5, Article 14 of Decree No. 02 stipulates in detail the implementation roadmap and health insurance (“HI”) benefit rates when receiving outpatient medical examination and treatment (“MET”) at medical examination and treatment facilities (“METF”) as follows:
(i) From January 1, 2025, when receiving outpatient MET at basic-level METF which are rated with a score of less than 50 points or temporarily classified as basic-level, 100% of the HI benefit will be paid;
(ii) From July 1, 2026, when receiving outpatient MET at basic-level METF which are rated with a score from 50 points to less than 70 points, 50% of the HI benefit will be paid;
(iii) From July 1, 2026, when receiving outpatient MET at basic-level METF which are determined to be provincial or central level or corresponding levels before January 1, 2025, 50% of the HI benefit will be paid;
(iv) From July 1, 2026, when receiving outpatient MET at specialized-level METF which are determined to be provincial level or corresponding levels before January 1, 2025, 50% of the HI benefit will be paid.
3. Simplification of medical examination and treatment procedures under health insurance
According to regulations in Article 15 of Decree No. 02, when receiving MET, health insurance participants only have to present information about their health insurance card in 1 of 2 forms:
- Health insurance card or health insurance number;
- ID card, Citizen ID card, or level 2 electronic identification account on VNeID application has integrated information about health insurance cards.
Decree 02 strictly prohibits METF from regulating additional procedures for MET under HI other than those already regulated in the Decree. If METF or social insurance agencies need a copy of HI cards or documents related to medical treatment, they must photocopy them themselves after obtaining the consent of patients or the patient's guardian. They must not ask the patient to photocopy or pay for this expense.
The above regulations create many favorable conditions for people in the process of receiving MET under HI.
4. Supplementation of regulations on maximum payment rate of health insurance for MET service costs of private METF
- Private specialized-level METF are paid no higher than the highest MET under HI service costs of State specialized-level METF in the province or of State basic-level METF in the province in case there is no specialized-level METF;
- Private basic-level METF are paid no higher than the highest MET under HI service costs of State basic-level METF in the province;
- Private primary METF are paid no higher than the lowest MET under HI service of State basic-level METF in the province.
- Private METF, performing technical services on a list approved by competent authorities, but its service costs have not been regulated or approved for State METF by the Provincial People's Council in the province, it shall be paid no higher than the highest MET service costs of State METF with the same level of technical expertise in neighboring provinces or other provinces nationwide in case METF in the neighboring province have not had service costs for that technical service.
Decree No. 02/2025/ND-CP takes effect from January 1, 2025.
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