Question:
Mr. A participates in Family Health Insurance (under 80 years old, not continuously insured for 5 years in Health Insurance; not classified as near-poor or poor households). Unfortunately, Mr. A is diagnosed with a long-term treatable disease, specifically Chronic Kidney Disease (listed as item 297 with code N18) according to Circular No. 46/2016/TT-BYT dated December 30, 2016, issued by the Ministry of Health. According to the current health insurance law:
1. What is the BHYT reimbursement rate when Mr. A has to undergo monthly artificial kidney treatment at a healthcare facility?
2. In the event that Mr. A already receives a 80% reimbursement rate (with a 20% co-payment), but the legally prescribed reimbursement rate is higher, what procedures does Mr. A need to follow, and where should he go to receive the higher reimbursement rate at a healthcare facility covered by BHYT?
Answer:
-The BHYT reimbursement rate for individuals with Family Health Insurance cards undergoing monthly artificial kidney treatment and not having continuous 5 years of participation in BHYT is as follows:
- For cases where individuals with Family Health Insurance cards receive treatment at the correct healthcare facility, the BHYT Fund will cover 80% of the healthcare costs within the regulations of BHYT.
- For cases where individuals with Family Health Insurance cards receive treatment at a healthcare facility not in their designated network, the BHYT Fund will cover healthcare costs as follows:
* At central-level hospitals: 80% x 40% = 32% of the inpatient treatment costs.
* At provincial-level hospitals until December 31, 2020: 80% x 60% = 48% of the inpatient treatment costs.
* At district-level hospitals: 80% x 100% = 80% of the healthcare costs.
-Based on Article 16(2), Article 22(2) of the Health Insurance Law (Law No. 25/2008/QH12), and Article 1(7), Article 13(2) of the Law amending and supplementing some articles of the Health Insurance Law (Law No. 46/2014/QH13 dated June 13, 2014), it is stipulated that in cases where an individual falls under multiple different BHYT participation groups as regulated in Article 12 of this Law, they shall pay health insurance based on the first group of participants determined in the order of the groups specified in Article 12 of this Law. In cases where an individual falls under multiple BHYT participation groups, they shall be entitled to health insurance benefits according to the group with the highest entitlement.
-Therefore, if the participant with Family Health Insurance cards falls under a group with a higher entitlement (e.g., veterans, people with meritorious services, war invalids, relatives of people with meritorious services, etc.), they should contact the People’s Committee of the ward/commune where they have permanent residence, provide relevant documents, and receive guidance on how to apply for a BHYT card according to the group with the highest entitlement.
Question:
Our company has a case: we have applied for a social insurance book (BHXH) for an employee using their old address and ID card number since 2011. Now, they have moved to their husband’s household, where they have registered their permanent residence and have been issued a new ID card. Does our company need to report this to the social insurance authority to inform them of and update the employee’s new ID card number?
Answer:
Based on Official Letter No. 3835/BHXH-CST dated September 27, 2013, issued by the Social Insurance Authority of Vietnam regarding discrepancies between social insurance books (BHXH) and ID cards, it is specified that insured individuals are only issued a new BHXH book in cases of loss, damage, or when there are changes or corrections to their personal information recorded in the BHXH book, such as their name, date of birth, etc. Other changes, such as changes to the ID card number, date of issuance, place of issuance, or permanent residence address, do not require the issuance of a new BHXH book.
In your employee’s case, you should prepare a dossier to adjust their personal information based on the form for submitting application documents (Form 302) and submit it to the social insurance agency where your company is registered for social insurance contributions. They will then adjust the data accordingly. You can refer to the application procedure at the following address: [http://bhxhtphcm.gov.vn/ thu-tuc-ho-so-doi-so-bhxh-the-bhyt/].
Question:
Currently, I am using the electronic social insurance system (KBHXH) for transactions with the Social Insurance Agency. However, I’m not sure which decision number governs the use of forms: 1018 or 959. Some forms under 1018 exist but are not found under 959. For example, the form for extending health insurance cards.
Could you please clarify which decision number the Social Insurance Agency is currently using for forms?
Answer:
On September 9, 2015, the Social Insurance of Vietnam issued Decision No. 959/QD-BHXH, which regulates the management of social insurance contributions, health insurance, unemployment insurance, and the management of social insurance books and health insurance cards. The forms specified in this Decision have been implemented by the Social Insurance of Ho Chi Minh City since December 1, 2015.
The electronic social insurance software KBHXH is a tool that helps businesses complete the electronic insurance declaration and submission process through the electronic portal of the Social Insurance Agency of Vietnam. It also allows for the extraction of electronic document sets for direct paper submission. Currently, the KBHXH software has updated its forms to comply with Decision No. 959/QD-BHXH, with a reduction in the number of procedures to 13 from the previous 37 under Decision No. 1018/QD-BHXH.
When using the KBHXH software, organizations should select the forms specified in Decision No. 959/QD-BHXH. For the case of extending health insurance cards, organizations should choose procedure number 8 – Annual Health Insurance Card Extension to perform this task.
Question:
Currently, foreign nationals are working and receiving a salary in Vietnam. Do these individuals fall under the mandatory health insurance (BHYT) scheme?
Answer:
The mandatory health insurance (BHYT) scheme includes the following categories: Employees working under indefinite labor contracts, labor contracts with a duration of at least 3 months or more, without distinction between Vietnamese or foreign nationals.
