According to the regulations, the participants of health insurance (HI) when going for medical examination and treatment (treatment) covered by insurance at the right level will be covered by the health insurance fund with 100% of the benefit rate. According to statistics from the social insurance agency, there are many inpatient medical care patients covered by health insurance with medical expenses of more than 1 billion VND/inpatient treatment.
However, not every case of medical care at the right level is also covered by the health insurance fund.
People come to register for medical examination and treatment at Phu Nhuan hospital. Photo: NGUYEN HIEN
According to the provisions of Article 23 of the Law on Health Insurance 2008 (amended and supplemented in Clause 16, Article 1 of the Law on Health Insurance 2014), there are 12 cases where they are not entitled to health insurance even if they go to the right medical facility.
Cases that are not covered by health insurance even though they go to medical examination and treatment at the right level include:
1. Expenses in case of medical examination for screening and early diagnosis of some diseases; Medical examination, treatment, rehabilitation, periodical antenatal care, childbirth; Transporting patients from district level to higher level… which has been paid for by the state budget (in Clause 1, Article 21 of the Law on Health Insurance).
2. Nursing and convalescence at convalescent and convalescent establishments.
3. Health examination.
4. Pregnancy testing and diagnosis is not for treatment purposes.
5. Using assisted reproductive technology, family planning services, abortion, abortion, except for cases of termination of pregnancy due to medical reasons of the fetus or the mother.
6. Treatment of strabismus, myopia and refractive errors of the eyes, except for children under 6 years old.
7. Medical examination, treatment and rehabilitation in case of disaster.
8. Use beauty services.
9. Use of alternative medical supplies including prosthetic limbs, artificial eyes, dentures, eyeglasses, hearing aids, mobility aids in medical examination, treatment and rehabilitation.
10. Medical examination and treatment for addiction to drugs, alcohol or other addictive substances.
11. Medical assessment, forensic examination, forensic psychiatric assessment.
12. Participating in clinical trials and scientific research.
Thus, when a person who has a health insurance card when going for medical treatment falls into one of the above cases, he or she is not entitled to health insurance.
at Blogtuan.info – Source: Eva.vn – Read the original article here
