09:19 | 28/05/2022
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In Vietnam, is radiation therapy on the list of costs covered by health insurance?

In Vietnam, is radiotherapy in the list of costs covered by health insurance? In Vietnam, how are health insurance benefits regulated? I am suffering from cancer and have an insurance policy at X hospital. Because my cancer is getting worse, I have to undergo radiation therapy at this hospital. However, X hospital requires me to pay for radiotherapy while I am covered by health insurance that pays 100% of medical examination and treatment costs. So, in my case, do I have to pay for radiation therapy? Thank you!

In Vietnam, is radiotherapy in the list of costs covered by health insurance?

Pursuant to the provisions of Article 23 of the Law on Health Insurance 2008 as amended by Clause 16, Article 1 of the Law on Health Insurance Amendment 2014 stipulates the cases of not being entitled to health insurance as follows:

1. Expenses in the case specified in Clause 1, Article 21 have been paid by the state budget.

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. Use beauty services.

7. Treatment of strabismus, myopia and refractive errors of the eyes, except for children under 6 years old.

8. Use of alternative medical supplies including prosthetic limbs, artificial eyes, dentures, eyeglasses, hearing aids, mobility aids in medical examination, treatment and rehabilitation.

9. Medical examination, treatment and rehabilitation in case of disaster.

10. (repeat)

11. Medical examination and treatment for addiction to drugs, alcohol or other addictive substances.

12. (repeal)

13. Medical assessment, forensic examination, forensic psychiatric assessment.

14. Participating in clinical trials and scientific research.

Accordingly, your case is not in the above cases, so you are entitled to health insurance and must pay for radiation therapy.

In Vietnam, how are health insurance benefits regulated?

Pursuant to Article 22 of the above Law as amended by Clause 15, Article 1 of the 2014 Law on Health Insurance, stipulates the level of health insurance as follows:

1. Health insurance participants, when going for medical examination and treatment according to the provisions of Articles 26, 27 and 28 of this Law, are entitled to payment of medical examination and treatment expenses by the health insurance fund to the extent permitted. with the following benefits:

a) 100% of medical examination and treatment expenses for the subjects specified at Points a, d, e, g, h and i, Clause 3, Article 12 of this Law. Expenses for medical examination and treatment outside the scope of health insurance coverage for the subjects specified at Point a, Clause 3, Article 12 of this Law shall be paid from the health insurance funds for medical examination and treatment of the patients. this target group; in case this funding source is not enough, the state budget shall ensure;

b) 100% of medical examination and treatment costs, for cases where the cost of a medical examination and treatment is lower than the level prescribed by the Government and medical examination and treatment at the commune level;

c) 100% of medical examination and treatment expenses when the patient has participated in health insurance for 5 consecutive years or more and the amount of money jointly paid for medical examination and treatment expenses in the year is greater than 6 months' salary. establishments, except for cases of going to medical examination and treatment at the wrong level;

d) 95% of medical examination and treatment expenses for the subjects specified at Point a, Clause 2, Point k, Clause 3 and Point a, Clause 4, Article 12 of this Law;

dd) 80% of medical examination and treatment expenses for other subjects.

2. In case a person belongs to many subjects participating in health insurance, he/she is entitled to health insurance benefits according to the subject with the highest benefits.

3. In case the health insurance card holders self-medicate for medical examination and treatment at the wrong line, the health insurance fund will pay the benefit rate specified in Clause 1 of this Article at the following rate, except for the case specified in Clause 5 of this Article:

a) 40% of inpatient treatment costs at central hospitals;

b) 60% of inpatient treatment costs at provincial hospitals from the effective date of this Law to December 31, 2020; 100% of inpatient treatment costs from January 1, 2021 nationwide;

c) 70% of medical examination and treatment costs at district hospitals from the effective date of this Law to December 31, 2015; 100% of medical examination and treatment expenses from January 1, 2016.

4. From January 1, 2016, health insurance participants who register for initial medical examination and treatment at commune health stations or general clinics or district hospitals are entitled to insured medical examination and treatment. Health insurance coverage at commune health stations or general clinics or district hospitals in the same province has the benefit rate specified in Clause 1 of this Article.

5. Ethnic minority people and people from poor households participating in health insurance are living in areas with difficult socio-economic conditions, areas with extremely difficult socio-economic conditions; Health insurance participants living in island communes, island districts, when they go to the wrong medical examination and treatment on their own, will be covered by the health insurance fund for medical examination and treatment expenses for district hospitals. inpatient treatment for hospitals at the provincial and central levels and enjoy the benefits prescribed in Clause 1 of this Article.

6. From January 1, 2021, the health insurance fund will pay inpatient treatment expenses according to the level of benefits specified in Clause 1 of this Article for health insurance participants who go to medical examination and treatment on their own. at the right level at provincial medical examination and treatment establishments nationwide.

7. The Government shall specify the level of enjoyment for medical examination and treatment covered by health insurance in contiguous areas; cases of medical examination and treatment at request and other cases not specified in Clause 1 of this Article.

Best regards!

Huỳnh Minh Hân

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