Chapter IV
SCOPE OF HEALTH INSURANCE BENEFITS
Article 21. Scope of health insurance benefits
1. The insured has the following costs covered by the health insurance fund:
a/ Costs of medical examination and treatment, function rehabilitation, regular pregnancy check-ups and birth giving;
b/ Costs of medical examination for screening and early diagnosis of some diseases;
c/ Costs of transferal from district hospitals to higher-level hospitals, for persons defined in Clauses 9, 13. 14, 17 and 20, Article 12 of this Law in case of emergency or for inpatients who need technical transferal.
2. The Minister of Health shall specify Point b, Clause 1 of this Article: and assume the prime responsibility for. and coordinate with relevant agencies in. promulgating lists of medicines, chemicals, medical supplies and equipment as well as technical services which the insured is entitled to.
Article 22. Levels of health insurance benefits
1. An insured who uses medical care services defined in Articles 26, 27 and 28 of this Law has medical care costs covered by the health insurance fund at the following levels:
a/ 100% of the costs, for persons defined in Clauses 2, 9 and 17, Article 12 of this Law;
b/ 100% of the costs, for cases in which the cost of a check-up is below the level prescribed by the Government and conducted at a commune hospital;
c/ 95% of the costs, for persons defined in Clauses 3, 13 and 14, Article 12 of this Law;
d/ 80% of the costs, for other persons.
2. If the insured belongs to different categories, he/she is eligible for the highest benefit for an insured of a category.
3. The Government shall specify levels of medical care costs paid for the cases of transferal to higher-level hospitals, medical examination and treatment at upon request, and use of hi-tech and expensive services and other cases not specified in Clause 1 of this Article.
Article 23. Cases not eligible for health insurance benefits
1. Cases specified in Clause 1 of Article 21 in which costs have been paid by the state budget.
2. Convalescence at sanatoria or convalescence establishments.
3. Medical check-up.
4. Prenatal tests and diagnosis for non-treatment purposes.
5. Use of obstetric supportive techniques, family planning services or abortion services, except for cases of discontinuation of pregnancy due to fetal or maternal diseases.
6. Use of aesthetic services.
7. Treatment of squint, short-sightedness and refractive defects.
8. Use of prostheses including artificial limbs, eyes, teeth, glasses, hearing aids or movement aids in medical examination, treatment and function rehabilitation.
9. Medical examination, treatment and function rehabilitation in case of occupational diseases, labor accidents or disasters.
10. Medical examination and treatment in case of suicide or self-inflicted injuries.
11. Medical examination and treatment for addiction to drugs, alcohol or other habit-forming substances.
12. Medical examination and treatment of physical or mental injuries caused by the injured’s law-breaking acts.
13. Medical assessment, forensic examination, forensic mental examination.
14. Participation in clinical trials or scientific research.
Tìm kiếm
Luật bảo hiểm y tế 2008 (Bản Pdf)
Luật bảo hiểm y tế 2008 (Bản Word)