BENEFITS:
EMERGENCY CASES: Receive medical treatment at any health care facility covered by health insurance and must present the required documents before being discharged from the hospital.

IMPROPER-LEVEL TREATMENT: If one does not have a paper referral, but fully presents the medical treatment procedures, he/she will be covered by the health insurance fund within the scope, benefit level and coverage rate as prescribed below Coverage rate (Medical expenses) Outpatient care at district hospitals Inpatient care at district and provincial hospitals Inpatient care at central hospitals.

PRIMARY-LEVEL TREATMENT

Receive treatment at the right place for initial treatment written on the card

Referrals of medical treatment under health insurance in accordance to regulations will be covered by the health insurance fund within the scope of benefits and coverage as follows: Coverage rate (Total medical expenses).

Getting commune-level medical care: If the medical costs are less than 15% of the base salary (1,490,000 VND/month) at the time of treatment
Participating in health insurance for 5 consecutive years or more and the amount of co-payment of medical expenses in the year is greater than 6 months; base salary, except for the case of not going for improper-level treatment.

Coverage rate
(Total medical expenses)
Other cases

Notes for medical treatment at provincial-level establishments
nationwide
* Provincial inpatient treatment:
The health insurance fund covers 100% of expenses within the scope and level of benefits of participants. Patients are not exempt from co-payment of medical expenses, and the co-payment in this case is not determined as a condition for issuing the Certificate of non-co-payment in the year.
* Provincial outpatient treatment:

Not covered by the health insurance fund.
6 MEDICAL CARE AT ESTABLISHMENTS WITHOUT CONTRACTS FOR TREATMENT UNDER HEALTH INSURANCE:
Covered by the social insurance agency for medical treatment costs
under health insurance in the following cases:
Health insurance card data is not provided or incorrectly provided

about card information:
The patient fails to present his/her health insurance card before getting discharged from the hospital or transferring on the same day due to an emergency, loss of consciousness or death.
The patient participates in health insurance for 5 consecutive years or more and the amount of co-payment of medical expenses in the year is greater than 6 months; base salary but not yet paid the co- payment amount greater than 6 months; base salary.

7 COVERAGE RATE
Maximum coverage for outpatient medical care at district hospitals
0.15 times base salary
(1,490,000 VND x 0.15 = 223,500 VND).
Maximum coverage for inpatient medical care at district hospitals
0.5 times base salary
(1,490,000 VND x 0.5 = 745,000 VND).
Maximum coverage for inpatient medical care at provincial hospitals
1 time base salary
(1,490,000 VND x 1 = 1,490,000 VND).
Maximum coverage for inpatient medical care at central hospitals
2.5 times base salary
(1,490,000 VND x 2.5 = 3,725,000 VND).
8 PROCEDURES TO PARTICIPATE AND WHERE TO REGISTER
Make a declaration of participation in household-based health insurance
according to the form guided at the place of registration (except for cases Where the health insurance card code is already available):

Headquarters of provincial and district social insurance agencies Social and health insurance collection agents: People Committees of communes, wards and townships; Post office; Unions, etc.

9 INAPPROPRIATE TREATMENT
In case of failing to present all procedures at the place of initial medical treatment, the social insurance agency will cover the costs for medical care under health insurance for the following cases:
Maximum coverage for outpatient medical care 0.15 times base salary (1,490,000 VND x 0.15 = 223,500 VND).
Maximum coverage for inpatient medical care 0.5 times base salary (1,490,000 VND x 0.5 = 745,000 VND).