Illustrative image (Source: VSS)

Accordingly, the Ministry of Health guides the application of the base salary in health insurance payment of medical examination and treatment expenses during the transitional period from July 1, 2023, to December 31, 2023. Specifically, the instructions are as follows:

(1) Regarding health insurance benefit levels as regulated in point d, clause 1, Article 14 of Decree No. 146/2018/NĐ-CP dated October 17, 2018, which details and guides the implementation of certain provisions of the Health Insurance Law, or in case patients are admitted or begin treatment before July 1, 2023, but are discharged or complete treatment after July 1, 2023: The costs for each medical examination or treatment shall be lower than 15% of the base salary level, equivalent to less than 270,000 VND.

(2) Regarding direct payment levels as regulated in Article 30 of Decree No. 146/2018/NĐ-CP from July 1, 2023, or in case patients are admitted or begin treatment before July 1, 2023, but are discharged or complete treatment after July 1, 2023:

In case of outpatient medical examinations and treatments, the payment shall be made according to the actual costs within the scope and at the level of health insurance benefits as prescribed without exceeding 0.15 times of the base salary at the time of medical examinations and treatments, equivalent to not more than 270,000 VND.

In case of inpatient medical examinations and treatments, the payment will be made according to actual costs within the scope and at the level of health insurance benefits as prescribed without exceeding 0.5 times of the base salary at the time of discharge, equivalent to no more than 900,000 VND.

In case patients receive inpatient medical examinations and treatments at a provincial- or equivalent-level health establishment without any health insurance-covered medical examination and treatment contract (except case of emergency), the payment will be made according to actual costs within the scope and at the level of health insurance benefits as prescribed which must not exceed 1.0 times of the base salary at the time of discharge, equivalent to not more than 1,800,000 VND.

In case patients who receive inpatient medical examinations and treatments at a central- or equivalent-level health establishment without any health insurance-covered medical examinations and treatment contract (except case of emergency), the payment will be made according to actual costs within the scope and at the level of health insurance benefits as prescribed which must not exceed 2.5 times of the base salary at the time of discharge, equivalent to not more than 4,500,000 VND.

Illustrative image (Source: VSS)

(3) The payment level for total medical supplies and services for a single use shall not exceed 45 times the base salary level as regulated in point b, clause 2, Article 3 of Circular No. 04/2017/TT-BYT dated April 14, 2017, issued by the Ministry of Health, which provides the list, ratio, and payment conditions for medical supplies within the scope of health insurance participation:

- In case patients are admitted or begin treatment from July 1, 2023: The payment level shall not exceed 81,000,000 VND.

- In case patients are admitted or begin treatment before July 1, 2023, but are discharged or complete treatment after July 1, 2023: The payment level for total medical supplies and services for a single use shall be determined based on the time of completion of the technical service, specifically:

+ Before July 1, 2023: The base salary level is stipulated in Government’s Decree No. 38/2029/NĐ-CP dated May 9, 2019, of the Government, which regulates the base salary level for officials, civil servants, public employees, and armed forces personnel, shall apply, not exceeding 67,050,000 VND.

+ From July 1, 2023: The base salary is level stipulated in Government’s Decree No. 24/2023/NĐ-CP dated May 14, 2023, of the Government, which regulates the base salary level for officials, civil servants, public employees, and armed forces personnel, shall apply, not exceeding 81,000,000 VND.

(4) From July 1, 2023, and in case patients are admitted or begin treatment before July 1, 2023, but are discharged or complete treatment after July 1, 2023, the total amount jointly paid for health insurance costs within the year that exceeds 6 months of the base salary level shall be used to determine the entitlement to benefits not subject to joint payment as stipulated in point đ, clause 1, Article 14 of Decree No. 146/2018/NĐ-CP, which exceeds the amount determined as follows: [Please provide the specific calculation for this part:

                            The total amount jointly paid from

               6-       (     January 1, 2023, until before Jul )      x 1.800.000 VND

                                          1.490.000 VND