Family Participation in Health Insurance: Small Costs, Significant Benefits

06/08/2023 03:40 PM


When participating in family health insurance, members are entitled to unlimited payment coverage for medical examination and treatment, with potential annual benefits reaching billions of dong. This is a privileged policy of the Party and the State, helping many people overcome economic difficulties when unfortunate illnesses or diseases occur.

The Law on Health Insurance stipulates that individuals can participate in family health insurance as part of a household group, which includes all members of a registered permanent or temporary resident household, except for those who have been issued health insurance cards under other beneficiary groups and those who have declared temporary absence. According to the regulations, participants in family health insurance are entitled to the following benefits: Being issued a health insurance card by the social security agency upon enrollment and payment of health insurance premiums; Choosing a convenient healthcare facility for initial registration according to the instructions of the social security agency, with the option to change the initially registered facility every quarter; Receiving medical treatment services covered by the Law on Health Insurance, with expenses paid by the social security agency; Receiving explanations and information about the health insurance regime from the social security agency, healthcare facilities providing health insurance services, and relevant authorities; Having the right to lodge complaints or report violations of the health insurance laws.

Illustrative image (internet)

Specifically, currently, when participating in family health insurance, starting from the second person, the payment amount is reduced. The first person pays 4.5% of the base salary: 81,000 VND/month (972,000 VND/year), the second person pays 70% of the payment amount of the first person: 56,700 VND/month (680,400 VND/year), the third person pays 60% of the payment amount of the first person: 48,600 VND/month (583,200 VND/year), the fourth person pays 50% of the payment amount of the first person: 40,500 VND/month (486,000 VND/year), and the fifth person and onwards pay 40% of the payment amount of the first person: 32,400 VND/month (388,800 VND/year).

Along with that, the regulation for family health insurance participation does not require the entire household to pay the fee at the same time. It is possible to make multiple payments throughout the financial year, and the fee is still reduced for members from the second person onwards. Participants in health insurance can choose to make payments every 3 months, 6 months, or once a year... These measures somewhat alleviate the burden of health insurance participation for many low-income households.

Illustrative image (internet)

For example, Mr. Le Gia Le (in Tho Xuong Ward, Bac Giang City, Bac Giang Province) has been participating in family health insurance for many years. Mr. Le said that besides his two employed children who have insurance coverage provided by their companies, the remaining five family members are self-employed, so they purchase family health insurance to save costs. On average, he spends over 2.5 million VND per year to buy health insurance. For a farming family, this is a considerable amount, but with the awareness of prevention for unexpected illnesses or accidents, he buys insurance for all members of the family every year. At the beginning of 2023, his health showed signs of decline. After visiting doctors, it was concluded that he had lung inflammation, fungal infection, and muscle weakness, requiring hospitalization for treatment. Fortunately, the health insurance covered the hospital fees, so the family only had to spend a small amount on food and daily expenses. Recently, during a medical check-up, the doctor discovered a heart problem and referred him to a higher-level hospital for treatment. Throughout the long process of medical examinations and hospitalization, almost 100% of the expenses were reimbursed by the health insurance.

It can be seen that participating in health insurance brings significant benefits to the participants. For self-employed individuals who are economically disadvantaged and do not have a stable income, the cost of medical treatment in case of illness or accidents can be a major concern. Health insurance helps alleviate this burden. Furthermore, participating in family health insurance gradually realizes the goal of community sharing and risk-sharing with patients. The lowest level is when family members share the risk among themselves, and the highest level is the implementation of universal health insurance. This is considered a form of saving, where contributions are made when one is healthy to have resources available when one is sick, in order to reduce the economic burden when individuals or family members fall ill./.

VSS