5-Year Continuous Health Insurance (HI) Coverage: 100% Reimbursement Update (2024)

Expanding eligibility for 100% healthcare cost reimbursement under the HI program for those with 5 consecutive years of contributions will help many citizens save on medical expenses. This article details the new changes to make it easier to understand and apply.

Expanded 100% Health Insurance Reimbursement for 5-Year Continuous Participants

Introduction to Eligibility Changes

Previously, HI participants who contributed for 5 consecutive years were eligible for 100% reimbursement if their total self-contribution costs exceeded 6 months of the base salary. However, the new 2024 HI law introduces significant changes to calculating this self-contribution amount, expanding opportunities for more beneficiaries.

100% Health Insurance Reimbursement Criteria (2024 Update)

The 2024 HI law significantly alters the calculation of the self-contribution amount for 100% coverage. The core requirement remains:

5 Consecutive Years of HI Participation: This condition hasn’t changed; continuous enrollment for 5 years is necessary.
Exceeding the Self-Contribution Threshold: The primary change is in determining this threshold. Instead of solely relying on in-network healthcare costs, the new law includes 7 additional situations:
- Referral/Transfer Costs: Reimbursement for transferring patients between healthcare facilities.
- Incorrect Appointment Location: Reimbursement if a patient needs to seek care at a different location due to relocated residence while registered at a specialist facility.
- Out-of-Network Care (Specific Cases): Reimbursement for out-of-network care in cases of confirmed diagnosis, treatment of rare/serious illnesses, surgeries, or advanced procedures as defined by the Ministry of Health.
- Indigenous Peoples/Low-Income Households: Reimbursement for in-patient care at specialized facilities for indigenous peoples and low-income households living in remote areas.
- Primary Healthcare Facility Treatment: Reimbursement for treatments at primary healthcare facilities.
- Outpatient Care at Basic Healthcare Facilities: Reimbursement for outpatient care at basic healthcare facilities.
- Emergency Care: Reimbursement for emergency care at any healthcare facility.
Reference Value Instead of Base Salary: Instead of comparing costs to 6 months of base salary, the new threshold will be based on a “reference value.” The government will determine this value based on specific salary policy changes.

Conclusion

The 2024 HI law broadens eligibility for 100% healthcare reimbursement for those with 5 years of continuous contributions, encompassing a wider range of healthcare expenses. This update offers more opportunities for citizens to access quality healthcare services. Consult your local HI office for the most accurate and up-to-date information.