Health insurance (HI) is a crucial policy designed to help reduce the financial burden of medical expenses for citizens. However, not all cases are covered by HI. This article will provide insights into situations where you may not be entitled to health insurance benefits.
Regulations on Non-Covered Health Insurance Cases
According to Article 23 of the Health Insurance Law, there are 12 specific cases where patients are not entitled to benefits from the HI fund, even if they receive treatment at authorized facilities. Below is a detailed analysis:
1. History of Regulation Updates
- 2008 HI Law: Initially outlined 14 cases not covered by HI.
- 2014 HI Law: Reduced to 12 cases, which remain in effect to this day.
- 2024 HI Law: Maintains the 12 cases but includes amendments to two specific scenarios.
2. Two Amended Cases in the 2024 HI Law
a. Case 7: Expanded Coverage for Refractive Disorders
- Old Rule (2014): Treatment for refractive errors such as myopia, hyperopia, or strabismus was not covered, except for children under 6 years old.
- New Rule (2024): Now applies only to individuals aged 18 and above. This means children and teenagers under 18 are now eligible for HI coverage for refractive issues.
b. Case 8: Clarified Wording
- The core content remains unchanged, but the wording has been revised for better clarity, helping citizens understand the information more accurately.
3. List of 12 Non-Covered Health Insurance Cases
Below is a detailed list of cases not covered by the HI fund:
- Medical costs due to traffic accidents, except in emergencies.
- Infertility treatment.
- Cosmetic services or plastic surgery not for medical purposes.
- Addiction treatment, including drug rehabilitation and alcohol/smoking cessation.
- Screening tests and community-based diagnostic assessments.
- Use of medications and medical supplies not included in the HI-covered list.
- Treatment for refractive disorders for individuals aged 18 and above.
- Rehabilitation services not included in approved technical lists.
- Routine health check-ups and general health screenings.
- Vaccinations (except those under national immunization programs).
- Treatment for occupational diseases or work-related injuries.
- Costs exceeding the scope of HI coverage.
Tips for Health Insurance Participants
To ensure your rights when using your HI card, keep the following in mind:
- Be aware of the list of cases not covered by HI.
- Double-check the list of medications and medical services covered by HI before undergoing treatment.
- Keep all relevant receipts and documents for reimbursement claims, if necessary.
Conclusion
The Health Insurance Law is continuously updated to meet the healthcare needs of citizens. Understanding these regulations, especially the cases not covered by HI, will help you take proactive steps to protect your rights. Stay informed about policy changes to maximize your HI benefits.
For more details, contact your local Social Security office or visit the official website of Vietnam’s Social Security.
Source: dantri.com.vn
