In 2024, there are forms, procedures and levels of health insurance transfer benefits that people need to know to implement correctly and avoid having their rights affected.
During the medical examination and treatment process, patients can move from one medical examination and treatment facility to another according to professional and technical requirements or personal wishes. During this process, people need to clearly understand the forms of health insurance referrals and the benefits when medical examination and treatment are transferred to ensure their rights.
Current health insurance medical examination and treatment routes
Technical professional routes are divided into 4 routes as follows:
– Central line and equivalent (line 1);
– Provincial and equivalent routes (route 2);
– District, district, town and equivalent lines (line 3);
– Commune, ward, town and equivalent lines (line 4).
3 forms of health insurance referral in 2024
Currently, there are 3 forms of health insurance referral, specifically as follows:
First, transfer the patient from lower level to higher level
– Transfer patients from the lower level to the adjacent higher level in the following order: level 4 moves to level 3, level 3 moves to level 2, level 2 moves up.
– Transferring patients without following the above order, if the adjacent higher-level medical examination and treatment facility does not have appropriate technical services, the lower-level medical examination and treatment facility will be transferred to the higher level.
Second, transfer the patient from the upper level to the lower level.
Third, transfer patients between medical examination and treatment facilities at the same level.
People need to clearly understand the regulations to avoid having their health insurance medical examination and treatment benefits affected when referred. Illustration.
What are the medical examination and treatment procedures when transferring?
Pursuant to the provisions of Article 15 of Decree 146/2018/ND-CP, when transferring for medical examination and treatment, you need to bring the following documents:
+ Health insurance card with photo; or the health insurance card does not have a photo and a document proving identity; or Appointment letter to reissue the card, change the health insurance card and a document proving the person’s identity in case the card is being reissued.
+ Transfer paper
In case the referral document is valid until December 31 but the treatment period has not ended, the referral document can be used until the end of the treatment period.
In case of re-examination as required for treatment, health insurance participants must have a re-examination appointment letter from the medical examination and treatment facility according to regulations.
Health insurance benefits when transferring in 2024
The case of a health insurance participant being transferred to a medical examination and treatment facility under health insurance regulations is one of the cases of medical examination and treatment at the correct route. At that time, the patient will receive health insurance payment rates when receiving a referral as follows:
– 100% of medical examination and treatment costs for the following subjects:
+ Officers, professional soldiers, non-commissioned officers, active military soldiers;…
+ People with meritorious services to the revolution, veterans;
+ Children under 6 years old;
+ People eligible for monthly social protection benefits;
+ People from poor households; Ethnic minorities living in areas with difficult socio-economic conditions; people living in areas with particularly difficult socio-economic conditions; people living in island communes and island districts;
+ Relatives of people who have contributed to the revolution are the father, mother, spouse, and children of martyrs; people who have contributed to nurturing martyrs;
+ Patients who have participated in health insurance for 5 consecutive years or more and have the amount of money to pay for medical examination and treatment costs in the year greater than 6 months of base salary,
– 95% of medical examination and treatment costs within the scope of health insurance coverage: People receiving pension or monthly disability allowance; relatives of people who contributed to the revolution; near-poor households,…
– 80% of medical examination and treatment costs within the scope of health insurance coverage: Remaining subjects.
It is expected to pilot the electronic health insurance referral form from April 1, 2024
Recently, the Ministry of Health issued Decision 4750/QD-BYT amending and supplementing Decision 130/QD-BYT dated January 18, 2023 stipulating output data standards and formats to serve management, assessment, payment of medical examination and treatment costs and settlement of related regimes.
In this decision, the Ministry of Health has officially added 2 new data tables including the health insurance referral data table and the re-examination appointment data table according to the provisions of Decree 75/2023/ND- Government CP.
From April 1, the Social Insurance agency and hospitals nationwide will begin testing the sending and receiving of electronic data on health insurance referrals and re-examination appointments, moving forward with implementation. Officially announced nationwide from July 1, 2024.
Also according to the plan in 2024, the Ministry of Health will coordinate with Department C06 – Ministry of Public Security and Vietnam Social Insurance to research and deploy the integration of these two types of documents on VneID applications (apps). electronic identification), VssID (Digital Social Insurance).
When these two types of documents are integrated on the VNeID and VssID applications, patients when making referral or re-examination procedures only need to present the electronic referral paper or electronic re-examination appointment paper on the VNeID or VssID application ( with built-in QR code).
The implementation of electronic health insurance referrals and electronic re-examination appointments promises to bring many practical meanings and values such as serving state management of health insurance referrals, Create a centralized data warehouse to serve analysis, statistics, and promptly adjust health insurance policies closer to reality. At the same time, it helps publicity and transparency in referral work and simplifies administrative procedures.
Besides, shortening the time, creating convenience and convenience for patients and medical examination and treatment facilities when receiving, carrying out referral procedures or re-examination. Along with that, limit fraud and forgery in referral work and support the Social Insurance agency in assessment and health insurance payments…
