What conditions are required for patients to enjoy 100% of medical examination and treatment costs covered by health insurance?

Master - Doctor Nguyen Thai Hoc, Deputy Head of Health Insurance Department, University of Medicine and Pharmacy Hospital, Ho Chi Minh City, answered: From January 1, 2025, University of Medicine and Pharmacy Hospital, Ho Chi Minh City is a high-tech specialized hospital. Therefore, to enjoy 100% of health insurance benefits at University of Medicine and Pharmacy Hospital, Ho Chi Minh City, patients need to have the following documents:

Photo: M.Tri

For outpatient examination and treatment:

• Information about health insurance card.
  
• Photo ID.
• Transfer form for medical examination and treatment facility under health insurance in accordance with regulations.
  

In case the patient is diagnosed and treated for some rare diseases, serious diseases, diseases requiring surgery or using high technology according to the list in Appendix I, Circular 01/2025/TT-BYT and meets the following conditions:

• Information about health insurance card.
  
• Photo ID.

* For inpatient examination and treatment:

• Information about health insurance card.
  
• Photo ID.

How does health insurance pay for out-of-network medical examination?

Master - Doctor Nguyen Thai Hoc said that when examining and treating patients with health insurance at the University of Medicine and Pharmacy Hospital in Ho Chi Minh City, patients have the following benefits:

For outpatient examination and treatment:

• On-line: 100% of the benefit level according to the card code.
• Left line: 0%.

For inpatient examination and treatment:

• On-line: 100% of the benefit level according to the card code.
• Off-line: 100% of the benefit level according to the card code.