The subjects using the hospital fee guarantee service include all customers with health care cards from life/non-life insurance companies with which the hospital has signed a hospital fee guarantee cooperation agreement.

Hospital fee guarantee is a convenient service that helps reduce the financial burden for patients when using medical services, but not everyone clearly understands the process and related benefits.

In case customers participate in health insurance, they can use it in parallel with the hospital fee guarantee service.

The scope of hospital fee guarantee will depend on the insurance package and the terms of the customer's contract with the insurance company. In addition, the insurance company will only agree to pay for appropriate medical services to diagnose and treat the actual health condition of the customer.

Therefore, people should carefully review the terms of the contract to understand the scope of their rights. In case you are not clear about your rights and have to be hospitalized, you can contact the insurance company's consultant or the hospital's hospital fee guarantee department for more information.

How will the medical examination and treatment costs when using the Hospital Fee Guarantee service at the hospital be paid? In response to this question, according to the representative of Phu Tho General Hospital, with the hospital, all medical examination and treatment costs that the insurance company confirms to guarantee for customers will be paid directly by the insurance company to the hospital.

Customers only have to pay the amount of expenses exceeding the limit or beyond the scope of the insurance contract guarantee to the Hospital (if any).

The time for the Insurance Company to confirm the guarantee for the customer according to the regulations for outpatient records is 30 minutes, for inpatient records is within 24 hours (unless the records need further appraisal, the Insurance Company will notify the customer).

However, every step in the hospital fee guarantee process will be directly supported by hospital fee guarantee staff and will be carried out as quickly as possible to save time for customers.

In which cases are hospital fees not covered by the insurance company? Not all cases of insurance coverage have the right to hospital fee coverage.

There are cases where hospital fees are not covered, specifically as follows: Failure to provide and present full insurance cards or relevant identification documents as required.

Cases where there is insufficient information to confirm the guarantee or further verification is required. People using medical services at facilities that are not part of the hospital/clinic network that cooperates with the insurance company.

People who are treating medical conditions that existed before the start of insurance. Services related to cosmetic surgery/cosmetic surgery. Accidents related to the use of alcohol and stimulants, not in compliance with the provisions of the law.

Treatment of diseases related to drugs and banned substances. Treatment costs for diseases caused by natural disasters, wars, etc.

Regarding the number of people participating in health insurance, according to statistics from the Ministry of Health, the rate is increasing. As of December 2023, the whole country has over 93 million people participating in health insurance, reaching a coverage rate of 93.35% of the population.

The quality of medical examination and treatment under health insurance is increasingly improving. People have access to modern medical technology services and many new, highly effective medicines, helping many people overcome illness and serious diseases.

The health insurance fund is always balanced and has a surplus, becoming a basic financial source serving the operation of medical examination and treatment facilities, protecting the finances of health insurance participants when they are sick and need examination and treatment. The health insurance policy has ensured the principle of risk sharing among health insurance participants.

From July 1, the basic salary increased from 1.8 million VND to 2.34 million VND, therefore, the health insurance benefits of patients have changed.

Specifically, regarding the level of health insurance benefits, in case a patient is admitted to the hospital or begins treatment before July 1 but is discharged from the hospital or ends treatment from July 1, and receives medical examination and treatment in accordance with the provisions of the Law on Health Insurance with a one-time cost of less than VND 351,000 (15% of the basic salary), the health insurance will cover 100%, meaning the patient receives free medical examination and treatment. This figure is an increase of VND 81,000 compared to the previous regulation.

Regarding direct payment, in case the patient is admitted to the hospital or starts treatment before July 1 but is discharged or finishes treatment from July 1, it is regulated.

Specifically, in the case of outpatient examination and treatment, payment is made according to actual costs within the scope of benefits and health insurance benefits according to regulations, but not exceeding 0.15 times the basic salary, equivalent to a maximum of not exceeding VND 351,000 (previously VND 270,000).

In case of inpatient examination and treatment, payment is made according to actual costs within the scope of benefits and health insurance benefits according to regulations, but not exceeding 0.5 times the basic salary at the time of discharge, equivalent to a maximum of not exceeding VND 1,170,000 (previously VND 900,000).

In case of inpatient examination and treatment at provincial level facilities and equivalent without a health insurance examination and treatment contract (except in emergency cases), payment shall be made according to actual costs within the scope of benefits and health insurance benefits according to regulations, but not exceeding 1 time the basic salary at the time of discharge from the hospital, equivalent to a maximum of 2,340,000 VND (previously 1.8 million VND).

In case a patient comes to a central-level facility for inpatient examination and treatment and does not have a health insurance contract (except in emergency cases), payment will be made according to the actual costs within the scope of benefits and health insurance benefits according to regulations, but not exceeding 2.5 times the basic salary at the time of discharge, equivalent to a maximum of not exceeding VND 5,850,000 (previously VND 4.5 million).

In addition, the Ministry of Health also stipulates that the total payment for medical supplies for one use of technical services must not exceed 45 months of basic salary. Specifically, in the case of a patient admitted to the hospital from July 1, the equivalent must not exceed VND 105.3 million, previously VND 81 million.

In case a patient is admitted to the hospital or begins treatment before July 1 but is discharged or ends treatment from July 1, the total payment for medical supplies for one use of technical services is determined by the time the technical service ends and the cost is calculated at 2 points in time.

Specifically, before July 1: Payment amount does not exceed 81 million VND and from July 1: Payment amount does not exceed 105.3 million VND.

Not only the health insurance benefits change, but when the basic salary changes from July 1, it will lead to many changes in policies, including health insurance contributions and benefits of health insurance participants.

Accordingly, the monthly family health insurance contribution is as follows: The first person contributes 4.5% of the basic salary; The second, third, and fourth persons contribute 70%, 60%, and 50% of the first person's contribution, respectively;

From the fifth person onwards, the contribution is 40% of the first person's contribution. For students, the monthly health insurance contribution is 4.5% of the basic salary (the State budget supports 30%, students pay 70%).

For students, the monthly health insurance premium is equal to 4.5% of the basic salary (the State budget supports 30%, students pay 70%).