1 Understanding Continuous 5-Year Health Insurance
Continuous 5-year health insurance refers to the situation where an insured individual has consistently paid for health insurance for a period of 5 years. An interruption in coverage is allowed for a maximum of 3 months.
The specific period of 5 years of continuous coverage is recorded on the health insurance card to determine if an individual meets the requirements or not.
As per Decision 1666/QD-BHXH 2020, the recording of the continuous 5-year period is defined as follows:
- For individuals who participated in health insurance for a continuous 5 years until January 1, 2015, the record will start from January 1, 2015.
- Since January 1, 2015, individuals who participate in health insurance and have not yet completed a continuous 5-year period will have the record starting from the first day of the sixth year.
2 Conditions for Eligibility of Continuous 5-Year Health Insurance
Based on point c clause 1 Article 22 of Health Insurance Law 2008, amended and supplemented in 2014, patients with health insurance cards are entitled to the benefits of continuous 5-year health insurance when they meet the following conditions:
1. Have participated in health insurance for a continuous 5 years: The duration of participation is directly recorded on the health insurance card.
2. Have total medical expenses higher than 6 months of the basic salary. The amount paid (VND) is the sum of money paid by the patient to the social insurance agency based on the percentage rate stated on the health insurance card.
3. Receive treatment at the appropriate level. According to Article 6 Circular 30/2020/TT-BYT, treatment at the appropriate level includes the following 8 scenarios:
- Insured individuals receive treatment at the facility stated on their health insurance card.
- Initial registration for treatment at the commune or district level and subsequent treatment at facilities of the same level within the same province.
- Emergency situations.
- Transfer of insured individuals as per regulations.
- Insured individuals temporarily residing, working, or moving to a different locality and receiving treatment at the same or equivalent facility as the initial registered facility stated on the health insurance card.
- Insured individuals with appointments for re-examination following transfer as per regulations.
- Immediate treatment for individuals donating body parts after donation.
- Immediate treatment for newborn infants.
3 Benefits of Continuous 5-Year Health Insurance
According to Article 12 Decree 146/2018/ND-CP: Individuals who have participated in health insurance for a continuous 5-year period, with an interruption not exceeding 3 months as regulated, the Health Insurance Card will determine the continuous 5-year period.
Once confirmed, patients will be reimbursed 100% of the costs of examination and treatment within the eligible range by the Health Insurance Fund, except in cases where they choose to seek medical care at a facility that is not at the appropriate level.
According to Clause 3 of Article 27 of Decree 146/2018/ND-CP:
– Patients with the same amount of payment for one or multiple examinations or treatments at the same facility that exceeds 6 months of the basic salary will be issued a “Certificate of non-co-payment within a year” and will be entitled to 100% reimbursement of medical expenses for subsequent visits.
– Patients with the same accumulated payment during the fiscal year at different or the same facility that exceeds 6 months of the basic salary:
- They must fully pay the co-payment amount to the facility.
- The Social Insurance Agency will directly reimburse the amount exceeding 6 months of the basic salary.
Note: The Health Insurance Fund only covers 100% of the medical expenses within the eligible entitlement range from the time the person meets the continuous 5-year requirement until December 31 of that year if the person’s co-payment amount exceeds 6 months of the basic salary calculated from January 1.
4 Procedures for Receiving Continuous 5-Year Health Insurance Benefits
If the total amount of payment for one or multiple visits to the same facility exceeds 6 months of the basic salary, there is no need to complete any additional procedures.
If the accumulated payment at different facilities or the same facility during the fiscal year exceeds 6 months of the basic salary, according to Notification 2298/TB-BHXH, individuals need to visit the Social Insurance Agency that issued their health insurance card to request reimbursement for the co-payment amount exceeding 6 months of the basic salary.
The following documents will be required:
- Health insurance card
- Copy of personal identification document with photo
- Original medical expense bill
5 Important Notes on Continuous 5-Year Health Insurance
Although each health insurance card specifies the specific duration of participating in health insurance for a continuous 5 years, there might be instances where the social insurance agency has not updated complete information about a patient’s health insurance due to lack of information or incorrect data during the card issuance and replacement process. This could potentially lead to individuals missing out on their entitlements.
To address this, the Vietnam Social Insurance, as per Official Letter 238/BHXH-CNTT 2018, requires provincial Social Insurance agencies to:
- Immediately replace the health insurance card on the same working day when an individual completes the issuance or replacement procedures due to incorrect information about the duration of health insurance participation.
- If there is incorrect information about the continuous 5-year period on the health insurance card, individuals only need to visit the Social Insurance Agency that issued the card to request a replacement.
- Processing time: Same working day
The above information provides insights into the benefits of participating in health insurance for a continuous 5-year period. If you have any further questions regarding your health insurance card, please contact for immediate assistance. Wishing you good health!
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