Can You Get the Same Benefits at a Central Hospital by Enrolling at a Health Station?

"Are you registered for healthcare insurance at a local clinic but want to visit a hospital instead? Or are you signed up in one district but need to see a doctor in another? Will your insurance cover these scenarios? This article aims to answer queries regarding insurance validity when your treatment location differs from your initial registration. "

Administrator

4 June, 2024

1. Out-of-District Healthcare: Understanding Your Options

As per Article 22 of the Health Insurance Law, if you’re enrolled in a district-level health insurance program but seek treatment at a medical facility in another district within the same city, rest assured that the health insurance fund will cover your expenses as per your registered tier. Just remember to follow the standard health insurance treatment procedures, including presenting your health insurance card and a form of photo identification.

2. Navigating Tiered Healthcare: Understanding Your Benefits

Your benefits will vary depending on where you initially registered for health insurance. Here’s a breakdown for clarity:

Registered at a District-Level Hospital, Polyclinic, or Commune Health Station

Provincial-level hospitals: The health insurance fund covers 100% of inpatient treatment costs but does not cover outpatient expenses.
Central-level hospitals: The health insurance fund covers 40% of inpatient treatment costs but does not cover outpatient expenses.

Registered at a Provincial or Central-Level Hospital

Central-level hospitals: The health insurance fund covers 40% of inpatient treatment costs but does not cover outpatient expenses.
Provincial-level hospitals: The health insurance fund covers 100% of inpatient treatment costs but does not cover outpatient expenses.
District-level hospitals: The health insurance fund covers 100% of treatment costs, including outpatient visits.
Polyclinics or commune health stations: These visits are not covered by the health insurance fund.

3. Understanding Your Options: Trạm Y Tế to Central-Level Hospitals

According to Point a, Clause 1, Article 4 of Circular No. 14/2014/TT-BYT, transferring patients from lower to higher levels must follow a specific sequence: from Tier 4 to Tier 3, Tier 3 to Tier 2, and Tier 2 to Tier 1.

Therefore, if you are registered for health insurance at a commune health station (Tier 4) and wish to fully utilize your health insurance benefits at a central-level hospital (Tier 1), you will need to obtain a transfer letter following the proper procedure.

4. Flexibility in Central-Level Hospitals: Understanding Your Coverage

Central-level hospitals: The health insurance fund covers 40% of inpatient treatment costs but does not cover outpatient expenses.
Provincial-level hospitals: The health insurance fund covers 100% of inpatient treatment costs but does not cover outpatient expenses.

Note: This article serves as a general guide. For specific advice regarding your health insurance benefits, please contact your local social insurance agency or healthcare provider for detailed guidance.

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Frequently asked questions

Yes, by enrolling at a health station, you can access the same benefits offered by a central hospital. Health stations are primary healthcare facilities that provide a range of services, including preventive care, treatment for common illnesses, and referrals to specialists if needed. They are typically connected to a network of healthcare providers, including central hospitals, which allows for seamless access to additional services and specialized care.

Enrolling at a health station offers several benefits. First, health stations provide convenient and accessible primary healthcare services, often closer to your home or workplace. Second, they offer comprehensive care, including preventive services, health education, and management of chronic conditions. Third, health stations typically have shorter wait times and more personalized care compared to larger hospitals. Finally, by enrolling at a health station, you become part of a coordinated care network, ensuring that your medical records are shared securely with other healthcare providers in the network, including central hospitals, for seamless continuity of care.

Health stations offer a range of services, including general practitioner consultations, preventive health checks, immunizations, management of chronic diseases, minor injury treatment, and referrals to specialists. They also often provide health education, counseling, and support services to promote overall well-being.

Health stations are typically part of a larger healthcare network, which includes central hospitals. This means that the health station has a formal relationship with the central hospital, allowing for easy referral and access to specialized services. Medical records can also be securely shared between the health station and the central hospital, ensuring that your healthcare team has a comprehensive view of your health history.

When making this decision, consider your specific healthcare needs and preferences. If you require specialized care for a complex condition, a central hospital may be more suitable, as they have a wider range of specialists and advanced medical equipment. However, if you are generally healthy and are looking for convenient access to primary care services, a health station can provide personalized and comprehensive care closer to home. It’s important to assess your own needs and also understand the specific services and benefits offered by the health station and central hospital in your area.