Tips

The Power of Time: Navigating the Procedure to Change Your Primary Healthcare Provider on Your Health Insurance

To change their initial healthcare appointment time under their medical insurance, individuals must be aware of the legal regulations, especially those pertaining to timing and procedures. We provide a detailed guide to make this process easier for everyone.

Administrator

28 July, 2024

Changing your primary healthcare provider for health insurance (HI) is not as complicated or serious as you may think. All you need is to be aware of some guidelines and legal documents regarding this matter. Let’s explore this topic further with the following content!

1When to Change Your Primary Healthcare Provider

Individuals with health insurance who wish to change their primary healthcare provider must do so during the months of January, April, July, and October each year. This is instead of being able to choose any time as many people believe.

Changing your primary healthcare provider must be done during the months of January, April, July, and October each year

This requirement is legally grounded in Article 26 of the 2008 Health Insurance Law regarding the timing of changing primary healthcare providers: “Health insurance participants are allowed to change their registered primary healthcare facility at the beginning of each quarter.”

2Procedures for Changing Your Primary Healthcare Provider

According to Clause 2, Article 26 of the 2008 Health Insurance Law, amended and supplemented in 2014, health insurance participants have the right to change their primary healthcare facility when they feel it is necessary.

This regulation benefits those who are temporarily residing or frequently traveling for work and do not have a fixed residence by allowing them to access healthcare services more promptly.

Health insurance participants have the right to change their primary healthcare facility when they feel it is necessary

This provision is intended to facilitate the process for those with health insurance, especially when individuals are working in a mobile capacity or temporarily residing in a different location. In such cases, they can change their primary healthcare facility to one that is more convenient for their travel needs.

However, the procedure for changing the primary healthcare provider must adhere to Clause 4, Article 27 of Decision 595/QD-BHXH. The direct application for changing the primary healthcare provider includes:

Declaration of participation and adjustment of social insurance and health insurance information (for health insurance participants)

List of information (for units)

Additionally, individuals need to submit their old health insurance card, which is still valid, to obtain a new one.

3Cost of Changing Your Primary Healthcare Provider

Health insurance participants do not incur any costs for changing their primary healthcare provider

According to Clause 3, Article 30 of Decision 595/QD-BHXH, health insurance participants do not have to pay any fees for changing their primary healthcare provider. The application for this procedure will be processed within three working days from the date of receiving a complete application according to legal regulations.

4Timeline and Process for Handling the Application to Change Primary Healthcare Provider

The details of the procedure for changing the primary healthcare provider on the health insurance card are stipulated in Clause 1, Article 19 of the 2008 Health Insurance Law, amended and supplemented in 2014, as follows:

Step 1: Prepare the Application

The application for changing the primary healthcare provider includes:

Declaration form for providing and changing information of social insurance and health insurance participants, using form TK1-TS (01 copy). Download the declaration form here.

Old health insurance card that is still valid.

Original and one copy of the citizen identification card.

Step 2: Submit the Application to Change the Primary Healthcare Provider

Procedure for changing the primary healthcare provider for health insurance

Employees or units submit the application to change the primary healthcare provider at the beginning of each quarter. Submit the application to:

The district-level social insurance agency to issue a new, replacement, or exchanged health insurance card for health insurance participants whose insurance is collected by the district-level agency.

The provincial-level social insurance agency to issue a new, replacement, or exchanged health insurance card for health insurance participants at units directly collected by the provincial-level agency.

Step 3: Wait for Processing

Employees and units submitting the application will then receive a notification or email from the social insurance agency (if using the electronic social insurance software) where the application was submitted.

The social insurance agency will issue a new health insurance card within three working days from the date of receiving a complete application. If the application cannot be processed, the social insurance agency must provide a clear reason.

Step 4: Receive the New Health Insurance Card with the Changed Primary Healthcare Provider

The social insurance agency will send the health insurance card with the changed primary healthcare provider to the participant or the unit where the procedure to register the change of the primary healthcare provider for the employee was carried out.

5Where to Submit the Application to Change Primary Healthcare Provider

Submit the application to change the primary healthcare provider

Based on Clause 3, Article 3 of Decision 595/QD-BHXH on the issuance of health insurance cards, you will submit the application to the relevant agency based on your place of residence:

For health insurance participants whose insurance is collected by the district-level social insurance agency, the application should be submitted to the district-level social insurance agency.

For health insurance participants at units directly collected by the provincial-level social insurance agency, the application should be submitted to the provincial-level social insurance agency.

6Healthcare Services During the Waiting Period for a New Health Insurance Card

Healthcare services during the waiting period for a new health insurance card

During the waiting period for a new health insurance card with a changed primary healthcare provider, individuals can still enjoy health insurance benefits at the newly registered facility by presenting the following documents:

Appointment slip for a new or replacement health insurance card

Identification document with a photo, such as a citizen identification card

This is clearly stipulated in Clause 3, Article 15 of Decree 146/2018/ND-CP regarding healthcare services during the waiting period for a new health insurance card:

“During the waiting period for a new or replacement health insurance card, when visiting a healthcare facility, the health insurance participant must present the appointment slip for a new or replacement health insurance card issued by the social insurance agency or the organization or individual authorized by the social insurance agency to receive the application for a new or replacement card, along with a personal identification document with a photo, according to Form No. 4 in the Appendix issued with this Decree.”

So, with just a few regulations to follow, you can successfully change your primary healthcare provider! Best of luck to you!

Frequently asked questions

Changing your primary healthcare provider is important as it allows individuals to choose a doctor that suits their needs, ensuring better access to healthcare services and improved overall health. This is especially crucial when an individual’s health insurance policy is renewed or when they are dissatisfied with their current provider.

The process typically varies across different insurance companies, but some standard steps include: Understanding your insurance policy and checking if it allows for a change of primary healthcare provider; researching and selecting a new preferred doctor; contacting your insurance company and initiating the change request, providing valid reasons and necessary documentation; and finally, following up with both the insurance company and the new healthcare provider to ensure a smooth transition.

To ensure a seamless transition, individuals should be proactive in communicating with all relevant parties. This includes informing their previous healthcare provider about the change, obtaining necessary medical records, and ensuring the new provider has all the required information. Additionally, staying organized and keeping track of important documents and communication threads can help identify and resolve any issues that may arise during the transition.

Challenges may include bureaucratic hurdles, such as insurance companies having strict policies or long processing times. There could also be instances where an individual’s chosen doctor is not part of their insurance network, requiring them to either choose another provider or request an exception from their insurance company. In some cases, individuals may encounter resistance or a lack of cooperation from their previous healthcare provider during the transition process.

The frequency of changing primary healthcare providers depends on the individual’s insurance policy and personal preferences. While there may be no specific limits, it is generally advisable to avoid frequent changes as it can disrupt continuity of care and may raise red flags with insurance companies. It is essential to carefully consider one’s reasons for changing providers and ensure that it aligns with maintaining and improving one’s health and well-being.