More benefits for patients using health insurance

(Dan Tri) - Circular 39 of the Ministry of Health, effective from 2025, amends and supplements many regulations to facilitate patients using health insurance (HI).

The Ministry of Health has just issued Circular No. 39/2024/TT-BYT amending and supplementing a number of articles of Circular No. 35/2016/TT-BYT on promulgating the list, rates, and payment conditions for medical technical services within the scope of benefits of health insurance participants.

Accordingly, in Clause 2, Article 1, Circular 39 amends and supplements the list of medical technical services covered by health insurance in the direction of simplifying conditions to expand the scope of implementation for lower-level medical facilities, helping patients have more choices.

Payment conditions for computed tomography (CT) scans are extended to cases such as chest or abdominal scans for children under 6 years old, and skull and face scans for congenital skull and face defects.

Many high-tech services supporting cancer diagnosis and treatment are also covered by health insurance, such as PET/CT scans to diagnose cancer, metastatic cancer of unknown primary tumor, determine stage, determine recurrence or metastasis, evaluate treatment response, etc.

Readers can follow the detailed list, rates, and payment conditions for medical technical services within the scope of benefits for health insurance participants issued with Circular 39 HERE.

Cancer patients will receive more support from health insurance (Illustration: Ho Chi Minh City Social Insurance).

In addition, Circular 39 adds Articles 4a, 4b, 4c, 4d after Article 4 of Circular 35 (regulations on instructions for health insurance payment).

In Article 4a, Circular 39 stipulates that the cost of many types of supplies not included in the price of a treatment bed day, is paid according to the actual use of the patient such as: Medicine, blood, blood products, infusion fluids, syringes, needles, etc.

Article 4a stipulates that costs not included in the price of technical services are paid according to actual use for patients; medical examination and treatment facilities do not collect from patients the costs of medicines, consumables, and replacement materials within the scope of payment of the Health Insurance Fund.

In Article 4b, Circular 39 stipulates that during the same medical examination at the same medical facility, if a patient, after being examined by one specialist, needs to see other specialists, from the second examination, only 30% of the price of one medical examination will be charged.

If a patient sees many specialists at the same time, the maximum payment for the medical examination cost will not exceed 2 times the price of one medical examination.

If the patient has finished the examination and received medicine to go home, but then shows abnormal symptoms and comes back for a check-up on the same day, this visit will also be counted as the second visit of the day, only 30% of the price of one medical visit will be charged.

In Article 4c, Circular 39 stipulates how to determine the number of bed days, apply prices and pay for bed days between the social insurance agency and medical examination and treatment facilities; including many provisions that are beneficial to patients.

Specifically, if a patient is transferred to two departments on the same day, each department will only be counted as half a day.

The price of the hospital bed service per day is calculated according to the standard of 1 person/1 bed. In case 2 people have to share a bed at the same time, only 1/2 of the service price will be paid. In case 3 or more people share a bed, only 1/3 of the price will be paid. In case the patient is on a stretcher or folding bed, 50% of the price will be applied.

Circular 39 officially takes effect from January 1, 2025.

Source: https://dantri.com.vn/an-sinh/them-quyen-loi-cho-nguoi-benh-su-dung-bao-hiem-y-te-20241123055255011.htm