Birth coverage is 100% covered by health insurance, many people do not know
Health insurance participants when giving birth can be paid by the insurance fund from 80% to 100% of the cost depending on the group of subjects and form of medical examination and treatment.
According to the Law on Health Insurance, periodic prenatal check-ups and childbirth are cases within the scope of payment by the health insurance fund. This means that people with valid health insurance cards will be partially or fully supported for childbirth costs when going to the right tuyến.
Health insurance will pay 80%, 95% or 100% of childbirth costs within the scope of benefits; the specific payment level depends on the group of subjects and health insurance benefits of participants.
According to point a, clause 1, Article 21 of the 2008 Health Insurance Law, amended by clause 16, Article 1 of the amended 2024 Health Insurance Law, health insurance participants are reimbursed by the health insurance fund for medical examination and treatment costs, including remote medical examination and treatment, support for remote medical examination and treatment, family medicine medical examination and treatment, home medical examination and treatment, rehabilitation, periodic pregnancy check-ups, childbirth.
How much health insurance will pay when giving birth will depend on the benefit level of health insurance participants.
Currently, the health insurance benefit level is divided into 3 main groups.
The group entitled to 100% of the cost includes some priority subjects such as children under 6 years old, people with meritorious services, people under social protection and people who have participated in health insurance for 5 consecutive years and meet the conditions according to regulations.
The group receiving 95% of the cost includes pensioners, near-poor households and some other subjects as prescribed by law.
The majority of health insurance participants today belong to the group that is paid 80% of medical examination and treatment costs within the scope of benefits enjoyed.
However, to be paid the correct benefit level, people need to go for medical examination and treatment at the right tuyến or at the right place of initial medical examination and treatment registration. In case of self-birth outside tuyến, the health insurance fund will only pay according to the prescribed ratio.
In addition, not all childbirth costs are covered by health insurance. Expenses arising outside the scope of enjoyment such as service rooms, on-demand costs or some types of drugs, special techniques will be paid by the patient themselves.
People participating in health insurance who are eligible for 100% health insurance will also receive 100% of the cost of childbirth when giving birth.
According to current regulations, the level of health insurance benefits when giving birth will depend on the participants, the time of health insurance participation and whether the medical examination and treatment form is right or wrong. People need to carefully check their health insurance benefits before being hospitalized to avoid incurring unexpected costs.
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