Changes to health insurance coverage levels for medical examinations and treatment starting in 2021.

Currently, when receiving medical treatment outside of designated healthcare facilities using a health insurance card, in some cases, patients will have their medical expenses reimbursed by the health insurance fund at a rate ranging from 40% to 100%. 

However, From January 1st, 2021, individuals with health insurance cards who receive medical treatment at provincial-level hospitals outside their designated network will have 100% of their inpatient medical expenses covered by the health insurance fund. According to the benefit levels of the health insurance card as specifically stipulated in Clause 15, Article 1 of the amended Health Insurance Law 2014, as follows:Note: The above regulation This does not apply to ethnic minorities and members of households. Poor people participating in health insurance are living in areas with difficult socio-economic conditions. Difficulties and particularly hardships, those participating in health insurance who are living in island communes and districts. The island was abandoned when people went for medical examinations on their own, not through the designated network.

Health insurance coverage levels for in-network medical examinations and treatments in 2021.

Individuals participating in health insurance, when undergoing medical examination and treatment as stipulated in Articles 26, 27, and 28 of the 2008 Health Insurance Law, will have their medical expenses reimbursed by the health insurance fund within the scope of their entitlement, with the following benefit levels:

– 100% of medical examination and treatment costs for subjects specified in Points a, d, e, g, h and i of Clause 3, Article 12 of the 2008 Health Insurance Law (This Article was amended by Clause 6, Article 1 of the 2014 Amended Health Insurance Law).

– 100% of medical examination and treatment costs will be covered in cases where the cost per medical examination and treatment is lower than the level stipulated by the Government and the examination and treatment takes place at the commune level;

– 100% of medical examination and treatment costs are covered when the patient has participated in health insurance for 5 consecutive years or more and the amount of co-payment for medical examination and treatment costs in the year is greater than 6 months of the basic salary, except in cases of self-initiated medical examination and treatment outside the designated network;

– 95% of medical examination and treatment costs for subjects specified in Point a, Clause 2, Point k, Clause 3 and Point a, Clause 4 of Article 12 of the 2008 Health Insurance Law;

– 80% of medical examination and treatment costs for other eligible individuals.

Note:

If a person belongs to multiple health insurance categories, they are entitled to health insurance benefits according to the category with the highest benefits.

– Individuals participating in health insurance who initially register for medical examination and treatment at a commune-level health station, polyclinic, or district-level hospital are entitled to receive health insurance-covered medical examination and treatment at the same commune-level health station, polyclinic, or district-level hospital within the same province, and will receive the same benefits as above.

– Ethnic minorities and people from poor households participating in health insurance who are living in areas with difficult socio-economic conditions or areas with particularly difficult socio-economic conditions; participants
For those residing in island communes or districts who seek medical treatment outside their designated network, the health insurance fund will cover the costs of medical examinations and treatment at district-level hospitals, and inpatient treatment at provincial and central-level hospitals, with the same benefit levels as mentioned above.