Newborn health insurance – Procedures to apply for a card and the latest benefits

1 What is infant health insurance?

Health insurance for infants belongs to the welfare group paid by the State budget. According to Circular 30/2020/TT-BYT, guiding in Decree 146/2018 on Health Insurance, from March 1, 2021, babies will be provided with free health insurance right after they are born.

At the same time, children will be provided with free health insurance until they are 6 years old and enjoy 100% of medical examination and treatment costs paid by health insurance when visiting at the right level.

2 Health insurance benefits for infants

According to Clause 7, Article 3 of Decree 146/2018/ND-CP, children under 6 years old who go for medical examination will be entitled to health insurance as follows:

Right line

Children are examined and treated at the right places registered on health insurance. Health insurance for infants is included in the health insurance premium for children under 6 years old.

Pursuant to Point b, Clause 1, Article 14 of Decree 146/2018/ND-CP, children under 6 years old are entitled to 100% of medical examination and treatment expenses, and no limit on the rate of payment of drugs, chemicals, and materials is applied. medical consulting and technical services.

Opposite line

In case of taking children under 6 years old to medical examination and treatment at the wrong line, the health insurance fund shall pay the following payment:

• At central hospitals: 40% of inpatient treatment costs.
• At provincial hospitals: 100% of inpatient treatment costs nationwide (previously 60%), effective from January 1, 2021.
• At district hospitals: 100% of medical examination and treatment costs, from January 1, 2016.

According to the above regulations, when children under 6 years of age are examined and treated outside the provincial and central levels, the health insurance fund will only cover the costs when the patient is in inpatient treatment. Outpatients at the provincial and central levels must pay all medical expenses themselves and the health insurance fund does not support this case.

3 Procedures for issuance of health insurance cards for infants

Dossier to prepare

Pursuant to Articles 6 and 7, Joint Circular No. 05/2015/TTLT-BTP-BCA-BYT 2015 stipulates as follows:

Dossier for interoperability of administrative procedures for birth registration, permanent residence registration, and health insurance card issuance for children under 6 years old includes the following documents:

1. Birth registration declaration (according to the form).

2. Birth certificate issued by the medical facility where the child was born. If there is no birth certificate, it can be replaced with other documents such as:

• Written certification of the witness, if the child is born outside a medical facility and there is no witness, there is a written assurance that the birth is real.
• Minutes of abandoned children in lieu of birth certificates if children are abandoned,…

3. Declaration of participation in health insurance.

The applicant can go to the Commune People’s Committee to receive the results, or if they want to receive the results by post or by courier service, they must register with the Commune People’s Committee and pay the service fee.

settlement agency

Article 5, also in the Joint Circular No. 05/2015/TTLT-BTP-BCA-BYT 2015 stipulates: The One-Stop-Shop Section of the Commune People’s Committee (People’s Committee) will receive the required documents. Health insurance card for children under 6 years old. This unit will be responsible for receiving dossiers and making and transferring the dossiers to the district social insurance agency to issue health insurance cards for children under 6 years old.

The time limit for processing applications

Clause 2, Article 12, Joint Circular No. 05/2015/TTLT-BTP-BCA-BYT 2015 stipulates that, from the date of receipt of complete dossiers, within 10 days, the district social insurance agency shall issue health insurance cards. for children under 6 years old and transferred to the Commune People’s Committee.

4 Some notes when using health insurance for babies

According to Clause 1, Article 10, Circular 30/2020/TT-BYT issued on January 6, 2021, by the Ministry of Health guiding the implementation of a number of articles of Decree 146/2018/ND-CP on health insurance as follows:

After a child is born, he/she is entitled to health insurance benefits according to the provisions of the Law on Health Insurance but has not yet been issued a health insurance card by the social insurance agency because the procedures for issuance of a birth certificate have not been completed, the medical examination and treatment establishment shall write a temporary health insurance card code for the child. . The regulation takes effect from March 1, 2021.

Card content includes the following information:

• Object code: Write the symbol TE.
• Health insurance benefit rate code: Write the symbol as number 1.
• Code of province or centrally run city: Write in accordance with the provisions of Decision 124/2004/QD-TTG where the mother or legal guardian resides or where the medical examination and treatment establishment is located, for the school In case the newborn is unclaimed or abandoned at a medical examination and treatment facility.
• Medical identification code: Record as prescribed in Decision 2153/QD-BYT 2020.

Thanks to this provision, even if a child is born without a birth certificate, he or she is still guaranteed to enjoy the required benefits thanks to a temporary health insurance card.

In addition, the Circular also guides how to write names in medical records for children as follows:

• If the infant has a mother or father (father): Enter the first and last name of the mother or father (father).
• If the infant has no mother or father (father) but has a guardian: Enter the guardian’s first and last name.
• If the newborn is unclaimed or abandoned at a medical examination and treatment facility: Enter the name of the medical examination and treatment facility where the child is being treated.

1. Vietnamese Law

2. Law on Health Insurance

3. Vietnam Social Insurance

Above is information about health insurance for babies, registration procedures, and benefits when children have health insurance cards. Hope this article is useful to you.

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