In which cases are medical examination and treatment fees directly paid by health insurance?

Question:

I would like to know in which cases the medical examination and treatment costs are directly paid by health insurance (HI) as well as what documents are required and where to submit them? - Ms. Le Ngan Hoa (Thanh Tri, Hanoi).

Hanoi Social Insurance replied:

Pursuant to Article 31 of the Consolidated Law on Health Insurance and Articles 28, 29, 30 of Decree 146/2018/ND-CP,

Doctor examines people in Hanoi.

1. Cases eligible for direct payment include:

- In case of medical examination and treatment at a medical facility that does not have a health insurance contract.

- In case of medical examination and treatment not in accordance with the provisions of Article 28, Law on Health Insurance (medical examination and treatment without presenting health insurance card and/or related documents (ID card, referral paper, re-examination appointment paper)).

2. Procedures: Pursuant to Article 28, Decree 146/2018/ND-CP:

“1. The documents are photocopies (with originals for comparison) including:

Health insurance card, identity card as prescribed in Clause 1, Article 15 of this Decree;

Hospital discharge papers, medical examination form or medical examination book of the medical examination or treatment for which payment is requested.

2. Invoices and related documents.”

3. Submit application to the district-level Social Insurance agency where you reside (pursuant to Article 29, Decree 146/2018/ND-CP).

Source: https://kinhtedothi.vn/truong-hop-nao-duoc-thanh-toan-truc-tiep-phi-kham-chua-benh-bao-hiem-y-te.html