Does someone receive health insurance benefits when going for a medical examination on Sunday
Wed, 19 Jul 2023 22:37:00 | Print | Email Share:
The initial registration for health examination and treatment under health insurance (BHYT) for Mrs. Tran A was at Phuc Hung private general hospital in Quang Ngai province. On May 28, 2023, which was a Sunday, Mrs. Tran A went for a medical examination and an ultrasound for her pregnancy. The hospital staff informed her that medical examinations on Sundays are not eligible for health insurance benefits.
Mrs. A asked if the hospital's response was correct and if she could submit a request for direct payment of the BHYT medical expenses.
Regarding this matter, the Quang Ngai provincial Social Insurance agency provided the following answer:
According to Point b, Clause 1, Article 27 of Decree No. 146/2018/NĐ-CP, medical facilities are responsible for ensuring human resources, professional conditions, and publicly announcing the costs that patients must pay beyond the eligible and reimbursable BHYT limits. They must notify patients in writing and inform the Social Insurance agency in advance to supplement the medical examination and treatment contract before conducting activities on holidays and days off for payment settlement.
Based on Clause 1, Article 1 of the BHYT medical examination and treatment contract No. 11/HĐKCB-BHYT dated December 28, 2022, between Phuc Hung private general hospital and Quảng Ngãi provincial Social Insurance agency, it states that the hospital's reception hours for patients are from Monday to Saturday. Morning hours are from 7:00 AM to 11:30 AM, and afternoon hours are from 1:30 PM to 5:00 PM, all on weekdays.
According to this regulation, Mrs. A's medical examination and ultrasound on Sunday (not an emergency case) are not eligible for BHYT benefits at Phuc Hung private general hospital.
By: Chinhphu.vn (Government News)./Translator: LeAnh-Bizic
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