Mr. Phi asked what the payment limit was for outpatient health insurance medical examinations and treatments at the district level, which falls within the 100% coverage at the general clinic.

Regarding this issue, the Vietnam Social Insurance responded as follows:

According to the regulations stated in Point d, Clause 1, Article 14 of Decree No. 146/2018/ND-CP guiding the implementation of some provisions of the Health Insurance Law, if the health examination and treatment are carried out in accordance with the prescribed guidelines, the Health Insurance Fund will cover 100% of the medical expenses for cases where the cost for a single examination and treatment is lower than 15% of the base salary level (currently equivalent to 223,500 VND, and from July 1, 2023, it will be 270,000 VND).

If the medical expenses for health insurance examination and treatment exceed this limit, the BHYT participants are required to share the payment of medical expenses according to the specified coverage level on their health insurance card.