Công văn 1537/BHXH-CSYT năm 2021 hướng dẫn thanh toán chi phí xét nghiệm COVID-19 theo chế độ bảo hiểm y tế do Bảo hiểm xã hội Việt Nam ban hành

On 28/5/2021, the Ministry of Health issued Official Dispatch No. 4356/BYT-KHTC on guidelines for COVID-19 testing costs covered by health insurance fund. Vietnam Social Security shall send copies of the abovementioned Official Dispatch to provincial social security authorities for them to implement it in cooperation with healthcare facilities providing healthcare services covered by health insurance (hereinafter referred to as “health insurance facilities”) and take note of the following matters:

1. Health insurance beneficiaries

Persons visiting for medical examination and inpatients who have COVID-19 symptoms and undergo confirmatory testing as indicated by health insurance facilities according to the Minister of Health’s guidelines on COVID-19 diagnosis and treatment enclosed with Decision No. 2008/QD-BYT dated 26/4/2021 by the Minister of Health, specifically:

- Patients who have fever and/or acute respiratory disease that cannot be attributed to other causes;

- Patients who have a respiratory symptom AND have traveled to/through/from or stayed in an infected area in the 14 days prior to symptom onset OR have had close contact with a suspected or confirmed COVID-19 case in the 14 days prior to symptom onset.

Those testing positive for COVID-19 and patients undergoing medical quarantine may have their medical costs covered by health insurance according to Section 1 of Official Dispatch No. 3100/BYT-BH dated 20/4/2021 by the Ministry of Health on payment of medical examination and treatment fees under health insurance related to COVID-19.

Those testing negative for COVID-19 may have their medical costs covered by health insurance according to Section 6 of Official Dispatch No. 3100/BYT-BH.

2. Payout limits

For individual samples: apply the price of service No. 1735: bacteria/ viruses/ mycotoxins/ parasites Real-time PCR testing mentioned in the Appendix to Circular No. 13/2019/TT-BYT dated 05/7/2019 by the Ministry of Health, which is VND 734.000/sample.

For health insurance facilities needing to transport samples to other healthcare facilities for testing: comply with regulations in Article 9 of Circular No. 30/2021/TT-BYT dated 31/12/2020. Provincial social security authorities shall assess and provide payments under health insurance in accordance with the guidelines in Circular No. 4356/BYT-KHTC by the Ministry of Health and Official Dispatch No. 561/BHXH-CSYT.

For pooled samples: follow the guidelines in Official Dispatch No. 4356/BYT-KHTC.

3. Payment time: from 28/5/2021 (issuance date of Official Dispatch No. 4356/BYT-KHTC).

4. Do not cover medical costs already paid by other sources. COVID-19 testing facilities shall organize procurement of medical materials and chemicals through bidding as per existing regulations or guidelines of the Ministry of Health or COVID-19 control committee during the pandemic.

For your reference and compliance. Any difficulty arising should be promptly reported to Vietnam Social Security for resolution./.

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