This is an automatically translated article.
The article was professionally consulted by Specialist Doctor I Pham Thi Yen - Department of Obstetrics and Gynecology - Vinmec Hai Phong International General Hospital. Doctor has more than 10 years of experience in examination and treatment in the field of Obstetrics and Gynecology.During pregnancy, female employees are allowed to take antenatal care leave and have the right to take time off if prescribed by a doctor. So, during the periodical antenatal check-ups, are female employees entitled to Insurance?
1. Pregnancy check-up for female employees
Pursuant to Law on Social Insurance 58/2014; Decision 636/QD, During pregnancy, women will be able to have antenatal check-ups 5 times, 1 time each time, in case the medical facility is far away or the fetus shows signs of illness or has other signs of illness. Normally, you are allowed to take 2 days off for 1 prenatal check-up. Time off is calculated in working days.Amount of benefits:
- Benefit rate = (Mbq6t / 24 days) x 100% x Number of days off
In which: Mbq6t : Average salary paid for social insurance contributions for 6 consecutive months before leaving job
Cases not enough After 6 months of paying social insurance premiums, the average salary is calculated based on the number of months of paying social insurance premiums.
2. Regulations on the amount of insurance to pay for periodical antenatal check-ups
Depending on the subjects participating in health insurance, the benefit level will comply with the provisions of Article 22 of the Law on Health Insurance Amendment and Supplement in 2014:Health insurance participants when going for medical examination and treatment under the provisions of Articles 26, 27 and 28 of this Law, the health insurance fund shall pay medical examination and treatment expenses within the scope of enjoyment with the following benefits: a) 100% of medical examination and treatment expenses, medical treatment for the subjects specified at Points a, d, e, g, h and i, Clause 3, Article 12 of this Law. Expenses for medical examination and treatment outside the scope of health insurance coverage for the subjects specified at Point a, Clause 3, Article 12 of this Law shall be paid from the health insurance funds for medical examination and treatment of the patients. this target group; in case this funding source is not enough, the state budget shall ensure;
3. In case the health insurance card holders go for medical examination and treatment on their own, at the wrong line, the health insurance fund will pay the benefit rate specified in Clause 1 of this Article at the following rate, except for the case specified in Clause 1 of this Article. specified in Clause 5 of this Article:
a) At a central hospital, 40% of inpatient treatment costs;
b) At provincial hospitals, 60% of inpatient treatment costs from the effective date of this Law to December 31, 2020; 100% of inpatient treatment costs from January 1, 2021 nationwide;
c) At district hospitals, 70% of medical examination and treatment costs from the effective date of this Law to December 31, 2015; 100% of medical examination and treatment costs from January 1, 2016.
In addition, according to Clause 4, Article 23 of the Law on Health Insurance Amendment and Supplement 2014:
“Article 23. Cases not entitled to insurance Health insurance
4. Pregnancy testing and diagnosis is not intended for treatment.”
Cases of antenatal care not for treatment purposes will not be covered by the health insurance fund.
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Source: Social Insurance
