Regarding this issue, according to information on Vietnamnet , in most cases, health insurance does not cover routine dental cleanings. The reason lies in the nature and purpose of the health insurance fund.
Health insurance is designed to cover the costs of medical examinations, treatment, rehabilitation, routine prenatal checkups, childbirth, and transportation of patients in emergency situations or while receiving inpatient treatment. These services typically relate to the treatment of illnesses, accidents, or health conditions requiring medical intervention.
Meanwhile, teeth cleaning is classified as a preventive care service, a routine oral hygiene procedure, and not a treatment for acute or chronic diseases.
Illustrative image.
If tartar is the cause of gingivitis, bleeding gums, receding gums, or a dental abscess, the dentist will recommend tartar removal as a treatment procedure, and in this case, the cost may be covered by health insurance according to regulations.
The health insurance fund is formed from contributions from the people and the state budget, with the aim of sharing the risk of medical costs when participants encounter serious health problems requiring expensive medical intervention.
Therefore, preventive and routine health care services such as teeth cleaning, teeth whitening, and orthodontic treatment are generally not covered by health insurance. These services are considered voluntary personal needs to maintain or improve aesthetics and hygiene, rather than mandatory treatment for underlying health conditions to protect overall health against disease risks.
Although routine dental cleanings are not covered by health insurance, it does cover certain dental issues related to disease, accidents, or medical treatment.
- Severe pulpitis or periodontitis: Health insurance covers the cost of examination, medication, and procedures such as periodontal pocket curettage or flap surgery when the condition is severe and requires intervention.
- Tooth extraction due to medical conditions: Severely decayed teeth, infections that cannot be preserved, or impacted wisdom teeth causing complications are covered by health insurance. Tooth extraction for cosmetic or orthodontic purposes is not covered by health insurance.
- Accident-related injuries: Broken teeth, fractured jaw requiring surgery are covered by health insurance according to accident regulations, including examination, tests, medication, and medical supplies.
- Special cases: Children under 6 years old and patients with chronic oral health problems requiring comprehensive treatment may be considered for support – this requires a doctor's prescription at a facility contracted with the health insurance scheme.
Twelve cases were not covered by health insurance despite receiving treatment at designated facilities.
According to Clause 18, Article 1 of the Law amending and supplementing the Health Insurance Law in 2024, the 12 cases in which patients are not entitled to health insurance benefits from the 2014 Health Insurance Law remain unchanged; however, two cases from the old law have been amended and supplemented.
Specifically, the 12 cases where medical expenses will not be covered by health insurance from July 1, 2025 include:
- Services that have been covered by the state budget include: routine prenatal checkups, childbirth, screening, early diagnosis, rehabilitation, and the cost of transporting patients from district-level to higher-level facilities.
- Cases of nursing care or convalescence at nursing or convalescence facilities.
- Go for a health check-up.
- When performing tests to diagnose pregnancy, the purpose is not to provide treatment.
- When using assisted reproductive techniques, family planning services, or abortion procedures. Note that this excludes cases where pregnancy termination is necessary due to pathological reasons related to the fetus or the mother.
- Patients using cosmetic services.
- Treatment of strabismus and refractive errors of the eye for individuals aged 18 and older.
- The use of replacement medical devices, including prosthetic legs, arms, eyes, teeth, eyeglasses, hearing aids, and mobility aids, in medical examinations, treatment, and rehabilitation.
- Patients receiving medical examination, treatment, and rehabilitation in the event of a disaster.
- Patients seeking examination and treatment for drug addiction, alcohol addiction, or addiction to other substances.
- Conducting medical examinations, forensic examinations, and forensic psychiatric examinations.
- Patients participating in clinical trials or scientific research.
Therefore, people who seek medical examination and treatment in the above cases will not be covered by health insurance, meaning they will have to pay the full cost of examination and treatment themselves.
Minh Hoa (compiled from Vietnamnet and Nhan Dan newspapers)
Source: https://www.nguoiduatin.vn/lay-cao-rang-co-duoc-huong-bao-hiem-y-te-20426100213555825.htm
