Is health insurance used when giving birth? and the benefits it brings in the US

Is health insurance used when giving birth? and the benefits it brings in the US For female workers, maternity benefits are among the most important concerns during pregnancy and childbirth. To fully enjoy their rights in accordance with the law, female employees need to understand and be well-informed about Health Insurance (BHYT) and Social Insurance (BHXH).

I. Benefits When Participating in Health Insurance (BHYT): Applicable only if the mother is enrolled in BHYT
Is health insurance used when giving birth? and the benefits it brings in the US

1. Giving birth at a designated healthcare facility (in-network)
   The benefits depend on the individual’s BHYT card classification, specifically:

• Category 1: 100% of childbirth costs within the BHYT coverage scope are reimbursed without any payment ratio limits.

• Category 2: 100% of childbirth costs within BHYT coverage are reimbursed (with some limits on payment ratios for certain drugs, chemicals, medical supplies, and technical services); transportation costs from district-level to higher-level facilities in emergency cases or inpatient referrals are also covered.

• Category 3: 95% of childbirth costs within BHYT coverage (with certain payment limits as above); 100% coverage if childbirth occurs at commune-level facilities and total costs are less than 15% of the basic monthly salary.

• Category 4: 80% of childbirth costs within BHYT coverage (with some limits); 100% coverage if childbirth occurs at commune-level facilities.

• Category 5: 100% of childbirth costs, including expenses outside BHYT coverage and transportation costs.

2. Giving birth at a non-designated healthcare facility (out-of-network)
   Payments will be made at the following rates, based on the in-network benefits above:

• Central-level hospitals: 40% of inpatient treatment costs

• Provincial-level hospitals: 60% of inpatient treatment costs

• District-level hospitals: 100% of total childbirth costs

II. Benefits When Participating in Compulsory Social Insurance (BHXH)

1. Case where only the mother participates in BHXH
   If the mother has contributed to BHXH for at least 6 months within 12 months prior to childbirth, she is entitled to:

• One-time childbirth allowance: The allowance equals the number of children multiplied by two times the basic salary at the month of birth.

• Maternity leave:

  • A total of 6 months off work before and after childbirth. In case of twins or more, the mother receives an additional 1 month per child starting from the second child. The maximum leave before childbirth is 2 months.

  • The maternity benefit equals 100% of the average monthly salary used for social insurance contributions over the 6 months prior to maternity leave.

  • For mothers who have contributed for 12 months or more, if prescribed bed rest by a qualified medical facility during pregnancy, the required minimum contribution is 3 months within the 12 months before childbirth.

• Health recovery after maternity: Female workers who return to work but have not fully recovered within 30 days after maternity leave may be granted 5 to 10 days of additional recovery leave (including holidays and weekends). The number of days is decided by the employer and the workplace’s labor union, or by the employer if no union exists.

  • Up to 10 days for mothers who give birth to two or more children at once.

  • Up to 7 days for mothers who deliver via surgery.

  • Up to 5 days for other cases.

2. Case where only the father participates in BHXH
   If the father has contributed to BHXH for at least 6 months in the 12 months before childbirth, he is entitled to:
   Is health insurance used when giving birth? and the benefits it brings in the US

• One-time childbirth allowance (same as the mother).

• Paternity leave:

  • 5 working days if the wife has a natural birth.

  • 7 working days if the wife has a surgical birth or delivers prematurely before 32 weeks.

  • 10 working days for twins; for triplets or more, an additional 3 days per child.

  • 14 working days if twins or more are delivered by surgery.
    This leave must be taken within 30 days from the wife’s childbirth.

• If the father has contributed less than 6 months at the time of birth, he may still take paternity leave as above but will not receive the one-time allowance.

3. Case where both parents participate in BHXH
   The mother receives maternity benefits as described in Section 1 above, and the father is entitled to paternity leave as described in Section 2.

4. Complications related to pregnancy
   In cases of miscarriage, abortion, stillbirth, or medically indicated termination, female workers are entitled to maternity leave as prescribed by qualified medical institutions. Maximum leave periods are as follows:

• 10 days for pregnancy under 5 weeks.

• 20 days for pregnancy between 5 and less than 13 weeks.

• 40 days for pregnancy between 13 and less than 25 weeks.

• 50 days for pregnancy at 25 weeks or more.

These leave days include holidays, Tet (Lunar New Year), and weekends.
Is health insurance used when giving birth? and the benefits it brings in the US

If both parents participate in BHXH and the mother dies after childbirth, the father is entitled to the remaining maternity leave. The benefit is calculated based on the father’s average social insurance salary contribution over the 6 months before leave. If the father has contributed for less than 6 months, the benefit is calculated based on the average salary of the months contributed.

The above summarizes some key maternity benefits for insured workers when giving birth. Cases involving surrogate pregnancy, adoption, and others can refer to the Social Insurance Law and relevant guiding documents for more details.