Outpatient and Dental Care Under BVCare (New): Visits, Physiotherapy and Dental Clinics

Everyday health concerns such as colds, sore throats, or toothaches are the most frequent reasons employees and their dependents seek medical treatment. Understanding the outpatient and dental provisions of the corporate health scheme helps participants manage out-of-pocket costs and select appropriate medical facilities. Here is a detailed breakdown of consultation limits, physiotherapy caps, and authorized dental clinics under BVCare (New).

🩺 Outpatient Consultations Under BVCare (New): Is There a Visit Limit?

Outpatient treatment for illness and maternity is an optional rider offering flexible sums insured ranging from VND 4,000,000 to VND 30,000,000 per person per year, depending on the tier chosen by the employer. For a broader overview of policy caps across all riders, consult our guide on BVCare (New) Coverage Limits: Life, Accident, Inpatient, Outpatient and Dental.

Regarding consultation frequency and claim boundaries, policy regulations specify:

• Annual consultation frequency: There is no limit on the number of outpatient visits per year until the annual outpatient sum insured is reached.
• Per-visit cap: A maximum payout of 20% of the outpatient sum insured applies per visit and treatment course.
• Eligible expenses: Doctor consultation fees, prescription medications ordered by an attending physician, paraclinical tests, X-rays, ultrasounds, and diagnostic imaging covered under policy terms. In addition, this benefit covers outpatient or day surgeries/procedures (where no room and board charges are incurred), as well as diagnostic endoscopies and non-treatment diagnostic procedures.
• Outpatient maternity expansion: Outpatient maternity complications are covered up to VND 500,000 per year; routine prenatal examinations (including check-ups, ultrasounds, urinalysis, complete blood count, and prescribed medications) are capped at 5% of the outpatient sum insured. Review the complete structure in our guide to Maternity Benefits in BVCare (New): Normal Delivery, C-Section and Prenatal Care.

🌿 Physiotherapy and Rehabilitation Coverage Rules

For office professionals or individuals managing musculoskeletal disorders, physical therapy is often essential. Under the outpatient benefit of BVCare (New), rehabilitation costs are reimbursed according to strict criteria:

• Approved therapies: Physiotherapy, radiation therapy, heat therapy, phototherapy, catgut embedding (cấy chỉ), and similar treatments prescribed by a licensed physician.
• Daily reimbursement cap: Capped at 2% of the outpatient sum insured per treatment day.
• Maximum duration: Up to 60 treatment days per policy year.

Please note that all rehabilitation sessions must be medically ordered by a qualified physician for disease treatment; self-directed rehabilitation, fitness routines, or general wellness exercises are not covered.

🦷 Dental Care: Basic Dental vs. Comprehensive Dental Coverage

BVCare (New) separates dental protection into two distinct options, enabling corporate sponsors to match their budget with practical workforce needs.

1. Basic Dental Treatment (Embedded in Outpatient Benefits)

This coverage is integrated within the outpatient rider, with liability limits ranging from 10% to 100% of the outpatient sum insured per person per year. Covered treatments include:

• Dental examinations and dental X-rays.
• Treatment of gingivitis and periodontitis.
• Dental fillings using standard materials such as amalgam, composite, fuji, or similar substances.
• Root canal treatment and pathological tooth extractions (including minor surgical extractions).
• Teeth scaling (tartar removal): capped at VND 500,000 per year.

2. Comprehensive Dental Care (Independent Rider)

This specialized add-on provides higher dedicated limits ranging from VND 3,000,000 to VND 20,000,000 per person per year. Covered items include:

• Routine teeth scaling: up to 2 times per year.
• Pathological tooth extractions requiring surgical intervention.
• Minor surgery to extract retained roots or subgingival calculus (deep tartar removal under the gums).
• Apicoectomy (root-end resection surgery).

Crucial policy notes:

• When an insured member is enrolled in the independent “Comprehensive Dental Care” rider, the “Basic Dental Treatment” under the outpatient benefit will not apply concurrently.
• The policy does not cover dentures or false teeth (repairs, fabrication, treatment, or replacement), cosmetic maxillofacial orthodontics, or dental damage/prosthetics caused by accidents (accidental injuries are evaluated under personal accident or accidental medical expense riders if enrolled).

📍 Where to Receive Covered Dental Treatment?

Unlike standard outpatient consultations, dental care under BVCare (New) enforces specific geographic rules regarding approved healthcare facilities:

Furthermore, expenses incurred at facilities listed on the insurer’s public exclusion/blacklist (accessible on the insurer’s official website) will not be reimbursed. For a clearer understanding of payment methods at partner facilities, see our article on DIRECT BILLING VS. CLAIM: WHAT IS THE DIFFERENCE?.

📋 Checklist Before and After Outpatient & Dental Visits

To ensure smooth claim reimbursement or direct billing, review these operational steps:

• ☐ Check facility eligibility: If seeking dental care in Hanoi or Ho Chi Minh City, confirm beforehand whether the clinic belongs to the insurer’s official direct billing panel.
• ☐ Carry identification: Present your Citizen ID/Passport along with your insurance card (physical card or digital app card) at the registration counter.
• ☐ Collect medical records: Request an outpatient medical report or examination sheet containing a clear diagnosis, physician signatures, doctor orders, and valid prescription forms with medical codes.
• ☐ Obtain an official financial VAT invoice: Request a valid electronic VAT red invoice (hóa đơn GTGT) alongside a detailed medical fee breakdown (bảng kê chi tiết).
• ☐ Submit claims promptly: File the reimbursement dossier within 1 year from the date treatment concludes.

Familiarity with the terms of your corporate health policy ensures that you and your family utilize your medical benefits efficiently. For verification of contracted dental networks or to review specific contract riders, contact paa.vn at 0347674755 for prompt consultation.