Key Limits in Tam Binh: Child Co-payment, TCM and Cancer Caps

When settling hospital bills, many families are surprised to receive less than the actual invoice. Understanding the Bao Viet Tam Binh co-payment rules and the policy’s special caps helps you stay in control of medical costs.

Every insurance contract contains clauses that apply across all benefit packages. Here are the three most important limits that members should keep in mind.

👶 Co-payment rules for children aged 15 days to 3 years

Young children in their earliest years tend to fall ill and visit clinics quite often. For this reason, the policy sets up a cost-sharing mechanism between the insurer and the family.

70/30 co-payment ratio

For insured members aged from 15 days to 3 years, the Bao Viet Tam Binh co-payment rule applies at a 70/30 ratio. This means:

• Bao Viet Insurance pays 70% of eligible medical costs.
• The insured person pays the remaining 30% out of pocket.

This ratio applies alongside the maximum benefit limits of the program you have chosen, such as the five Tam Binh programs (Basic, Expanded, Advanced, Comprehensive and Superior).

When co-payment does not apply

The 70/30 co-payment does not apply if the insured person is examined and treated at public medical facilities or public hospitals. Eligible costs are then paid up to the actual limits, without the 30% deduction.

Note one exclusion: if treatment takes place in an International Department, a Voluntary Treatment Department or a Requested Treatment Department within a public hospital, the 70/30 co-payment rule is still triggered as usual.

🌿 50% payment cap for Traditional Chinese Medicine (TCM)

Many patients wish to strengthen their bodies or recover function through traditional medicine. For TCM treatments, the policy sets a specific cap.

Benefit limits for treatment under Traditional Chinese Medicine methods are paid up to a maximum of 50% of the sum insured of the corresponding benefit. Even if actual costs run higher, the maximum payment stops at this 50% ceiling.

Therefore, before choosing a long-term TCM regimen, members should check the inpatient or outpatient benefits in their contract to budget for the out-of-pocket portion.

🎗️ 50% cap and waiting period for cancer

Cancer is one of the most serious health risks and requires substantial treatment funding. For this reason, the product applies strict rules on both the waiting period and the maximum payment.

Two consecutive years waiting condition

The insurer does not pay for cancer during the first two years of membership. You must complete a full waiting period of 730 days (2 years), with cover applying from the 3rd continuous year onward.

This waiting period is detailed in the article on Tam Binh waiting periods, which you should review carefully.

Maximum payment of 50%

Once the condition of the 3rd continuous year is met, cancer-related costs are handled as follows:

• Applies to treatment, allowance, death and total permanent disability due to cancer, along with related complications or consequences.
• Maximum payment of no more than 50% of the sum insured for each benefit specified in the contract package.

This rule helps limit the risk of overloading the insurance fund, while members still receive significant financial support if faced with a serious illness.

📋 Checklist before using your insurance benefits

To avoid wondering why you were not paid 100% of the hospital bill, review the following:

• ☐ Confirm the insured person’s exact age at the time of treatment to see whether the 70/30 co-payment group applies.
• ☐ Choose the right facility (regular public hospital vs. voluntary treatment department or private hospital) based on your payment needs.
• ☐ Check whether the prescribed treatment is standard Western medicine or TCM to calculate the 50% benefit ceiling.
• ☐ For serious conditions such as cancer, check whether the contract has been continuously held long enough to reach the 3rd year.
• ☐ Keep all medical records, invoices and medical prescriptions as required by the insurer.

Every insurance contract comes with detailed rules attached to the certificate. If you need more clarification on benefits or want to review your family’s contract, call the hotline 0347674755 or visit paa.vn for fast, reliable and accurate support.