The Medical Care Benefit Package
SSO offers a broad health care benefit scheme. It excludes only very few treatments (i.e. chemo-therapy, open heart surgery, road traffic accidents). The patients receive services by the contracted hospitals. Currently, SSO holds contracts with a number of hospitals as follows:
1.) In Vientiane Capital city: Mahosoth, Sethathirath and Mittapab Hospital
2.) In Vientiane Province: Vientiane's Province Or Maria Teresa Hospital, and District Hospital: Vangvieng Hospital
3.) In Savannaket Province: Savannaket's Province Hospital
4.) In Khammouan Province: Khammouan's Province Hospital, and District hospital: Nagai, Mahaxay and Yommalard Hospital
5.) In Bolikhamxay Province: Bolikhamxay's Province Hospital
6.) In Champasack Province: Champasack's Province Hospital.
The beneficiaries receive a wide range of health care services including:
Out-patient Services: (without over-night stay):
Medical consultation, diagnostics, treatment, drugs, prevention and rehabilitation, pre- and post-natal services, registration
In-patient Services: (with hospitalization):
Doctor fees, nursing care, diagnostics, medical treatment, surgery, deliveries, room service, medical documentation
Emergency Services: In case of emergency, all SSO members can approach the next located hospital for treatment. In this case, the costs will be reimbursed by the contracted hospital, which has been selected for SSO treatment. The patient has to take care, that the paying hospital must be informed within 72 hours.
Medical Care in Case of Employment Injury or Occupational Disease: If an injury happens by performing work for the employer, the SSO member will get the same medical benefits. However, when related to work, treatment of road traffic accidents is included and qualifying periods are not applied.
Who has access?
All contributing SSO members and their families are entitled to receive medical care benefits. Whereas spouses are always covered under the family membership, the children are included up to less than 18 years of age. The first three months of contributions are considered as qualifying period, which means that the beneficiaries are not yet covered during this time. As pensioners pay contributions on their pension benefits, their access to SSO medical care benefits will remain. After resigning from a working contract, the entitlement to hospital benefits will last for additional three months.
Conditions in the use of Medical Care Services.
Every member has to choose for himself and his family members one of the contracted hospitals as their hospital for treatment. They will get all services with the exemption of emergency only by the selected hospital. For all visits, the beneficiaries have to present the SSO membership card, ID card as well as the family book to be identified as SSO patient. In the following, all services are free of charge for the patient. If a service by another hospital is required, the selected hospital will issue a referral. The SSO member is bound to its selection of hospital for minimum of Twelve months after the selection of a hospital, a new hospital may be selected by applying to the SSO for consideration. As a new hospital has been selected, the former hospital shall transfer the concerned persons' files to the newly selected hospital.
Additional Payments by Insured Persons.
Insured persons have to take in charge any balance outstanding fees from the treatment or service, which are not covered by the SSO benefit package (special room, road traffic accidents, special nursing service, cosmetic surgery).
Payments of Hospital Fees.
SSO pays to the contracted hospital for each beneficiary an amount in advance (capitation) for possible treatment cost according to the number of patients that have chosen them as their hospital for treatment. The capitation payment is negotiated on an annual basis between SSO and the contracted hospitals.