Amended Law on Health Insurance in Vietnam from 2025

The Law on Health Insurance 2008 has been amended and supplemented many times in 2013, 2014, 2015, 2018, 2020, and 2023. Recently, the Law on Health Insurance has continued to be amended and supplemented with a number of articles and was officially passed by the National Assembly on November 27, 2024. This aims to perfect the health insurance legal system, meet the practical requirements of life, and improve the quality of medical examination and treatment services for people and HI participants. The Law amending and supplementing a number of articles of the Law on Health Insurance will take effect from July 1, 2025. Below, Viet An Law will update some notable new points in the amended Law on Health Insurance in Vietnam, which will take effect from July 1, 2025.

Amended Law on Health Insurance in Vietnam from 2025

The Law on Health Insurance 2008 has been amended and supplemented many times in 2013, 2014, 2015, 2018, 2020, and 2023. Recently, the Law on Health Insurance has continued to be amended and supplemented with a number of articles and was officially passed by the National Assembly on November 27, 2024. This aims to perfect the health insurance legal system, meet the practical requirements of life, and improve the quality of medical examination and treatment services for people and HI participants. The Law amending and supplementing a number of articles of the Law on Health Insurance will take effect from July 1, 2025. Below, Viet An Law will update some notable new points in the amended Law on Health Insurance in Vietnam, which will take effect from July 1, 2025.

Summary of new points in the amended Law on Health Insurance in Vietnam, effective from July 1, 2025

• From 01/07/2025, patients who receive medical examination and treatment at home will still be covered by health insurance.
• Change the conditions for receiving health insurance for 5 consecutive years.
• Expand the subjects entitled to 100% of medical examination and treatment costs.
• Flexible health insurance payment methods.
• Each person is given a health insurance code from 01/07/2025
• Add 4 more cases to receive health insurance payment support from the State budget
• New points for initial health insurance examination and treatment registration, and referral
• Allowed to bypass specialized medical examination and treatment lines if suffering from rare or serious diseases

From July 1, 2025, patients who receive medical examination and treatment at home will still be covered by health insurance.

This is one of the notable contents stipulated in Clause 16, Article 1 of the amended law on health insurance, which amended and supplemented Article 21 on the scope of benefits for health insurance participants of the Law on Health Insurance 2008.

Specifically, health insurance participants will be paid the following expenses by the health insurance fund:

• Medical examination and treatment, including remote medical examination and treatment, support for remote medical examination and treatment, family medical examination and treatment, medical examination and treatment at home, rehabilitation, periodic pregnancy examination and birth;
• Transport of patients specified in points a, b, c, d, dd, e, h, i, o, and r, Clause 3, Article 12 of the Law on Health Insurance, in case of inpatient treatment or emergency treatment, and must be transferred to a medical examination and treatment facility;
• Expenses for the use of medical technical services, drugs, medical equipment, blood, blood products, medical gases, supplies, tools, instruments, and chemicals used in medical examination and treatment within the scope of payment of the health insurance fund.

Thus, from 01/07/2025, patients who receive medical examination and treatment at home will still be covered by health insurance. This is new content that the current Law has not yet regulated.

Changes in conditions for enjoying health insurance for 5 consecutive years

At Point d, Clause 1, Article 22 of the Law on Health Insurance 2008 (amended in 2024), regulations on the level of health insurance benefits for health insurance participants are stipulated. Accordingly, to enjoy health insurance for 5 consecutive years from 01/07/2025, the following conditions must be met at the same time:

• Health insurance participation period: 5 consecutive years or more;
• Amount of co-payment for medical examination and treatment costs in a year: greater than 06 times the reference level (based on Clause 5, Article 3 of the Law amending and supplementing the Law on Health Insurance 2024, 06 times the reference level from July 1, 2025, is 14.04 million VND until new regulations are issued)
• Medical examination and treatment: correct route, correct procedure for transferring patients between health insurance medical examination and treatment facilities, or examination in the wrong route according to regulations or emergency in all cases.

The reference level is the amount of money decided to be used to calculate the contribution level and enjoy some social insurance (SI) regimes based on Article 7 of the Social Insurance Law 2024. Thus, instead of basing on the basic salary to calculate the contribution level and enjoy some social insurance regimes, from July 1, 2025, the Government will base on the reference level.

Currently, the basic salary is 2.34 million VND (according to Decree 73/2024/ND-CP). Therefore, people who have participated in health insurance for 5 consecutive years or more must have a co-payment amount for medical examination and treatment costs in the year greater than 14.04 million VND (6 months of basic salary) and receive medical examination and treatment at the right place to enjoy health insurance benefits for 5 consecutive years.

Expanding the scope of beneficiaries to include 100% of medical examination and treatment costs

The 2024 amended Law on Health Insurance expands some cases where health insurance participants are entitled to 100% of medical examination and treatment costs. Accordingly:

• Health insurance participants are entitled to 100% of the benefits when examining and treating at primary health insurance examination and treatment facilities nationwide; 100% of the benefits when going for inpatient examination and treatment at basic health insurance examination and treatment facilities nationwide; 100% of the benefits when examining and treating at any basic or specialized health insurance examination and treatment facility that was identified as a district level before January 1, 2025.
• Ethnic minorities and poor households living in areas with difficult socio-economic conditions, areas with especially difficult socio-economic conditions, and people living in island communes will have their medical examination and treatment costs paid 100% by the Health Insurance Fund at specialized medical examination and treatment facilities;
• People with rare diseases, serious diseases, diseases requiring surgery or high technology will have their medical examination and treatment costs paid 100% by the Health Insurance Fund according to the prescribed percentage of the benefit level, allowing access to specialized medical examination and treatment facilities.
• At the same time, the law has expanded the scope of benefits for people with health insurance cards, including treatment of strabismus and refractive errors of the eyes for people under 18 years old.

Flexible health insurance payment method

The health insurance payment method is adjusted more flexibly, suitable for the characteristics of each group of subjects. Specifically:

• For employees and employers: can pay monthly, with employers responsible for deducting from employees’ salaries.
• For enterprises, cooperatives, cooperative unions, and business households in the fields of agriculture, forestry, fishery, and salt production that pay wages based on products or contracts: can choose to pay monthly, every 3 months, or every 6 months.
• For groups paid or supported by the state budget: The state budget transfers the payment or supports quarterly payments to the health insurance fund.

This adjustment is to facilitate health insurance participants, while ensuring timeliness in collecting and managing the health insurance fund…

At the same time, the latest health insurance payment deadline for employers is specified as follows:

• Monthly payment method: The deadline is the last day of the following month.
• Payment method 03 months/time or 06 months/time: The deadline is the last day of the following month immediately after the payment cycle.

Changes in health insurance cards from July 1, 2025

According to the provisions of the Law on Health Insurance amended and supplemented in 2024, health insurance cards with health insurance codes are the basis for people to enjoy health insurance benefits.

• Health insurance cards are issued in electronic and paper versions and have the same legal value. Each person is only issued one health insurance code.
• Thus, instead of the current regulation that each person is “only issued one health insurance card”, the new law stipulates that each person is issued one “health insurance code”. This health insurance code is integrated into electronic applications (such as VssID, VNeID), chip-embedded CCCD cards…

Accordingly, the VssID, VNeID, or chip-embedded citizen identification cards (CCCD) are electronic methods to replace paper health insurance cards. Electronic cards use biometric technology for authentication, increase safety, limit profiteering, and facilitate health insurance examination and treatment.

Adding 4 more cases with State budget support for health insurance premiums

Compared to current regulations, the Law on Health 2004 Insurance has added 4 more cases with State budget support for premiums, including:

4 more cases supported by the State budget for health insurance premiums

• Village and hamlet health workers; village and hamlet midwives;
• Part-time workers in villages and residential groups as prescribed by law;
• People awarded the title of People’s Artist or Meritorious Artist.
• Victims as prescribed by the Law on Prevention and Combat of Human Trafficking 2011.

Based on Clause 11, Article 1 of the 2024 amended Law on Health Insurance, the monthly premiums of the above subjects are supported at a maximum of 6% of the reference level paid by the subjects themselves and are partially supported by the State budget.

New points for initial health insurance examination and treatment registration and referral

According to the new regulations in Article 26 of the Law amending and supplementing the Law on Health Insurance 2024, health insurance participants can register for initial medical examination and treatment at any medical facility in the health insurance system nationwide, without being limited by administrative boundaries.

• This is different from the previous regulation, when health insurance participants were usually only allowed to register at the local health facility where they reside or work. In addition, health insurance participants are allowed to change their initial health insurance examination and treatment facility every quarter (if needed); the change deadline is within the first 15 days of each quarter.
• In particular, regarding referrals, the amended Law expands the right to inpatient examination and treatment at basic health insurance facilities nationwide without a referral letter. Previously, patients were required to have a valid referral letter to ensure health insurance benefits when examining and treating at facilities not in the initial registration line, causing many inconveniences and limitations.

Can bypass specialized medical examination and treatment lines if suffering from rare or serious diseases

In Clause 14, Article 1 of the amended Law on Health Insurance 2024, Clause 4 was added after Article 22 of the current Law on Health Insurance as follows:

“4. Health insurance participants who self-examine or treat at a facility not registered for initial health insurance examination and treatment, or not in accordance with the regulations on patient transfer prescribed in Articles 26 and 27 of this Law, except for the cases prescribed in Clauses 3 and 5 of this Article, shall be paid by the health insurance fund according to the percentage of the benefit prescribed in Clause 1 of this Article as follows:

a) 100% of the benefit when examining or treating at a basic or specialized medical examination and treatment facility in the case of definitive diagnosis and treatment of certain rare diseases, serious diseases, diseases requiring surgery, or using high technology as prescribed by the Minister of Health;”

Thus, patients diagnosed with rare diseases, serious diseases… according to regulations will be paid 100% of medical examination and treatment costs by the Health Insurance Fund according to the prescribed percentage of the benefit level, and when they are examined and treated beyond the prescribed level, they do not need to be transferred to another level as is currently the case.

Above are some notable new updates in the amended Law on Health Insurance in Vietnam, which will take effect from July 1, 2025. If clients have any related questions or need advice on social insurance and health insurance, please contact Luat Viet An for the best advice and support!