Decree 02 amending the guidance on the Law on Health Insurance from 2025

Decree No. 02/2025/ND-CP is a significant legal document marking substantial changes in the implementation of the Law on Health Insurance from 2025. This decree aims to improve the legal framework on health insurance, facilitate public access to healthcare services, and enhance the efficiency of the health insurance fund management. The following article provides an overview of Decree No. 02/2025/ND-CP.

Effectiveness of Decree 02 amending the guidance on the Law on Health Insurance from 2025

Decree No. 02/2025/ND-CP was issued and became effective on January 1, 2025, amending and supplementing several provisions of Decree No. 146/2018/ND-CP, which details and guides measures for the implementation of the Law on Health Insurance. This decree was previously amended by Decree No. 75/2023/ND-CP dated October 19, 2023. The new decree provides detailed regulations on procedures for health insurance-covered medical care, as well as benefit levels for specific cases..

Impact of Decree 02 amending the guidance on the Law on Health Insurance from 2025

• For citizens:
  • Citizens can access more free healthcare services or receive partial cost support, reducing their financial burden when they fall ill.
  • Simplified procedures make it easier for citizens to register, undergo medical check-ups, and use health insurance services.
  • With stricter regulations on service quality, citizens can feel more secure when using healthcare services.
• For health establishments:
  • Healthcare establishments must adjust their operational procedures to comply with the new regulations of the decree.
  • To comply with the decree’s requirements, healthcare establishments must continuously improve service quality.
  • The reformed payment system requires healthcare establishments to enhance management practices and prevent fraud.

New points of Decree 02 amending the guidance on the Law on Health Insurance from 2025

Health insurance benefit levels

According to Clause 1, Article 1 of Decree 02/2025/ND-CP, the following benefit levels apply:

100% Coverage:

• The insured specified in Clauses 3, 4, 5, 8, 9, 11, 17 and 20, Article 3 of Decree 146/2018/NĐ-CP shall be entitled to 100% of the costs of medical care as prescribed at Point a, Clause 1, Article 22 of the Law on Health Insurance.
• The insured is entitled to 100% of the costs of medical care as prescribed at Point a, Clause 1, Article 22 of the Law on Health Insurance, without applying the payment rates under Point c, Clause 2, Article 21 of the Law on Health Insurance, include:
  • Revolutionary activists before January 1, 1945;
  • Revolutionary activists between January 1, 1945, and the August 1945 Uprising date;
  • Vietnamese heroic mothers;
  • War invalids, persons entitled to policies like war invalids, grade-B war invalids, and diseased soldiers suffering a working capacity decrease of 81% or more;
  • War invalids, persons entitled to policies like war invalids, grade-B war invalids, and diseased soldiers receiving treatment for recurring injuries or diseases;
  • Persons participating in resistance wars and infected with chemical toxins who suffer a working capacity decrease of 81% or more;
  • Under-6 children.
• 100% of the costs of medical care for cases in which the cost of a check-up is below 15% of the base salary.

95% Coverage

95% of the costs of medical care for the persons defined in Clause 1, Article 2; Clauses 12, 18 and 19 Article 3, and Clauses 1, 2 and 5, Article 4, of Decree 146/2018/NĐ-CP.

Implementation Roadmap for Outpatient Medical Care

The implementation roadmap and benefit rates for outpatient medical care services at basic-level health establishments, as stipulated in Points e and h, Clause 4, Article 22 of the Law on Health Insurance, are as follows:

• From January 1, 2025, when using outpatient medical care services at the basic-level health establishments graded below 50, or temporarily classified as basic level, the insured shall receive 100% of the benefits from the health insurance fund;
• From July 1, 2026, when using outpatient medical care services at the basic-level health establishments graded 50 to below 70, the insured shall receive 50% of the benefits from the health insurance fund;
• From July 1, 2026, when using outpatient medical care services at the basic-level health establishments that have been determined as provincial or central level or an equivalent level by competent agencies before January 1, 2025, the insured shall receive 50% of the benefits from the health insurance fund;
• From July 1, 2026, when using outpatient medical care services at the intensive-level health establishments that have been determined as provincial level or an equivalent level by competent agencies before January 1, 2025, under Point h, Clause 4, Article 22 of the Law on Health Insurance, the insured shall receive 50% of the benefits from the health insurance fund.

Medical Examination and Treatment Upon Request

• For the insured receiving on-demand medical care:
  • The insured possessing a health insurance card when receiving on-demand medical care shall receive payment within the scope of benefits (if any) from the health insurance fund as prescribed in Article 22 of the Law on Health Insurance. Patients shall pay health establishments the difference between the charges for on-demand medical care services and the payment rates of the health insurance fund;
  • The health establishments shall ensure human resources, professional conditions, medical equipment, and the ability to provide medical care services in accordance with the health insurance medical examination and treatment contract signed with the social security office and publicly disclose the expenses that patients must pay outside the scope of benefits and the level of health insurance benefits, the difference in costs, and must notify patients in advance.
  • In case the insured changes the group of subjects specified in Article 12 of the Law on Health Insurance according to decisions of competent state agencies, leading to a change in the level of health insurance benefits and having to change the health insurance card and information on the health insurance card, the new level of health insurance benefits will be calculated from the time the health insurance card and information on the health insurance card newly issued to the insured are valid for use.

Procedures for health insurance-covered medical care

To receive medical care, an insured shall produce information about his/her health insurance cards according to any of the following cases:

• Health insurance cards or codes; if the card has no photo, he/she shall also produce a photo-stuck personal identification paper such as identity card, citizen’s identity card, identity card certificate, passport, 2-level electronic identification account on VNeID application, or other personal identification papers issued by a competent agency or organization, or a written certification given by the commune-level Public Security agency or another paper certified by the education institution that manages the insured;
• Information about the health insurance card has been integrated into his/her citizen’s identity card or 2-level electronic identification account on the VNeID application.
• Decree 02/2025/NĐ-CP stipulates that For an under-6 child, only his/her health insurance card is required. If the child has not been granted a health insurance card, an original, a copy, or an extract of his/her birth certificate, an original or copy of his/her birth certification paper, or an identity card is required. For a newly born, his/her parent or relative shall sign his/her medical records for certification, or the representative of the health establishment shall sign his/her medical records for certification if the child does not have a parent or relative.
• Pending the re-grant or renewal of his/her health insurance card, or health insurance card information, to receive medical care, an insured shall produce the paper of dossier receipt and appointment for grant, re-grant or renewal of the card, or health insurance card information issued by the social security office or its authorized organization or person according to Form No. 4 in the Appendix to this Decree, and his/her personal identification paper as prescribed at Point a, Clause 1 of this Article.
• According to Decree 02, amending the guidance on the Law on Health Insurance from 2025, an insured who has donated his/her body organ shall produce his/her health insurance card information.
• If such person has not yet been granted a health insurance card, he/she shall produce the hospital discharge paper issued by the health establishments where his/her body organ has been taken, and any of his/her personal identification papers such as identity card, citizen’s identity card, identity card certificate, passport, 2-level electronic identification account on VNeID application, or other personal identification papers issued by a competent agency or organization.
• In cases where immediate treatment is required after the donation, the representative of the health establishment where his/her body organ has been taken and the patient or his/her relative shall sign his/her medical records for certification.
• In case of emergency aid, the insured shall produce the papers prescribed as stipulated above before the end of the treatment period.
• Decree 02/2025/NĐ-CP strictly stipulates that health establishments or the social security office must not impose additional medical procedures beyond those specified in this Article. If it needs copies of health insurance cards or medical care-related papers of patients to serve management work, it should photocopy them by itself after obtaining consent from the patients or their guardians and may not request patients to do so or to pay photocopying costs.

The foregoing information is the legal consultation of Viet An Law regarding Decree 02, amending the guidance on the Law on Health Insurance from 2025. If you have any legal inquiries, please contact us for timely assistance.