The Ministry of Health has just issued Decision No. 2555/QD-BYT on promulgating newly issued, amended and supplemented administrative procedures in the field of health insurance and abolished in the field of health finance in Decree 188/2025/ND-CP dated July 1, 2025 of the Government under the management scope of the Ministry of Health.
This document specifically stipulates the procedures for medical examination and treatment under health insurance; Components and number of records; Processing time; Subjects performing administrative procedures; Agencies handling administrative procedures; Results of administrative procedure implementation; Fees, charges, etc.
Accordingly, the decision guides the procedure for medical examination and treatment under health insurance, including 2 steps :
Step 1 : When seeking medical examination and treatment, health insurance participants must present information about their health insurance card, personal identification documents and related documents as prescribed to the medical examination and treatment facility.
Step 2 : The medical examination and treatment facility receives the patient participating in health insurance to the medical examination and treatment facility for diagnosis and treatment.
Regarding the dossier components, the decision provides specific instructions for 9 cases of medical examination and treatment covered by health insurance, including:
Case 1 : When receiving medical examination and treatment, health insurance participants must present information about their health insurance card in one of the following forms:
Identity card or citizen identification card or level 2 electronic identification account (VNeID) has integrated information about health insurance card;
Electronic or paper health insurance card. For health insurance participants specified in Points a, b, c and d, Clause 3, Article 12 of the Law on Health Insurance whose health insurance card information cannot be looked up on the information technology system, they must present a paper health insurance card. In case of using a health insurance card without a photo or health insurance code, they must present one of the following identification documents: ID card, citizen identification card, identity certificate, passport, linked to a level 2 electronic identification account (VNeID) or VssID application or other identification documents issued by a competent authority or organization or a confirmation paper from the commune-level police.
Case 2 : For children under 6 years old, only present a paper or electronic health insurance card or health insurance code; in case a health insurance card has not been issued, present an original or photocopy of the birth certificate. For newborns, the father or mother or relative of the child must sign the confirmation on the medical record or the representative of the medical examination and treatment facility must confirm on the medical record in case the child has no father, mother or relative.
Case 3: Health insurance participants, while waiting for the issuance or change of information on the health insurance card, when coming to see a doctor or receive treatment, must present the receipt of the application and appointment to return the results of the issuance, re-issuance and exchange of the health insurance card, information on the health insurance card issued by the social insurance agency or an organization or individual authorized by the social insurance agency to receive the application for re-issuance of the card, exchange of the card, and a type of document proving the identity of that person: ID card, citizen ID card, identity certificate, passport, linked to a level 2 electronic identification account (VNeID) or VssID application or other identity documents issued by a competent agency or organization or a confirmation paper from the commune-level police.
Case 4: The person who donated the human body part must present information about the health insurance card according to case 1 or case 3 in this procedure (according to the provisions of Clause 4, Article 37 of Decree No. 188/2025/ND-CP). In case he/she does not have a health insurance card, he/she must present a hospital discharge paper issued by the medical examination and treatment facility where the human body part was taken to the person who donated the human body part and one of the following identification documents of that person: ID card, citizen identification card, identity certificate, passport, linked to a level 2 electronic identification account (VNeID) or VssID application or other identification documents issued by a competent authority or organization.
In case there is no health insurance card but treatment must be received immediately after donation, the medical examination and treatment facility and the patient or the patient's relative must confirm in the medical record.
Case 5 : In case of emergency, the health insurance participant must present documents according to case 1 or case 2 or case 3 in this procedure before the end of the treatment period (according to the provisions of Clause 5, Article 37 of Decree No. 188/2025/ND-CP).
Case 6: In case a patient has an electronic health insurance card when going for medical examination or treatment under health insurance but cannot present the electronic health insurance card due to the connection with the level 2 electronic identification account (VNeID) or the VssID application has an error or due to an Internet connection error, the following steps will be taken:
- The patient provides the health insurance card number information so that the medical examination and treatment facility can look up the information on the Vietnam Social Security Data Portal. In case the Vietnam Social Security Data Portal cannot look up the information, the medical examination and treatment facility will record the health insurance card number information and receive the patient for medical examination and treatment. The medical examination and treatment facility will coordinate with the social insurance agency to look up the patient's health insurance card information to determine the scope, benefits, and health insurance regime;
- In case at the time the patient finishes the medical examination and treatment and is discharged from the hospital, the electronic health insurance card management data system still has errors and cannot extract information and the social insurance agency has not verified or clarified, the medical examination and treatment facility is responsible for sending all medical examination and treatment records, patient contact information, along with a screenshot of the search screen to the social insurance agency to continue verifying the information when the system is restored and assessing and paying for medical examination and treatment costs according to regulations. The patient is responsible for providing information about health insurance participants and health insurance card information to the medical examination and treatment facility and ensuring the accuracy of the information provided.
Case 7: A person who registers for initial health insurance examination and treatment at a specialized or basic medical examination and treatment facility when receiving medical examination and treatment at a place other than the place of initial health insurance examination and treatment registration due to a change in temporary residence or place of stay shall be entitled to receive medical examination and treatment at a basic medical examination and treatment facility suitable for the new temporary residence or place of stay. A health insurance participant who has changed his/her place of residence for less than 30 days and has declared his/her residence information according to the provisions of law on residence must present:
- Documents according to one of the following cases: 1, 2, 3, 4 in this procedure.
- One of the following documents: Document of assignment for work; Student card; Document of leave of absence confirmed by the agency or unit managing the health insurance participant; Document of assignment or assignment of mobile work tasks by the agency or unit managing the health insurance participant; Document showing family member relationship according to the law on marriage and family and updated residence information on the level 2 electronic identification account on the VNeID application.
Case 8: Patients in cases where the health insurance medical examination and treatment facility makes a follow-up appointment
- Medical examination and treatment facilities record the content and schedule of re-examination appointments in the Re-examination Appointment Form (paper or electronic) according to the form prescribed in Appendix V issued with Circular No. 01/2025/TT-BYT or record in the prescription, hospital discharge papers (paper or electronic) for the patient (collectively referred to as the Re-examination Appointment Form).
- The paper copy of the re-examination appointment form has the medical facility's stamp on the upper left corner and the signature of the treating physician. The electronic copy of the re-examination appointment form has the digital signature of the treating physician. Each re-examination appointment form can only be used once.
Case 9 : Patients in case of transferring health insurance medical examination and treatment facilities:
- In case of transferring a health insurance medical examination and treatment facility according to professional requirements, the medical examination and treatment facility where the patient is transferred must have a Medical Examination and Treatment Facility Transfer Form according to the form prescribed in Appendix VI issued with Circular No. 01/2025/TT-BYT in paper or electronic form. The Medical Examination and Treatment Facility Transfer Form is valid for 10 working days from the date of signing.
- Health insurance participants suffering from diseases, groups of diseases and cases specified in Appendix III issued with Circular No. 01/2025/TT-BYT are allowed to use the Medical Examination and Treatment Facility Transfer Voucher, which is valid for 1 year from the date of signing.
Source: https://nhandan.vn/bo-y-te-huong-dan-thu-tuc-kham-chua-benh-bao-hiem-y-te-moi-nhat-post901404.html
![[Photo] Party and State leaders visit President Ho Chi Minh's Mausoleum and offer incense to commemorate Heroes and Martyrs](https://vphoto.vietnam.vn/thumb/402x226/vietnam/resource/IMAGE/2025/8/17/ca4f4b61522f4945b3715b12ee1ac46c)
Comment (0)