According to Vietnam Social Security, the Law amending and supplementing a number of articles of the Health Insurance Law No. 51/2024/QH15 (Health Insurance Law 2024), passed by the National Assembly on November 27, 2024, is an important step forward in expanding access to health services and ensuring equity in health care. The Law pays special attention to groups such as the poor, people living in disadvantaged areas, and people with revolutionary contributions. One of the highlights of the Law is the specific provisions on groups of subjects entitled to 100% of health insurance examination and treatment costs, clearly demonstrating the humanity and sustainable social security orientation of the State in the new period.
Groups of subjects entitled to 100% of medical examination and treatment costs
Specifically, the subjects specified in points a, b, c, d, đ, e, h, i, o, r and s, Clause 3, Article 12 of the 2024 Law on Health Insurance will enjoy all costs of health insurance examination and treatment, including:
- Armed forces and people enjoying the same regime as military personnel: Officers, professional non-commissioned officers, professional soldiers on active duty in the army and officers, technical non-commissioned officers of the people's police; people doing cryptographic work receiving salaries like military personnel.
- Armed forces students include: Non-commissioned officers and soldiers of the People's Army on active duty; non-commissioned officers and soldiers on duty in the People's Police; military students, police students, and cryptography students receiving living expenses who are Vietnamese; military students, police students, and cryptography students receiving living expenses who are foreigners; students in reserve officer training for 3 months or more who have not participated in social insurance and health insurance.
- Other subjects include: Regular militia; people with meritorious services to the revolution and veterans; children under 6 years old; relatives of martyrs, people with meritorious services to raise martyrs; people from poor households; ethnic minorities from near-poor households residing in communes and villages in ethnic minority and mountainous areas; ethnic minorities living in areas with difficult socio -economic conditions; people residing in areas with special difficulties, island communes, island districts; people receiving monthly social allowances; people receiving monthly nursing allowances according to the law; people receiving monthly death benefits who are eligible for social allowances; people aged 75 and over receiving monthly death benefits, people aged 70 to under 75 in near-poor households receiving monthly death benefits.
In some special cases, the health insurance fund will pay 100% of the costs.
Pursuant to points b, c, d, clause 1 and clause 5, Article 22 of the 2024 Law on Health Insurance, in addition to the above groups of subjects, the law also stipulates special cases in which the Health Insurance Fund covers 100% of the costs:
- One-time medical examination and treatment costs are lower than the level prescribed by the Government; medical examination and treatment at primary health facilities at the primary level, including: Health stations; family medicine medical examination and treatment facilities; military-civilian medical stations, military-civilian medical clinics; district-level medical centers with medical examination and treatment activities licensed to operate in the form of clinics; medical agencies, units, and organizations as prescribed by the Minister of Health; medical examination and treatment facilities at the primary health examination and treatment level in the army and police as prescribed by the Minister of National Defense and the Minister of Public Security . 100% of outpatient medical examination and treatment costs at regional polyclinics.
- People who have participated in health insurance for 5 consecutive years or more and the amount of co-payment for medical examination and treatment in the year is greater than 6 times the basic salary; emergency medical examination and treatment at any medical facility.
Some cases of out-of-line medical examination and treatment are covered by 100% of the cost.
According to points a, b, c, d, đ, e, h, Clause 4, Article 22, the Law on Health Insurance 2024 also expands the rights for patients who go to medical examination and treatment at a place other than the initial registration place but are still paid 100% of the costs in the following cases: Medical examination and treatment at a basic or specialized facility that is diagnosed to treat certain serious diseases, rare diseases, requiring surgery or high technology according to regulations of the Ministry of Health; ethnic minorities and people from poor households living in difficult or especially difficult socio-economic areas, people living in island communes and island districts when receiving inpatient treatment at specialized facilities; medical examination and treatment at a primary level facility, inpatient treatment at a basic level; basic and specialized medical examination and treatment facilities that before January 1, 2025 were determined by competent authorities to be district level; Inpatient examination and treatment at a specialized medical examination and treatment facility that, before January 1, 2025, has been identified by a competent authority as a provincial level.
Source: https://www.sggp.org.vn/chi-phi-kham-chua-benh-bao-hiem-y-te-tu-1-7-2025-cac-truong-hop-duoc-huong-100-post799634.html
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