New instructions: Will late health insurance cover medical examination and treatment costs?

For personal reasons or urgent emergency care, forgetting to bring your health insurance card, or being late in presenting your card... In these cases, the Ministry of Health has just issued new guidelines on payment for medical examination and treatment.

Health insurance card in Ho Chi Minh City - Photo: TTO

The Ministry of Health has just issued a document guiding the implementation of Decree 188/2025 of the Government detailing and guiding the implementation of a number of articles of the Law on Health Insurance.

In which, the Ministry of Health guides the payment of medical examination and treatment costs under health insurance (HI) in case the patient presents the card late.

Payment for late presentation of health insurance card

According to the provisions of Decree No. 188/2025, in case a patient with a health insurance card comes to see a doctor or receive treatment but presents the card information late, the health insurance fund will pay the medical examination and treatment costs within the scope of benefits and levels from the time of presenting the health insurance card information, except in emergency cases.

Medical examination and treatment costs during the time the patient has not presented health insurance card information will be paid directly by the Health Insurance Fund according to regulations.

In this case, the Ministry of Health instructs that expenses incurred before the time of card presentation will be paid directly to the patient by the Health Insurance Fund, according to the provisions of Article 57 of Decree 188 of 2025.

Accordingly, in case of outpatient examination, the maximum payment shall not exceed 0.15 times the basic salary. In case of inpatient treatment, the maximum shall not exceed 0.5 times the basic salary.

After the patient provides the card, the remaining costs continue to be paid normally within the scope of health insurance benefits.

How to get a refund on direct payment health insurance

To be paid for the cost before presenting the card, the patient or family member must fill out a direct payment request form. Choose to receive cash at the one-stop department of Vietnam Social Security or transfer money to a personal account.

Submit application on the National Public Service Portal, via the application of the social insurance agency, send by post or submit directly to the social insurance agency of the place of residence, the place of card issuance or the place of signing the health insurance examination and treatment contract.

Within 25 days from the date of receiving complete and valid documents, the social insurance agency must complete the assessment and pay the patient.

If additional documents are needed, the social insurance agency will notify within 5 working days. The patient has a maximum of 20 days to supplement. After receiving all valid additional documents, the social insurance will pay within the next 20 days.

Note, to be paid directly, patients should keep all invoices and documents during the time they have not presented their card as a basis for payment.

Presenting the card early will help to pay immediately, avoiding the need for additional direct procedures. In case of emergency, the patient will still enjoy full benefits even if he/she does not have time to bring the card.

With this regulation, people will not be affected by their benefits if they present their health insurance card late. However, to save time and avoid unnecessary procedures, it is best to always carry the card, or save the electronic health insurance card information when going to see a doctor.

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Source: https://tuoitre.vn/huong-dan-moi-cham-trinh-bao-hiem-y-te-co-duoc-chi-tra-tien-kham-chua-benh-20251010103324934.htm