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.
Health insurance examination and treatment for people. Photo: VNA
- 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 Public Security; 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; Reserve officer training students for 3 months or more who have not participated in social insurance and health insurance.
- Standing militia.
- People with revolutionary contributions and veterans.
- Children under 6 years old.
- Relatives of martyrs, people who have contributed to raising martyrs.
- Poor households; ethnic minorities in 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, and island districts.
- People receiving monthly social benefits; people receiving monthly child support benefits according to law; people receiving monthly death benefits who are eligible for social benefits.
- People aged 75 and over receive monthly pension benefits, people aged 70 to under 75 years old from near-poor households receive monthly pension 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 Government's prescribed level.
- Medical examination and treatment at primary health care facilities at the primary level include: Medical stations; family 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 care for agencies, units, and organizations as prescribed by the Minister of Health; medical examination and treatment facilities at the primary health care level in the military and police as prescribed by the Minister of National Defense and the Minister of Public Security . 100% of the cost of outpatient medical examination and treatment 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 6 times greater than the basic salary.
- Emergency medical examination and treatment at any medical facility.
Some cases of self-examination and treatment outside the designated medical facility are entitled to 100% of the benefit level.
According to points a, b, c, d, đ, e, h, clause 4, Article 22, Law on Health Insurance 2024 also expands benefits for patients who go to medical examination and treatment at a place other than the original registration place but are still paid 100% of the cost in the following cases:
- Examination and treatment at basic or specialized facilities with confirmed diagnosis to treat certain serious diseases, rare diseases, requiring surgery or advanced techniques according to regulations of the Ministry of Health.
- Ethnic minorities and poor households living in economically and socially disadvantaged areas, especially disadvantaged areas, and people living in island communes and island districts when receiving inpatient treatment at specialized facilities.
- Examination and treatment at primary level facilities, inpatient treatment at basic level.
- Basic and specialized medical examination and treatment facilities that, before January 1, 2025, have been identified by competent authorities as district-level.
- Inpatient examination and treatment at specialized medical examination and treatment facilities that, before January 1, 2025, have been identified by competent authorities as provincial level.
The Law amending and supplementing a number of articles of the Law on Health Insurance No. 51/2024/QH15 (Law on Health Insurance 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.
Source: https://baobinhphuoc.com.vn/news/9/173758/nhung-nhom-doi-tuong-duoc-huong-100-chi-phi-kham-chua-benh-bhyt-tu-1-7-2025
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