New regulations for health insurance participants for 5 consecutive years

The Ministry of Health has just issued Official Letter No. 6872/BYT-BH to Vietnam Social Security to guide the implementation of Decree No. 188/2025/ND-CP of the Government. One of the notable contents is the new regulation on payment of medical examination and treatment costs (KCB) under health insurance (HI) for people who have participated for 5 consecutive years.

The Ministry of Health has just issued Official Letter No. 6872/BYT-BH to Vietnam Social Security to guide the implementation of Decree No. 188/2025/ND-CP of the Government. One of the notable contents is the new regulation on payment of medical examination and treatment costs (KCB) under health insurance (HI) for people who have participated for 5 consecutive years.

Previously, according to the provisions of Point b, Clause 3, Article 27 of Decree No. 146/2018/ND-CP, if a patient has a cumulative co-payment amount in the fiscal year at different medical facilities or at the same medical facility greater than 6 months of basic salary, the patient must bring documents to the Social Insurance agency that issued the health insurance card to pay the co-payment amount greater than 6 months of basic salary and receive a certificate of no co-payment in that year.

People who have participated in health insurance for 5 consecutive years or more will not need to submit their own direct payment documents as before (Illustration photo)

However, from July 1, 2025, when Decree No. 188/2025/ND-CP officially takes effect replacing Decree 146/2018/ND-CP, this process will be changed.

Specifically, according to the guidance of the Ministry of Health in Official Dispatch No. 6872/BYT-BH, the Social Insurance agency will compile and regularly update information on the patient's accumulated co-payment amount in the fiscal year, the time of participating in health insurance for 5 consecutive years, and publicly announce it on the Vietnam Social Insurance Data Portal. Medical facilities will use this information to determine when the patient is eligible for exemption from co-payment when coming for medical examination and treatment.

Thus, from the effective date of Decree No. 188/2025/ND-CP, health insurance participants who have participated in health insurance for 5 consecutive years will no longer need to submit their own direct payment documents as before. Instead, the determination of exemption from payment and co-payment will be done automatically through the data system of the social insurance agency and medical facilities.

This is an important step forward in administrative procedure reform and digital transformation in the field of health insurance, helping to reduce procedural burdens while still ensuring that people's rights are fully, promptly and transparently implemented.

The document also emphasizes the responsibility of medical facilities and social insurance agencies in updating and accurately disclosing information, and properly implementing regulations on determining costs within the scope of benefits and co-payments of patients. The two sides need to coordinate closely to ensure that people fully enjoy health insurance benefits according to the new regulations of the Government .

Kim Pha

Source: https://baolongan.vn/quy-dinh-moi-doi-voi-nguoi-tham-gia-bao-hiem-y-te-du-5-nam-lien-tuc-a205424.html