Regulations on health insurance benefits have just come into effect.

The Government has just issued Decree No. 02/2025/ND-CP amending and supplementing a number of articles of Decree No. 146/2018/ND-CP dated October 17, 2018 detailing and guiding measures to implement the Law on Health Insurance, which has been amended and supplemented by a number of articles in Decree No. 75/2023/ND-CP dated October 19, 2023.

The Government has just issued Decree No. 02/2025/ND-CP amending and supplementing a number of articles of Decree No. 146/2018/ND-CP dated October 17, 2018 detailing and guiding measures to implement the Law on Health Insurance, which has been amended and supplemented by a number of articles in Decree No. 75/2023/ND-CP dated October 19, 2023.

Decree No. 02/2025/ND-CP amends and supplements regulations on health insurance benefits for cases specified in Article 22 of the Law on Health Insurance. Specifically:

1. The subjects specified in Clauses 3, 4, 5, 8, 9, 11, 17 and 20, Article 3 of this Decree are entitled to 100% of the cost of medical examination and treatment as prescribed in Point a, Clause 1, Article 22 of the Law on Health Insurance.

2. Subjects entitled to 100% of medical examination and treatment costs as prescribed in Point a, Clause 1, Article 22 of the Law on Health Insurance and not subject to the payment rate as prescribed in Point c, Clause 2, Article 21 of the Law on Health Insurance, include:

a) Revolutionary activists before January 1, 1945;

b) Revolutionary activists from January 1, 1945 to the August 1945 uprising;

c) Heroic Vietnamese mother;

d) War invalids, people enjoying policies like war invalids, war invalids of type B, and sick soldiers with a working capacity reduction of 81% or more;

d) War invalids, people enjoying policies like war invalids, war invalids of type B, sick soldiers when treating wounds or recurring illnesses;

e) Resistance fighters infected with toxic chemicals with a labor capacity reduction rate of 81% or more;

g) Children under 6 years old.

3. 100% of medical examination and treatment costs in cases where the cost for one medical examination and treatment is lower than 15% of the basic salary.

4. 95% of medical examination and treatment costs for subjects specified in Clause 1, Article 2, Clauses 12, 18 and 19, Article 3 and Clauses 1, 2 and 5, Article 4 of this Decree.

5. Implementation roadmap and benefit rates for outpatient medical examination and treatment at basic medical examination and treatment facilities as prescribed in Point e and Point h, Clause 4, Article 22 of the Law on Health Insurance are as follows:

a) From January 1, 2025, when examining and treating outpatients at a basic medical examination and treatment facility with a score below 50 points or temporarily classified as basic, health insurance participants will have 100% of the benefit level paid by the health insurance fund;

b) From July 1, 2026, when examining and treating outpatients at basic medical examination and treatment facilities and achieving a score from 50 points to less than 70 points, health insurance participants will be paid 50% of the benefit level by the health insurance fund;

c) From July 1, 2026, when examining and treating outpatients at a basic medical examination and treatment facility that before January 1, 2025 was determined by a competent authority to be a provincial or central level or equivalent to a provincial or central level, health insurance participants will have the health insurance fund pay 50% of the benefit level;

d) From July 1, 2026, when examining and treating outpatients at specialized medical examination and treatment facilities that before January 1, 2025 were determined by competent authorities to be provincial level or equivalent to provincial level according to regulations in Point h, Clause 4, Article 22 of the Law on Health Insurance, health insurance participants will be paid 50% of the benefit level by the health insurance fund.

6. The case specified in Point a, Clause 5 of this Article shall be calculated to determine the amount of co-payment for medical examination and treatment costs in the year specified in Point d, Clause 1, Article 22 of the Law on Health Insurance.

7. In case the health insurance participant goes for medical examination and treatment upon request:

a) People with health insurance cards who go for medical examination and treatment upon request will have the health insurance fund pay part of the medical examination and treatment costs within the scope of benefits (if any) as prescribed in Article 22 of the Law on Health Insurance. The difference between the price of medical examination and treatment services upon request and the payment level of the health insurance fund shall be paid by the patient to the medical examination and treatment facility;

b) Medical examination and treatment facilities are responsible for ensuring human resources, professional conditions, medical equipment, and the ability to provide medical examination and treatment services in accordance with the health insurance medical examination and treatment contract signed with the social insurance agency and publicly disclosing expenses that patients must pay outside the scope of benefits and health insurance benefits, the difference in costs, and must notify patients in advance.

8. In case a health insurance participant changes the group of subjects specified in Article 12 of the Law on Health Insurance according to decisions of competent state agencies, leading to a change in the level of health insurance benefits and having to change the health insurance card and information on the health insurance card, the new level of health insurance benefits will be calculated from the time the health insurance card and information on the health insurance card are newly issued to the health insurance participant and are valid for use.

Decree No. 02/2025/ND-CP has taken effect from January 1, 2025.

Source: https://baodautu.vn/quy-dinh-ve-muc-huong-bao-hiem-y-te-vua-co-hieu-luc-d238106.html