More subjects are supported by the state to pay health insurance

The Law amending and supplementing a number of articles of the Law on Health Insurance in 2024 expands the scope of subjects receiving state budget support for health insurance premiums, bringing the total number to 9 groups, of which 4 groups are added compared to previous regulations.

From July 1, 2025, the Law amending and supplementing a number of articles of the Law on Health Insurance 2024 officially takes effect. One of the notable points of the new law is the expansion of the scope of subjects receiving state budget support for health insurance premiums, bringing the total number to 9 groups, of which 4 groups are added compared to previous regulations.

People need to proactively check their health insurance participation information to clearly understand the benefits they will receive from July 1, 2025.

Specifically, according to Clause 4, Article 12 of the 2024 amended Law on Health Insurance, the groups of subjects supported by the State budget for health insurance premiums include: People from near-poor households; students. People participating in security and order protection forces at the grassroots level.

People in households engaged in agriculture, forestry, fishery and salt production with an average living standard according to the provisions of law; ethnic minorities living in communes determined to no longer be in areas with difficult or extremely difficult socio -economic conditions; village and hamlet health workers; village and hamlet midwives. (newly added)

Part-time workers in villages and residential groups as prescribed by law (newly added); people awarded the title of People's Artisan or Meritorious Artisan as prescribed by the Law on Cultural Heritage (newly added); victims as prescribed by the Law on Prevention and Combat of Human Trafficking 2011 (newly added)

Thus, compared with the provisions of Article 12 of the 2008 Law on Health Insurance and Clause 4, Article 12 of the Law amending and supplementing a number of articles of the 2014 Law on Health Insurance, the new law has added 4 more groups of subjects receiving State support for health insurance premiums.

This addition aims to expand benefits and create more favorable conditions for people, especially the disadvantaged, to access health care services.

Under the new regulations, patients covered by health insurance will likely have 100% of their medical examination and treatment costs covered, especially in cases of serious illness, illness requiring surgery or the use of advanced medical techniques.

According to statistics from the Vietnam Social Security, by the beginning of 2025, the country had about 95.52 million people participating in health insurance, reaching a coverage rate of 94.2% of the population. It is estimated that by the end of May 2025, the insurance industry had paid health insurance examination and treatment costs for nearly 80 million people, an increase of 8.59% over the same period in 2024. The total amount paid was about VND 63,324 billion, an increase of 15.59% over the same period last year.

Notably, up to now, 100% of medical facilities nationwide have implemented health insurance examination and treatment using chip-embedded citizen identification cards.

As of June 2025, there have been more than 214 million searches for health insurance card information using personal identification codes or citizen identification cards to serve medical examination and treatment.

This amendment to the Law on Health Insurance is considered an important step forward to ensure social security, improve the quality of health care for all people and move towards the goal of sustainable universal health insurance.

Under the new regulations, people who have participated in health insurance for 5 consecutive years are allowed to interrupt for up to 3 months and will enjoy a number of outstanding benefits that have never been available before.

The first and most notable benefit is that the health insurance fund will cover 100% of medical examination and treatment costs in many cases, including out-of-network medical examination and treatment.

Specifically, according to Clause 17 of the amended Law on Health Insurance, patients will be paid the entire cost of medical examination and treatment if they simultaneously meet three conditions: Having participated in health insurance for 5 consecutive years or more; the amount of co-payment in the year exceeds 6 times the reference level (the amount prescribed by the Government in place of the previous minimum wage); and falling into valid cases of medical examination and treatment, including medical examination and treatment not at the original registered place in some specific situations.

Cases considered eligible for 100% benefits even if examined outside the designated area include: medical examination at basic or specialized facilities when treating serious illnesses, rare illnesses, illnesses requiring surgery or high technology according to regulations of the Ministry of Health; being an ethnic minority, a person from a poor household living in a difficult area or in an island commune or island district; inpatient treatment at district-level facilities or equivalent facilities before January 1, 2025; emergency care at any medical facility; examination at the place of initial registration; and transfer to the hospital in accordance with regulations.

Another important new point of the 2024 revised Law on Health Insurance is the abolition of the 180-day waiting period to enjoy high-tech services for new or intermittent health insurance participants. Under current regulations, first-time or intermittent health insurance participants must wait 180 days to enjoy high-tech services.

However, from July 1, 2025, according to the new regulation in Clause 3, Article 16, people who participate in health insurance for the first time or have an interruption of more than 90 days only need to wait 30 days from the date of full payment for the card to be valid and enjoy all benefits, including high technology. This change helps people access modern medical services sooner without worrying about time barriers.

In addition, the Law also changes the way benefits and contributions are calculated by introducing the concept of "reference level" instead of the previous "minimum wage".

This is a new basis for calculating health insurance benefits, while ensuring flexibility and being more suitable to current socio-economic conditions.

Accordingly, when the total amount of money that the patient pays exceeds 6 times the reference level in the year, the health insurance fund will pay all medical examination and treatment costs within the scope of benefits, regardless of whether the patient is on-line or off-line, if they fall under permitted cases.

With important and beneficial adjustments for the people, the revised Law on Health Insurance 2024 is a big step forward in expanding health insurance coverage, encouraging people to participate long-term and continuously, and reducing the burden of medical costs for vulnerable groups.

According to the health agency's recommendation, people need to proactively check their health insurance participation information to clearly understand the benefits they will enjoy from July 1, 2025.

Source: https://baodautu.vn/them-nhieu-doi-tuong-duoc-nha-nuoc-ho-tro-dong-bao-hiem-y-te-d299710.html