Decree 02.2025.NĐ-CP amends and supplements provisions on health insurance benefits

The Government has issued Decree No. 02/2025/NĐ-CP dated January 1, 2025, amending and supplementing certain articles of Decree No. 146/2018/NĐ-CP dated October 17, 2018, detailing and guiding measures for implementing the Law on Health Insurance, as amended and supplemented by Decree No. 75/2023/NĐ-CP dated October 19, 2023.

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

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

2. Persons entitled to coverage of 100% of medical examination and treatment costs under Point a, Clause 1, Article 22 of the Law on Health Insurance, without application of the reimbursement rates specified in Point c, Clause 2, Article 21 of the Law on Health Insurance, include:

a) Persons who participated in revolutionary activities before January 1, 1945;

b) Persons who participated in revolutionary activities from January 1, 1945, to the date of the August 1945 Uprising;

c) Heroic Mothers of Vietnam;

d) War invalids, persons entitled to the same benefits as war invalids, category B war invalids, and sick soldiers with a reduction in working capacity of 81% or more;

e) War invalids, persons entitled to the same benefits as war invalids, category B war invalids, and diseased soldiers receiving treatment for recurrent wounds or illnesses;

e) Resistance participants exposed to toxic chemicals with a reduction in working capacity of 81% or more;

g) Children under 6 years of age.

3. Coverage of 100% of medical examination and treatment costs where the cost of a single medical examination and treatment visit is less than 15% of the statutory base salary.

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

5. The implementation schedule and benefit rates for outpatient examination and treatment at basic-level medical examination and treatment facilities under Points e and h, Clause 4, Article 22 of the Law on Health Insurance are as follows:

a) From January 1, 2025, health insurance participants receiving outpatient examination and treatment at basic-level medical examination and treatment facilities scoring below 50 points or provisionally classified at the basic level shall have 100% of their benefit entitlement paid by the health insurance fund;

b) From July 1, 2026, health insurance participants receiving outpatient examination and treatment at basic-level medical examination and treatment facilities scoring from 50 to below 70 points shall have 50% of their benefit entitlement paid by the health insurance fund;

c) From July 1, 2026, health insurance participants receiving outpatient examination and treatment at basic-level medical examination and treatment facilities that, before January 1, 2025, were designated by a competent authority as provincial-level or central-level facilities, or equivalent to provincial-level or central-level facilities, shall have 50% of their benefit entitlement paid by the health insurance fund;

d) From July 1, 2026, health insurance participants receiving outpatient examination and treatment at specialized-level medical examination and treatment facilities that, before January 1, 2025, were designated by a competent authority as provincial-level facilities or equivalent to provincial-level facilities under Point h, Clause 4, Article 22 of the Law on Health Insurance shall have 50% of their benefit entitlement paid by the health insurance fund.

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

7. For health insurance participants receiving medical examination and treatment services on request:

a) Health insurance cardholders receiving medical examination and treatment services on request shall have the portion of medical examination and treatment costs within their scope of benefits (if any) paid by the health insurance fund under Article 22 of the Law on Health Insurance. Patients shall pay the medical examination and treatment facility the difference between the price of services on request and the amount paid by the health insurance fund;

b) Medical examination and treatment facilities shall ensure staffing, professional conditions, medical equipment, and the capacity to provide medical examination and treatment services in accordance with the health insurance medical examination and treatment contracts signed with social insurance agencies. They shall publicly disclose the costs patients must pay beyond the scope and level of health insurance benefits, as well as the cost difference, and shall notify patients in advance.

8. Where a health insurance participant changes to a different category specified in Article 12 of the Law on Health Insurance pursuant to decisions of competent state authorities, resulting in a change in health insurance benefits and requiring replacement of the health insurance card or health insurance card information, the new health insurance benefits shall apply from the date on which the newly issued health insurance card or health insurance card information becomes valid.

Decree No. 02/2025/NĐ-CP takes effect on January 1, 2025.

This is an automated translation. If you notice any errors, please contact the Department of Communications, National Economics University at phongtruyenthong@neu.edu.vn.