| CONGRESS —– |
SOCIAL REPUBLIC OF VIETNAM Independence - Freedom - Happiness |
| Law No.: 51/2024/QH15 | Hanoi, date 27 month 11 year 2024 |
THE LAW
AMENDING AND SUPPLEMENTING CERTAIN ARTICLES OF THE LAW ON HEALTH INSURANCE
Based on the Constitution of the Socialist Republic of Vietnam;
The National Assembly enacted the Law amending and supplementing a number of articles of the Health Insurance Law No. 25/2008/QH12, which has been amended and supplemented by Law No. 32/2013/QH13, Law No. 46/2014/QH13, Law No. 97/2015/QH13, Law No. 35/2018/QH14, Law No. 68/2020/QH14 and Law No. 30/2023/QH15.
Article 1. Amendments and additions to certain articles of the Law on Health Insurance
1. To add Clause 9 after Clause 8, Article 2 as follows:
"9. Reference level "This is the amount of money determined by the Government to calculate the contribution and benefit levels for certain cases participating in health insurance as stipulated in this Law."
2. Amend and supplement Clause 2 of Article 3 as follows:
2. The health insurance contribution rate is determined as a percentage of the salary used as the basis for mandatory social insurance contributions as stipulated in the Social Insurance Law (hereinafter referred to as monthly salary), pension, allowance, or reference rate.
3. To amend and supplement a number of clauses of Article 6 as follows:
a) Amend and supplement Clause 1 as follows:
“1. To issue, within its authority, or submit to competent authorities for issuance, policies and laws on health insurance, the organization of the health system, and financial resources to serve the work of protecting, caring for, and improving the health of the people based on universal health insurance; and solutions to strengthen the capacity for medical examination and treatment under health insurance for grassroots health facilities;”;
b) Amend and supplement clauses 3 and 4 as follows:
3. Promulgating regulations, procedures, and professional guidelines on medical examination and treatment; reviewing and regularly updating guidelines on diagnosis and treatment; regulations on evaluating the reasonableness of providing medical examination and treatment services; regulations on the application of information technology, digital transformation, and data sharing in the field of health insurance, and the interoperability and use of interconnected paraclinical results between health insurance medical examination and treatment facilities in accordance with professional requirements;
4. Issue, within their authority, or submit to competent authorities for issuance, solutions to ensure the balance of the health insurance fund;”.
4. Article 7a is amended and supplemented as follows:
Article 7a. Responsibilities of the Ministry of Labour, Invalids and Social Affairs
1. Directing and guiding the organization and implementation of the identification and management of subjects under the management of the Ministry of Labour, Invalids and Social Affairs as stipulated in points e, h, i, k, o, r, s and t of Clause 3, and points a, b, d and g of Clause 4, Article 12 of this Law.
2. Inspect and monitor the implementation of legal regulations on the responsibility of employers and employees to participate in health insurance as stipulated in Clause 1, Article 12 of this Law, and the subjects managed by the Ministry of Labor, War Invalids and Social Affairs as stipulated in points e, h, i, k, o, r, s and t of Clause 3, and points a, b, d and g of Clause 4, Article 12 of this Law, excluding subjects managed by the Ministry of National Defense and the Ministry of Public Security.”
5. Amend and supplement certain clauses of Article 7c as follows:
a) Amend and supplement Clause 1 as follows:
“1. Directing, managing, guiding, and organizing the implementation of identifying, managing, and compiling lists of participants in health insurance for subjects under the management of the Ministry of National Defense and the Ministry of Public Security as stipulated in points a, c, e, h, and i of Clause 1, points a, b, c, d, l, and n of Clause 3, and point b of Clause 4 of Article 12 of this Law.”;
b) Amend and supplement Clause 3 as follows:
3. Inspect and monitor the implementation of legal regulations on the responsibility of participating in health insurance for subjects managed by the Ministry of National Defense and the Ministry of Public Security as stipulated in points a, c, e, h and i of Clause 1, points a, b, c, d, l and n of Clause 3, and point b of Clause 4 of Article 12 of this Law.”
6. Amend and supplement Clauses 2 and 3 of Article 8 as follows:
“2. The People's Committees of provinces and centrally-administered cities, in addition to fulfilling the responsibilities stipulated in Clause 1 of this Article, are responsible for directing the development of the apparatus and resources to implement state management of health insurance in their localities.
3. The People's Committee of the commune, ward, or town (hereinafter referred to as the People's Committee at the commune level) has the following responsibilities:
a) Fulfill the responsibilities stipulated in Clause 1 of this Article;
b) Compile a list of health insurance participants for the subjects specified in Clauses 2, 3, 4, and 5 of Article 12 of this Law, based on households, excluding subjects under the management authority of other Ministries, branches, agencies, and units as specified in points a, b, c, d, l, and n of Clause 3, and point b of Clause 4 of Article 12 of this Law;
c) The list of children eligible for health insurance cards must be compiled simultaneously with the issuance of birth certificates.
7. Article 9 is amended and supplemented as follows:
Article 9. Health Insurance Implementing Agency
1. The social insurance agency is responsible for implementing regulations, policies, and laws on health insurance, and for managing and utilizing the health insurance fund.
2. The Government shall specify the functions, tasks, powers, and organizational structure of the social insurance agency in the implementation of health insurance.”
8. Article 10 is amended and supplemented as follows:
Article 10. Auditing of the health insurance fund
1. The State Audit Office shall periodically (every three years) conduct audits of the health insurance fund and report the results to the National Assembly; and conduct ad hoc audits of the health insurance fund at the request of the National Assembly, the Standing Committee of the National Assembly, the President, the Government, and the Prime Minister.
2. Annually, the State Audit Office conducts an audit of the expenditure on the organization and operation of health insurance when auditing the final accounts report on the organization and operation of social insurance.
9. Amend and supplement Clause 1 of Article 11 as follows:
"1. Late payment or evasion of health insurance contributions."
10. Article 12 is amended and supplemented as follows:
Article 12. Subjects eligible for health insurance
1. Groups whose contributions are paid by the employer, the employee, or jointly include:
a) Employees working under indefinite-term employment contracts, fixed-term employment contracts with a term of one month or more, including cases where the employee and employer agree on a different name but the content reflects paid work, wages, and management, direction, and supervision by one party; enterprise managers, controllers, representatives of state capital, representatives of enterprise capital as prescribed by law; members of the Board of Directors, General Director, Director, members of the Supervisory Board or controllers and other elected management positions of cooperatives and cooperative unions as prescribed by the Law on Cooperatives who receive salaries;
b) Business managers, controllers, representatives of state capital, representatives of enterprise capital as prescribed by law; members of the Board of Directors, General Director, Director, members of the Supervisory Board or controllers and other elected management positions of cooperatives and cooperative unions as prescribed by the Law on Cooperatives who do not receive salaries;
c) Foreign citizens working in Vietnam under fixed-term employment contracts of 12 months or more with Vietnamese employers, except in cases of internal transfers within the enterprise as stipulated by the law on foreign workers in Vietnam, or at the time of signing the employment contract, having reached the retirement age as prescribed in Clause 2, Article 169 of the Labor Code or an international treaty to which the Socialist Republic of Vietnam is a party that provides otherwise;
d) Employees working under indefinite-term employment contracts, fixed-term employment contracts with a term of one month or more, including cases where the employee and employer agree on a different name but the content reflects paid work, wages and management, direction and supervision by one party, and agree with the employer to work part-time, with a monthly wage equal to or higher than the lowest wage used as the basis for compulsory social insurance contributions as prescribed by the law on social insurance;
d) The head of a business household with a business registration is subject to mandatory social insurance participation according to the provisions of the law on social insurance;
e) Officials, civil servants, and public employees;
g) Non-professional personnel at the commune level as prescribed by law;
h) Defense workers and officials serving in the military, public security workers working in the People's Public Security; and other personnel working in cryptographic organizations as stipulated in the Law on Cryptography;
i) Relatives of defense workers and officials serving in the military, and relatives of police workers working in the People's Public Security are not eligible for health insurance under the provisions of points a, b, c, d, e, g, and h of this clause, and clauses 2 and 3 of this Article.
2. The group whose contributions are paid by the social insurance agency includes:
a) Persons receiving monthly pensions or disability benefits;
b) Employees on leave receiving monthly compensation for work-related accidents or occupational diseases; employees on leave receiving sickness benefits for those suffering from illnesses on the list of diseases requiring long-term treatment, or employees on sick leave for 14 working days or more in a month as prescribed by the law on social insurance; employees on maternity leave for 14 working days or more in a month as prescribed by the law on social insurance;
c) Former commune, ward, and town officials who are receiving monthly social insurance benefits;
d) Individuals currently receiving unemployment benefits.
3. Groups funded by the state budget include:
a) Officers of the People's Army, professional soldiers currently serving; officers, non-commissioned officers, and technical specialists working in the People's Public Security Force; and personnel working in cryptography who receive salaries equivalent to those of military personnel;
b) Non-commissioned officers and soldiers of the People's Army currently serving; non-commissioned officers and conscripted soldiers in the People's Public Security; military trainees, police trainees, and cryptography trainees receiving living allowances who are Vietnamese citizens;
c) Foreign students in the military, police, and cryptography fields who receive living allowances;
d) Reserve officer trainees with a training period of 03 months or more who have not yet participated in social insurance or health insurance;
d) Permanent militia;
e) Persons who have rendered meritorious services to the revolution as stipulated in the Ordinance on Preferential Treatment for Persons Who Have Rendered Meritorious Services to the Revolution; veterans;
g) Current members of the National Assembly and members of People's Councils at all levels;
h) Children under 6 years old;
i) Relatives of martyrs, and those who have contributed to raising martyrs as stipulated in the Ordinance on Preferential Treatment for People with Meritorious Contributions to the Revolution;
k) Relatives of persons who have rendered meritorious services to the revolution, the spouse of a martyr who has remarried and is receiving a monthly survivor's benefit, and related individuals as stipulated in the Ordinance on Preferential Treatment for Persons Who Have Rendered Meritorious Services to the Revolution, excluding those specified in point i of this clause;
l) Relatives of the individuals specified in points a and b of this clause, as prescribed by law;
m) Persons who have donated human body parts in accordance with the law;
n) Foreigners studying in Vietnam who are granted scholarships from the Vietnamese State budget;
o) Persons belonging to poor households; ethnic minorities belonging to near-poor households residing in communes and villages in ethnic minority and mountainous areas; ethnic minorities residing in areas with difficult socio-economic conditions; persons residing in areas with particularly difficult socio-economic conditions; persons living in island communes and districts;
p) Former commune, ward, and town officials who are receiving monthly allowances from the state budget;
q) Persons who have ceased receiving disability benefits but are still receiving monthly allowances from the state budget;
r) Persons receiving monthly social assistance; persons receiving monthly child support allowances as prescribed by relevant laws; persons receiving monthly survivor's benefits who are eligible for social assistance;
s) Persons aged 75 years and older who are receiving monthly survivor's benefits, and persons aged 70 to under 75 years belonging to near-poor households who are receiving monthly survivor's benefits;
t) Persons currently receiving monthly social retirement benefits in accordance with the law on social insurance;
u) Workers who are not eligible for a pension and have not yet reached the age to receive social retirement benefits, but are currently receiving monthly benefits as prescribed by the law on social insurance.
4. The group whose contributions are subsidized by the state budget includes:
a) Individuals belonging to near-poor households;
b) Students;
c) Individuals participating in the security and order protection force at the grassroots level;
d) Individuals belonging to households engaged in agriculture, forestry, fisheries, and salt production who have an average standard of living as defined by law;
d) Village health workers; village midwives;
e) Non-professional personnel working in villages and residential areas as prescribed by law;
g) Ethnic minority people living in communes that are no longer classified as areas with difficult or extremely difficult socio-economic conditions will receive state budget support for health insurance contributions as prescribed by the Government;
h) Persons awarded the titles of People's Artisan or Distinguished Artisan according to the provisions of the Law on Cultural Heritage;
i) Victims as defined by the Law on Prevention and Combatting Human Trafficking.
5. The group that pays for their own health insurance includes:
a) Individuals belonging to a household participating in health insurance under the household scheme;
b) Persons living and working, or being cared for and nurtured in charitable or religious organizations and institutions;
c) Employees on unpaid leave or with a temporary suspension of their employment contract;
d) Persons who do not fall under the cases specified in points a, b, and c of this clause.
6. Other subjects besides those specified in Clauses 1, 2, 3, 4 and 5 of this Article as prescribed by law or ordinance.
7. The Government shall specify other subjects in addition to those stipulated in Clauses 1, 2, 3, 4, 5 and 6 of this Article, including:
a) Individuals eligible for health insurance as stipulated by law before January 1, 2025;
b) Other entities besides those specified in point a of this clause, after reporting to the Standing Committee of the National Assembly.”
11. Article 13 is amended and supplemented as follows:
Article 13. Contribution rates and responsibilities for health insurance contributions
1. The contribution rates, whether paid by the employer, the employee, or jointly, are stipulated as follows:
a) The monthly contribution rate for the subjects specified in points a, c, d, and e of Clause 1, Article 12 of this Law shall be a maximum of 6% of the monthly salary, of which the employer contributes two-thirds and the employee contributes one-third;
b) The monthly contribution rate for the subjects specified in point b, clause 1, Article 12 of this Law shall be a maximum of 6% of the monthly salary used as the basis for compulsory social insurance contributions and shall be paid by the subject;
c) The monthly contribution rate for the subjects specified in point d, clause 1, Article 12 of this Law shall be a maximum of 6% of the monthly salary used as the basis for compulsory social insurance contributions and shall be paid by the subject;
d) The monthly contribution rate for the subjects specified in point g, clause 1, Article 12 of this Law shall be a maximum of 6% of the reference rate, of which the employer contributes two-thirds and the employee contributes one-third;
d) The monthly contribution rate for the subjects specified in point h, clause 1, Article 12 of this Law shall be a maximum of 6% of their monthly salary, and the contribution responsibility shall be as prescribed by the Government;
e) The monthly contribution rate for the subjects specified in point i, clause 1, Article 12 of this Law shall be a maximum of 6% of the reference rate, and the payment responsibility shall be as prescribed by the Government.
2. The contribution rates paid by the social insurance agency are stipulated as follows:
a) The monthly contribution rate for the subjects specified in point a, clause 2, Article 12 of this Law shall be a maximum of 6% of their pension or disability allowance;
b) The monthly contribution rate for the subjects specified in points b and c of Clause 2, Article 12 of this Law shall be a maximum of 6% of the reference rate;
c) The monthly contribution rate for the subjects specified in point d, clause 2, Article 12 of this Law shall be a maximum of 6% of the unemployment benefit.
3. The contribution rates paid and subsidized by the state budget are stipulated as follows:
a) The monthly contribution rate for the subjects specified in point a, clause 3, Article 12 of this Law shall be a maximum of 6% of their monthly salary and shall be paid by the state budget;
b) The monthly contribution rate for the subjects specified in points b, c, d, e, g, h, i, k, l, m, o, p, q, r, s, t, and u of Clause 3, Article 12 of this Law shall be a maximum of 6% of the reference rate and shall be paid by the state budget;
c) The monthly contribution for the subjects specified in point n, clause 3, Article 12 of this Law shall be a maximum of 6% of the reference rate and shall be paid by the state budget through the agency, organization, or unit granting the scholarship;
d) The monthly contribution rate for the subjects specified in Clause 4, Article 12 of this Law shall be a maximum of 6% of the reference rate, which is paid by the subject themselves and partially subsidized by the state budget.
4. The monthly contribution rate for the subjects specified in Clause 5, Article 12 of this Law shall be a maximum of 6% of the reference rate and shall be paid by the subject either as a household or as an individual participant.
5. Determine the order of health insurance contributions for cases where a person simultaneously belongs to multiple different health insurance categories as follows:
a) Individuals who simultaneously belong to multiple different health insurance categories as stipulated in Article 12 of this Law shall pay health insurance contributions according to the first category they are identified as belonging to, in the order of the categories stipulated in Article 12 of this Law, except for the cases specified in points c, d, e, f, and g of this clause;
b) Individuals falling under the categories specified in points a, c, d, e, and f of Clause 1, Article 12 of this Law, who simultaneously hold one or more labor contracts, shall pay health insurance contributions based on their labor contracts as the basis for compulsory social insurance participation;
c) Individuals who fall under the category specified in point g, clause 1, Article 12 of this Law and simultaneously belong to multiple different health insurance participation categories specified in Article 12 of this Law shall pay health insurance contributions in the following order: contributions from the social insurance agency, contributions from the state budget, contributions subsidized by the state budget, and contributions jointly paid by the individual and the People's Committee of the commune.
d) Individuals who fall under the categories specified in points a and c of Clause 2, Article 12 of this Law and simultaneously belong to multiple different health insurance participation categories as stipulated in Article 12 of this Law shall participate according to the category for which the social insurance agency pays contributions;
d) Individuals who fall under the categories specified in points s, t, and u of Clause 3, Article 12 of this Law and simultaneously belong to multiple different health insurance participation categories as stipulated in Article 12 of this Law shall participate according to the category for which the state budget pays;
e) Persons falling under the categories specified in points a, c, d, e, g, h, and i of Clause 4, Article 12 of this Law, and also falling under the category specified in point a of Clause 5, Article 12 of this Law, may choose which category of health insurance they are enrolled in;
g) Individuals belonging to multiple categories eligible for state budget support for contributions as stipulated in Clause 4, Article 12 of this Law may choose to participate according to the category with the highest level of support;
h) Individuals who fall under the categories specified in points b and c of Clause 5, Article 12 of this Law, and who also fall under the category specified in point a of Clause 5, Article 12 of this Law, may choose to participate in health insurance under the household scheme.
6. Household members specified in point a, clause 5, Article 12 of this Law who participate in health insurance under the household scheme during the fiscal year shall be entitled to a reduction in contributions as follows:
a) The first person pays a maximum of 6% of the reference amount;
b) The second, third, and fourth persons pay 70%, 60%, and 50% respectively of the first person's contribution;
c) From the fifth person onwards, the contribution is 40% of the contribution of the first person.
7. The government stipulates the following:
a) The contribution rates and contribution support rates stipulated in this Article;
b) The responsibility for payment, the amount of payment, and the level of support for payment for the subjects specified in Clauses 6 and 7 of Article 12 of this Law.”
12. Amend and supplement Clauses 4 and 5 of Article 14 as follows:
4. For subjects not covered by Clauses 1, 2, and 3 of this Article, the basis for paying health insurance premiums is the reference rate.
5. The maximum monthly salary used to calculate health insurance contributions is 20 times the reference salary.
13. To amend and supplement a number of clauses of Article 15 as follows:
a) Amend and supplement clauses 2, 3, 4 and 5 as follows:
2. For businesses, cooperatives, cooperative unions, and household businesses operating in the fields of agriculture, forestry, fisheries, and salt production that pay wages based on output or piecework, contributions shall be made monthly, quarterly, or semi-annually.
3. Monthly, the social insurance agency shall pay health insurance contributions as prescribed in Clause 2, Article 13 of this Law into the health insurance fund.
4. Quarterly, the agency, organization, or unit providing the scholarship shall pay health insurance contributions as prescribed in point c, clause 3, Article 13 of this Law into the health insurance fund.
5. Quarterly, the state budget transfers the amount of contributions and support for health insurance premiums as stipulated in points a, b, and d of Clause 3, Article 13 of this Law to the health insurance fund.”;
b) Add clauses 7 and 8 after clause 6 as follows:
7. The subjects specified in points b and d of Clause 1, Article 12 of this Law shall pay the full amount of contributions they are responsible for paying directly to the social insurance agency or pay through participating business households, enterprises, cooperatives, or cooperative unions in the form of monthly, quarterly, or semi-annual payments.
8. The latest deadline for employers to pay health insurance contributions is stipulated as follows:
a) The last day of the following month for monthly payments;
b) The last day of the month immediately following the payment cycle for the quarterly or semi-annual payment method.”
14. To amend and supplement a number of clauses of Article 16 as follows:
a) Amend and supplement clause 1 and clause 2 as follows:
“1. A health insurance card with a health insurance number is issued to health insurance participants and serves as the basis for enjoying health insurance benefits as prescribed by this Law. Health insurance cards are issued in electronic and paper forms and have the same legal validity.
2. Each person is only issued one health insurance number.
b) Amend and supplement point c, clause 3 as follows:
“c) Individuals participating in health insurance as prescribed in Clauses 4 and 5 of Article 12 of this Law who are participating in health insurance for the first time, or who have participated in health insurance under one of the categories specified in Article 12 of this Law but not continuously for 90 days or more, will have their health insurance card valid 30 days after the date of full payment of health insurance premiums;”;
c) Amend and supplement Clause 5 as follows:
5. The Vietnam Social Security will issue the health insurance card mẫu after obtaining the consensus of the Ministry of Health.
15. Article 17 is amended and supplemented as follows:
Article 17. Issuance of health insurance cards
1. The documents required for obtaining a health insurance card are as follows:
a) Health insurance application form from agencies, organizations, units, individuals, and households for those participating in health insurance for the first time;
b) The list of health insurance participants for the subjects specified in Clause 1, Article 12 of this Law shall be compiled by the employer within 30 days from the date the employee becomes eligible for health insurance. In cases where the health insurance participant, who is eligible under points b and d of Clause 1, Article 12 of this Law, submits the application themselves, the application form specified in point a of this Clause shall be submitted to the social insurance agency within 30 days from the date they are determined to be eligible for health insurance;
c) The list of health insurance participants for the subjects specified in Clauses 2, 3, 4 and 5 of Article 12 of this Law shall be compiled by the People's Committee of the commune on a household basis, except for the subjects on the list specified in points d and e of this Clause;
d) The list of health insurance participants for subjects managed by the Ministry of Education and Training, the Ministry of Labour, Invalids and Social Affairs, and other Ministries and sectors as stipulated in point n, clause 3, and point b, clause 4, Article 12 of this Law shall be compiled by educational institutions and vocational training institutions;
d) The list of health insurance participants for subjects managed by the Ministry of National Defense and the Ministry of Public Security as stipulated in points a, c, e and h of Clause 1, points a, b, c, d, l and n of Clause 3, point b of Clause 4 of Article 12 of this Law, and the list of subjects stipulated in point i of Clause 1 of Article 12 of this Law, compiled by the Ministry of National Defense and the Ministry of Public Security.
2. Within 05 working days from the date of receiving all the documents specified in Clause 1 of this Article, the social insurance agency must issue health insurance cards to health insurance participants and notify or deliver the cards to the agency or organization managing and compiling the list of beneficiaries.
3. The government regulates the issuance of health insurance cards in both paper and electronic formats.
16. Article 21 is amended and supplemented as follows:
Article 21. Scope of benefits for health insurance participants
1. Individuals covered by health insurance will have the following costs reimbursed by the health insurance fund:
a) Medical examination and treatment, including telemedicine, support for telemedicine, family medicine, home-based medical examination and treatment, rehabilitation, routine prenatal check-ups, and childbirth;
b) Transporting patients for the subjects specified in points a, b, c, d, e, h, i, o and r of Clause 3, Article 12 of this Law in cases where they are receiving inpatient treatment or emergency care and need to be transferred to a medical examination and treatment facility as prescribed in Article 27 of this Law;
c) Costs for the use of medical technical services, medicines, medical equipment, blood, blood products, medical gases, supplies, instruments, tools, and chemicals used in medical examination and treatment are covered by the health insurance fund.
2. The Minister of Health shall prescribe the following:
a) Principles and criteria for developing the list of medicines, medical equipment, and medical technical services covered by health insurance for insured individuals;
b) To issue a list of medicines, medical equipment, and medical technical services covered by health insurance for insured individuals, based on the principles and criteria stipulated in point a of this clause;
c) The rate of reimbursement for medicines, medical equipment, and medical technical services covered by health insurance for insured individuals;
d) The level, conditions, and payment for medicines, medical equipment, and medical technical services covered by health insurance for insured individuals;
d) Payment for blood, blood products, medical gases, supplies, equipment, tools, and chemicals used in medical examinations and treatments falls within the scope of coverage for health insurance participants.
3. The government stipulates the following:
a) Payment of patient transportation costs as stipulated in point b, clause 1 of this Article;
b) The scope of benefits for the subjects specified in points a, b, c, d and e of Clause 3, Article 12 of this Law;
c) The payment rate specified in point c, clause 2 of this Article does not apply to these entities.”
17. Article 22 is amended and supplemented as follows:
Article 22. Health insurance coverage levels for health insurance participants
1. Individuals participating in health insurance, when undergoing medical examination and treatment as prescribed in Articles 26 and 27 of this Law, will have their medical examination and treatment costs reimbursed by the health insurance fund within the scope of their entitlement, with the following benefit levels:
a) 100% of the medical examination and treatment costs for the subjects specified in points a, b, c, d, e, h, i, o, r, and s of Clause 3, Article 12 of this Law. Medical examination and treatment costs outside the scope of health insurance coverage for the subjects specified in points a, b, c, d, and e of Clause 3, Article 12 of this Law shall be paid from the health insurance fund allocated for medical examination and treatment of this group; if this fund is insufficient, it shall be covered by the state budget;
b) 100% of the cost of medical examination and treatment in cases where the cost for a single medical examination or treatment is lower than the level stipulated by the Government;
c) 100% of the costs of medical examination and treatment at medical facilities at the primary level, including: health stations; family medicine medical facilities; military-civilian medical stations, military-civilian clinics; district-level medical centers with licensed medical examination and treatment activities operating as clinics; medical facilities of agencies, units, and organizations as prescribed by the Minister of Health; medical facilities at the primary level in the military and police as prescribed by the Minister of National Defense and the Minister of Public Security. 100% of the costs of outpatient medical examination and treatment at regional polyclinics;
d) 100% of the cost of medical examination and treatment when the patient has participated in health insurance for 5 consecutive years or more and the amount of co-payment for medical examination and treatment costs in the year for the medical examinations and treatments as prescribed in Clause 3, points a, b, c, d and e of Clause 4, Clause 5 of this Article, Article 26 and Article 27 of this Law is greater than 6 times the reference level;
d) 95% of the costs of medical examination and treatment for the subjects specified in point a, clause 2, point k, clause 3, and points a and g, clause 4 of Article 12 of this Law;
e) 80% of the medical examination and treatment costs for other eligible individuals.
2. Individuals belonging to multiple health insurance categories are entitled to health insurance benefits according to the category with the highest benefits.
3. Individuals initially registered for health insurance-covered medical examination and treatment at specialized and basic-level medical facilities, when receiving medical examination and treatment at a different location from their initial registration due to a change in temporary residence or lodging, are entitled to receive medical examination and treatment at a basic-level medical facility appropriate to their new temporary residence or lodging, and the health insurance fund will reimburse the costs as stipulated in Clause 1 of this Article. The Minister of Health shall prescribe the procedures and circumstances under which individuals are eligible for health insurance-covered medical examination and treatment as stipulated in this Clause.
4. Individuals covered by health insurance who seek medical examination and treatment at facilities other than their initial health insurance registration facility, or who violate the regulations on patient referral stipulated in Articles 26 and 27 of this Law, except for cases specified in Clauses 3 and 5 of this Article, shall be reimbursed by the health insurance fund at a percentage of the benefit level stipulated in Clause 1 of this Article as follows:
a) 100% of the benefit level when receiving medical examination and treatment at basic or specialized medical facilities in cases of definitive diagnosis and treatment of certain rare diseases, life-threatening diseases, diseases requiring surgery or the use of advanced techniques as prescribed by the Minister of Health;
b) 100% of the benefit level for ethnic minorities and poor households living in areas with difficult socio-economic conditions, areas with especially difficult socio-economic conditions, people living in island communes and island districts when receiving inpatient medical examination and treatment at specialized medical examination and treatment facilities;
c) 100% of the benefit amount when receiving medical examination and treatment at the initial level of medical examination and treatment;
d) 100% of the benefit level for inpatient examination and treatment at basic-level medical facilities;
d) 100% of the benefit level when receiving medical examination and treatment at basic and specialized medical facilities that, before January 1, 2025, have been determined by competent authorities to be at the district level;
e) From 50% to 100% of the benefit level for outpatient examination and treatment at basic-level medical facilities based on the results of professional and technical classification according to the roadmap and specific benefit rate prescribed by the Government, except for the cases specified in points a and d of this clause;
g) 40% of the benefit level for inpatient examination and treatment at specialized medical facilities, except for cases specified in points a, b, d, and h of this clause;
h) 50% of the benefit level for outpatient medical examination and treatment according to the roadmap prescribed by the Government, and 100% of the benefit level for inpatient medical examination and treatment in cases where medical examination and treatment is conducted at a specialized medical facility that, before January 1, 2025, has been determined by the competent authority to be at the provincial level.
5. Health insurance participants are entitled to 100% of the benefits stipulated in Clause 1 of this Article when receiving medical examination and treatment at any medical facility in emergency cases.
6. The Government shall specify in detail the benefit levels for the subjects stipulated in points a, b, c, d, and e of Clause 3, Article 12 of this Law; and shall stipulate the benefit levels for cases where health insurance participants use medical examination and treatment services on demand and other cases not covered by Clause 1 of this Article.”
18. Amend and supplement Clauses 7 and 8 of Article 23 as follows:
7. Treatment of strabismus and refractive errors of the eye for individuals aged 18 years and older.
8. Use of replacement medical devices including prosthetic legs, prosthetic arms, prosthetic eyes, dentures, eyeglasses, hearing aids, and mobility aids in medical examination, treatment, and rehabilitation.
19. Article 24 is amended and supplemented as follows:
Article 24. Medical examination and treatment facilities covered by health insurance
"Health insurance medical examination and treatment facilities are medical examination and treatment facilities as stipulated in the Law on Medical Examination and Treatment that have signed a health insurance medical examination and treatment contract with the social insurance agency as prescribed by the Government."
20. Amend and supplement certain points and clauses of Article 25 as follows:
a) Amend and supplement point e of clause 2 as follows:
“e) Conditions for changing, liquidating, suspending, or terminating the contract.”;
b) Amend and supplement clauses 3 and 4 as follows:
3. Agreements on the conditions for changing, liquidating, suspending, or terminating contracts as stipulated in point e, clause 2 of this Article must ensure that they do not interrupt the medical examination and treatment of health insurance participants.
4. The Government shall provide detailed regulations for this Article and prescribe the model contract for medical examination and treatment under health insurance.”
21. Article 26 is amended and supplemented as follows:
Article 26. Initial registration for medical examination and treatment under health insurance.
1. Individuals participating in health insurance have the right to register for initial health insurance-covered medical examinations and treatments at primary or basic-level medical facilities; they also have the right to change their initial health insurance-covered medical examination and treatment facility within the first 15 days of each quarter.
2. The allocation of health insurance cards to initial health insurance registration facilities must ensure balance and suitability with the initial health insurance needs of the people, the capacity of the medical facilities, and the actual capacity in the locality.
3. The Minister of Health shall provide detailed regulations for Clauses 1 and 2 of this Article; and regulate the cases for initial registration for medical examination and treatment under health insurance at specialized medical facilities.
4. The Minister of Public Security and the Minister of National Defense shall regulate the registration of initial medical examination and treatment under health insurance for primary, basic, and specialized medical facilities and health insurance participants under their management authority.
22. Article 27 is amended and supplemented as follows:
Article 27. Transfer of patients between medical examination and treatment facilities covered by health insurance.
1. The transfer of patients between medical examination and treatment facilities is carried out according to professional requirements and the capacity of each medical examination and treatment facility.
2. The Minister of Health shall regulate the transfer of patients back to their initial health insurance-covered medical examination and treatment facilities for treatment, management, and monitoring of chronic diseases, including the use of prescribed medications, medical equipment, and medical technical services, in accordance with the professional capacity of the facility where the chronic disease is treated, managed, and monitored; and shall provide detailed regulations for Clause 1 of this Article, except as stipulated in Clause 3 of this Article.
3. The Minister of Public Security and the Minister of National Defense shall regulate the transfer of patients under their management authority between medical examination and treatment facilities covered by health insurance under their management authority.”
23. Article 28 is amended and supplemented as follows:
Article 28. Procedures for medical examination and treatment under health insurance.
1. Individuals covered by health insurance must present their health insurance card information and identification documents when seeking medical examination or treatment. Children under 6 years old and organ donors who have not yet been issued a health insurance card must present other valid documents. In emergency cases, patients must present their health insurance card information and the documents as stipulated in this clause before the end of their treatment.
The government will provide detailed regulations for this provision.
2. In cases of follow-up examinations as required by medical professionals during examination and treatment, health insurance participants will be scheduled for follow-up examinations by the medical facility according to procedures prescribed by the Minister of Health.
3. In cases where a patient is transferred to another medical facility under health insurance coverage due to professional requirements while receiving inpatient treatment, the transferring medical facility must have the transfer records as prescribed by the Minister of Health.
24. Article 30 is amended and supplemented as follows:
Article 30. Methods of payment for medical examination and treatment costs under health insurance.
1. Payment for medical examination and treatment costs under health insurance is made using the following methods:
a) Payment based on fixed rates;
b) Payment based on service charges;
c) Payment based on diagnostic groups.
2. The Government shall provide detailed regulations for Clause 1 of this Article and regulate the application of payment methods for medical examination and treatment costs under health insurance.”
25. Article 31 is amended and supplemented as follows:
Article 31. Payment of medical examination and treatment costs under health insurance.
1. The social insurance agency pays the costs of medical examination and treatment covered by health insurance to medical facilities according to the health insurance contract.
2. The social insurance agency will directly reimburse the costs of medical examination and treatment covered by health insurance to the health insurance cardholder when they receive medical examination and treatment in the following cases:
a) At medical examination and treatment facilities that do not have a contract for medical examination and treatment under health insurance;
b) Providing medical examination and treatment in violation of the regulations in Article 28 of this Law;
c) Other special cases as prescribed by the Government.
3. In cases where, at the time a patient is prescribed medication, medical equipment, or paraclinical services covered by health insurance, the medical facility does not have these items available and cannot substitute them with other medications, medical equipment, or paraclinical services, the medical facility may receive medications and medical equipment transferred from another health insurance medical facility to treat the patient, or transfer the patient or specimen to another facility that is qualified to perform the paraclinical services.
The health insurance medical examination and treatment facility that receives medications, medical equipment, transfers patients or specimens compiles the costs of these medications, medical equipment or paraclinical services and settles them with the social insurance agency.
4. The government stipulates the following:
a) Conditions and authority to decide on cases eligible to receive medicines and medical equipment transferred from other health insurance medical examination and treatment facilities for patient treatment, and the payment of costs for transferred medicines and medical equipment as stipulated in Clause 3 of this Article;
b) Managing and utilizing funds allocated for medical examination and treatment under health insurance, assessing and settling medical examination and treatment costs under health insurance for subjects specified in points a, b, c, d, and e of Clause 3, Article 12 of this Law;
c) The payment and settlement of medical examination and treatment costs under health insurance shall be appropriate for members of the People's Armed Forces and the people in border areas, islands, and particularly difficult villages and communes, in order to ensure national defense and security policies.
5. The Government shall provide detailed regulations for points a and b of Clause 2, and Clause 3 of this Article, except as provided in Clause 4 of this Article.”
26. Article 32 is amended and supplemented as follows:
Article 32. Advance payment, settlement, and final accounting of medical examination and treatment costs under health insurance.
1. Advance payments from the social insurance agency to health insurance medical examination and treatment facilities are made quarterly as follows:
a) Within 05 working days from the date of receiving the previous quarter's financial statement from the medical examination and treatment facility, the social insurance agency shall make a one-time advance payment equal to 90% of the medical examination and treatment costs covered by health insurance according to the previous quarter's financial statement of the medical examination and treatment facility;
b) For medical examination and treatment facilities signing a health insurance contract for the first time, based on the medical examination and treatment costs of the month preceding the signing of the health insurance contract, the social insurance agency shall advance 90% of the health insurance medical examination and treatment costs for the first month of the contract; after one month of the contract, the social insurance agency shall estimate and advance 90% of the health insurance medical examination and treatment costs for the quarter as stipulated in point a of this clause;
c) In cases where the advance funding for health insurance medical examination and treatment facilities in the province exceeds the allocated funds for the quarter, the provincial/city-level social insurance agency shall report to the Vietnam Social Insurance to request additional funding.
2. The payment and settlement process between medical examination and treatment facilities and social insurance agencies is carried out as follows:
a) Within the first 15 days of each month, health insurance medical examination and treatment facilities are responsible for submitting a summary of requests for payment of health insurance medical examination and treatment costs for the previous month to the social insurance agency; within the first 15 days of each quarter, health insurance medical examination and treatment facilities are responsible for submitting a report on the settlement of health insurance medical examination and treatment costs for the previous quarter to the social insurance agency;
b) Within 30 days of receiving the previous quarter's settlement report from the medical examination and treatment facility, the social insurance agency is responsible for notifying the medical examination and treatment facility of the assessment results and the settlement amount of medical examination and treatment costs covered by health insurance, including actual medical examination and treatment costs within the scope of health insurance benefits and coverage levels. For the fourth quarter of the year, the deadline for notifying the assessment results and the settlement amount of medical examination and treatment costs covered by health insurance shall not exceed 60 days from the date the social insurance agency receives the fourth quarter settlement report from the medical examination and treatment facility;
c) Within 10 days from the date of notification of the settlement number for medical examination and treatment costs covered by health insurance, the social insurance agency must complete the payment with the medical examination and treatment facility;
d) The annual financial audit of the health insurance fund must be completed before October 1st of the following year.
3. Within 40 days from the date of receiving complete payment request documents from health insurance participants in the cases stipulated in Clause 2, Article 31 of this Law, the social insurance agency must directly pay the health insurance medical examination and treatment costs to these individuals.”
27. Article 35 is amended and supplemented as follows:
Article 35. Allocation and use of health insurance funds
1. The health insurance fund is allocated and used as follows:
a) 92% of health insurance premiums are used for medical examinations and treatment;
b) 8% of health insurance premiums are allocated to the reserve fund for the organization and operation of health insurance, with at least 4% of the health insurance premiums specifically reserved for the reserve fund.
2. The investment of temporarily idle funds from the health insurance fund is governed by the provisions of the Social Insurance Law regarding the principles, list, methods of investment, and management of social insurance fund investment activities.
3. In cases where the amount of health insurance revenue allocated for medical examination and treatment exceeds the amount of medical examination and treatment expenses for the year, the remaining unused funds shall be fully accounted for in the reserve fund for general allocation.
4. In cases where the amount of health insurance revenue allocated for medical examination and treatment is less than the amount of medical examination and treatment expenses incurred during the year, the Vietnam Social Security is responsible for supplementing the deficit from its reserve fund.
5. The Government shall provide detailed regulations for this Article and regulations on the organization and operation of health insurance.”
28. Amend and supplement Clause 2 of Article 36 as follows:
2. To be registered as the initial health insurance medical examination and treatment facility in accordance with the provisions of Article 26 of this Law.
29. Amend and supplement Clause 3 of Article 39 as follows:
3. Deliver the health insurance card or notify the health insurance participant of the results of the card issuance within 03 working days from the date of receiving the card or receiving the notification of the results of the health insurance card issuance from the social insurance agency.
30. Amend and supplement Clause 2 of Article 40 as follows:
“2. Inspect the implementation of health insurance contracts for medical examination and treatment; conduct health insurance assessments; and revoke or temporarily retain health insurance cards in cases stipulated in Article 20 of this Law.”
31. Amend and supplement Clause 8 of Article 41 as follows:
8. Inspect the implementation of health insurance contracts for medical examination and treatment; conduct health insurance audits.
32. To add Clause 9 after Clause 8, Article 43 as follows:
9. Ensure that the conditions for conducting medical examinations and treatments under health insurance are met in accordance with the law on health insurance, the law on medical examination and treatment, and the health insurance medical examination and treatment contract.
33. Add Articles 48a and 48b after Article 48 as follows:
Article 48a. Late payment of health insurance premiums
Late payment of health insurance contributions is an act by the employer falling under one of the following circumstances:
1. Failure to pay or insufficient payment of health insurance contributions since the latest health insurance payment date stipulated in Clause 8, Article 15 of this Law, except for cases stipulated in Point c, Clause 1, Article 48b of this Law;
2. Failure to compile a list or compiling an incomplete list of the number of people required to participate in health insurance within 60 days from the expiration of the deadline stipulated in point b, clause 1, Article 17 of this Law;
3. This falls under the category of cases not considered as evasion of health insurance contributions as stipulated in Clause 2, Article 48b of this Law.
Article 48b. Evasion of health insurance contributions
1. Evading health insurance contributions is an act by the employer falling under one of the following cases:
a) After 60 days from the expiration of the period stipulated in point b, clause 1, Article 17 of this Law, if the employer fails to compile a list or compiles an incomplete list of the number of people required to participate in health insurance;
b) Registering a salary as the basis for health insurance contributions that is lower than the salary stipulated in Article 14 of this Law;
c) Failure to pay or insufficient payment of the registered health insurance premium within 60 days from the date of payment of health insurance premiums as stipulated in Clause 8, Article 15 of this Law, and after being urged by the competent authority as prescribed by the Government;
d) Other cases considered as evasion of health insurance contributions according to government regulations.
2. The Government shall provide detailed regulations for this Article; it shall stipulate the cases falling under Clause 1 of this Article that, if justified, shall not be considered as evasion of health insurance contributions.”
34. Article 49 is amended and supplemented as follows:
Article 49. Handling violations of the law on health insurance
1. Agencies, organizations, and individuals who violate the law on health insurance shall, depending on the nature and severity of the violation, be subject to disciplinary action, administrative penalties, or criminal prosecution; if they cause damage, they must compensate according to the provisions of the law.
2. Measures to address the issue of late payment of health insurance premiums include:
a) Mandatory payment of the full amount of overdue payments; a fee equal to 0,03% per day calculated on the overdue health insurance amount and the number of days of delay will be paid into the health insurance fund;
b) Imposing administrative penalties in accordance with the law;
c) Titles of emulation and forms of commendation will not be considered.
3. Measures to address the act of evading health insurance contributions include:
a) Mandatory payment of the full amount of evaded contributions; payment of 0,03% per day calculated on the amount of evaded health insurance contributions and the number of days of evasion into the health insurance fund;
b) Imposing administrative penalties or prosecuting criminal liability in accordance with the law;
c) Titles of emulation and forms of commendation will not be considered.
4. Agencies, organizations, and employers who are late in paying or evade paying health insurance for their employees must reimburse all medical examination and treatment costs within the scope of health insurance benefits and coverage that the employee has paid during the period when they did not have a health insurance card due to the late or evaded payment.
5. The Government shall provide detailed regulations for point a of clause 2, point a of clause 3, and clause 4 of this Article.”
35. Replace the phrase in the following points and clauses:
a) Replace the phrase “health insurance organization” with the phrase “social insurance agency” in Clauses 3 and 6 of Article 2, Clauses 2 and 4 of Article 7c, Clause 3 of Article 18, Clause 3 of Article 19, Clause 1 of Article 25, Clause 3 of Article 29, Clause 1 of Article 34, Clauses 4 and 5 of Article 36, Clause 4 of Article 37, Clause 1 of Article 38, Clause 4 of Article 39, Article title and Clause 5 of Article 40, Article title of Article 41, Clauses 1 and 2 of Article 42, Clauses 2, 3 and 4 of Article 43, Clause 1 of Article 44, and Point c of Clause 1 of Article 48;
b) Replace the phrase “Vietnam Social Insurance Management Council” with the phrase “Social Insurance Management Council” in Clause 1, Article 34.
Article 2. Amendments and additions to the Law on Forces Participating in Protecting Security and Order at the Grassroots Level No. 30/2023/QH15
Clause 2 of Article 32 of Law No. 30/2023/QH15 on Forces Participating in Protecting Security and Order at the Grassroots Level is hereby repealed.
Article 3. Terms enforcement
1. This Law shall come into effect on July 1, 2025, except for the provisions in paragraphs 2 and 3 of this Article.
2. Regulations relating to the level of technical expertise in medical examination and treatment, initial registration for medical examination and treatment under health insurance, patient transfer between medical examination and treatment facilities under health insurance, and procedures for medical examination and treatment under health insurance, as stipulated in Clauses 3, 16, 17, 21, 22, 23, and 28 of Article 1 of this Law, shall take effect from January 1, 2025.
3. The provisions on the scope of benefits in Clause 16, Article 1 of this Law, excluding provisions on telemedicine, support for telemedicine, family medicine, home-based medical examination and treatment, and the principles for developing a list of medical equipment and technical services within the scope of benefits for health insurance participants, and the provisions on benefit levels in Clause 17, Article 1 of this Law, shall apply to the following cases and shall take effect from January 1, 2025:
a) The subjects specified in Clause 10, Article 1 of this Law, which have already been specified in Article 12 of the Health Insurance Law No. 25/2008/QH12, as amended and supplemented by Law No. 32/2013/QH13, Law No. 46/2014/QH13, Law No. 97/2015/QH13, Law No. 35/2018/QH14, Law No. 68/2020/QH14 and Law No. 30/2023/QH15,
b) Individuals specified in point a of this clause who receive medical examination and treatment at medical facilities before January 1, 2025, and whose treatment period ends on or after January 1, 2025.
4. By January 1, 2027 at the latest, the interconnection and use of clinical laboratory results between health insurance medical examination and treatment facilities shall be implemented in accordance with professional requirements as prescribed by the Government.
5. Transitional provisions:
a) In cases where patients who do not fall under the categories specified in points a and b of Clause 3 of this Article receive medical examination and treatment at a medical facility before July 1, 2025, and complete their treatment from July 1, 2025, the provisions of this Law shall apply;
b) The reference level stipulated in this Law shall be based on the basic salary. In case of changes in wage policy, the Government shall decide on the specific reference level;
c) Health insurance contracts for medical examination and treatment signed before July 1, 2025, that remain valid after July 1, 2025, shall be implemented according to the regulations of the Government;
d) For health insurance premiums that employers are responsible for paying according to the provisions of Health Insurance Law No. 25/2008/QH12, which has been amended and supplemented by Law No. 32/2013/QH13, Law No. 46/2014/QH13, Law No. 97/2015/QH13, Law No. 35/2018/QH14, Law No. 68/2020/QH14 and Law No. 30/2023/QH15, but which are not paid or not paid in full by June 30, 2025, they shall be handled according to the provisions on late payment of this Law.
This law was passed by the 11th National Assembly of the Socialist Republic of Vietnam at its 8th session on June 27, 2024.