Decree 188/2025/ND-CP provides detailed regulations and guidance on the Law on Health Insurance.

DECREE

DETAILED REGULATIONS AND GUIDELINES FOR IMPLEMENTING CERTAIN ARTICLES OF THE LAW ON HEALTH INSURANCE

Based on the Law on Organization of the Government dated June 18, 2025;

Based on the Law on Health Insurance dated November 14, 2008; the Law amending and supplementing a number of articles of the Law on Health Insurance dated June 13, 2014; and the Law amending and supplementing a number of articles of the Law on Health Insurance dated November 27, 2024;

Based on Law No. 90/2025/QH15 dated June 25, 2025, amending and supplementing a number of articles of the Law on Bidding, the Law on Investment in the Public-Private Partnership Method, the Law on Customs, the Law on Value Added Tax, the Law on Export and Import Taxes, the Law on Investment, the Law on Public Investment, and the Law on Management and Use of Public Assets;

Based on Resolution No. 190/2025/QH15 dated February 19, 2025, of the National Assembly, which stipulates the handling of certain issues related to the reorganization of the state apparatus;

As requested by the Minister of Health;

The government has issued a Decree detailing and guiding the implementation of certain articles of the Health Insurance Law.

Chapter I

GENERAL RULES

Article 1. Scope

This Decree provides detailed regulations and guidance for the implementation of several articles of the Health Insurance Law No. 25/2008/QH12 dated November 14, 2008, 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, Law No. 30/2023/QH15, and Law No. 51/2024/QH15 (hereinafter referred to as the Health Insurance Law), including:

1. Detailed regulations on the following matters:

a) Contracts for medical examination and treatment under health insurance as stipulated in Article 25 of the Health Insurance Law;

b) Procedures for medical examination and treatment under health insurance as prescribed in Clause 1, Article 28 of the Health Insurance Law;

c) Payment methods and the application of payment methods for medical examination and treatment costs under health insurance as stipulated in Article 30 of the Health Insurance Law;

d) Payment of medical examination and treatment costs covered by health insurance as stipulated in points a and b of clause 2 and clause 3 of Article 31 of the Health Insurance Law;

d) Allocate and utilize funds in accordance with the provisions of Clause 5, Article 35 of the Health Insurance Law;

e) Handling violations of the law on health insurance as prescribed in point a, clause 2, point a, clause 3 and clause 4 of Article 49 of the Law on Health Insurance.

2. Regulations concerning:

a) Individuals eligible for health insurance as stipulated in point a, clause 7, Article 12 of the Health Insurance Law;

b) Contribution rates, contribution support levels, responsibilities, and methods of health insurance contributions as stipulated in points d and e of Clause 1 and Clause 7 of Article 13 of the Health Insurance Law;

c) Issuing both paper and electronic health insurance cards as prescribed in Clause 3, Article 17 of the Health Insurance Law;

d) The scope of benefits for health insurance participants as stipulated in points a and c of Clause 3, Article 21 of the Health Insurance Law;

d) The level of health insurance benefits for health insurance participants as prescribed in point b, clause 1, points e and h, clause 4, Article 22 of the Health Insurance Law; in cases where health insurance participants use medical examination and treatment services on demand as prescribed in clause 6, Article 22 of the Health Insurance Law and other cases not covered by clause 1, Article 22 of the Health Insurance Law;

e) Signing contracts for medical examination and treatment under health insurance as stipulated in Article 24 of the Health Insurance Law;

g) Payment of medical examination and treatment costs covered by health insurance as stipulated in point c, clause 2, and point a, clause 4 of Article 31 of the Health Insurance Law;

h) Managing the health insurance fund, deciding on financial sources to ensure health insurance coverage for medical examinations and treatments in cases of imbalance between revenue and expenditure of the health insurance fund as stipulated in Clause 2, Article 34 of the Health Insurance Law;

i) Expenses for organizing and operating health insurance as prescribed in Clause 5, Article 35 of the Health Insurance Law;

k) Cases falling under Clause 1, Article 48b of the Health Insurance Law, but with justifiable reasons, shall not be considered as evasion of health insurance contributions;

l) Transitional provisions for the implementation of health insurance contracts for medical examination and treatment signed before July 1, 2025, that remain in effect after July 1, 2025.

3. Instructions for implementing the following:

a) Payment of costs for medicines and medical equipment as stipulated in Clause 3, Article 55 of the 2023 Law on Bidding, as amended and supplemented by Law No. 90/2025/QH15;

b) Application of information technology and digital transformation in the implementation of health insurance;

c) Duties and powers of ministries, localities, agencies, and competent authorities regarding health insurance after organizational restructuring;

d) Responsibilities of stakeholders in the implementation process.

Article 2. Subject of application

1. This Decree applies to health insurance participants, health insurance medical examination and treatment facilities, social insurance agencies, and other organizations and individuals related to health insurance, including those falling under the cases specified in Clause 2 of this Article.

2. Individuals participating in health insurance, and health insurance-covered medical examination and treatment facilities in the following cases:

a) Individuals covered by health insurance under the management authority of the Ministry of National Defense and the Ministry of Public Security may receive medical examination and treatment at health insurance medical facilities not under the management authority of the Ministry of National Defense and the Ministry of Public Security;

b) Individuals covered by health insurance who are not under the management authority of the Ministry of National Defense or the Ministry of Public Security may receive medical examination and treatment at health insurance medical facilities under the management authority of the Ministry of National Defense or the Ministry of Public Security.

3. Individuals participating in health insurance who are members of the People's Army, the People's Public Security, and those working in cryptography, and who receive medical examination and treatment at health insurance medical facilities under the management authority of the Ministry of National Defense and the Ministry of Public Security, shall be subject to separate regulations issued by the Government for these individuals.

Article 3. Cases not considered as evasion of health insurance contributions.

Cases stipulated in points a and c of Clause 1, Article 48b of the Health Insurance Law shall not be considered as evasion of health insurance contributions when one of the following reasons, as announced by competent authorities on disaster prevention and control, emergency situations, civil defense, and disease prevention and control, is present, including:

1. Storms, floods, inundations, earthquakes, major fires, prolonged droughts, and other natural disasters directly and severely affect production and business activities.

2. Dangerous epidemics declared by competent state authorities that seriously affect the production, business activities, and financial capacity of agencies, organizations, and employers.

3. A state of emergency as defined by law that causes sudden and unexpected impacts on the operations of agencies, organizations, and employers.

4. Other force majeure events as stipulated by civil law.

Article 4. Determining the amount payable and reimbursement of costs to patients in cases of late payment or evasion of health insurance contributions.

1. Agencies, organizations, and employers who are late in paying or evade health insurance contributions must pay the amount due to the late payment or evasion to the social insurance agency. The amount due for late payment or evasion of health insurance contributions is determined as follows:

Cdt = Pst xnx 0,03%

In which:

– Cdt: The amount payable based on the number of days of late payment or evasion of payment for month t (t=1,2,3,…12)

– Pst: The amount payable for month t

– n: Number of days of late payment or evasion of payment.

2. Agencies, organizations, and employers who are late in paying or evade health insurance contributions shall reimburse the health insurance medical examination and treatment costs to their employees in the following cases:

a) The employee, or their family member, or their legal representative as prescribed by law, shall directly submit the application dossier, as stipulated in Clauses 2, 3, and 4 of Article 55 of this Decree, to the agency, organization, or employer that is late in paying or evades paying health insurance contributions;

b) Agencies, organizations, and employers are responsible for paying the medical examination and treatment costs for employees or their relatives or legal representatives as prescribed by law within 40 days from the date of receiving complete payment request documents;

c) The medical examination and treatment facility shall provide a statement of expenses determining the amount the patient has paid to the medical examination and treatment facility, along with a valid invoice, upon the patient's request, as a basis for the patient to request reimbursement of medical examination and treatment costs under health insurance.

Chapter II

ELIGIBILITY CRITERIA, CONTRIBUTION LEVELS, CONTRIBUTION SUPPORT LEVELS, AND RESPONSIBILITIES FOR HEALTH INSURANCE CONTRIBUTIONS

Article 5. Subjects eligible for health insurance

In addition to the individuals covered by health insurance as stipulated in Clauses 1, 2, 3, 4, 5, and 6 of Article 12 of the Health Insurance Law, the following individuals are also eligible for health insurance:

1. Rubber plantation workers receiving monthly allowances as stipulated by the Government participate in group health insurance, with contributions paid by the social insurance agency as prescribed in Clause 2, Article 12 of the Health Insurance Law.

2. Residents of communes that were revolutionary safe zones during the resistance against France or the United States, and who are currently residing in those same communes, have had their information updated in the National Population Database and the Residence Database and are eligible to participate in group health insurance funded by the state budget as stipulated in Clause 3, Article 12 of the Health Insurance Law.

3. Individuals awarded the title of People's Artisan or Distinguished Artisan who belong to households with a monthly average per capita income lower than the basic salary stipulated by the Government, and who do not fall under the categories specified in Clauses 1, 2, and 3 of Article 12 of the Health Insurance Law, shall participate in group health insurance funded by the state budget as stipulated in Clause 3 of Article 12 of the Health Insurance Law.

4. Victims of landmines and unexploded ordnance after the war, as stipulated in Clause 8, Article 3 of Government Decree No. 18/2019/ND-CP dated February 1, 2019, on the management and implementation of activities to mitigate the consequences of landmines and unexploded ordnance after the war, who do not fall under the categories specified in Clauses 1, 2, and 3, Article 12 of the Health Insurance Law, shall participate in health insurance under the group whose contributions are subsidized by the state budget as stipulated in Clause 4, Article 12 of the Health Insurance Law.

5. Relatives of other personnel working in cryptographic organizations as prescribed by law on cryptography, who are not eligible for health insurance under points a, b, c, d, e, g, h, and i of Clause 1, Clause 2, and Clause 3 of Article 12 of the Health Insurance Law, shall participate in group health insurance with contributions from the employer, the employee, or jointly contributed as prescribed in Clause 1 of Article 12 of the Health Insurance Law.

6. Individuals who participated in the resistance war, defended the Fatherland, performed international duties, and other individuals whose health insurance premiums were paid by the state budget as stipulated in legal documents issued before January 1, 2025, shall participate in health insurance under the group scheme with premiums paid by the state budget as stipulated in Clause 3, Article 12 of the Health Insurance Law.

7. Military trainees at the commune-level Military Command with college or university degrees in basic military science, full-time program as decided by the Prime Minister and in accordance with legal regulations before January 1, 2025, who are receiving living allowances from the state budget and have not yet participated in health insurance, shall participate in health insurance under the group scheme funded by the state budget as stipulated in Clause 3, Article 12 of the Health Insurance Law.

8. Individuals specified in Clauses 1, 2, 3, 4, 5, 6, and 7 of this Article who simultaneously belong to multiple different health insurance participation categories according to the groups specified in Article 12 of the Health Insurance Law shall participate in health insurance according to the principle stipulated in point a, Clause 5, Article 13 of the Health Insurance Law.

9. Individuals who fall under the categories specified in Clause 4 of this Article and who also fall under the categories specified in Clause 4 of Article 12 of the Health Insurance Law may choose to participate according to the category with the highest level of support.

Article 6. Contribution rates, contribution support levels, 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 the Health Insurance Law is 4,5% of the monthly salary used as the basis for compulsory social insurance contributions, of which the employer contributes two-thirds and the employee contributes one-third;

b) The monthly contribution rate for the subjects specified in points b and d of Clause 1, Article 12 of the Health Insurance Law is 4,5% of the monthly salary used as the basis for compulsory social insurance contributions and is paid by the subject;

c) The monthly contribution rate for the subjects specified in point g, clause 1, Article 12 of the Health Insurance Law is 4,5% of the basic salary, 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 the Health Insurance Law is 4,5% of the monthly salary used as the basis for compulsory social insurance contributions, of which the employer contributes two-thirds and the employee contributes one-third;

d) The monthly contribution rate for the subjects specified in point i, clause 1, Article 12 of the Health Insurance Law is 4,5% of the basic salary and is paid by the employer of defense workers and civil servants serving in the army, and the employer of police workers working in the People's Public Security.

e) The monthly contribution rate for the subjects specified in Clause 5, Article 5 of this Decree is 4,5% of the basic salary and is paid by the employer of the person working in other positions within the cryptography organization as prescribed by law on cryptography;

g) For employees who are officials, civil servants, or public employees currently under temporary detention, temporary arrest, temporary suspension from work, or temporary suspension from their position, and who have not yet been subjected to disciplinary action, the monthly contribution rate shall be 4,5% of 50% of the monthly salary used as the basis for compulsory social insurance contributions for the month immediately preceding the temporary detention, arrest, or suspension as prescribed by law, with the employer contributing two-thirds and the employee contributing one-third. If the competent authority concludes that there has been no violation of the law, the employer and the employee must pay retroactive health insurance contributions based on the back pay received.

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 the Health Insurance Law is 4,5% 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 the Health Insurance Law and Clause 1, Article 5 of this Decree is equal to 4,5% of the basic salary;

c) The monthly contribution rate for the subjects specified in point d, clause 2, Article 12 of the Health Insurance Law is 4,5% of the unemployment benefit.

3. The contribution rates for the group whose contributions are paid by the state budget are stipulated as follows:

a) The monthly contribution rate for subjects specified in points e, g, h, i, k, l, m, o, p, q, r, s, t and u of Clause 3, Article 12 of the Health Insurance Law and Clauses 2, 3, 6 and 7, Article 5 of this Decree is 4,5% of the basic salary;

b) The monthly contribution rate for the subjects specified in point n, clause 3, Article 12 of the Health Insurance Law is 4,5% of the basic salary and is paid through the agency, organization, or unit that provides the scholarship.

4. The contribution rates for groups whose contributions are subsidized by the state budget are stipulated as follows:

The monthly contribution rate for the subjects specified in Clause 4, Article 12 of the Health Insurance Law and Clause 4, Article 5 of this Decree is 4,5% of the basic salary, paid by the subject themselves, with a portion of the contribution subsidized by the state budget as stipulated in Clause 6 of this Article.

5. The monthly contribution rate for the subjects specified in Clause 5, Article 12 of the Health Insurance Law is stipulated as follows:

a) The monthly contribution is 4,5% of the basic salary and is paid by the individual or household; or by the individual participating.

b) Household members as stipulated in point a, clause 5, Article 12 of the Health Insurance Law who participate in health insurance under the household scheme during the fiscal year are entitled to a reduction in contributions as follows: the first person pays 4,5% of the basic salary; the second, third, and fourth persons pay 70%, 60%, and 50% respectively of the first person's contribution; from the fifth person onwards, they pay 40% of the first person's contribution.

6. The level of support from the state budget is stipulated as follows:

a) Providing 100% support for health insurance premiums for individuals belonging to near-poor households residing in poor communes as defined by the Prime Minister's Decision and other relevant documents from competent authorities;

b) Provide support covering at least 70% of the health insurance premium for the subjects specified in point a, clause 4, Article 12 of the Health Insurance Law;

c) Provide support covering at least 70% of the health insurance premium for the subjects specified in point g, clause 4, Article 12 of the Health Insurance Law. The support period is 36 (thirty-six) months from the time the commune where the subject is residing is no longer classified as a region with difficult or extremely difficult socio-economic conditions;

d) Provide support covering at least 50% of the health insurance premium for the subjects specified in point i, clause 4, Article 12 of the Health Insurance Law. The support period is one year from the date the subject is confirmed as a victim by the competent authority in accordance with the Law on Prevention and Combat of Human Trafficking;

d) Provide support covering at least 50% of the health insurance premium for the subjects specified in points b, c, d, e, and h of Clause 4, Article 12 of the Health Insurance Law;

e) Provide a minimum subsidy of 30% of the health insurance premium for the subjects specified in point d, clause 4, Article 12 of the Health Insurance Law and clause 4, Article 5 of this Decree.

Article 7. Methods and responsibilities for paying health insurance for certain groups.

1. For individuals receiving monthly pensions, disability benefits, or social insurance benefits guaranteed by the state budget as stipulated in Clause 2, Point q, Clause 3, Article 12 of the Health Insurance Law and Clause 1, Article 5 of this Decree, the social insurance agency shall transfer the health insurance contribution funds for these individuals monthly from the funds allocated for pension and social insurance benefit payments guaranteed by the state budget.

2. For the subjects specified in points e, i, and k of Clause 3, Article 12 of the Health Insurance Law and Clause 6, Article 5 of this Decree, the Department of Internal Affairs shall transfer health insurance contributions from the fund for preferential policies for people with meritorious services to the revolution to the health insurance fund quarterly. The Department of Internal Affairs must complete the transfer of funds to the health insurance fund for that year no later than December 15th of each year.

3. For the subjects specified in point r, clause 3, Article 12 of the Health Insurance Law and clause 2, Article 5 of this Decree, the Department of Health shall transfer health insurance contributions from the social welfare policy implementation source to the health insurance fund quarterly. The Department of Health must complete the transfer of funds to the health insurance fund for that year no later than December 15th of each year.

4. For the subjects specified in points c, d, e, h, and i of Clause 4, Article 12 of the Health Insurance Law and Clause 4, Article 5 of this Decree, quarterly, the social insurance agency shall compile the number of health insurance cards issued and the amount of contributions and support payments according to Form No. 1 in the Appendix attached to this Decree and send it to the Department of Finance to transfer health insurance contributions from the local budget as prescribed in Clause 10 of this Article.

5. For the subjects specified in points g, h, l (excluding relatives of subjects managed by the Ministry of National Defense), m, o, p, s, t and u of Clause 3, points a and g of Clause 4 of Article 12 of the Law on Health Insurance and Clause 3 of Article 5 of this Decree:

a) Quarterly, the social insurance agency shall compile the number of health insurance cards issued and the amount of contributions and subsidies paid according to Form No. 1 of the Appendix issued with this Decree, and send it to the Department of Finance to transfer funds to the health insurance fund as prescribed in Clause 10 of this Article;

b) The payment amount for individuals listed annually is calculated from January 1st; for individuals added during the year, the payment is calculated according to the provisions of Clauses 3 and 4 of Article 6 of this Decree, and the benefits are received from the date specified in the approval decision.

6. For students as stipulated in point b, clause 4, Article 12 of the Health Insurance Law:

a) Periodically, every 03, 06, or 12 months, students or their parents or guardians are responsible for paying the health insurance premiums that are their responsibility to pay as stipulated in Clause 2, Article 8 of this Decree to the social insurance agency;

b) Students studying at educational institutions or vocational training institutions under the central government or ministries are supported by the central budget. Periodically, every 03, 06, or 12 months, the Social Insurance agencies of provinces and centrally-administered cities shall compile the number of health insurance cards issued, the amount collected from students, and the amount of state budget support for contributions according to Form No. 1 in the Appendix attached to this Decree, and send it to the Vietnam Social Insurance for consolidation and submission to the Ministry of Finance for transfer of funds to the health insurance fund;

c) For students studying at other educational or vocational training institutions, the local budget, including any central government support (if applicable), where the educational institution is located, shall provide support, regardless of the student's permanent residence. Periodically, every 03, 06, or 12 months, the social insurance agency shall compile the number of health insurance cards issued, the amount collected from students, and the amount of state budget support for contributions, using Form No. 1 in the Appendix attached to this Decree, and send it to the Department of Finance to transfer funds to the health insurance fund as stipulated in Clause 10 of this Article.

7. For those whose health insurance contributions are partially subsidized by the state budget as stipulated in point d, clause 4, Article 12 of the Health Insurance Law:

a) Periodically, every 03, 06, or 12 months, the household representative shall directly pay the health insurance premium for the portion of the amount they are responsible for paying as stipulated in Clause 2, Article 8 of this Decree to the social insurance agency;

b) Periodically, every 03, 06, or 12 months, the social insurance agency shall compile the number of health insurance cards issued, the amount collected from participants, and the amount of state budget support for contributions according to Form No. 1 in the Appendix attached to this Decree, and send it to the Department of Finance to transfer funds to the health insurance fund as prescribed in Clause 10 of this Article.

8. For individuals participating in health insurance under the household scheme as stipulated in Clause 5, Article 12 of the Health Insurance Law: periodically, every 3 months, 03 months, or 12 months, the household representative or a household member participating in health insurance shall pay health insurance contributions as prescribed in Clause 06, Article 8 of this Decree to the social insurance agency.

9. For individuals covered by health insurance as stipulated in points h and i of Clause 1, Article 12 of the Health Insurance Law and Clause 5, Article 5 of this Decree, the employer shall monthly pay health insurance contributions for these individuals along with health insurance contributions for employees as prescribed, from the following sources:

a) For entities using state budget funds, the funding is guaranteed by the state budget;

b) For non-profit organizations, the organization's funds shall be used in accordance with the law on the autonomous mechanism of public non-profit organizations;

c) For businesses, use the company's own funds.

10. The Department of Finance, based on regulations on budget management decentralization of competent authorities and the summary table of beneficiaries and state budget contributions and support payments transferred by the social insurance agency, is responsible for transferring funds to the health insurance fund once every quarter. The transfer of funds to the health insurance fund for that year must be completed no later than December 15th of each year.

11. For the beneficiaries specified in point n, clause 3, Article 12 of the Health Insurance Law, the agency, unit, or organization providing the scholarship shall pay health insurance contributions to the health insurance fund quarterly as prescribed.

12. For the subjects specified in point l, clause 3, Article 12 of the Law on Health Insurance, who are relatives of subjects managed by the Ministry of National Defense, and the subjects specified in clause 7, Article 5 of this Decree, the financial agency of the unit directly under the Ministry of National Defense shall make quarterly health insurance contributions to the Military Social Insurance.

13. In the event that a health insurance participant dies, goes missing, or ceases to reside in Vietnam, the health insurance contributions will be calculated from the time of payment to the time of cessation of payment, based on the list of reduced contributions compiled by the competent authority.

Article 8. Determining the amount of contributions and support for contributions for certain subjects when the State adjusts the health insurance contribution rate and the basic salary level.

1. For the groups of subjects specified in Clause 3, Article 12 of the Health Insurance Law and subjects entitled to 100% support for health insurance contributions as stipulated in Point a, Clause 6, Article 6 of this Decree, who receive 100% support from the state budget for their health insurance contributions:

a) The amount of state budget contributions and support for monthly contributions is determined by multiplying the health insurance contribution rate by the basic salary. When the state adjusts the health insurance contribution rate or the basic salary, the amount of state budget contributions will be adjusted from the date the new health insurance contribution rate or the new basic salary is applied;

b) The amount of health insurance contributions for the subjects specified in point h, clause 3, Article 12 of the Health Insurance Law is calculated from the date of birth until the child reaches 72 months of age. In the case of Vietnamese children born abroad, the amount of health insurance contributions is calculated from the date the child returns to reside in Vietnam according to the provisions of the law.

2. For the groups of beneficiaries whose health insurance contributions are partially subsidized by the state budget as stipulated in points b and d, clause 4, Article 12 of the Health Insurance Law:

a) The monthly contribution amount of the participant and the state budget support are determined by multiplying the health insurance contribution rate by the basic salary at the time the participant pays health insurance;

b) When the State adjusts the health insurance contribution rate or the basic salary, participants and the state budget are not required to pay additional contributions or receive reimbursement for the difference resulting from the adjustment of the health insurance contribution rate or the basic salary for the remaining period for which the participant has already paid health insurance contributions.

3. For the group of individuals participating in health insurance as stipulated in Clause 5, Article 12 of the Health Insurance Law:

a) The monthly contribution amount of the participant is determined by multiplying the health insurance contribution rate by the basic salary at the time of health insurance contribution;

b) When the State adjusts the health insurance contribution rate or the basic salary, participants are not required to pay additional contributions or receive reimbursement for the difference resulting from the adjustment of the health insurance contribution rate or the basic salary for the remaining period for which they have already paid health insurance contributions.

4. For individuals participating on any day of the month, the health insurance premium will be determined monthly from the date of payment.

Chapter III

HEALTH INSURANCE CARD

Article 9. Compiling a list for issuing health insurance cards to certain groups.

1. The responsibility for compiling lists for issuing health insurance cards is carried out in accordance with the provisions of Clause 3, Article 8 and Clause 1, Article 17 of the Health Insurance Law.

2. The social insurance agency shall compile a list for issuing health insurance cards to individuals who have donated body parts in accordance with the law, based on the discharge papers issued by the medical facility where the body parts were harvested. The medical facility shall guide the donor to fully declare information according to Form No. 2 in the Appendix attached to this Decree on the National Public Service Portal or through the social insurance agency's application, and guide the donor to carry out the procedure for issuing a health insurance card as prescribed in Article 11 of this Decree.

3. The People's Committee at the commune level shall compile a list for issuing health insurance cards to the subjects specified in Clauses 1, 2, 3, 4 and 6 of Article 5 of this Decree, the subjects specified in points e, h, i, k, o, r, s and t of Clause 3, and points a, d and g of Clause 4 of Article 12 of the Health Insurance Law who are living in the community.

4. Employers shall compile a list of eligible individuals for health insurance cards as stipulated in Clause 5, Article 5 of this Decree.

5. Facilities for the care and rehabilitation of wounded soldiers and people with meritorious services to the revolution, and social assistance facilities (hereinafter referred to as care facilities) shall compile a list for issuing health insurance cards to the subjects specified in points e, h, i, k, r, and s of Clause 3, Article 12 of the Health Insurance Law who are regularly cared for in the care facility.

6. The list of individuals participating in health insurance shall be compiled according to Form No. 3 and Form No. 4 of the Appendix issued with this Decree.

Article 10. Health insurance card information

1. An electronic or paper health insurance card issued by the social insurance agency, containing the health insurance number and the following basic information:

a) Personal information of the health insurance participant, including: full name, gender, date of birth;

b) Information on health insurance coverage levels based on health insurance participation categories;

c) The date when the health insurance card becomes valid;

d) The place of initial registration for medical examination and treatment under health insurance;

d) Having participated in health insurance for at least 05 consecutive years for those who are required to co-pay for medical examination and treatment costs.

2. The electronic health insurance card is presented in the form of electronic data created by the Vietnam Social Security using electronic means, containing information as prescribed in Clause 1 of this Article.

3. The health insurance card information stipulated in Clause 1 of this Article shall be integrated and synchronized according to the health insurance number and the identity card number of the health insurance participant.

Article 11. Procedures for issuing health insurance cards

1. The social insurance agency issues each health insurance participant an electronic health insurance card. If the health insurance participant requests it, the social insurance agency will issue a paper health insurance card.

2. The issuance of health insurance cards (including initial issuance and re-issuance) and the updating of health insurance card information are carried out as follows:

a) Individuals participating in health insurance shall fully declare information according to Form No. 2 of the Appendix issued with this Decree, or the agency or organization managing the insured shall fully declare information according to Form No. 3 of the Appendix issued with this Decree on the National Public Service Portal or through the application of the social insurance agency, or submit directly to the one-stop service department of the social insurance agency assigned to receive the application, or send it via public postal service to the social insurance agency assigned to receive the application;

b) The health insurance participant or the agency/organization managing the participant shall select whether to issue an electronic health insurance card or a paper health insurance card on the Participation Declaration Form or the list of participants. In case of changes to personal information or changes to benefit information, the health insurance participant must provide scanned copies of relevant documents and materials to submit along with the Declaration Form on the National Public Service Portal or through the social insurance agency's application, or submit directly to the one-stop service department of the social insurance agency assigned to receive the application, or send it via public postal service to the social insurance agency assigned to receive the application;

c) The national public service portal or the social insurance agency's application will automatically issue a Receipt of Application and a scheduled date for the issuance of the health insurance card to the health insurance participant or to the agency/organization managing the beneficiary. In the case of submitting the application directly at the one-stop service counter of the social insurance agency, the officer receiving the application at the one-stop service counter will directly check the application, issue a Receipt of Application, and schedule a date for the issuance of the health insurance card to the health insurance participant or to the agency/organization managing the beneficiary;

d) In the case of issuing electronic health insurance cards, within 05 working days from the date of receiving complete documents as prescribed in points a, b, and c of this section, the social insurance agency will send the electronic health insurance card results to the digital social insurance application (VssID), personal email address, linked to the level 2 electronic identification account (VNeID). Health insurance participants use electronic devices with the VNeID or VssID application installed and connected to the internet to receive their electronic health insurance card.

In the case of issuing a paper health insurance card, within 05 working days from the date of receiving all the required documents as stipulated in points a, b, and c of this clause, the social insurance agency shall transfer the paper health insurance card to the health insurance participant or the organization managing the beneficiary for onward transfer to the health insurance participant.

3. For children under 6 years old, the issuance of health insurance cards is carried out in conjunction with the procedures for birth registration and permanent residence registration as stipulated in Government Decree No. 63/2024/ND-CP dated June 10, 2024, which regulates the electronic integration of two groups of administrative procedures: birth registration, permanent residence registration, and issuance of health insurance cards for children under 6 years old; and death registration, removal of permanent residence registration, and settlement of funeral expenses and death benefits.

4. The Military Social Insurance agency issues health insurance cards to the subjects specified in Clause 7, Article 5 of this Decree.

Article 12. Revocation, temporary suspension, or temporary suspension of the validity of health insurance cards.

1. Health insurance cards are revoked in the cases stipulated in Clause 1, Article 20 of the Health Insurance Law.

2. Cases of fraud in the issuance of health insurance cards include:

a) There was fraudulent activity involving the provision of information regarding eligibility and benefit levels in the issuance of health insurance cards;

b) Other fraudulent acts.

3. Health insurance cards are temporarily suspended or their validity is temporarily blocked in the cases stipulated in Clause 2, Article 20 of the Health Insurance Law.

4. Upon detecting violations of the provisions in Clauses 1, 2, and 3 of this Article, the medical examination and treatment facility shall notify the social insurance agency.

5. The social insurance agency shall revoke, temporarily detain, or temporarily suspend the validity of health insurance cards upon detecting or receiving notification from medical examination and treatment facilities regarding violations of the regulations specified in Clauses 1, 2, and 3 of this Article.

6. When revoking, temporarily suspending, or temporarily suspending the validity of a health insurance card, the social insurance agency must notify the health insurance participant.

7. Health insurance cards that have been temporarily suspended or temporarily held will be unlocked and returned when the person who lent the card to another person and the person who used the other person's health insurance card have fulfilled their obligations to pay the fine and take remedial measures (if any) as stipulated in the administrative penalty decision for the case specified in Clause 3 of this Article.

Article 13. When the health insurance card becomes valid

1. For the subjects specified in point d, clause 2, Article 12 of the Health Insurance Law: From the date of receiving unemployment benefits as stated in the decision on receiving unemployment benefits issued by the competent state agency.

2. For the subjects specified in point h, clause 3, Article 12 of the Health Insurance Law:

a) For children born on or before September 30th: from the date of birth until September 30th of the year the child reaches 72 months of age;

b) For children born after September 30th: from the date of birth until the last day of the month, the child is considered to be 72 months old.

3. For subjects specified in point r, clause 3, Article 12 of the Health Insurance Law: from the date of receiving social assistance as decided by the People's Committee according to the delegated authority.

4. For subjects specified in point o, clause 3 and point a, clause 4 of Article 12 of the Health Insurance Law who receive 100% support from the state budget for their health insurance contributions: from the date determined in the Decision approving the list by the competent state agency.

5. For the subjects specified in point m, clause 3, Article 12 of the Health Insurance Law: immediately after organ donation.

6. For subjects specified in point h, clause 4, Article 12 of the Health Insurance Law: from the date determined in the Decision approving the list by the competent state agency.

7. The subjects specified in point b, clause 4, Article 12 of the Health Insurance Law are students of general education institutions who pay health insurance annually as follows:

a) First grade students: from October 1st of the first year of primary school; from the last day of the month in which the child reaches 72 months of age in the case stipulated in point b, clause 2 of this Article;

b) 12th grade students: from January 1st to September 30th of that year. 12th grade students are encouraged to pay for health insurance and will receive health insurance premium support until December 31st of their final school year to ensure continuous health insurance benefits. They will not have to repay the state budget's health insurance premium support in case of a change in eligibility.

8. The subjects specified in point b, clause 4, Article 12 of the Health Insurance Law are students of higher education institutions and vocational education institutions who pay health insurance annually, including:

a) First-year students: from the date of enrollment; in cases where the health insurance card of a 12th-grade student is still valid after the enrollment date, payment should be made from the date the health insurance card expires;

b) Final-year students: from January 1st to the last day of the month the course ends. Final-year students are encouraged to enroll in health insurance and receive health insurance premium support until December 31st of their final academic year to ensure continuous health insurance benefits. They will not have to repay the state budget's health insurance premium support in case of a change in eligibility.

9. For other individuals, the health insurance card is valid from the date the insured pays for health insurance, except as stipulated in point c, clause 3, Article 16 of the Health Insurance Law.

10. The validity of the health insurance card stipulated in this Article corresponds to the amount of health insurance contributions as prescribed, except for children under 6 years old.

Chapter IV

SCOPE AND LEVEL OF BENEFITS FOR HEALTH INSURANCE PARTICIPANTS

Article 14. Scope of entitlement to reimbursement of patient transportation costs.

1. Individuals covered by health insurance who fall under the categories specified in points a, b, c, d, e, h, i, o, and r of Clause 3, Article 12 of the Health Insurance Law, and who are undergoing inpatient treatment or emergency care and require transfer to another medical facility, are entitled to reimbursement of transportation costs.

2. The health insurance fund will reimburse the patient transportation costs to the medical facility transferring the patient based on the specific patient transportation service rates as follows:

a) For state-owned medical examination and treatment facilities, payment shall be made according to the patient transportation service price approved or regulated by the competent authority;

b) For private medical examination and treatment facilities, the patient transportation service fees of state-owned medical examination and treatment facilities shall be applied as the basis for requesting payment from the health insurance fund, following the same principles as the payment of technical service costs in medical examination and treatment under health insurance for private medical examination and treatment facilities as stipulated in Article 47 of this Decree.

3. In cases where there is no established price for patient transportation services, the transportation costs covered by health insurance will be determined based on the following criteria:

a) Based on the actual distance between the two medical examination and treatment facilities;

b) Fuel cost reimbursement is calculated based on the commonly consumed rate of 0,2 liters of gasoline per kilometer and does not apply the rates and benefit levels stipulated in Article 22 of the Health Insurance Law. The gasoline price will be based on the prevailing price in the area of ​​the medical facility transporting the patient at the time of transport, as recorded on the referral form.

4. For medical examination and treatment facilities providing patient transportation services in cases where there is no approved or regulated price for patient transportation services, the health insurance fund will make payments as follows:

a) Payment of transportation costs for both the outbound and return journeys to the medical facility transferring the patient, based on the unit price on the fuel purchase invoice, according to the actual fuel consumed by the vehicle transporting the patient, but not exceeding the fuel cost payment rate stipulated in point b, clause 3 of this Article;

b) In cases where the vehicle transporting the patient does not use gasoline or diesel fuel, the fuel cost reimbursement rate specified in point b, clause 3 of this Article shall apply;

c) In cases where more than one patient is transported on the same vehicle, the payment will be calculated according to the rate prescribed for transporting one patient;

d) The medical facility that refers the patient for transfer is responsible for compiling all transportation costs and reimbursing them to the social insurance agency. Medical staff at the receiving medical facility sign the transfer vehicle dispatch form.

5. For patients who arrange their own transportation, the health insurance fund will cover the costs as follows:

a) Payment of one-way (outbound) transportation costs according to the patient transportation invoice to the medical facility receiving the patient, at a rate not exceeding the rates stipulated in points a and b of Clause 3 of this Article;

b) The medical facility that refers a patient for transfer is responsible for noting that the patient is responsible for their own transportation on the referral form.

c) The medical facility receiving the patient shall reimburse the patient for transportation costs based on the transportation invoice provided by the patient as stipulated in point a of this clause, and shall consolidate the transportation costs for payment to the social insurance agency.

Article 15. Health insurance coverage levels for certain subjects and cases.

1. Individuals covered by health insurance who fall under the categories specified in Clauses 1, 2, 3, 4, 5, 6, and 7 of Article 5 of this Decree, when undergoing medical examination and treatment as prescribed in Articles 26 and 27 of the Health Insurance 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 costs of medical examination and treatment for the subjects specified in Clauses 2 and 6 of Article 5 of this Decree;

b) 80% of the medical examination and treatment costs for the subjects specified in Clauses 1, 3, 4, 5 and 7 of Article 5 of this Decree.

2. Individuals covered by health insurance who fall under the categories specified in points a, b, c, d, and e of Clause 3, Article 12 of the Health Insurance Law, when undergoing medical examination and treatment at health insurance medical facilities not under the management authority of the Ministry of National Defense or the Ministry of Public Security, will have their medical examination and treatment costs reimbursed by the health insurance fund according to the benefit level stipulated in Article 11 of Government Decree No. 70/2015/ND-CP dated September 1, 2015, detailing and guiding the implementation of a number of articles of the Health Insurance Law for the People's Army, the People's Public Security, and those working in cryptography, as amended and supplemented by Government Decree No. 74/2025/ND-CP dated March 31, 2025.

Article 16. Subjects not subject to the payment rate stipulated in point c, clause 2, Article 21 of the Health Insurance Law.

The following individuals are exempt from the payment rate stipulated in point c, clause 2, Article 21 of the Health Insurance Law:

1. People who were revolutionary activists before January 1, 1945.

2. Revolutionary activists from January 1, 1945, to the August 1945 uprising.

3. Heroic Vietnamese Mother.

4. War invalids, those receiving benefits similar to war invalids, war invalids of type B, and sick soldiers with a disability rate of 81% or higher.

5. War invalids, those receiving benefits similar to war invalids, war invalids of type B, and sick soldiers when treating recurring wounds or illnesses.

6. Resistance fighters exposed to chemical toxins who have a disability rate of 81% or higher.

7. Children under 6 years old.

Article 17. Application of health insurance benefits in certain cases

1. The cost of a single medical examination and treatment to determine whether a health insurance participant is entitled to 100% coverage of medical examination and treatment costs as stipulated in point b, clause 1, Article 22 of the Health Insurance Law is less than 15% of the basic salary.

2. The provisions in point b, clause 1, Article 22 of the Health Insurance Law and clause 1 of this Article apply to cases where health insurance participants seek medical examination and treatment as prescribed in clauses 1, 3, 4, and 5 of Article 22 of the Health Insurance Law.

3. The provisions in points d and e of Clause 1, Article 22 of the Health Insurance Law apply to cases where health insurance participants seek medical examination and treatment as prescribed in Clauses 3, 4, and 5 of Article 22 of the Health Insurance Law, except for cases specified in Clause 2 of this Article and excluding those entitled to 100% reimbursement of medical examination and treatment costs.

4. Individuals covered by health insurance who fall under multiple categories with different benefit levels as stipulated in Clause 1, Article 22 of the Health Insurance Law shall be subject to the highest benefit level. If the benefit levels stipulated in points a, b, c, and d of Clause 1, Article 22 of the Health Insurance Law are applied, the benefit levels stipulated in points e and f of Clause 1, Article 22 of the Health Insurance Law shall not apply.

Article 18. Application of benefit levels for cases with 05 consecutive years or more of health insurance participation.

1. Certain cases are considered as periods of continuous health insurance participation for the purpose of applying the benefit level when having 5 consecutive years or more of health insurance participation as stipulated in point d, clause 1, Article 22 of the Health Insurance Law, specifically as follows:

a) A period of interruption in health insurance coverage of 90 days is counted as continuous health insurance coverage;

b) For individuals sent abroad for work, study, or employment by competent authorities, or accompanying their spouse or legally adopted child under 18 years of age who is assigned to work abroad at a Vietnamese agency, the time spent abroad is counted as time participating in health insurance;

c) For workers going to work abroad under the Law on Vietnamese Workers Working Abroad under Contract and in cases where they are sent to work abroad by state agencies, the period of health insurance participation before going to work abroad will be counted as health insurance participation if they continue to participate in health insurance within 30 days of their return to Vietnam;

d) For employees applying for unemployment benefits under the provisions of the Employment Law, excluding the period from the date of termination of the labor contract or employment contract to the date of submitting the application for unemployment benefits, the period of previous health insurance participation shall be counted as health insurance participation time;

d) For individuals specified in points a, b, and d of Clause 3, Article 12 of the Health Insurance Law, upon retirement, discharge from military service, transfer to another sector, or termination of employment, the time spent studying and working in the People's Army, People's Public Security, and cryptographic organizations shall be counted as time participating in health insurance. If there is insufficient basis to determine the time participating in health insurance, the social insurance agency shall base its determination on one of the following documents issued by the military, police, or cryptographic unit showing the work history: Social insurance book; demobilization/discharge decision; personnel record: military personnel, defense workers and civil servants, People's Public Security, cryptographic organizations; certificate of work history from a unit at the regiment level or equivalent or higher to determine the time participating in health insurance for the individual;

e) For individuals specified in point d, clause 3, Article 12 of the Health Insurance Law, upon ceasing their permanent militia service, the period of service performed shall be counted as time participating in health insurance.

2. Payment of medical examination and treatment costs for patients who have participated in health insurance for 05 consecutive years or more and whose co-payment amount for medical examination and treatment costs in the year exceeds 06 months of the basic salary as stipulated in point d, clause 1, Article 22 of the Health Insurance Law is as follows:

a) The health insurance fund will pay 100% of the costs of medical examination and treatment within the scope of benefits for the insured person from the time the patient simultaneously meets the conditions for participating in health insurance for 5 consecutive years or more and the amount of co-payment for medical examination and treatment costs in the fiscal year is greater than 6 months of the basic salary up to December 31 of that year; in cases where the insured person receives medical examination and treatment before January 1 and completes the examination, treatment, and discharge from the hospital from January 1 of the following year, the treatment costs will be determined annually to calculate the co-payment amount;

b) The social insurance agency compiles information on the cumulative co-payment amount for the patient in the fiscal year, the time when the patient has participated in health insurance for 05 consecutive years or more, and announces it on the Vietnam Social Insurance Data Reception Portal. Medical examination and treatment facilities use the cumulative co-payment amount and the time when the patient has participated in health insurance for 05 consecutive years or more to determine when the patient is eligible for exemption from co-payment for their next medical examination or treatment;

c) In the event that the base salary changes during the year, the method for determining the remaining amount to be co-paid from the time the base salary changes until December 31 of that year is as follows:

(6 – (Total amount co-paid from January 1st until before the change in base salary / Old base salary)) x New base salary

For cases where the total co-payment amount from January 1st until before the date of the change in the base salary level in the year is sufficient or exceeds 6 months of the base salary, the benefits are entitled according to regulations and this formula does not apply.

Article 19. Implementation roadmap and benefit rates for outpatient examination and treatment at basic-level medical facilities as prescribed in points e and h, clause 4, Article 22 of the Health Insurance Law.

1. From January 1, 2025, when receiving outpatient medical examination and treatment at a basic-level medical facility with a score below 50 points or temporarily classified as basic level, health insurance participants will be reimbursed 100% of their benefit amount by the health insurance fund, except for basic-level medical facilities that, before January 1, 2025, were determined by competent authorities to be at the provincial or central level.

2. From July 1, 2026, when receiving outpatient medical examination and treatment at basic-level medical facilities with a score from 50 points to less than 70 points, health insurance participants will have 50% of their benefit reimbursed by the health insurance fund.

3. From July 1, 2026, when receiving outpatient medical examination and treatment at a basic-level medical facility that, before January 1, 2025, was determined by a competent authority to be at the provincial or central level or equivalent, health insurance participants will have 50% of their benefit reimbursed by the health insurance fund.

4. From July 1, 2026, when receiving outpatient medical examination and treatment at specialized medical facilities that were previously designated as provincial-level facilities by competent authorities before January 1, 2025, as stipulated in point h, clause 4, Article 22 of the Health Insurance Law, health insurance participants will have 50% of their benefit amount reimbursed by the health insurance fund.

Article 20. Benefit levels for cases where health insurance participants seek medical examination and treatment on demand.

1. Individuals with health insurance cards who seek medical examination and treatment on demand will have their medical expenses reimbursed by the health insurance fund, within the scope and level of coverage stipulated by health insurance law. The difference between the cost of the requested medical examination and treatment and the cost reimbursed by the health insurance fund will be paid by the patient to the medical facility.

2. Healthcare facilities are responsible for ensuring adequate staffing and professional conditions, publicly disclosing any costs that patients must pay outside the scope and level of health insurance coverage, and notifying patients of any difference in costs in advance.

Article 21. Regulations on the effective date of health insurance benefits in cases of multiple benefit levels or changes in benefit levels.

1. If a health insurance participant is eligible for benefits under multiple categories stipulated in Article 22 of the Health Insurance Law, they shall receive benefits at the highest level.

2. In cases of changes in health insurance coverage levels, the new coverage level will be calculated from the date the new health insurance card becomes valid. Patients with health insurance cards who are undergoing inpatient treatment and experience changes in their coverage level are responsible for providing information on their cards related to the change. Healthcare facilities are responsible for verifying the benefits and coverage level of health insurance participants before the end of the examination, treatment, and discharge.

Chapter V

MEDICAL EXAMINATION AND TREATMENT CONTRACT UNDER HEALTH INSURANCE

Article 22. Conditions for signing a health insurance contract for medical examination and treatment.

1. Ensure that the operating conditions of medical examination and treatment facilities comply with the regulations in Article 49 of the Law on Medical Examination and Treatment, in accordance with the scope of medical examination and treatment services provided under health insurance.

2. Ensure the standards for connecting and integrating medical examination and treatment data under health insurance with the health insurance information and assessment system of the social insurance agency as prescribed by the Minister of Health, and verify medical examination and treatment cost payment data in accordance with the law.

Article 23. Health insurance contracts for medical examination and treatment.

1. The health insurance contract for medical examination and treatment is signed between a medical examination and treatment facility that meets the conditions stipulated in Article 22 of this Decree and the social insurance agency authorized by the competent authority to sign the contract:

a) Each operating license shall be used to sign one health insurance contract for medical examination and treatment, except as stipulated in points b and d of this clause;

b) In cases where a medical examination and treatment facility has additional medical examination and treatment facilities in the same province or centrally-administered city, it may sign one health insurance contract with the social insurance agency or separate health insurance contracts for each medical examination and treatment facility with the social insurance agency;

c) In cases where a medical examination and treatment facility has additional medical examination and treatment facilities in other provinces or centrally-administered cities, each medical examination and treatment facility shall sign a health insurance contract with the social insurance agency where the medical examination and treatment facility is located;

d) If a medical examination and treatment facility has a subordinate medical examination and treatment facility that meets the conditions stipulated in Article 22 of this Decree but is not of the same technical and professional level, it shall sign a separate medical examination and treatment contract with the subordinate facility;

d) In cases where a medical examination and treatment facility covered by health insurance falls under the management authority of the Ministry of National Defense or the Ministry of Public Security, the facility may sign one health insurance medical examination and treatment contract with the military or police social insurance agency and one contract with a social insurance agency under the Vietnam Social Insurance.

2. The health insurance contract for medical examination and treatment shall be implemented according to Form No. 5 in the Appendix issued with this Decree and shall contain the basic contents stipulated in Article 25 of this Decree. The contract appendix as stipulated in Clause 2, Article 24 of this Decree and the notification documents as stipulated in Clause 3, Article 24 of this Decree are an integral part of the contract and shall have a validity period corresponding to the validity period of the contract.

3. In case of changes as stipulated in Clause 2, Article 24 of this Decree, the medical examination and treatment facility and the social insurance agency must sign an addendum to the contract as stipulated in Article 29 of this Decree.

4. The health insurance contract for medical examination and treatment is effective from the date of signing or as specifically stipulated in the contract.

5. Health insurance contracts for medical examination and treatment are contracts of indefinite duration or of a fixed term as agreed upon by both parties, except in cases of contract termination as stipulated in points b, c, d, and e of Clause 1, Article 32 of this Decree. Annually, at the end of the fiscal year, the social insurance agency and the health insurance medical examination and treatment facility shall jointly agree on the contents and amounts of medical examination and treatment costs requested for payment, advance payments, audited, paid, unpaid, settled, refused payment, and recovered during the year, as well as the methods and deadlines for resolving each unresolved issue, and the obligations of each party. This serves as the basis for the medical examination and treatment facility to fulfill its financial rights and obligations, settle accounts, and pay taxes (if any) on time, and for the social insurance agency to summarize, report, and settle accounts.

6. Upon termination of the contract, the parties must follow the contract liquidation procedures as specified in Form No. 6 of the Appendix attached to this Decree and the provisions of Article 33 of this Decree.

7. Medical examination and treatment facilities are only permitted to provide medical examination and treatment covered by health insurance and to reimburse medical examination and treatment costs covered by health insurance from the time the health insurance medical examination and treatment contract comes into effect. The contracting parties must ensure compliance with the contract's conditions throughout its duration.

8. The person signing the health insurance contract for medical examination and treatment at a medical facility is the head of the medical facility as stipulated in Clause 7, Article 2 of Government Decree 96/2023/ND-CP dated December 30, 2023, detailing some provisions of the Law on Medical Examination and Treatment; the person whose name is on the registration of a private medical facility owned by an individual business; the person assigned to head the medical facility in the cooperative's charter; or a deputy assigned or authorized by the subjects specified in this clause.

9. For units and schools that are not state agencies or public service units, the medical examination and treatment facilities of these units and schools shall apply the regulations on medical examination and treatment contracts applicable to private medical examination and treatment facilities.

Article 24. Cases for signing contract addendums and notifying changes in the implementation of health insurance contracts for medical examination and treatment.

1. During the execution of the contract, if any changes or modifications to the contract's contents arise, the parties shall follow the procedures for signing an addendum as stipulated in Clause 2 of this Article; provide notification as stipulated in Clause 3 of this Article; and terminate the contract as stipulated in Article 32 of this Decree.

2. In cases of changes to the name, seal, account, or account holder of a medical examination and treatment facility or social insurance agency, changes in technical expertise level, changes in the number of hospital beds requiring adjustment of the operating license, or changes in payment methods, an addendum to the contract must be signed.

3. In other cases where changes or alterations arise regarding the contract's implementation that do not fall under the provisions of Clause 2 of this Article and Article 32 of this Decree, the parties are not required to re-sign the contract or its addendum. The medical examination and treatment facility and the social insurance agency that signed the contract shall carry out the notification procedure as follows:

a) The medical examination and treatment facility shall send a document containing information and documents related to the change to the social insurance agency where the contract was signed. The document signed and issued by the medical examination and treatment facility shall be the original copy, while the document issued by the competent authority shall be a photocopy bearing the seal of the medical examination and treatment facility for verification;

b) In cases where the social insurance agency has comments on changes or developments at a medical examination and treatment facility, within a maximum of 05 working days from the date of receiving the notification from the medical examination and treatment facility, the social insurance agency is responsible for sending a written response to the medical examination and treatment facility stating the content and reasons in the response. If the social insurance agency does not comment within 05 working days from the date of receiving the notification, it shall be considered as agreeing;

c) Within a maximum period of 15 days from the date of receiving the written response containing the social insurance agency's comments, the medical examination and treatment facility is responsible for sending a written response to the social insurance agency's comments.

4. While awaiting the signing of the contract addendum, the health insurance fund will continue to pay for health insurance-covered medical examination and treatment costs to the medical facility, ensuring continuity.

Article 25. Contents of the health insurance contract for medical examination and treatment.

1. The basic content of the health insurance contract for medical examination and treatment, as stipulated in Clause 2, Article 25 of the Health Insurance Law, shall be prepared according to Form No. 5 in the Appendix issued with this Decree. In cases where a medical examination and treatment facility has multiple affiliated facilities licensed to operate in different locations and signs a joint contract, the content for each affiliated facility must be clearly stated.

2. The content regarding the target population and the scope of services provided by the medical examination and treatment facility must be consistent with the scope of professional activities approved by the competent authority. The projected number of health insurance cards and the structure of target groups participating in health insurance for the initial health insurance medical examination and treatment facility must comply with the regulations of the Minister of Health.

3. Depending on the conditions of the medical examination and treatment facility, the social insurance agency and the medical examination and treatment facility may add other content to the contract, provided that it is agreed upon by both parties and does not violate the law. If the agreement cannot be reached between the two parties regarding the additional content, it shall not be included in the contract.

4. The method of payment for medical examination and treatment costs shall be implemented in accordance with the provisions of Chapter VII of this Decree.

5. Regulations on payment and settlement of medical examination and treatment costs covered by health insurance in the contract shall be agreed upon by both parties in accordance with the provisions of this Decree and the law on health insurance.

6. The term of the health insurance contract for medical examination and treatment shall comply with the provisions of Article 23 of this Decree.

7. The method of resolving contract disputes shall be agreed upon by both parties. If the parties choose to file a lawsuit in court to resolve the contract dispute, the provisions of civil law shall apply. In case of difficulties arising regarding policies, laws, regulations, or professional guidelines, the parties shall report and make recommendations to the competent state agency for resolution.

8. Regulations governing notification and feedback between parties regarding changes or issues arising from contract implementation; mechanisms for receiving and responding to information related to data extraction, submission for assessment, and payment of medical examination and treatment costs under health insurance.

Article 26. Documents for signing a contract for medical examination and treatment under health insurance.

1. The contract documents include:

a) A written request for signing a health insurance contract for medical examination and treatment from a medical facility, using Form No. 7 in the Appendix attached to this Decree;

b) A copy of the license to operate medical examination and treatment services issued by the competent state agency to the medical examination and treatment facility, bearing the facility's official seal for verification;

c) A copy of the decision on the classification or provisional classification of technical expertise for the medical examination and treatment facility issued by the competent authority; for cases stipulated in points d and h of Clause 4, Article 22 of the Health Insurance Law and Clauses 3 and 4, Article 19 of this Decree, a copy of the document from the competent authority confirming that the medical examination and treatment facility has been classified according to technical expertise before January 1, 2025, must also be included. These documents must bear the seal of the medical examination and treatment facility for confirmation;

d) A copy bearing the seal of the medical examination and treatment facility to confirm the decision approving the list of medical technical services approved by the competent authority;

d) List of medicines and medical equipment used at the medical examination and treatment facility;

e) A list of personnel and the total number of hospital beds in the medical examination and treatment facility, broken down by department, ward, and specialized unit, as approved by the competent authority;

g) A copy bearing the seal of the medical examination and treatment facility to confirm the decision approving the prices of medical examination and treatment services included in the list covered by health insurance, as approved by the competent authority. For cases stipulated in Article 47 of this Decree, the medical examination and treatment facility shall submit a written proposal for the prices of medical examination and treatment services covered by health insurance to determine the payment level at the facility;

h) A list of software and hardware equipment ensuring interoperability for the electronic data transfer in health insurance payments, according to Form No. 8 in the Appendix issued with this Decree;

i) For the documents stipulated in points b, c, d, and g of this clause, medical examination and treatment facilities are not required to submit photocopies if the competent authority, when issuing the document, has already sent it to the social insurance agency, or if it can be retrieved online by the competent authority. However, the medical examination and treatment facility must cite the address of the searchable website in the application for signing a health insurance medical examination and treatment contract as stipulated in point a of this clause.

2. In cases where a contract is renewed after the previous contract expires or both parties agree to terminate the contract prematurely, provided that the documents remain unchanged, the medical facility is not required to resubmit the documents and may use the documents submitted under the immediately preceding contract. If the documents in the file specified in Clause 1 of this Article change, the medical facility only needs to submit documents proving the changes.

3. Number of documents: 01 set.

4. Applications must be submitted electronically through the National Public Service Portal or via the social insurance agency's application. Until the online public service system is fully implemented, and in administrative units located in economically and socially disadvantaged or particularly difficult areas, applications must be submitted directly to the one-stop service department of the social insurance agency assigned to receive applications, or sent via public postal service to the social insurance agency assigned to receive applications.

Article 27. Documents for signing contract addendums

1. Documents required for signing the contract addendum include:

a) A written request for signing an addendum to the health insurance contract for medical examination and treatment, submitted by the medical facility or social insurance agency, using Form No. 7 in the Appendix issued with this Decree;

b) A copy of the document proving the change in the case stipulated in Clause 2, Article 24 of this Decree, bearing the seal of the medical examination and treatment facility or social insurance agency for confirmation.

2. Number of documents: 01 set.

3. Applications must be submitted electronically through the national public service portal or via the social insurance agency's application. Until the online public service system is fully implemented, and in administrative units located in economically and socially disadvantaged or particularly difficult areas, applications must be submitted directly to the one-stop service department of the social insurance agency assigned to receive applications, or sent via public postal service to the social insurance agency assigned to receive applications.

Article 28. Procedures for signing health insurance contracts for medical examination and treatment.

1. Medical examination and treatment facilities shall submit the dossiers as prescribed in Article 26 of this Decree to the social insurance agency authorized by the competent authority to sign the contract.

2. If no amendments or additions to the documents are required, within 10 days from the date of receiving all valid and eligible documents for contract signing (in the case of submitting paper documents, based on the date stamped on the incoming document), the social insurance agency must complete the contract signing.

3. In case amendments or additions to the application are required, the following procedures shall be followed:

a) Within 05 working days from the date of receiving the application (in the case of submitting a paper application, based on the date stamped on the incoming document), the social insurance agency is responsible for responding in writing, specifying the necessary amendments and additions, to the medical examination and treatment facility;

b) Within 30 days from the date of receiving the request for amendment or supplementation (in the case of submitting paper documents, based on the date stamped on the incoming document), the medical examination and treatment facility is responsible for amending and supplementing the dossier and sending it to the social insurance agency. If more than 30 days have passed and the medical examination and treatment facility has not supplemented and sent the dossier, the procedure according to Clauses 1 and 2 of this Article must be repeated;

c) Within 10 days from the date of receiving the amended or supplementary documents (in the case of submitting paper documents, based on the date stamped on the incoming document), the social insurance agency shall sign the contract if the conditions are met or issue a written notice refusing to sign the contract if the conditions are not met, clearly stating the reasons and legal basis for determining that the conditions for signing the contract have not been met.

4. The assessment for signing a health insurance contract for medical examination and treatment is carried out based on the records submitted by the medical examination and treatment facility as stipulated in Article 26 of this Decree. The medical examination and treatment facility is fully responsible before the law for the accuracy of the records and for ensuring compliance with the conditions for operating medical examination and treatment as prescribed by law.

5. In the case of signing a new contract when the existing contract expires or when both parties agree to terminate the contract prematurely, the parties shall follow the procedures as prescribed below:

a) Medical examination and treatment facilities shall submit the dossiers as prescribed in Clause 2, Article 26 of this Decree to the social insurance agency authorized by the competent authority to sign the contract;

b) If no amendments or additions to the documents are required, within 03 working days from the date of receiving all valid documents and meeting the conditions for signing the contract (in the case of submitting paper documents, based on the date stamped on the incoming document), the social insurance agency must complete the contract signing;

c) In case of a request for amendment or supplementation of the dossier, within 02 working days from the date of receipt of the dossier (in the case of submitting a paper dossier, based on the date stamped on the incoming document), the social insurance agency is responsible for responding in writing, specifying the content that needs to be amended or supplemented, and sending it to the medical examination and treatment facility;

d) Within 10 days from the date of receiving the request for amendment or supplementation (in the case of submitting paper documents, based on the date stamped on the incoming document), the medical examination and treatment facility is responsible for amending and supplementing the dossier and sending it to the social insurance agency. If more than 10 days have passed and the medical examination and treatment facility has not supplemented and sent the dossier, the procedure must be repeated as prescribed in this Article;

d) Within 03 working days from the date of receiving the amended and supplementary documents (in the case of submitting paper documents, based on the date stamped on the incoming document), the social insurance agency shall sign the contract if the conditions are met or issue a written notice refusing to sign the contract if the conditions are not met, clearly stating the reasons and legal basis for determining that the conditions for signing the contract are not met;

e) In cases where the medical examination and treatment facility and the social insurance agency agree to continue signing a new contract upon the expiration of the health insurance medical examination and treatment contract, the signing of the new contract must ensure that the effective date of the new contract follows the effective date of the old contract.

Article 29. Procedures for signing addendums to health insurance contracts for medical examination and treatment.

1. Within 03 working days from the date of the document from the competent authority regarding the change in the case stipulated in Clause 2, Article 24 of this Decree, the social insurance agency shall send, or the medical examination and treatment facility shall send, the documents for signing the contract addendum to the other party.

2. Within 05 working days from the date of receiving the documents, the medical examination and treatment facility and the social insurance agency shall complete the signing of the contract addendum.

Article 30. Signing contracts for medical examination and treatment under health insurance at commune/ward health stations, special zone health centers, maternity homes, regional polyclinics, and medical examination and treatment facilities of agencies, units, and schools.

1. For commune/ward health stations, special zone health centers, maternity homes, and regional polyclinics, the signing of health insurance contracts for medical examination and treatment shall be carried out in one of the following two forms:

a) The provincial People's Committee shall decide on one representative unit to sign a contract with the social insurance agency for commune/ward health stations, special zone health centers, maternity homes, and regional polyclinics under its management;

b) Commune/ward health stations, special zone health centers, maternity homes, and regional polyclinics directly sign contracts with social insurance agencies.

2. For medical examination and treatment facilities of agencies, units, and schools (except for agencies, units, and schools that receive funding for medical examination and treatment in primary healthcare as stipulated in Article 63 of this Decree), the social insurance agency shall sign a health insurance medical examination and treatment contract directly with the agency, unit, or school.

3. The contracting entity specified in Clauses 1 and 2 of this Article is responsible for ensuring the operating conditions of the medical examination and treatment facility in accordance with the signed contract.

Article 31. Suspension of health insurance contracts for medical examination and treatment.

1. The health insurance contract for medical examination and treatment will be suspended in whole or in part if the medical facility is suspended in whole or in part by a decision of the competent authority.

2. When deciding to suspend all or part of the operation of a medical examination and treatment facility, the competent authority is responsible for sending a notification to the social insurance agency that signed the contract. The suspension of the medical examination and treatment contract takes effect from the time the decision to suspend all or part of the operation of the medical examination and treatment facility takes effect. When deciding to allow the medical examination and treatment facility to resume operation, the competent authority is responsible for sending a notification to the social insurance agency that signed the contract.

3. In cases where a medical examination and treatment facility is suspended from operation but is later permitted to resume by the competent authority, the facility must notify the social insurance agency in writing about the continuation of the contract and provide supporting documents if there are any changes compared to the medical examination and treatment contract signed before the temporary suspension of the contract.

4. When suspending the contract, both parties must agree on a plan to ensure the rights of patients during the suspension period. Upon resuming the contract, the medical facility is responsible for ensuring that its operating conditions comply with the signed health insurance contract.

Article 32. Cases of contract termination and procedures for terminating health insurance contracts for medical examination and treatment.

1. Cases of termination of health insurance contracts for medical examination and treatment include:

a) The contract has expired;

b) Both parties agree to terminate the contract before its expiration date;

c) Medical examination and treatment facilities cease operations, are dissolved, or go bankrupt;

d) Medical examination and treatment facilities whose operating licenses have been revoked;

d) After the 03-month suspension period has expired, the medical examination and treatment facility has not rectified the violations to resume operations.

2. Upon the expiration of the contract term as stipulated in points a and b of Clause 1 of this Article, the parties shall carry out the contract liquidation procedures as prescribed in Article 33 of this Decree.

3. In cases of contract termination as stipulated in points c and d of Clause 1 of this Article, within 03 working days from the date of cessation of operations as decided by the competent state agency, the medical examination and treatment facility is responsible for notifying the social insurance agency where the contract was signed about the contract termination. The parties shall carry out the contract liquidation procedures as prescribed in Article 33 of this Decree. The contract termination date is from the date the decision to cease operations or revoke the operating license of the medical examination and treatment facility takes effect.

4. If, after the deadline stipulated in point d, clause 1 of this Article, the medical examination and treatment facility has not been authorized by the competent authority in accordance with the law on medical examination and treatment to resume operations, the social insurance agency that signed the contract and the medical examination and treatment facility shall terminate the contract and liquidate it in accordance with Article 33 of this Decree.

Article 33. Termination of health insurance contracts for medical examination and treatment.

1. The health insurance contract for medical examination and treatment between the social insurance agency and the medical examination and treatment facility shall be liquidated upon termination of the contract as stipulated in Article 32 of this Decree. The form for liquidating the health insurance contract for medical examination and treatment shall be in accordance with Form No. 6 in the Appendix issued with this Decree.

2. The termination of the contract shall be carried out in accordance with the provisions of civil law.

3. Both parties shall compare, determine, and agree on the contents and amounts of medical examination and treatment costs requested for payment, advance payments, audited, paid, unpaid, settled, refused payment, and recoverable expenses for the year, as well as the method and timeframe for resolving each unresolved issue, the obligations of each party, and any amounts to be recovered or refunded (if any) as a basis for terminating the contract. After agreement and confirmation, the social insurance agency shall make payments or recover the relevant amounts in accordance with regulations.

4. Rights and obligations of the social insurance agency:

a) Inspect and verify outstanding debts and settlement documents of medical examination and treatment facilities; request reimbursement of any payments made in violation of regulations (if any); refuse liquidation if the medical examination and treatment facility has not fulfilled its financial obligations or has not provided sufficient documentation for settlement;

b) Be responsible for making timely payments of outstanding expenses; do not request the handover of original medical records, except as otherwise stipulated by law.

5. Rights and obligations of medical examination and treatment facilities:

a) Request the social insurance agency to fully pay all settled expenses; retain medical records in accordance with regulations and only hand over documents for settlement purposes; request to continue the contract if needed and meet the conditions as prescribed;

b) Be responsible for completing financial settlements and paying any reimbursements (if any); provide documents for verification and inspection, but must ensure compliance with regulations on medical record archiving and be legally responsible for the records and documents settled with the social insurance agency; ensure the transfer of patients to other medical examination and treatment facilities without affecting the rights of health insurance participants.

Article 34. Rights and responsibilities of social insurance agencies in contract implementation

1. Rights of the social insurance agency

a) Rights as stipulated in Article 40 of the Health Insurance Law;

b) Require medical examination and treatment facilities to transfer authenticated electronic data for the purpose of processing health insurance payments for medical examination and treatment costs as prescribed by the Minister of Health;

c) Require medical examination and treatment facilities to provide explanations in cases where the social insurance agency's statistics show that the cost of medical examination and treatment covered by health insurance is higher than the average increase of medical examination and treatment facilities of the same technical level and type (general or specialized) in the province, centrally-administered city, or nationwide, or the average increase of that medical examination and treatment facility in the same period of the previous year;

d) Refusing to pay for medical examination and treatment costs covered by health insurance that do not comply with the regulations of the law on health insurance and medical examination and treatment.

2. Responsibilities of the social insurance agency

a) Comply with the provisions of Article 41 of the Health Insurance Law;

b) Provide healthcare facilities with information about the medical history of the health insurance participant;

c) To maintain the confidentiality of information collected during the process of medical examination and treatment assessment and payment under health insurance, and the exploitation and use of medical records in accordance with the law;

d) Coordinate with medical examination and treatment facilities in verifying and clarifying information of health insurance participants upon request and resolving difficulties and obstacles in receiving and checking procedures for medical examination and treatment under health insurance; consider revoking, temporarily suspending, or temporarily blocking health insurance cards and handling violations within their authority upon receiving information about violations; provide guidance and technical support in transferring electronic data to serve the work of auditing and paying medical examination and treatment costs under health insurance for medical examination and treatment facilities;

d) Maintain timely reception and response to requests for payment data, return error files specifying the errors, the portion of the requested payment returned due to errors, the results of the medical examination and treatment cost assessment under health insurance, and any incidents or difficulties related to data reception for medical examination and treatment facilities as prescribed;

e) Advance payments, settlements, and final payments of medical examination and treatment costs covered by health insurance must be made on time and in the correct amount and percentage as stipulated by health insurance laws;

g) To standardize the number of records submitted for assessment, and the amount of advance payment for medical examination and treatment costs in the next period when incidents or difficulties occur in receiving data;

h) Inspect the implementation of the contract and check the maintenance of post-contract conditions by the medical examination and treatment facility.

3. Exercise other rights and responsibilities as prescribed by law regarding health insurance and medical examination and treatment.

4. Accountability to state health management agencies in cases where there are complaints or reports of social insurance agencies violating health insurance contracts for medical examination and treatment, or making payments, refusing payments, or recovering medical examination and treatment costs in violation of the law.

Article 35. Rights and responsibilities of medical examination and treatment facilities in the implementation of contracts.

1. Rights of medical examination and treatment facilities

a) Rights as stipulated in Article 42 of the Health Insurance Law and legal regulations on medical examination and treatment;

b) To be provided with timely information when the health insurance claims information system detects an increase in health insurance medical examination and treatment costs that is significantly higher than the average cost of medical facilities of the same technical expertise level and type (general or specialized) in the province, centrally-administered city, or nationwide, or the average increase of that medical facility in the same period of the previous year, in order to promptly review, verify, and implement appropriate adjustment solutions;

c) Request the social insurance agency to clarify the reasons for the delay in payment and settlement of medical examination and treatment costs covered by health insurance;

d) To be promptly notified by the social insurance agency about system malfunctions, errors in records, and data related to medical examination and treatment costs covered by health insurance when submitting payment requests;

d) To request guidance and resolution of any difficulties arising during the implementation of the contract from the state management agencies in the fields of health and finance;

e) To be consulted by competent authorities regarding the assessment process and procedures, and regulations and policies on health insurance related to the rights and obligations of health insurance medical examination and treatment facilities.

2. Responsibilities of medical examination and treatment facilities

a) Implement the provisions of Article 43 of the Health Insurance Law and fulfill the responsibilities stipulated by law regarding medical examination and treatment;

b) Review and promptly issue professional procedures and guidelines for medical examination and treatment under health insurance; comply with legal regulations on medical examination and treatment, professional guidelines of the Ministry of Health, and relevant legal regulations on procurement and bidding to ensure the supply of quality, effective, and economical medicines, chemicals, medical equipment, and medical technical services;

c) Send electronic data on medical examination and treatment costs covered by health insurance after the patient's medical examination and treatment is completed; digitally sign the summary of medical examination and treatment costs for health insurance participants monthly and quarterly as prescribed by the Minister of Health; verify electronic data according to the law; be legally responsible for the accuracy of the summary of costs requested for payment compared with the medical examination and treatment cost statement of the patient covered by health insurance;

d) Establishing information technology infrastructure, upgrading and improving the hospital management software system to comply with legal regulations on input data standards, output data standards, electronic data transfer, digital transformation, and electronic transactions in the healthcare sector;

d) Comply with regulations on payment of medical examination and treatment costs under health insurance; proactively review and inspect high medical examination and treatment costs under health insurance at the facility based on recommendations and warnings from the social insurance agency; identify subjective and objective causes, develop and implement solutions to overcome subjective causes and inadequacies, and submit them to the social insurance agency where the contract is signed;

e) Publicly disclose the results of the technical and professional ranking approved by the competent authority, along with the scores, on the facility's website and at the patient reception area. The competent authority responsible for ranking technical and professional facilities shall publicly disclose the list of ranked medical examination and treatment facilities, along with the scores, on the agency's electronic portal and on the information system for managing medical examination and treatment activities;

g) In cases where medical examinations and treatments are conducted on weekends and holidays, medical facilities must allocate sufficient professional personnel, administrative staff, and financial and accounting departments to meet the requirements of medical examinations and treatments, promptly address patients' rights, and ensure compliance with the scope of medical examinations and treatments on weekends and holidays;

h) Comply with regulations on the management and use of medicines and medical equipment to ensure quality and safety in the provision of medical examination and treatment services under health insurance;

i) Fully designate and ensure the coverage of health insurance funds for health insurance participants according to professional requirements and medical conditions; do not charge additional fees from health insurance patients and do not reimburse the social insurance agency for costs already included in the price structure of medical examination and treatment services as prescribed or approved by competent authorities for medical examination and treatment facilities.

3. Accountability to state health management agencies in cases where there are complaints or reports of medical examination and treatment facilities violating health insurance contracts.

4. Exercise other rights and responsibilities as prescribed by law regarding health insurance and medical examination and treatment.

Article 36. Inspection of the implementation of health insurance contracts for medical examination and treatment.

1. The cases to be tested include:

a) Regular inspections according to the annual plan;

b) Conduct unannounced inspections when violations of the law are detected or when there are signs of violations related to the implementation of health insurance contracts for medical examination and treatment.

2. Inspection principles:

a) Inspections must be based on an inspection plan approved by the competent authority;

b) Regular inspections must ensure that medical examination and treatment facilities are not inspected more than once on the same subject matter in a year, including inspection, audit, and investigation teams from competent authorities, except in cases where violations of the law are detected or there are signs of violations;

c) The inspection content is based on the articles, clauses, contents, and responsibilities in the signed health insurance contract for medical examination and treatment. It does not include content outside the scope of the signed health insurance contract for medical examination and treatment, or content that falls outside the functions and duties of the social insurance agency;

d) The inspection plan must be sent to the inspected entity immediately after approval. The inspection time must be notified to the inspected entity at least 07 days before the inspection takes place; unscheduled inspections must be notified in writing to the inspected entity at least 01 day in advance;

d) The inspection report must be sent to the inspected entity. Within 03 months from the date of receiving the inspection report, the inspected entity must submit a report on the implementation of the inspection report to the inspection agency.

3. The Minister of Finance shall prescribe the authority to inspect the implementation of health insurance contracts for medical examination and treatment.

Chapter VI

PROCEDURES FOR MEDICAL EXAMINATION AND TREATMENT UNDER HEALTH INSURANCE

Article 37. Procedures for medical examination and treatment under health insurance as stipulated in Clause 1, Article 28 of the Health Insurance Law.

1. Individuals covered by health insurance must present their health insurance card information and identification documents in one of the following forms when seeking medical examination or treatment:

a) Identity card or citizen identification card or level 2 electronic identification account (VNeID) with integrated health insurance card information;

b) Electronic or paper health insurance card. For individuals participating in health insurance as stipulated in points a, b, c, and d of Clause 3, Article 12 of the Health Insurance Law whose health insurance card information is not yet available on the information technology system, a paper health insurance card must be presented. In cases where the health insurance card does not have a photo or health insurance number, one of the following identity documents must also be presented: identity card, citizen identification card, certificate of identity, passport, linked to a level 2 electronic identification account (VNeID) or the VssID application, or other identity documents issued by a competent agency or organization, or a confirmation letter from the commune-level police.

2. For children under 6 years old, only a paper or electronic health insurance card or health insurance code needs to be presented; if a health insurance card has not yet been issued, the original or a copy of the birth certificate must be presented. For newborns, the father or mother or a relative of the child must sign the medical record, or a representative of the medical facility must sign the medical record in cases where the child has no father, mother, or relative.

3. Individuals participating in health insurance while awaiting the issuance or updating of their health insurance card information must present the application receipt and appointment slip for the issuance, re-issuance, and exchange of their health insurance card, along with the health insurance card information issued by the social insurance agency or an organization/individual authorized by the social insurance agency to receive applications for re-issuance or exchange of the card, and a document proving their identity as prescribed in point b, clause 1 of this Article, when seeking medical examination or treatment.

4. Individuals who have donated organs must present their health insurance card information as stipulated in Clause 1 or Clause 3 of this Article. If they do not have a health insurance card, they must present a discharge certificate issued by the medical facility where the organ was harvested, along with one of the following identity documents: a national identity card, citizen identification card, certificate of identity, passport, linked to a level 2 electronic identification account (VNeID) or the VssID application, or other identity documents issued by a competent authority or organization. If they do not have a health insurance card but require immediate treatment after donation, the medical facility and the patient or their family member must confirm this in the medical record.

5. In emergency cases, the insured person must present the documents as prescribed in Clause 1 or Clause 2 or Clause 3 of this Article before the end of the treatment period.

Article 38. Procedures for medical examination and treatment under health insurance in certain cases.

1. In cases where a patient with a health insurance card presents their card information late upon arrival for examination or treatment, the health insurance fund will reimburse the costs of examination and treatment within the scope of benefits and coverage levels from the time the health insurance card information is presented, except in emergency cases. Costs of examination and treatment incurred during the period when the patient has not yet presented their health insurance card information will be reimbursed directly by the health insurance fund as stipulated in Articles 55, 56, and 57 of this Decree.

2. In cases where a patient with an electronic health insurance card is unable to present their electronic health insurance card when seeking medical examination or treatment under health insurance due to a link to their Level 2 electronic identification account (VNeID), a malfunctioning VNeID application, or an internet connection error, the following procedures should be followed:

a) The patient provides their health insurance card number so that the medical facility can look up the information on the Vietnam Social Security Data Reception Portal. If the Vietnam Social Security Data Reception Portal cannot retrieve the information, the medical facility records the health insurance card number and accepts the patient for examination and treatment. The medical facility cooperates with the social security agency to re-look up the patient's health insurance card information to determine the scope, benefits, and entitlements covered by health insurance;

b) In cases where, at the time a patient finishes their medical examination, treatment, or discharges, the electronic health insurance card management system is still malfunctioning and unable to extract information, and the social insurance agency has not yet verified or clarified the information, the medical facility is responsible for sending all medical records, patient contact information, and screenshots of the search to the social insurance agency for further verification once the system is restored and for assessment and payment of medical expenses according to regulations. The patient is responsible for providing information about their health insurance coverage and health insurance card information to the medical facility and ensuring the accuracy of the information provided.

3. Medical examination and treatment facilities and social insurance agencies are not allowed to prescribe additional procedures for medical examination and treatment under health insurance beyond those stipulated in this Article. If a medical examination and treatment facility or social insurance agency needs to photocopy health insurance cards and other documents related to a patient's medical examination and treatment for management purposes, they must do so themselves after obtaining the consent of the patient or their guardian. They are not allowed to require the patient to photocopy or pay for this service.

Chapter VII

METHODS OF PAYMENT FOR MEDICAL EXAMINATION AND TREATMENT COSTS UNDER HEALTH INSURANCE

Article 39. Payment method based on service price

1. The service-based payment method is a payment method based on the price of medical examination and treatment services and other costs included in the price structure of medical examination and treatment services as stipulated by law on medical examination and treatment, but not yet included in the price used as the basis for determining the payment level of medical examination and treatment costs by the health insurance fund.

2. The level of reimbursement for medical examination and treatment costs by the health insurance fund is determined as follows:

a) For state-owned medical examination and treatment facilities, the health insurance fund will reimburse the costs of medical examination and treatment covered by health insurance at the price of medical examination and treatment services included in the list of services reimbursed by the health insurance fund, as stipulated or approved by the competent authority;

b) For private medical examination and treatment facilities, the health insurance fund will reimburse the costs of medical examination and treatment covered by health insurance based on the prices of medical examination and treatment services included in the list covered by the health insurance fund, as stipulated or approved by competent authorities in accordance with the law on medical examination and treatment for state-owned medical examination and treatment facilities in the area, according to the principles stipulated in points a, b, c, and d of Clause 2, Article 47 of this Decree. The difference between the price of medical examination and treatment services at private medical examination and treatment facilities and the price of medical examination and treatment services included in the list covered by the health insurance fund shall be paid by the patient.

3. For medical examination and treatment costs within the scope of coverage and benefit levels of health insurance participants, as stipulated in the price structure of medical examination and treatment services according to the roadmap and regulations of the law on medical examination and treatment, but not yet included in the price, the health insurance fund will reimburse based on the actual quantity used, the purchase price as stipulated by the law on bidding, or the reimbursement rate of the health insurance fund for medical examination and treatment costs for private medical facilities; the cost of blood and blood products will be reimbursed according to the regulations of the Minister of Health.

Article 40. Payment method based on fixed rates

1. Fixed-rate payment is applied to outpatient medical examinations and treatments covered by health insurance.

2. The scope of payment under the fixed rate includes outpatient medical examination and treatment costs within the scope and level of coverage for the health insurance cardholder.

3. The Vietnam Social Insurance determines the fixed-rate fund for implementation during the year based on the total actual outpatient medical examination and treatment costs covered by health insurance and the projected medical examination and treatment costs covered by health insurance for the year as stipulated in Clause 6 of this Article, so that the social insurance agency can notify the medical examination and treatment facilities covered by health insurance.

4. In cases where there is a surplus of allocated funds at the end of the year, the medical examination and treatment facility may retain a portion of the funds and account for it as revenue from its operational activities; the remaining funds will be transferred to the health insurance fund for allocation.

5. In case of a budget deficit in the year, the medical examination and treatment facility shall balance the deficit within its revenue sources as prescribed; if the medical examination and treatment facility has a budget deficit in the allocated funds for two consecutive years, it may be considered for adjustment in the following year.

6. The Minister of Health shall determine the diseases, disease groups, medical services, and costs not covered by the capitation payment system, provide technical guidance on determination, and organize the implementation of capitation payment.

7. The Ministry of Health, in coordination with the Ministry of Finance, shall regulate the allocation of fixed-rate funding, regulate the remaining funds, determine the amount of remaining funds that medical examination and treatment facilities are allowed to retain, and establish a payment schedule based on fixed rates.

Article 41. Payment method based on diagnostic groups

1. Diagnostic Group Reimbursement (DRG) is payment based on a predetermined cost for each diagnostic group that shares similar clinical characteristics and required resources, regardless of the actual costs incurred in medical examinations and treatments covered by health insurance.

2. The scope of payment by diagnostic group includes the cost of medical examination and treatment within the scope and level of coverage for health insurance cardholders when receiving inpatient and day-care medical examinations and treatments under health insurance.

3. The Minister of Health shall regulate the scope of data used in developing the DRG-based payment method, the DRG list; the principles, methods, and techniques for developing and adjusting the DRG classification algorithm and cost accounting to calculate DRG-based payment parameters, determine the cost level, and the total DRG fund; and provide guidance on the organization and implementation of the payment roadmap based on diagnostic groups.

4. The Vietnam Social Security determines the DRG list, estimates the total DRG costs, relative weights, base rate, and adjustment coefficients as prescribed in Clause 3 of this Article, and submits them to the Ministry of Health for promulgation. Simultaneously, it sends the medical examination and treatment cost data used in the DRG development for archiving and to facilitate the review and promulgation process.

Article 42. Application of payment methods

1. Medical examination and treatment costs covered by health insurance for medical services that have already been reimbursed through one payment method cannot be reimbursed twice through another payment method.

2. The payment method applied at the medical examination and treatment facility shall be specifically stated in the medical examination and treatment contract with the social insurance agency as stipulated in Article 25 of this Decree.

Chapter VIII

PAYMENT OF MEDICAL EXAMINATION AND TREATMENT COSTS BETWEEN SOCIAL INSURANCE AGENCIES AND MEDICAL FACILITIES

Article 43. Payment of costs for medicines and medical equipment transferred between health insurance medical examination and treatment facilities.

The health insurance fund covers the costs of medicines and medical equipment transferred between health insurance-covered medical examination and treatment facilities in cases where, at the time the patient is prescribed or instructed to use the medicine or medical equipment, it is not available and cannot be replaced by other medicines or medical equipment, specifically as follows:

1. The determination of whether a medical facility does not have the necessary medications or medical equipment available at the time of prescription or indication, and which cannot be replaced with other medications or medical equipment, is regulated as follows:

a) The medical facility does not have any commercially available drugs containing the active ingredient prescribed for the patient, or has drugs with the same active ingredient but at different concentrations, dosages, formulations, or routes of administration that cannot be substituted for the patient;

b) Medical examination and treatment facilities that do not have the medical equipment prescribed for the patient and do not have alternative medical equipment, except for in vitro diagnostic medical equipment, personal specialized medical equipment, and medical equipment included in the list of medical equipment issued by the Minister of Health, which can be bought and sold as ordinary goods according to the regulations in Government Decree No. 98/2021/ND-CP dated November 8, 2021 on the management of medical equipment, as amended and supplemented by Government Decree No. 07/2023/ND-CP dated March 3, 2023 and Government Decree No. 04/2025/ND-CP dated January 1, 2025.

2. At the time the patient is prescribed the medication or prescribed the necessary drugs, the medical facility does not have the required drugs or medical equipment available due to one of the following reasons:

a) During a Group A epidemic, this applies to medical examination and treatment facilities that are under lockdown, medical quarantine, or located in areas implementing social distancing measures or carrying out epidemic prevention and control tasks;

b) Medical examination and treatment facilities that are in the process of selecting contractors according to the approved contractor selection plan using one of the following methods: open bidding, limited bidding, competitive bidding, direct procurement, or contractor selection in special cases but have not yet selected a contractor, or online bidding or online procurement and have implemented simplified direct contracting according to the law on bidding but have not selected a contractor;

c) The medical facility has signed a contract with the supplier of medicines and medical equipment, but at the time of prescribing the medicines and medical equipment to the patient, there is written evidence confirming that the supplier is unable to supply the medicines (documents regarding the supply of medicines from the supplier, contract appendices, minutes confirming that the supplier failed to supply the medicines).

3. The authority to decide on cases eligible to receive medicines and medical equipment transferred from other health insurance medical examination and treatment facilities is regulated as follows:

a) The director of the medical facility where the patient is treated shall, based on the actual situation and the conditions stipulated in Clauses 1 and 2 of this Article, select a medical facility covered by health insurance that has available medicines and medical equipment and agrees to the transfer;

b) The decision on selecting medical facilities for transferring medicines and medical equipment must be appropriate, effective, and economical; the transfer of medicines and medical equipment between medical facilities within the same province or centrally-administered city is encouraged.

4. The transfer and payment for medicines and medical equipment shall be carried out as follows:

a) Healthcare facilities are responsible for notifying patients about the transfer of medications, medical equipment, and other costs that health insurance patients must pay in cases where patients have to pay additional costs beyond the co-payment amount as stipulated;

b) The facility transferring the drugs and medical equipment and the facility receiving the drugs and medical equipment must have a written handover document;

c) The health insurance fund will pay for the cost of medicines and medical equipment within the scope of benefits and entitlement levels of the insured person as prescribed, to the receiving medical facility at the health insurance payment rates of the medical facility transferring the medicines and medical equipment. Other costs will be paid by the patient to the medical facility where treatment is provided;

d) The medical examination and treatment facility receiving medicines and medical equipment is responsible for paying the costs of medicines and medical equipment to the medical examination and treatment facility where the patient is being treated. The medical examination and treatment facility treating the patient will consolidate the portion of the cost of medicines and medical equipment covered by the health insurance fund into the patient's medical examination and treatment costs for reimbursement by the social insurance agency;

d) The social insurance agency is responsible for publishing the quantity of unused medicines, medical equipment, and supplies based on the bidding results of health insurance medical examination and treatment facilities on the data receiving portal of Vietnam Social Insurance for medical examination and treatment facilities to refer to and request the transfer of medicines and medical equipment.

5. If a patient covered by health insurance refuses to pay for costs outside the scope and level of coverage for the insured when transferring medication or medical equipment, the medical facility shall transfer the patient to another medical facility that ensures the supply of medication and medical equipment for the patient's treatment.

Article 44. Regulations on transferring patients or specimens to other facilities qualified to perform paraclinical services.

1. Medical examination and treatment facilities may only transfer patients or specimens to receiving facilities that have been approved by competent authorities and meet the requirements for performing paraclinical services. Facilities receiving patients or specimens for paraclinical services are not permitted to transfer patients or specimens to a third (other) facility.

2. The transfer of paraclinical services shall be carried out in accordance with the technical and professional requirements in medical examination and treatment, ensuring the rights of health insurance participants, and in the following cases:

a) Paraclinical services approved by competent state agencies for medical examination and treatment facilities and currently being performed at those facilities, but at the time of prescribing them to the patient, the medical examination and treatment facility is unable or insufficient to meet all the needs for paraclinical services. The medical examination and treatment facility transferring the patient or specimen shall fill in Form No. 9 of the Appendix issued with this Decree and send it along with the transfer of the patient or specimen to the facility performing the paraclinical service. The medical examination and treatment facility transferring the patient or specimen shall send a list of paraclinical services already performed to the facility performing the paraclinical service to the social insurance agency with which it has a medical examination and treatment contract for health insurance purposes as a basis for payment;

b) Paraclinical services that have not been approved by the competent state agency for the medical examination and treatment facility but are actually necessary for professional activities and are included in the list issued by the Minister of Health. The head of the health insurance medical examination and treatment facility where the patient or specimen is transferred, based on the functions, duties, and scope of professional activities approved by the competent authority, shall compile a list of paraclinical services to be transferred and sign a framework contract with the facility providing the paraclinical services. The framework contract shall include an agreement that the social insurance agency that signs the health insurance medical examination and treatment contract with the transferring medical examination and treatment facility will inspect the paraclinical services received and performed at the facility providing the paraclinical services. The health insurance medical examination and treatment facility that transfers the patient or specimen must send a list of the necessary paraclinical services and the preliminary contract to the social insurance agency that signed the health insurance medical examination and treatment contract before implementation.

3. The medical facility transferring the patient or specimen is responsible for paying the costs to the medical facility or unit providing the service, and simultaneously including the cost of paraclinical services in the patient's medical examination and treatment costs for reimbursement by the social insurance agency. The receiving facility providing paraclinical services is not allowed to charge additional fees for the patient's examination. In cases where the patient has to pay additional costs for paraclinical services beyond the co-payment stipulated, the medical facility transferring the patient or specimen must notify and obtain the patient's consent before transferring the patient or specimen.

4. The health insurance fund will cover the costs of paraclinical services according to the scope and benefit level of the health insurance participant, specifically as follows:

a) In the case stipulated in point a, clause 2 of this Article: the health insurance fund shall reimburse according to the price of paraclinical services approved by the competent authority for the facility performing the paraclinical services, but not exceeding the price of medical examination and treatment services of the referring facility. If the facility performing the paraclinical services has not been approved by the competent authority or does not have a price list for medical examination and treatment services covered by health insurance, the health insurance fund shall reimburse according to the price of the technical service approved by the competent authority for the medical examination and treatment facility where the patient or specimen is referred;

b) In the case stipulated in point b, clause 2 of this Article: the health insurance fund shall pay according to the price of paraclinical services approved by the competent authority for the facility performing the paraclinical services. If the facility performing the paraclinical services has not yet had its prices for health insurance-covered medical examination and treatment services approved by the competent authority, the health insurance fund shall pay according to the prices of technical services approved by the competent authority for state-owned health insurance-covered medical examination and treatment facilities, applying the payment principles stipulated in points a, b, c, and d, clause 2, Article 47 of this Decree.

Article 45. Payment of medical examination and treatment costs during the technology transfer process.

1. Payment of medical examination and treatment costs during the technology transfer process shall be made by personnel of the medical facility transferring the technology, in accordance with the technology transfer project and technology transfer contract as prescribed by law on medical examination and treatment.

2. Healthcare facilities receiving technology transfer are responsible for notifying the social insurance agency that signed the health insurance contract in writing about the healthcare services provided under the transfer project or contract, as well as the approval document from the competent authority for special techniques. The health insurance fund will reimburse based on the number of healthcare services in the project, contract, or the approval document from the competent authority for special techniques.

3. The payment level for medical examination and treatment services included in the list of services covered by health insurance funds, as approved by the competent authority, shall be applied to the medical facility transferring the technology. If the medical facility transferring the technology is a private medical facility, the provisions of point b, clause 2, Article 39 of this Decree shall apply.

4. For medical examination and treatment costs covered by the health insurance fund that are not included in the price structure of medical examination and treatment services, the health insurance fund shall reimburse them according to the provisions of Clause 3, Article 39 of this Decree.

5. After completing the contract for the transfer of medical examination and treatment facilities, the competent authority must approve the list of technical procedures and approve the prices in accordance with the law on pricing of medical examination and treatment services to serve as the basis for payment for those technical services.

Article 46. Payment of medical examination and treatment costs for medical facilities that provide medical examination and treatment under health insurance outside of regular working hours or on weekends and holidays.

1. Individuals with health insurance cards who seek medical examination and treatment will have their expenses covered by the health insurance fund within the scope and limits of their health insurance benefits.

2. Medical examination and treatment facilities are responsible for ensuring adequate staffing and professional conditions, publicly disclosing any costs that patients must pay outside the scope and level of health insurance coverage, and must notify patients in advance; they must also notify the local state health management agency and the social insurance agency with which they have a health insurance contract at least 03 working days before conducting medical examination and treatment outside of regular working hours or on weekends and holidays, as a basis for implementing and settling medical examination and treatment costs.

Article 47. Payment of medical examination and treatment service costs under health insurance for private medical examination and treatment facilities.

1. The level of payment for medical examination and treatment services by the health insurance fund shall be implemented in accordance with the provisions of Article 39 of this Decree.

2. In cases where private medical examination and treatment facilities apply the health insurance fund's payment rates for medical examination and treatment costs as stipulated in point b, clause 2, Article 39 of this Decree, the following procedures shall apply:

a) Specialized medical examination and treatment facilities shall be reimbursed at actual prices, but not exceeding the highest price for that medical examination and treatment service offered by a state-owned specialized medical examination and treatment facility of the same level in the province, or by a state-owned basic medical examination and treatment facility in the province in cases where there is no such price offered by a state-owned specialized medical examination and treatment facility in the province;

b) Basic-level medical examination and treatment facilities shall be reimbursed at actual prices, but not exceeding the highest price for that medical examination and treatment service offered by other state-owned basic-level medical examination and treatment facilities in the province. If a state-owned basic-level medical examination and treatment facility in the province does not have a price for that medical examination and treatment service, it shall be reimbursed up to the lowest price for that technical service offered by a state-owned specialized-level medical examination and treatment facility in the province;

c) Initial-level medical examination and treatment facilities shall be reimbursed at the actual price, but not exceeding the highest price for that medical examination and treatment service offered by other state-owned initial-level medical examination and treatment facilities in the province. If a state-owned initial-level medical examination and treatment facility in the province does not have a price for that medical examination and treatment service, it shall be reimbursed up to the lowest price for that medical examination and treatment service offered by other state-owned basic-level medical examination and treatment facilities in the province;

d) In cases where the price of a medical examination and treatment service has not been stipulated or approved by the competent authority for a state-owned medical facility in the province, private medical facilities shall be reimbursed according to the principles stipulated in points a, b, and c of this clause, based on the price of that medical examination and treatment service approved by the competent authority for a state-owned medical facility in one of the neighboring provinces. If a state-owned medical facility in a neighboring province does not have a price for that medical examination and treatment service, reimbursement shall be based on the price of that medical examination and treatment service approved by the competent authority for a state-owned medical facility in another province nationwide.

Article 48. Payment levels in cases where a technical service has been prescribed and performed by a medical examination and treatment facility, but due to the patient's condition or illness, the procedure cannot be continued.

1. The health insurance fund will reimburse the actual quantity of medicines, medical equipment, medical gases, supplies, instruments, tools, and chemicals used to perform the technical service that is being reimbursed by the health insurance fund to the medical examination and treatment facility, and the purchase price as stipulated by the law on bidding; for the cost of blood and blood products, reimbursement will be based on the regulations of the Minister of Health.

2. The health insurance fund will pay the actual costs of salaries, wages, allowances, contributions, and surgical/procedural allowances (if any) at the rate stipulated by the Minister of Health, based on the price structure of the technical services for which the facility is covered by the health insurance fund.

Article 49. Payment of costs for purchasing medicines, chemicals, laboratory supplies, and medical equipment for medical examination and treatment facilities that are public or private non-profit organizations that ensure recurrent and investment expenditures, public non-profit organizations that self-finance recurrent expenditures, and private medical examination and treatment facilities falling under the cases specified in Clause 3, Article 55 of the 2023 Law on Bidding, as amended and supplemented by Law No. 90/2025/QH15.

In cases where a medical examination and treatment facility is a public non-profit organization that self-finances its recurrent and investment expenditures, a public non-profit organization that self-finances its recurrent expenditures, or a private medical examination and treatment facility that does not choose to apply the provisions of the Law on Bidding for the purchase of drugs, chemicals, laboratory supplies, and medical equipment, and falls under the payment provisions of Clause 3, Article 39 of this Decree, the health insurance fund shall reimburse within the scope and level of benefits of the health insurance participant according to the purchase price, but not higher than the unit price according to the valid contractor selection results at the time of payment for drugs with the same trade name, manufacturer, origin, concentration, dosage, route of administration, same group of technical criteria, dosage form, unit of measurement, or for the same chemicals, laboratory supplies, or medical equipment from the same manufacturer, origin, and technical criteria, according to the following principles and order of priority:

1. Results of national centralized procurement, results of price negotiations.

2. Results of centralized procurement in the province.

3. Procurement results of state-owned medical examination and treatment facilities with the same level of technical expertise in the same province as that medical examination and treatment facility.

4. In cases where there is no unit price specified in Clause 3 of this Article, the health insurance fund shall make payments according to the following principles:

a) Primary healthcare facilities shall be reimbursed based on the lowest winning bid price of a state-owned basic healthcare facility in the province. If there is no winning bid price from a state-owned basic healthcare facility, the healthcare facility shall be reimbursed based on the lowest winning bid price of a state-owned specialized healthcare facility in the province;

b) Basic-level medical examination and treatment facilities shall be reimbursed according to the lowest winning bid price of the initial state-owned medical examination and treatment facility in the province. In cases where there is no winning bid price from the initial state-owned medical examination and treatment facility, the medical examination and treatment facility shall be reimbursed according to the lowest price of the specialized state-owned medical examination and treatment facility in the province;

c) Specialized medical examination and treatment facilities will be reimbursed based on the lowest winning bid price of state-owned initial or basic level medical examination and treatment facilities in the province.

5. In cases where there is no unit price specified in Clause 4 of this Article, the health insurance fund shall pay according to the winning bid price of the state-owned medical examination and treatment facility, based on the results of centralized procurement in the neighboring province, in the following order of priority:

a) Based on the results of centralized procurement in the area;

b) Procurement results of state-owned medical examination and treatment facilities at the same level of technical expertise as that medical examination and treatment facility;

c) In accordance with the principles stipulated in points a, b, and c of Clause 4 of this Article.

6. In cases where there is no unit price specified in Clause 5 of this Article, the health insurance fund shall pay according to the winning bid price of the state-owned medical examination and treatment facility, or the results of centralized procurement in other provinces nationwide, in accordance with the principles stipulated in points a, b, and c of Clause 5 of this Article.

Article 50. Payment of medical examination and treatment costs in certain cases

1. Payment of medical examination and treatment costs for children under 6 years old and organ donors who do not yet have health insurance cards:

a) Medical examination and treatment facilities shall use the temporary health insurance card code lookup function on the Vietnam Social Security Data Reception Portal to obtain temporary health insurance card codes, compile health insurance medical examination and treatment costs according to the scope and level of benefits, and send them to the social insurance agency for payment as prescribed. In cases where the patient has not yet been issued a temporary card code, the medical examination and treatment facility shall enter all information on the Vietnam Social Security Data Reception Portal so that the Portal can automatically issue a temporary card code;

b) The social insurance agency is responsible for verifying the information on the temporary health insurance card code; and for making payments for medical examination and treatment costs according to regulations.

2. In cases where a patient is transferred to another medical facility requiring the presence of medical personnel and the use of medications and medical equipment as needed during transportation, the costs of these medications and equipment will be included in the treatment costs of the medical facility that referred the patient.

3. In cases where a patient, after stable inpatient treatment, needs to continue taking medication after discharge as prescribed by the medical facility, the health insurance fund will cover the cost of the medication within the scope and level of coverage as stipulated by the Minister of Health. The medical facility will include this medication cost in the patient's medical examination and treatment expenses before discharge.

4. In cases where a patient's health insurance card is still valid when they visit a medical facility for examination and treatment, but their health insurance card expires while they are receiving inpatient, day, or outpatient treatment, the health insurance fund will cover the medical examination and treatment costs within the scope and level of coverage until discharge, for a maximum of 15 days from the date the health insurance card expires. Upon discharge, after completing the examination and treatment, the patient is responsible for paying health insurance premiums for the remaining period of the expired health insurance card.

5. For medical examination and treatment expenses for health insurance participants who receive medical examination and treatment before January 1st and complete their examination, treatment, and discharge from the hospital on or after January 1st of the following year, the following procedures shall apply:

a) If the medical examination and treatment facility continues to sign a contract for medical examination and treatment under health insurance, the costs will be included in the medical examination and treatment expenses of the following year;

b) If the medical examination and treatment facility does not renew the health insurance contract, the costs will be included in the previous year's medical examination and treatment expenses.

6. In cases where a patient with a health insurance card presents their card information late during a medical examination or treatment, the health insurance fund will reimburse the medical examination and treatment costs within the scope of benefits and coverage levels from the time the health insurance card information is presented. Medical examination and treatment costs incurred during the period when the patient has not yet presented their health insurance card information will be reimbursed directly by the health insurance fund according to the procedures stipulated in Article 56 and the reimbursement rates stipulated in Article 57 of this Decree.

Article 51. Refusal to pay for medical examination and treatment costs covered by health insurance.

1. Refusal to pay for medical examination and treatment costs covered by health insurance means that the social insurance agency refuses to pay for medical examination and treatment costs that are determined to be incorrect according to the regulations of the law on health insurance and medical examination and treatment during the assessment process and before payment to the medical facility.

2. The refusal of payment must clearly state the grounds, reasons for refusal, and the amount refused in the assessment report, including medical examination and treatment costs covered by health insurance that are requested to be paid electronically by the social insurance agency and automatically paid when the medical facility submits the data. Representatives of the social insurance agency and representatives of the medical facility shall jointly sign the assessment report on medical examination and treatment costs covered by health insurance as the basis for settlement within the time period specified in point b, clause 2, Article 32 of the Health Insurance Law.

3. Medical examination and treatment facilities have the right to request the social insurance agency to reconsider the refusal to pay for medical examination and treatment costs covered by health insurance, or to request the competent authority to consider and resolve the matter in accordance with the law.

Article 52. Recovery of medical examination and treatment costs covered by health insurance.

1. The recovery of health insurance medical examination and treatment costs is carried out for medical examination and treatment costs already paid but found to be in violation of the law through inspection, examination, auditing, resolution of difficulties, handling of legal violations by competent authorities, and discovered during the implementation process.

2. Based on the conclusions and handling results of the competent authority as prescribed in Clause 1 of this Article, the director of the social insurance agency shall issue a document to recover medical examination and treatment costs covered by health insurance within their authority. The recovery document must clearly state the legal basis for recovery, the nature of the violation, the amount to be recovered, the deadline for recovery, and the responsibilities of the organizations and individuals involved in the recovered costs. The medical examination and treatment facility is responsible for returning the recovered funds to the Health Insurance Fund.

3. The recovered funds are accounted for in the year the recovery takes place.

4. Medical examination and treatment facilities have the right to request the social insurance agency to reconsider the recovery of medical examination and treatment costs covered by health insurance, or to request the competent authority to consider and resolve the matter in accordance with the law.

5. In cases where the recovery of medical examination and treatment costs covered by health insurance during inspections, audits, and handling of legal violations by competent state agencies is regulated differently from this Article, those regulations shall apply.

Article 53. Responsibilities of relevant parties in refusing payment and recovering medical examination and treatment costs covered by health insurance.

1. Agencies, organizations, and individuals whose medical examination and treatment costs under health insurance are refused payment or whose claims for recovery are requested to be made are responsible for complying with the decision of the social insurance agency or the final resolution of the competent authority as prescribed by law.

2. When resolving cases of payment refusal or recovery of medical examination and treatment costs covered by health insurance, the resolving agency must clearly identify the responsibilities and the handling or recommendation for handling of the responsibilities of the relevant agencies, organizations, and individuals in accordance with the law.

3. In cases where the refusal to pay or recovery is not in accordance with the law, the social insurance agency that refused to pay or recover must be responsible for making additional payments or reimbursing the medical facility.

Chapter IX

DIRECT PAYMENT OF MEDICAL EXAMINATION AND TREATMENT COSTS BETWEEN THE SOCIAL INSURANCE AGENCY AND HEALTH INSURANCE PARTICIPANTS

Article 54. Cases in which the social insurance agency directly pays the costs of medical examination and treatment covered by health insurance to health insurance cardholders as stipulated in point c, clause 2, Article 31 of the Health Insurance Law.

The social insurance agency directly pays the costs to health insurance participants according to the scope and level of benefits as prescribed by the law on health insurance in the following cases:

1. Patients in emergency situations, unconscious, or deceased who have not presented their health insurance card information before discharge.

2. Individuals covered by health insurance under the management authority of the Ministry of National Defense or the Ministry of Public Security who have lost their health insurance cards but have not yet received replacements, or whose health insurance card information is incorrect or inaccurate and has not been corrected by the social insurance agency at the time of completion of their medical examination, treatment, or discharge from the hospital.

3. Individuals covered by state-funded health insurance but who have not yet been issued a health insurance card, except for cases specified in Clause 1, Article 50 of this Decree, are entitled to full reimbursement of medical examination and treatment costs within the scope and level of benefits from the date they are determined to be covered by state-funded insurance but have not yet received reimbursement due to not being issued a health insurance card.

4. Patients admitted to the emergency room at a medical facility that does not have a contract with the health insurance system will have their medical examination and treatment costs fully reimbursed within the scope of their entitlement and the amount of reimbursement not yet covered, as stipulated by health insurance laws.

5. In cases where a person has changed to a group with a higher level of health insurance coverage but has not yet been issued a new health insurance card, the social insurance agency will directly pay the difference in costs between the two coverage levels to the insured person.

6. In cases where patients purchase medicines and medical equipment themselves as stipulated in Articles 58 and 59 of this Decree. For subjects as stipulated in points a, b, c, and d of Clause 3, Article 12 of the Law on Health Insurance, the payment of costs for medicines and medical equipment shall be carried out in accordance with the provisions of Government Decree No. 70/2015/ND-CP dated September 1, 2015, detailing and guiding the implementation of a number of articles of the Law on Health Insurance for the People's Army, the People's Public Security, and those working in cryptography, as amended and supplemented by Government Decree No. 74/2025/ND-CP dated March 31, 2025.

7. In cases where a health insurance participant receives medical examination and treatment during the period their insurance card is revoked, temporarily suspended, or temporarily blocked as stipulated in Clauses 1, 2, and 3 of Article 12 of this Decree, and this is not due to the fault of the health insurance participant, the patient shall be reimbursed the full cost of medical examination and treatment within the scope and level of benefits applicable to the eligible group.

Article 55. Documents for requesting direct payment

1. Request for direct payment using Form No. 10 in the Appendix issued with this Decree.

2. The following documents are photocopies:

a) Health insurance card or health insurance number in cases where electronic health insurance card information is available, or identity card as prescribed in point b, clause 1, Article 37 of this Decree. In cases prescribed in clause 5, Article 54 of this Decree, the health insurance card includes both the old card with the old benefit level and the new card with the higher benefit level;

b) Discharge papers, medical examination forms, or medical records from the medical examination or treatment for which payment is requested (photocopies bearing the official seal of the medical facility);

c) Prescription (if any).

3. Invoices and expense statements.

4. In the case stipulated in Clause 6, Article 54 of this Decree, the application for direct payment, in addition to the provisions in Clauses 2 and 3 of this Article, shall also include the following documents:

a) Medical device prescription form for patients in cases where medical devices are prescribed;

b) A certificate confirming the shortage of medicines and medical equipment, as prescribed in Form No. 11 of the Appendix issued with this Decree, shall be issued to the patient by the medical examination and treatment facility.

Article 56. Procedures for direct payment

1. Patients or their relatives, as stipulated by law on medical examination and treatment, must fully declare information in the application for direct payment using Form No. 10 in the Appendix issued with this Decree (including selecting to receive payment directly at the one-stop service department of the social insurance agency or via the personal account number declared in Form No. 10), and simultaneously submit the documents as prescribed in Clauses 2, 3 and 4 of Article 55 of this Decree on the National Public Service Portal or through the social insurance agency's application or submit directly at the one-stop service department or send via postal service to the social insurance agency in the area where the patient resides or the social insurance agency that issued the card or the social insurance agency that signed the medical examination and treatment contract with the medical facility where the patient is treated.

2. The national public service portal or the social insurance agency's application will automatically issue a Receipt of Application and Appointment for Payment Results directly to the patient or their relatives, or the officer receiving the application at the one-stop service department of the social insurance agency will directly check the application and issue the Receipt of Application and Appointment for Payment Results directly to the patient or their relatives.

3. If no amendments or additions to the application are required, within 25 days from the date of receiving a complete and valid application (in the case of paper applications, based on the date stamped on the incoming document or the application receipt), the social insurance agency must complete the health insurance assessment and pay the costs to the patient. Direct payment will be made in cash or by bank transfer to the patient's account number provided in the direct payment request document.

4. In case amendments or additions to the application are required, the following procedures shall be followed:

a) Within 05 working days from the date of receiving the application (in the case of submitting a paper application, based on the date stamped on the incoming document or the application receipt), the social insurance agency must send a written document specifying the necessary amendments and additions to the patient or their family member;

b) Within 20 days from the date of receiving the request for amendment or supplementation (in the case of submitting paper documents, based on the date stamped on the incoming document or the document receipt), the patient or their family member is responsible for amending or supplementing the documents and submitting them to the social insurance agency for consideration;

c) Within 20 days from the date of receiving the amended and supplementary documents that meet the prescribed conditions (in the case of submitting paper documents, based on the date stamped on the incoming document or the document receipt), the social insurance agency must make payment to the patient. Payment can be made directly in cash or via bank transfer to the patient's account number provided in the direct payment request document.

Article 57. Direct payment rates for cases specified in points a and b of Clause 2, Article 31 of the Health Insurance Law.

1. In cases where a patient seeks medical examination and treatment at a basic-level medical facility that, before January 1, 2025, was determined by the competent authority to be a district-level facility or a basic-level medical facility with a score below 50 or temporarily classified as basic-level, excluding basic-level medical facilities that, before January 1, 2025, were determined by the competent authority to be a provincial-level facility and do not have a health insurance contract (except in emergency cases), the payment rates are as follows:

a) In the case of outpatient medical examination and treatment, the health insurance fund will reimburse the actual costs within the scope of coverage and the level of health insurance benefits as prescribed, but not exceeding 0,15 times the basic salary at the time of medical examination and treatment;

b) In the case of inpatient medical examination and treatment, the health insurance fund will reimburse the actual costs within the scope of coverage and the level of health insurance benefits as prescribed, but not exceeding 0,5 times the basic salary at the time of discharge.

2. In cases where patients receive inpatient medical examination and treatment at a basic-level medical facility that, before January 1, 2025, was determined by the competent authority to be a provincial-level facility or a basic-level medical facility with a score from 50 points to less than 70 points, and does not have a health insurance contract (except in emergency cases), the health insurance fund will reimburse the actual costs within the scope of coverage and the level of health insurance benefits as prescribed, but not exceeding 1,0 times the basic salary at the time of discharge.

3. In cases where patients receive inpatient medical examination and treatment at specialized medical facilities without a health insurance contract (except in emergency cases), the health insurance fund will reimburse the actual costs within the scope of coverage and the level of health insurance benefits as prescribed, but not exceeding 2,5 times the basic salary at the time of discharge.

4. In cases where a patient seeks medical examination or treatment in violation of the regulations in Clause 1, Article 28 of the Health Insurance Law, fails to present their health insurance card information, or presents the information late before the end of the examination, treatment, or discharge, except as stipulated in Clause 1, Article 54 of this Decree and Clause 5 of this Article, the health insurance fund shall reimburse the actual costs within the scope and level of health insurance coverage during the period the patient has not presented their health insurance card information, but not exceeding the following specific limits:

a) In the case of outpatient medical examination and treatment, the maximum amount shall not exceed 0,15 times the basic salary at the time of examination and treatment;

b) In the case of inpatient medical examination and treatment, the maximum amount shall not exceed 0,5 times the basic salary at the time of discharge.

5. During the period when the patient has not yet presented the health insurance card information as stipulated in Clause 1, Article 38 of this Decree, the subjects specified in points a, b, c, d, and e of Clause 3, Article 12 of the Health Insurance Law shall have their medical examination and treatment costs covered by health insurance funds within the scope of their benefits and entitlement levels.

Article 58. Medicines and medical equipment that are eligible for direct reimbursement from the patient when purchased by the patient themselves.

1. The drug is on the list of rare drugs as regulated by the Minister of Health.

2. Medical devices of class C or D, excluding in vitro diagnostic medical devices, personal specialized medical devices, and medical devices included in the list of medical devices issued by the Minister of Health, may be bought and sold as ordinary goods in accordance with the provisions of Government Decree No. 98/2021/ND-CP dated November 8, 2021, on the management of medical equipment, as amended and supplemented by Government Decree No. 07/2023/ND-CP dated March 3, 2023, and Government Decree No. 04/2025/ND-CP dated January 1, 2025.

Article 59. Conditions for direct reimbursement of costs to patients in cases where patients purchase medicines and medical equipment themselves.

At the time of prescribing medication or prescribing the use of medical devices, all of the following conditions must be met:

1. At the time the patient is prescribed medication, the medical facility does not have the necessary drugs and medical equipment available as stipulated in point b, clause 2, Article 43 of this Decree, and falls under the following circumstances:

a) For medications: no commercially available medication containing the active ingredient prescribed to the patient, or the same active ingredient but with a different concentration, dosage, pharmaceutical form, or route of administration, can be substituted for the patient's prescription;

b) Regarding medical equipment: there is no medical equipment that the patient was prescribed to use, and no alternative medical equipment is available.

2. It is not possible to transfer the patient to another medical facility in any of the following cases:

a) The patient's health condition or medical history has been determined to make them unsuitable for transfer;

b) The medical facility where the patient is being examined and treated is currently under medical quarantine in accordance with the law on prevention and control of infectious diseases;

c) The medical facility where the patient is being examined and treated is a specialized medical facility or the highest level of technical expertise facility in the province or centrally-administered city.

3. It is not possible to transfer medicines and medical equipment between medical examination and treatment facilities.

4. Prescribed medications and medical devices must be consistent with the scope of expertise of the medical examination and treatment facility.

5. Prescribed medications and medical devices must be within the scope of health insurance coverage for the insured and the medical examination and treatment costs must have been reimbursed by health insurance at one of the medical facilities nationwide.

6. Medical examination and treatment facilities are responsible for providing patients with a confirmation slip regarding the shortage of medicines and medical equipment, using Form No. 11 in the Appendix attached to this Decree, as a basis for payment.

Article 60. Level of direct reimbursement for patient expenses in cases where the patient purchases medication and medical equipment themselves.

1. The social insurance agency will pay patients directly according to the following regulations:

a) For medicines: the basis for calculating the payment amount is the quantity and unit price recorded on the invoice purchased by the patient at the pharmaceutical business establishment. In cases where the medicine has regulations on payment rates and conditions, those rates and conditions shall be followed;

b) For medical equipment: the basis for calculating the payment amount is the quantity and unit price recorded on the invoice issued by the patient at the medical equipment supplier. If the medical equipment has a specified payment limit, the payment shall not exceed the limit stipulated for that medical equipment.

2. The unit price of medicines and medical equipment used as a basis for determining the payment amount must not exceed the payment unit price at the most recent time of payment in cases where the medicines and medical equipment were awarded through a tender at the medical facility where the patient received medical examination and treatment.

In cases where medicines and medical equipment have not been awarded through a tender at the medical facility where the patient received examination and treatment, the unit price used to determine the level of health insurance reimbursement will be the valid bid price at the time of payment, in the following order of priority:

a) Results of national-level centralized procurement or price negotiation results;

b) Results of centralized procurement at the local level in the area;

c) The lowest bid result from state-owned medical examination and treatment facilities of the same technical expertise level in the area. If there are no bid results from state-owned medical examination and treatment facilities of the same technical expertise level in the area, the lowest bid result from other state-owned medical examination and treatment facilities in the area shall be used as the basis;

d) The lowest bid price at the time of payment from state-owned medical examination and treatment facilities of the same technical expertise level nationwide. If there are no bid price results from state-owned medical examination and treatment facilities of the same technical expertise level nationwide, the lowest bid price from other state-owned medical examination and treatment facilities nationwide will be used as the basis.

3. The social insurance agency shall deduct the medical insurance costs paid by the medical facility where the patient is treated as follows:

a) In cases where the cost of medicines and medical equipment is included in the price of medical examination and treatment services: the deduction shall be made from the medical examination and treatment service costs covered by health insurance of the medical facility at the payment rate as stipulated in Clauses 1 and 2 of this Article;

b) In cases where the cost of medicines and medical equipment is not included in the price structure of medical examination and treatment services: no deduction will be made from the medical examination and treatment service costs covered by health insurance of the medical facility;

c) The cost of medicines and medical equipment paid directly to patients by the social insurance agency is included in the projected expenses of the medical examination and treatment facility.

Chapter X

MANAGEMENT AND UTILIZATION OF HEALTH INSURANCE FUNDS

Article 61. Allocation and use of health insurance contributions

1. The allocation of 92% of health insurance premiums for medical examination and treatment (hereinafter referred to as the medical examination and treatment fund) shall be used for the following purposes:

a) Covering expenses within the scope of health insurance benefits for insured individuals as stipulated by health insurance laws;

b) A portion shall be allocated to educational institutions or vocational training institutions, agencies, organizations, and businesses that meet the conditions stipulated in Article 63 of this Decree.

2. The allocation of 8% of health insurance premiums to the reserve fund and for the organization and operation of health insurance is stipulated as follows:

a) The reserve fund contribution rate is the remaining amount after deducting expenses for the organization and operation of health insurance as stipulated in point b of this clause, and must be at least 4% of the health insurance contributions.

b) Expenses for organizing and operating health insurance shall not exceed 4% of the health insurance contributions. After the Social Insurance Management Council approves the annual settlement of expenses for organizing and operating social insurance, unemployment insurance, and health insurance, Vietnam Social Insurance is responsible for supplementing any unused funds into the reserve fund for general allocation. The Prime Minister shall decide on the specific level of expenses for organizing and operating health insurance for each year.

Article 62. Expenditure levels for medical examination and treatment in primary healthcare.

1. The amount of money retained by the educational institution or vocational training institution includes:

a) Deduct 5% of health insurance premiums based on the total number of children under 6 years old or students attending educational institutions, using the following formula:

Amount deducted = 5% x (N)_number x M_{Health Insurance} xL_basis x Th)

In which:

- N_number: Total number of children under 6 years old; students attending educational institutions or vocational training institutions who participate in health insurance.

- M_{Health Insurance}The health insurance contribution rates applicable to children under 6 years old or students are as stipulated in Clauses 3 and 4 of Article 6 of this Decree.

- L_basis: The base salary at the time of health insurance contribution.

– Th: Number of months of health insurance contributions.

Periodically, every 03, 06, or 12 months, the social insurance agency is responsible for transferring the amount stipulated in this point to the educational institution or vocational training institution and consolidating it into the final settlement of the health insurance fund for medical examination and treatment.

b) Deduct 1% of the monthly health insurance contributions for employees at educational institutions or vocational training institutions. The social insurance agency is responsible for paying this amount immediately after receiving the health insurance contributions from the educational institution or vocational training institution.

2. The amount retained by eligible agencies, organizations, and enterprises as stipulated in Clause 1, Article 63 of this Decree shall be 1% of the monthly health insurance contributions for employees of those agencies, organizations, and enterprises. The social insurance agency is responsible for paying this amount immediately after receiving the health insurance contributions from the agency, organization, or enterprise.

3. Amount of money retained for workers on offshore fishing vessels:

a) The expenditure is equal to 10% of the health insurance revenue calculated based on the number of employees on board who participate in health insurance, to purchase medicine cabinets, medicines, medical equipment, and tools and instruments for first aid and initial treatment. The calculation formula is as follows:

Amount deducted = 10% x (N)_number x M_{Health Insurance} xL_basis x Th)

In which:

- N_number: Number of people covered by health insurance working on fishing vessels.

- M_{Health Insurance}The health insurance contribution rate for the first person in a household is as stipulated in Article 6 of this Decree.

- L _basis: Base salary at the time of contribution.

– Th: Number of months of health insurance contributions;

b) The Chairman of the Provincial People's Committee shall organize the purchase and distribution of medicine cabinets, medicines, medical equipment, and tools to owners of offshore fishing vessels. The Social Insurance agency shall transfer the amount stipulated in point a of this clause to the agency or organization assigned by the Chairman of the Provincial People's Committee to purchase medicine cabinets, medicines, medical equipment, and tools; and consolidate the transferred amount into the settlement of the medical examination and treatment fund.

4. Based on actual needs and the balance of the health insurance fund, the Minister of Health shall submit to the Government a proposal to adjust the level of transfer of funds for medical examination and treatment expenses in primary healthcare.

Article 63. Conditions, content of expenditure, and settlement of medical examination and treatment costs in primary healthcare.

1. Educational institutions or vocational training institutions, agencies, organizations, and businesses (except for educational institutions or vocational training institutions, agencies, organizations, and businesses that have signed contracts for medical examination and treatment under health insurance as stipulated in Article 30 of this Decree) are eligible for funding from the health insurance fund to provide medical examination and treatment in primary healthcare when they meet the following conditions:

a) There must be at least one person who is qualified to work full-time or part-time in primary healthcare as prescribed in Article 19 of the Law on Medical Examination and Treatment;

b) There must be a medical room or a separate office for providing first aid and initial treatment to individuals under the management of the educational institution or vocational training institution, agency, organization, or enterprise who suffer injuries or common illnesses while studying or working at the educational institution or vocational training institution, agency, organization, or enterprise.

2. Expenditure details:

a) Expenses for purchasing medicines, medical equipment, supplies, tools, and chemicals for first aid and initial treatment for children, students, and other individuals under the management of agencies, organizations, and businesses when they suffer accidents, injuries, or common illnesses while studying or working at educational institutions or vocational training institutions, agencies, organizations, and businesses;

b) Expenses for purchasing and repairing common medical equipment for primary healthcare, and filing cabinets for managing health records at educational institutions or vocational training institutions, agencies, organizations, and businesses;

c) Expenses for purchasing materials to support disease prevention, hygiene and sanitation activities, and medical examination and treatment activities in primary healthcare.

3. Payment and settlement of expenses:

a) For public educational institutions or vocational training institutions, the costs of medical examinations and treatment in primary healthcare services shall be accounted for as medical service expenses at the institution and settled with the superior management unit in accordance with current regulations;

b) For non-public educational or vocational training institutions, the costs of medical examinations and treatment in primary healthcare services shall be accounted for as expenses of the institution and settled with the superior unit (if any);

c) For businesses and economic organizations, separate accounting records must be maintained to reflect the receipt and use of funds, and these records should not be included in the final expense settlement of the business or economic organization;

d) For other agencies and units, the expenses for medical examinations and treatment in primary healthcare shall be accounted for as medical service costs of the agency or unit and settled with the superior management agency or unit (if any) or the finance agency at the same level in accordance with current regulations.

4. Educational institutions or vocational training institutions, agencies, organizations, and businesses that receive funding for medical examination and treatment in primary healthcare as stipulated in this Decree are responsible for using the funds for primary healthcare, ensuring the availability of medicines and medical equipment for primary healthcare, and are not allowed to use them for other purposes. Any unused funds at the end of the year may be carried over to the following year for continued use. The management and use of these funds must be included in the annual activity report and are not required to be settled with the social insurance agency.

5. The Minister of Health shall prescribe the list of medical examination and treatment services covered by health insurance and the list of basic medicines and medical equipment in primary healthcare covered by the Health Insurance Fund.

Article 64. Management and use of the reserve fund

1. Sources of funding for the reserve fund

a) The amount deducted annually as stipulated in point a, clause 2, Article 61 of this Decree;

b) Late payments or evasion of health insurance contributions;

c) Interest on late payments or evasion of health insurance contributions;

d) Income from investment activities related to health insurance;

(d) Expenditures made in violation of regulations must be recovered.

2. The reserve fund will be used as follows:

a) Supplementing the budget for medical examination and treatment under health insurance in cases where the health insurance revenue allocated for medical examination and treatment as stipulated in Clause 1, Article 61 of this Decree is less than the expenditure on medical examination and treatment in the year. After auditing the final accounts, the Vietnam Social Security is responsible for supplementing the entire difference from the reserve fund;

b) Advance payment and supplementary payment of medical examination and treatment costs covered by health insurance incurred in the previous year as stipulated in point b, clause 4, Article 65 of this Decree;

c) Reimburse the state budget for the costs incurred in issuing duplicate health insurance cards.

3. In cases where the reserve fund is insufficient to supplement the costs of medical examination and treatment as stipulated in Clause 2 of this Article, the Vietnam Social Security shall report to the Social Security Management Council on a solution before reporting to the Ministry of Health and the Ministry of Finance.

The Ministry of Health, in coordination with the Ministry of Finance, will submit to the Government measures to ensure sufficient and timely funding for medical examinations and treatment under health insurance as prescribed.

Article 65. Preparation of revenue and expenditure estimates, notification of projected expenditures, and settlement of revenue and expenditure accounts of the health insurance fund.

1. Annually, the Vietnam Social Security, in coordination with the Military Social Security and the People's Public Security Social Security, prepares the revenue and expenditure budget for the health insurance fund, including: expenses for medical examination and treatment under health insurance, expenses for organizing and operating health insurance, expenses for allocating funds from the reserve fund from the annual revenue, and expenses for allocating funds from the reserve fund to cover medical examination and treatment costs incurred by medical facilities in the previous year but not yet settled due to outstanding issues (if any), and investments from temporarily idle funds of the health insurance fund. This budget is submitted to the Social Insurance Management Council for approval and sent to the Ministry of Finance before July 20th of each year. The Ministry of Finance, in coordination with the Ministry of Health, compiles and submits the budget to the Prime Minister before November 30th of each year to allocate the revenue and expenditure budget for the health insurance fund to the Vietnam Social Security, the Military Social Security, and the People's Public Security Social Security.

2. Allocate the budget for medical examination and treatment under health insurance and notify the projected amount for medical examination and treatment under health insurance:

a) Within 15 days from the date of receiving the Prime Minister's decision on the allocation of the health insurance fund's revenue and expenditure estimates, the Vietnam Social Security shall allocate the health insurance expenditure estimates for medical examination and treatment to the Social Security branches of provinces and centrally-administered cities, up to a maximum of 92% of the national health insurance contribution revenue estimates after deducting the estimates already allocated by the Prime Minister to the Military Social Security and the Public Security Social Security;

b) Based on the provisions of point c of this clause, medical examination and treatment facilities shall prepare a projected expenditure and submit it to the Social Insurance agency that has signed the health insurance contract for medical examination and treatment. Based on the request of the medical examination and treatment facility and the allocated budget, the Social Insurance agency of the province or centrally-administered city shall notify the medical examination and treatment facility of the projected expenditure for medical examination and treatment under health insurance. In case the medical examination and treatment facility's projected expenditure for the year increases or decreases compared to the amount already notified, the medical examination and treatment facility shall send a written document to the Social Insurance agency of the province or centrally-administered city before October 15th of each year for consolidation and adjustment within the allocated budget of the Social Insurance agency of the province or centrally-administered city;

c) The projected expenditure is determined based on the budget for medical examination and treatment under health insurance allocated by the Prime Minister and the actual expenditure on medical examination and treatment under health insurance in the immediately preceding year, projected increases or decreases in the number of medical examinations and treatments, average medical examination and treatment costs under health insurance of the medical facility, prices of medical examination and treatment services, scope of health insurance benefits, and changes in policies and laws related to health insurance;

d) In cases where the total projected expenditure for medical examination and treatment under health insurance of medical facilities in the year increases or decreases compared to the budget allocated by Vietnam Social Security, the Social Security branches of provinces and centrally-administered cities shall compile and send the information to Vietnam Social Security before October 30th of each year for consideration and adjustment among provinces and centrally-administered cities. Vietnam Social Security shall compile and review the adjustment of the budget for medical examination and treatment under health insurance among the Social Security branches of provinces and centrally-administered cities within the scope of the budget for medical examination and treatment and the budget for reserve fund allocation allocated for the year before November 15th of each year, as a basis for adjusting the projected expenditure for medical examination and treatment under health insurance of medical facilities.

3. In cases where the actual medical examination and treatment expenses covered by health insurance for the year, as verified by the social insurance agency, exceed the projected expenses (including the amount notified at the beginning of the year and the amount adjusted during the year), the medical examination and treatment facility shall review and submit a written explanation of the reasons for the excess expenses to the Social Insurance agency and the Department of Health of the province or centrally-administered city. The Social Insurance agency of the province or centrally-administered city, in coordination with the Department of Health, is responsible for:

a) Coordinate with medical examination and treatment facilities to review the causes affecting the exceeding of projected medical examination and treatment expenses covered by health insurance, as explained by the medical examination and treatment facilities; review expenses that are higher than the average increase of medical examination and treatment facilities of the same technical expertise level and type (general or specialized) in the province, centrally-administered city, or nationwide;

b) Review and agree on the determination of medical examination and treatment costs covered by health insurance that exceed the projected expenditure, ensuring that these costs are reimbursed in accordance with the law on medical examination, treatment, and health insurance, and that additional funding is provided to medical facilities; refuse payment for medical examination and treatment costs that, upon review, are determined not to comply with the law on medical examination, treatment, and health insurance.

In cases where there is disagreement with the refusal to pay for medical examination and treatment costs, the medical facility has the right to petition the Provincial/City Social Insurance agency or the Department of Health for consideration or to compile and send the matter to the Ministry of Health for resolution in accordance with the law;

c) In cases where the budget allocated by Vietnam Social Security is insufficient to supplement funding for medical examination and treatment facilities, the Social Security branches of provinces and centrally-administered cities shall send requests to Vietnam Social Security for supplementary funding for medical examination and treatment under health insurance within the scope of the budget for medical examination and treatment under health insurance allocated by the Prime Minister.

4. In cases where the total actual medical examination and treatment expenses covered by health insurance in the year exceed the health insurance expenditure budget allocated by the Prime Minister, the Vietnam Social Security shall proceed as follows:

a) In cases where the amount allocated from the reserve fund from the annual revenue as projected by the Prime Minister is sufficient to cover the additional medical examination and treatment expenses covered by health insurance that exceed the projected amount, Vietnam Social Security will supplement the medical examination and treatment costs covered by health insurance from the reserve fund to cover the payments and report the results to the Social Security Management Council, the Ministry of Health, and the Ministry of Finance;

b) In cases where the amount allocated from the annual revenue as projected by the Prime Minister is insufficient to cover the additional medical examination and treatment expenses covered by health insurance exceeding the projected amount, the Vietnam Social Security shall report to the Social Insurance Management Council for approval and submission to the Ministry of Finance, which will coordinate with the Ministry of Health to present to the Prime Minister for consideration and allocation of additional funds for medical examination and treatment covered by health insurance exceeding the projected amount from the reserve fund (if any), and this will be settled in the fiscal year in which the payments are made.

While awaiting the Prime Minister's approval, the social insurance agency will advance the costs of medical examination and treatment covered by health insurance, as approved by the Social Insurance Management Council.

After approval by the Prime Minister, the social insurance agency will supplement the remaining funds for medical examination and treatment facilities.

c) In cases where the reserve fund is insufficient to supplement the funding for medical examination and treatment under health insurance, the Vietnam Social Security shall compile and report to the Management Council for approval of a plan to ensure financial resources for medical examination and treatment under health insurance before submitting it to the Ministry of Health, which will coordinate with the Ministry of Finance to report to the competent authority for decision in accordance with Clause 3, Article 64 of this Decree.

5. Advance payments, settlements, and final payments of medical examination and treatment costs covered by health insurance for medical facilities shall be made quarterly in accordance with the provisions of Clauses 1 and 2, Article 32 of the Health Insurance Law.

In cases where there are issues regarding the payment of medical examination and treatment costs as stipulated by regulations, the time for resolving these issues and making payments shall not exceed 12 months from the date the medical facility requests payment.

6. Annually, before October 1st, the Vietnam Social Security is responsible for compiling and preparing a report on the settlement of the health insurance fund for the previous year, as stipulated in Article 32 of the Health Insurance Law.

7. Matters concerning the financial mechanisms of the health insurance fund not stipulated in this Decree shall be implemented in accordance with the Government's regulations on the financial mechanisms of the social insurance, health insurance, and unemployment insurance funds.

Chapter 11

APPLICATION OF INFORMATION TECHNOLOGY AND DIGITAL TRANSFORMATION IN THE IMPLEMENTATION OF HEALTH INSURANCE

Article 66. Principles of applying information technology and digital transformation in the implementation of health insurance.

1. Comply with legal regulations on the application of information technology; legal regulations on medical examination and treatment under health insurance; laws on the protection of state secrets and related secrets; and legal regulations on electronic transactions, storage, and information security.

2. Comply with technical standards and regulations, ensuring compatibility, seamless operation, and security, facilitating electronic transactions between medical examination and treatment facilities and social insurance agencies.

3. Ensuring the confidentiality and privacy of medical examination and treatment data and information of health insurance participants.

4. Ensure that technical infrastructure, network connectivity, software, and human resources meet the requirements for applying information technology and digital transformation in the implementation of health insurance.

5. Ensure the ability to connect and share health insurance data with other information technology systems.

Article 67. Content of information technology application and digital transformation in the implementation of health insurance.

1. Applying information technology to serve the state management of health insurance at the central and local levels.

2. Applying information technology to digitize the information of health insurance participants.

3. Applying information technology to develop and establish methods for paying medical examination and treatment costs under health insurance.

4. Application of information technology to support medical examination and treatment under health insurance at medical facilities.

5. Application of information technology to support the process of advance payment, assessment, payment, and settlement of medical examination and treatment costs under health insurance between social insurance agencies and medical examination and treatment facilities.

6. Application of information technology to serve the management and allocation of health insurance funds, and the collection and disbursement of health insurance benefits.

7. Applying information technology in the implementation of health insurance to serve other tasks directed by the Government.

Article 68. Responsibilities of agencies and units regarding the application of information technology and digital transformation in the implementation of health insurance.

1. Responsibilities of the Ministry of Health:

Develop, regulate, and issue common code lists applicable in medical examination and treatment under health insurance; standards, data formats, connectivity, interoperability, and electronic data transfer in medical examination and treatment under health insurance, assessment, and payment of medical examination and treatment costs under health insurance.

2. Responsibilities of the Ministry of Finance:

Directing and organizing the implementation of information technology and digital transformation in the management and execution of regulations and policies on health insurance, and the management and use of the Health Insurance Fund.

3. The Ministry of Public Security is responsible for ensuring the connection and interoperability of the National Insurance Database with the National Population Database, and for developing utilities on the National Electronic Identification Application (VNeID) to serve citizens and relevant agencies and units in resolving issues related to health insurance policies and regulations.

4. Responsibilities of the Vietnam Social Insurance under the Ministry of Finance:

a) Applying information technology and digital transformation to facilitate and serve citizens, agencies, and organizations in implementing regulations, policies, and laws on health insurance;

b) Develop and implement a monitoring and warning system for the implementation of regulations and policies on health insurance;

c) Organize online health insurance premium collection and payment, integrate automatic notifications to health insurance participants about the payment deadline and the amount for the next payment 10 days before the health insurance card expires, automatically extend the health insurance participation period when the health insurance participant has paid the premium, and notify the payment results;

d) Implement the assessment and signing of health insurance contracts for medical examination and treatment with medical facilities in an electronic environment;

d) Ensure the data receiving portal operates effectively;

e) Share complete, accurate, and timely data from the National Insurance Database with the Ministry of Health to perform the state management function regarding health insurance.

5. Responsibilities of medical examination and treatment facilities:

a) Implement information technology applications and digital transformation in medical examination and treatment under health insurance in accordance with the law;

b) Ensuring the maintenance of standards for connectivity and data exchange between verified medical examination and treatment data under health insurance and the health insurance information and assessment system of the social insurance agency as prescribed during the implementation of health insurance medical examination and treatment contracts;

c) Be legally responsible for the accuracy and legality of the data; ensure the security and confidentiality of information in accordance with the law.

Chapter 10

TERMS ENFORCEMENT

Article 69. Transitional provisions

1. In cases where a patient enters a medical examination and treatment facility before the effective date of this Decree and completes their examination and treatment period after the effective date of this Decree, the provisions of this Decree or the regulations in effect before this Decree shall apply, in a way that is more favorable to the patient in terms of procedures and health insurance benefits.

2. In cases where a health insurance participant was determined by a competent authority to be eligible for health insurance coverage funded or subsidized by the state budget before the effective date of this Decree, and their eligibility changes due to the merger of administrative units during the reorganization of the political system's organizational structure, the health insurance participant shall continue to receive state budget contributions or subsidies for health insurance and enjoy benefits according to the category previously determined in the document issued by the competent authority until the expiration of that document or until their eligibility is re-determined according to a new document.

3. In cases where a health insurance contract for medical examination and treatment was signed before July 1, 2025, and remains valid after July 1, 2025, it shall be implemented until the end of the signed contract term, except as stipulated in Clause 8 of this Article.

4. In cases where private medical examination and treatment facilities have signed contracts for the supply of medicines, chemicals, laboratory supplies, and medical equipment before July 1, 2025, in accordance with the law on bidding, they are allowed to use and pay for the entire quantity of medicines, chemicals, laboratory supplies, and medical equipment as stipulated in the signed contract.

5. The subjects participating in health insurance 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 the Health Insurance Law, and the dossiers related to the compilation of lists of health insurance participants currently being processed by district-level agencies, shall be transferred to the People's Committees of communes to continue implementation according to the legal documents issued before the effective date of this Decree until new documents are issued.

6. District, county, town, and city health centers under provincial and centrally-administered cities, when reorganized under new names, shall continue to apply the provisions of point c, clause 1, Article 22 of the Health Insurance Law in health insurance medical examination and treatment.

7. Replace the phrase "island district" in point b, clause 4, Article 22 of the Health Insurance Law with the phrase "special zone".

8. In cases where medical examination and treatment facilities undergo restructuring, reorganization, merger, or name changes during the implementation of the two-level local government organizational restructuring:

a) Medical examination and treatment facilities may continue to use the prices of medical examination and treatment services covered by health insurance that were prescribed and approved by competent authorities before the date the facilities were reorganized, merged, or renamed, until the prices for the new facilities are prescribed and approved by competent authorities;

b) In cases where a medical examination and treatment facility needs to obtain a new, renewed, or adjusted operating license, during the period of carrying out the procedures for obtaining a new, renewed, or adjusted operating license as prescribed, the operating licenses already issued to medical examination and treatment facilities before the date of reorganization, merger, or name change shall continue to be used for both the old and new facilities to provide medical examination and treatment services and maintain the validity of the health insurance medical examination and treatment contracts already signed until a health insurance medical examination and treatment contract is signed with the new facility under the new operating license. The medical examination and treatment facility is responsible for ensuring the quality of medical examination and treatment services;

c) The initial health insurance registration for medical examination and treatment of health insurance participants and the number of health insurance cards allocated to the initial health insurance registration facilities before the date of reorganization, merger, or name change will continue to be used for the new facility until further instructions are given by the Department of Health;

d) The code of the medical examination and treatment facility, the seal of the medical examination and treatment facility, and the seal of the facility that signed the health insurance medical examination and treatment contract before the date of reorganization, merger, or name change shall continue to be used until the new facility is issued a new code and a new seal; In case the medical examination and treatment facility has its old seal revoked before a new seal is issued, it is allowed to complete the procedure after receiving the new seal;

d) Health insurance cards and health insurance card information that have changed due to restructuring, reorganization, merger, or name changes may continue to be used until adjusted by the competent authority;

e) Based on practical requirements in the locality, the People's Committee of the province or centrally-administered city shall decide on solutions to handle arising situations to ensure the stable operation of medical examination and treatment facilities during the transitional period when rearranging, reorganizing, merging, or changing the names of medical examination and treatment facilities; assign a focal unit to be responsible for representing and handling issues arising from the implementation of contracts, payment, settlement of medical examination and treatment costs under health insurance, transfer of patients between medical examination and treatment facilities under health insurance, procurement, ensuring the supply of medicines and medical equipment, and resolving related difficulties arising during the transfer process until the medical examination and treatment facilities are granted new operating licenses and sign new medical examination and treatment contracts under health insurance.

9. The implementation of electronic data verification for medical examination and treatment costs covered by health insurance shall be carried out no later than January 1, 2026.

Article 70. Enforcement

1. This Decree shall take effect from August 15, 2025, except for the provisions in Clauses 2 and 3 of this Article.

2. Articles 1 to 11, Articles 14, 15, 17, 18, 19, Articles 22 to 36, Articles 39 to 44, Articles 49 and 50, Articles 54 to 61, Articles 69, 70, 71 and 72 of this Decree shall take effect from July 1, 2025.

3. Clause 8 of Article 69 of this Decree shall be effective from July 1, 2025 to December 31, 2025.

4. The following articles and clauses of the following documents shall be repealed from July 1, 2025:

a) Articles 1 to 12, Clauses 1, 2, 3, 4, 5 and 6 of Article 14, Articles 16 to 26, Clauses 1, 2, 3, 4, 5, 6, 8, 9 and 11 of Article 27, Articles 28 to 36 and all forms in the Appendix issued with Government Decree No. 146/2018/ND-CP dated October 17, 2018, detailing and guiding the implementation of some articles of the Law on Health Insurance, as amended and supplemented by Government Decree No. 75/2023/ND-CP dated October 19, 2023 and Government Decree No. 02/2025/ND-CP dated January 1, 2025;

b) Clauses 3 and 4 of Article 95 of Government Decree No. 24/2024/ND-CP dated February 27, 2024, detailing some provisions and measures for implementing the Law on Bidding regarding contractor selection;

c) Clause 5, Article 4 of Government Decree No. 74/2025/ND-CP dated March 31, 2025, amending and supplementing a number of articles of Government Decree No. 70/2015/ND-CP dated September 1, 2015, detailing and guiding the implementation of a number of articles of the Law on Health Insurance for the People's Army, the People's Public Security, and those working in cryptography.

5. The following documents shall be repealed from August 15, 2025:

a) Government Decree No. 146/2018/ND-CP dated October 17, 2018, detailing and guiding the implementation of several articles of the Law on Health Insurance;

b) Government Decree No. 75/2023/ND-CP dated October 19, 2023, amending and supplementing a number of articles of Government Decree No. 146/2018/ND-CP dated October 17, 2018, detailing and guiding the implementation of a number of articles of the Law on Health Insurance;

c) Government Decree No. 02/2025/ND-CP dated January 1, 2025, amending and supplementing a number of articles of Government Decree No. 146/2018/ND-CP dated October 17, 2018, detailing and guiding the implementation of a number of articles of the Law on Health Insurance, which has been amended and supplemented by Government Decree No. 75/2023/ND-CP dated October 19, 2023.

6. In case the documents referenced in this Decree are replaced or amended, the replacement document or the amended document shall be followed.

Article 71. Responsibilities for implementation

1. The Ministry of Health is responsible for:

a) Guidance on the organization and implementation of policies and laws on health insurance;

b) Guidance on compiling lists of subjects under management authority; the identification and compilation of lists of subjects as stipulated in points h, r, s, and t of Clause 3, Article 12 of the Health Insurance Law;

c) Instruct medical examination and treatment facilities to enhance the application of information technology in medical examination and treatment under health insurance; digitally sign, authenticate, and transfer data requesting payment of medical examination and treatment costs under health insurance to the Ministry of Health's medical examination and treatment data receiving system and the Vietnam Social Security's information system for assessment to serve health insurance management and assessment and payment of medical examination and treatment costs under health insurance;

d) Directing medical examination and treatment facilities and centralized procurement units to strictly implement regulations related to procurement and bidding to ensure timely supply of medicines, chemicals, and medical equipment covered by health insurance, and to practice thrift and combat waste;

d) Directing medical examination and treatment facilities to comply with legal regulations on medical examination and treatment, professional guidelines of the Ministry of Health; and legal regulations related to the provision of medical technical services ensuring quality, efficiency and cost-effectiveness;

e) To chair and coordinate with the Ministry of Finance in preparing a report to the Government for submission to the National Assembly on the implementation of health insurance policies and regulations, including the management and use of health insurance funds on an ad hoc, periodic, or annual basis;

g) To preside over and coordinate with relevant agencies in inspecting the implementation of policies and laws on health insurance;

h) Issuing guidelines for preparing and adjusting projected expenditures for medical examination and treatment under health insurance, and for determining the amount of medical examination and treatment expenses exceeding the projected expenditure that will be reimbursed by the health insurance fund.

2. The Ministry of Finance is responsible for:

a) To balance and allocate central government budget support for localities that are unable to balance their own budgets, in order to ensure the resources for implementing health insurance policies as stipulated by the law on state budget;

b) Directing and guiding the organization and implementation of health insurance policies and laws, and managing and utilizing the Health Insurance Fund under its management authority;

c) Regulations on the authority of social insurance agencies to sign contracts for medical examination and treatment under health insurance, in accordance with the functions, tasks, powers, and organizational structure of Vietnam Social Insurance;

d) Issuing consolidated payment and settlement forms for medical examination and treatment costs covered by health insurance, and specifying the procedures for auditing medical examination and treatment costs covered by health insurance;

d) Report annually on the management and use of the health insurance fund and submit it to the Ministry of Health for compilation as prescribed.

3. The Ministry of National Defence, the Ministry of Public Security, and the Government Cipher Committee are responsible for guiding the implementation of health insurance for individuals under the management of the Ministry of National Defence and the Ministry of Public Security who receive medical examination and treatment as prescribed in this Decree; and for guiding the identification of dependents of other personnel working in cipher organizations as prescribed in Clause 5, Article 5 of this Decree.

4. The Ministry of Interior is responsible for:

a) Guidance on identifying and compiling a list of beneficiaries under the management of the Ministry of Interior as stipulated in points e, i, and k, and those residing in island communes and special zones as stipulated in point o, clause 3, Article 12 of the Health Insurance Law;

b) Inspect 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 the Health Insurance Law and the subjects specified in point a of this Clause, except for those managed by the Ministry of National Defense and the Ministry of Public Security.

5. The Ministry of Education and Training is responsible for guiding the identification and compilation of the list of subjects specified in point b, clause 4, Article 12 of the Health Insurance Law.

6. The Ministry of Culture, Sports and Tourism is responsible for identifying and guiding the compilation of the list of subjects specified in point h, clause 4, Article 12 of the Health Insurance Law and clause 3, Article 5 of this Decree.

7. The Ministry of Agriculture and Environment is responsible for:

a) Research and develop criteria for identifying poor households; near-poor households; and households engaged in agriculture, forestry, fisheries, and salt production with an average standard of living, in accordance with the socio-economic situation of each period, and submit them to the Prime Minister for promulgation;

b) Guidance on identifying and compiling a list of beneficiaries under the management of the Ministry of Agriculture and Environment, including people from poor households; ethnic minorities from near-poor households residing in communes and villages in ethnic minority and mountainous areas; and people residing in areas with particularly difficult socio-economic conditions as specified in point o, clause 3 and points a and d, clause 4 of Article 12 of the Health Insurance Law.

8. The Ministry of Ethnic Minorities and Religions is responsible for guiding the identification and listing of ethnic minority individuals residing in areas with difficult socio-economic conditions as stipulated in point o, clause 3 and point g, clause 4 of Article 12 of the Health Insurance Law.

9. The Vietnam Social Insurance, under the Ministry of Finance, is responsible for:

a) Directing social insurance agencies at all levels to sign contracts with medical examination and treatment facilities that meet the conditions stipulated in this Decree; providing forms and guidance to commune-level People's Committees in compiling and managing lists of health insurance participants for subjects under their management authority in the area;

b) Directing provincial and centrally-administered city social insurance agencies to proactively coordinate with the Department of Health, the Department of Finance, and health insurance medical examination and treatment facilities in their respective areas, neighboring areas, and relevant agencies to resolve, within their authority, or propose to competent authorities for consideration and timely handling, any difficulties arising in the implementation of health insurance policies and laws;

c) Improve the information technology system to ensure timely, smooth, and complete reception, assessment, and response to medical examination and treatment facilities regarding data requesting payment of medical examination and treatment costs under health insurance; ensuring accuracy, security, confidentiality of information, and protection of the rights of all relevant parties;

d) Ensuring the effectiveness of the assessment activities and the capacity of the health insurance assessment team; Proactively reviewing, detecting, and promptly sending warning information to health insurance medical examination and treatment facilities about health insurance medical examination and treatment costs that are significantly higher than the average costs of medical examination and treatment facilities of the same technical expertise level and type (general or specialized medical examination and treatment facilities) so that medical examination and treatment facilities can check and review according to the provisions of the law in order to use the health insurance fund rationally and effectively;

d) Timely compile information on the cumulative co-payment amount for the patient in the fiscal year, the time when the patient has participated in health insurance for 05 consecutive years or more, and notify it on the Data Reception Portal so that medical examination and treatment facilities can look up and determine when the patient is eligible to receive exemption from co-payment in the patient's examination and treatment; ensuring that the patient's rights are not affected;

e) To compile and submit periodic, annual, or ad hoc reports as requested by state management agencies on the implementation of health insurance policies and regulations; the situation of collection, expenditure, management, and use of the health insurance fund, and send them to the Ministry of Health and the Ministry of Finance for consolidation as prescribed;

g) Share and transfer data on medical examination and treatment costs covered by health insurance to the Ministry of Health fully and promptly for the purpose of developing and implementing payment methods and formulating policies in accordance with the law;

h) Provide the Department of Health of the province or centrally-administered city with the number and structure of beneficiaries according to groups of people participating in health insurance who register for initial health insurance examination and treatment, and information on changes within the first 15 days of each quarter (if any changes) according to Form No. 12 in the Appendix issued with this Decree;

i) Publicly and promptly update requirements and guidelines on receiving, reporting incidents and problems related to receiving, and rejecting data on medical examination and treatment costs covered by health insurance on the Data Reception Portal before applying them in health insurance claims assessment.

10. The People's Committee of the province or centrally-administered city is responsible for:

a) Directing and organizing the implementation of policies and laws on health insurance at the local level;

b) Submit to the People's Council at the same level a proposal to ensure funding for health insurance contributions for those eligible for state-funded or subsidized health insurance according to current regulations;

c) Directing, urging, and ensuring the conditions for the deployment of information technology applications, digital transformation, and data interoperability in medical examination and treatment under health insurance at medical facilities under its management authority, in accordance with regulations;

d) Directing and presiding over the resolution of difficulties encountered in the implementation of policies and laws on health insurance between medical examination and treatment facilities and social insurance agencies within the managed area;

d) To properly implement the planning of the system of medical examination and treatment facilities; to direct and inspect the compliance with the operating conditions of medical examination and treatment facilities covered by health insurance; to assess the needs of people for medical examination and treatment covered by health insurance and the capacity of the medical examination and treatment system in the area to meet those needs, and to implement solutions to ensure a balance and appropriateness between the number of medical examination and treatment facilities covered by health insurance and the needs of people in the area for medical examination and treatment;

e) Based on the local budget capacity and other legitimate funding sources, the Provincial/City People's Council shall decide on the level of support for health insurance contributions for beneficiaries exceeding the minimum support level stipulated in points b, c, d, e, and f of Clause 6, Article 6 of this Decree; the level of support for health insurance contributions for beneficiaries not entitled to the support level stipulated in points b, c, d, e, and f of Clause 6, Article 6 of this Decree; and the beneficiaries and level of support for co-payment of medical examination and treatment costs covered by health insurance for health insurance participants when seeking medical examination and treatment.

Article 72. Responsible for implementing

Ministers, heads of ministerial-level agencies, heads of government agencies, chairpersons of provincial and centrally-administered city People's Committees, and relevant organizations and individuals are responsible for implementing this Decree.

APPENDIX

(Attached to Decree No. 188/2025/ND-CP dated June 01, 2025 of the Government)

Download the form attached to the Appendix of Decree 188/2025/ND-CP (I.e.