Continuous health insurance participation for 5 years refers to an individual who has been consistently contributing to health insurance for 5 years, with a maximum allowed interruption of 3 months.
Starting July 1st, 2025, the amended Health Insurance Law of 2024 will come into force, bringing three prominent benefits to millions of long-term health insurance participants.
Full health insurance coverage for various situations, including out-of-network services
One of the significant changes in the amended Health Insurance Law is that individuals with continuous health insurance participation of 5 years or more will be eligible for full reimbursement of medical expenses if their total out-of-pocket payments in a year exceed 6 times the reference level (a government-determined amount, replacing the previous minimum wage standard).
Additionally, individuals may receive 100% coverage for out-of-network services under certain conditions. These include diagnosing critical or rare illnesses that require surgery or advanced medical techniques at specialized hospitals.
Individuals will be eligible for full health insurance coverage in various situations, including out-of-network services.
No more waiting period for advanced medical technique benefits
According to the 2008 Health Insurance Law, first-time health insurance participants or those with interrupted insurance had to wait 30 days for their insurance to become effective, and an additional 180 days for benefits related to advanced medical techniques. The new regulation eliminates this waiting period.
As of July 1st, individuals in these categories will only need to wait 30 days for their insurance to become effective, regardless of whether they require basic or advanced medical services.
This improvement allows patients to access modern medical services more swiftly during critical situations.
A new approach to calculating out-of-pocket expenses
Previously, the minimum wage was the basis for calculating an individual’s out-of-pocket expenses. However, starting in July, the new law will introduce a “reference level” concept, determined by the government, to calculate contribution and benefit levels, replacing the previous minimum wage standard.
This change makes the health insurance policy more flexible and encourages individuals to maintain continuous participation, as the health insurance fund will cover all expenses once they exceed 6 times the reference level.
Conditions for Availing Full Health Insurance Benefits
To avail of the full health insurance benefits (100% coverage of medical expenses) from July 1st, health insurance participants need to ensure the following:
– Continuous health insurance participation of 5 years or more (with a maximum interruption of 3 months)
– Total out-of-pocket expenses in a year exceed 6 times the reference level. Currently, the base salary is VND 2.34 million. Therefore, individuals with continuous health insurance participation of 5 years or more must have out-of-pocket medical expenses exceeding VND 14.04 million (6 times the base salary)
– Adherence to the correct medical service network and referral procedures or belonging to the defined out-of-network cases.
Four additional groups eligible for health insurance contribution support
According to the amended Law on Health Insurance of 2024, effective July 1st, 2025, there are nine groups eligible for government support in health insurance contributions.
Four additional groups are eligible for government support in health insurance contributions.
These groups include:
– Individuals from near-poor households.
– Students and pupils.
– Individuals participating in security and order protection forces at the grassroots level.
– Individuals from agricultural, forestry, fishery, and salt-making households with a medium living standard as defined by the law.
– Village health workers and traditional midwives.
– Non-professional staff working in villages and residential areas as per legal regulations.
– Ethnic minority individuals living in communes no longer considered difficult or extremely difficult will receive health insurance contribution support as per government regulations.
– Individuals awarded the titles of People’s Artist or Meritorious Artist according to the Law on Cultural Heritage.
– Victims as defined by the Law on Prevention and Control of Human Trafficking.
Compared to the 2008 Health Insurance Law and its 2014 amendment, the new law adds four more cases eligible for government support in health insurance contributions.
According to Vietnam Social Security, as of early 2025, approximately 95.52 million people participated in health insurance, covering 94.2% of the population.
It is estimated that by the end of May, social insurance had reimbursed medical examination and treatment expenses for nearly 80 million people, an increase of 8.59% compared to the same period in 2024. The total payment is estimated at VND 63,324 billion, an increase of 15.59% over the same period last year.
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