5 Unique Circumstances Where You Can Avail Health Insurance Benefits Without Presenting Your Card, Take Note!

The Government’s Decree No. 188/2025/ND-CP, which provides guidance on the implementation of the Law on Health Insurance and took effect on July 1, 2025 (with certain articles such as Article 37 taking effect on August 15, 2025), outlines five special cases where individuals are still entitled to health insurance reimbursement even if they are unable to present their insurance card at the time of medical examination and treatment.

5 Special Cases for Health Insurance Reimbursement Without Insurance Card Presentation

1. Children under 6 years old without a health insurance card

In the event that a child has not yet been issued a health insurance card, their parents or guardians can present a birth certificate or household registration book to facilitate the medical examination and treatment process. The child will still be eligible for full reimbursement from the health insurance fund, equivalent to the benefits of an insured individual (as per Point 2, Article 37, taking effect on August 15, 2025).

2. Individuals awaiting card issuance, replacement, or information update

During the waiting period for card issuance, replacement, or information update, individuals can present a scheduled appointment issued by the social insurance agency along with their personal identification documents to receive medical examination and treatment. The health insurance fund will provide full reimbursement according to the correct beneficiary entitlement (Point 3, Article 37, taking effect on August 15, 2025).

3. Emergency cases, unconscious or deceased individuals without card presentation

As per Point 1, Article 54 (taking effect on July 1, 2025), in emergency situations, or when a patient is unconscious or deceased and unable to present their health insurance card, the medical facility can verify their health insurance code or eligibility, and the individual will still be eligible for reimbursement of medical examination and treatment costs.

4. Individuals with lost, damaged, or incorrect information on their health insurance card, but have not yet made corrections

In cases where an individual has already enrolled in health insurance but their card is lost, damaged, or contains incorrect information, and they have not had the chance to replace or amend it, if their health insurance code is still valid and can be verified, they will receive health insurance reimbursement according to the correct beneficiary entitlement (Point 1, Article 54, taking effect on July 1, 2025).

5. Individuals from groups with health insurance funded by the state budget but have not yet been issued a card

For individuals from groups such as the poor, near-poor, or individuals with meritorious services, whose health insurance is supported by the state budget but have not yet been issued a card, if they have confirmation from the social insurance agency and a valid health insurance code, they will still be eligible for reimbursement of medical examination and treatment costs (Point 1, Article 54, taking effect on July 1, 2025).

General Conditions and Notes

Patients or their families must present personal identification documents (ID card/citizen identification card/passport), birth certificate/household registration book, scheduled appointment, or other verification documents.

Medical facilities and social insurance agencies must verify the validity of the health insurance code before making any reimbursement.

The reimbursement amount provided by the health insurance fund will comply with the specific health insurance benefits of each beneficiary group.

Decree No. 188/2025 officially stipulates these five beneficiary groups who are entitled to health insurance benefits even without presenting their insurance card at the time of medical examination. This ensures flexibility, timeliness, and protection of citizens’ rights in special cases. It is a step forward in perfecting the health insurance reimbursement mechanism, overcoming previous limitations such as card issuance delays, loss, or incorrect information. This policy came into effect on July 1, 2025 (with certain articles taking effect on August 15, 2025) and is being widely implemented nationwide.