New Benefits for Continuous Enrollment of 5 Years or More
According to Article 18 of the Decree, individuals with continuous enrollment in health insurance for 5 years or more are entitled to have 100% of their medical examination and treatment costs covered by the health insurance fund within the scope of benefits, provided that their co-payment costs exceed 6 months’ worth of the basic salary in a year.
Enrollment is considered continuous even with interruptions of up to 90 days. Special cases, such as employees, students, or scholars who are abroad for work or study; those accompanying families on term assignments; children under 18 traveling with their parents; and individuals awaiting unemployment benefits, are also recognized as continuous enrollees.
In the absence of electronic data, the social insurance agency will rely on valid paper documents, including social insurance books, military discharge decisions, and work confirmation letters, to ensure benefits. Individuals who previously served in the military, police, or full-time militia and then transferred to another sector or retired are also entitled to continuous enrollment time.
The new regulations also clarify that from the time of eligibility until the end of December of the fiscal year, patients are exempt from all co-payments. If treatment extends into the following year, the costs will be separated for each year.
When the basic salary changes, the co-payment amount will be adjusted accordingly. However, if the co-payment has already exceeded 6 months’ worth of the basic salary before the change, the benefits will remain unchanged.
The health insurance applies a series of new regulations from August 15, 2025.
Reimbursement Rates for Different Groups
As per Article 15 of Decree 188, the health insurance fund reimburses:
- 100% of the cost for priority groups (as specified in clauses 2 and 6 of Article 5 of the Decree).
- 80% of the cost for other groups (as specified in clauses 1, 3, 4, 5, and 7 of Article 5).
Individuals covered by the health insurance of the military, police, or cipher agencies who seek medical treatment at facilities not belonging to the Ministry of National Defense or the Ministry of Public Security will receive benefits according to the regulations stipulated in Decree 70/2015/ND-CP, amended and supplemented by Decree 74/2025/ND-CP.
5 Cases of Reimbursement without Presenting the Health Insurance Card
The new Decree adds provisions to address long-standing difficulties in health insurance reimbursement. Specifically, the following five groups are eligible for reimbursement without presenting their cards:
1. Children under 6 years old who do not have a card but can present a birth certificate or birth declaration.
2. Individuals waiting for card issuance, replacement, or information correction, carrying an appointment slip along with their ID.
3. Emergency cases, unconscious patients, or those who have passed away.
4. Individuals with a card that is lost, damaged, or contains incorrect information, and who have not yet had it corrected.
5. Individuals belonging to the group covered by state budget health insurance but have not yet been issued a card.
The medical facility and the social insurance agency will verify the validity of the health insurance code and make payments according to the benefit levels of each object.
Previously, cases such as not having a card, losing a card, or having incorrect card information were not specifically regulated, causing difficulties in practical reimbursement approval.
7 Cases of Health Insurance Card Revocation or Temporary Lock
From August 15, health insurance cards may be revoked if card issuance fraud is detected or if the named individual is no longer a health insurance participant. Fraudulent acts include providing false information about the object, benefit levels, or using other tricks to obtain the card.
Article 12 of Decree 188 states that when revoking, temporarily holding, or temporarily locking the value of the health insurance card, the social insurance agency must notify the insured.
The temporarily locked card will be unlocked, and the temporarily held card will be returned when the borrower has fulfilled their obligation to pay the fine and remedy the consequences (if any) according to the administrative sanction decision for the case specified in Article 12.
“A Proposal to Support Voluntary Social Insurance Contributions for Workers Aged 45 to 60 to Ensure Retirement Benefits”
We propose an additional 20% support for voluntary social insurance participants, on top of the existing 20% central support. This means that participants who have contributed to the social insurance fund for a total of 15 years will be eligible for a pension.
5 Unique Circumstances Where You Can Get Paid Without Presenting Your Health Insurance Card
The decree states that patients or their family members in the above-mentioned cases must present their identity documents, birth certificates, appointment cards, or other relevant paperwork for verification purposes.
“A Plea for Inclusion: Expanding Healthcare Coverage to More Vulnerable Groups”
The proposed addition of new beneficiary groups under the draft law has sparked interest and discussion among delegates, particularly regarding the suggestion to include the family members of regular military personnel as a group eligible for state-funded health insurance. This amendment aims to extend coverage to a wider range of individuals, ensuring that they have access to essential healthcare services.
A Proposal to Increase Social Insurance Support for Freelancers
The voters of Can Tho City propose an increase in subsidies to support farmers and freelance workers. This initiative aims to encourage greater participation in social insurance schemes, thereby enhancing social security for these vulnerable groups in the future.
The FLC Group Requests Quang Ngai to Return Over VND 80.5 Billion: What’s the Story?
This sum is what the FLC Group considers to be the cost of investing in projects in Quang Ngai.
