According to Article 20 of Decision 595/QĐ-BHXH in 2017 and Decision 896/QĐ-BHXH in 2021, individuals participating in group health insurance (BHYT) supported by the state budget and household groups are eligible for reimbursement under specific conditions. To safeguard your financial rights, it’s essential to understand the four scenarios where refunds are applicable and the procedures involved.
1. Detailed Breakdown of 4 Refundable Cases for BHYT Contributions in 2025
Current regulations outline situations where participants can receive refunds for unused insurance contributions.
Case One: Applies when a participant is issued a new BHYT card under a different group category and reports reduced usage of the previously issued card. This typically occurs when transitioning to a higher-priority group as defined in Article 12 of the 2008 Health Insurance Law. The refund amount is calculated based on the contribution level and the unused period, starting from the activation date of the new card.
Case Two: Applies when the state increases its subsidy for BHYT contributions. Similar to Case One, the refund is calculated based on the contribution level and the unused period, starting from the effective date of the adjustment decision.
Case Three: A regrettable yet important scenario is when a participant passes away before the insurance card becomes active. The refund is calculated from the card’s intended activation date.
Case Four: Occurs due to duplicate BHYT contributions. As per Article 20 of Decision 595/QĐ-BHXH, if duplicate payments are made, the Social Insurance Agency will refund the amount corresponding to the overlapping period, starting from the activation date of the new card.
2. 2025 Health Insurance Contribution Refund Procedure Guide
Decision 896/QĐ-BHXH in 2021 outlines the process and required documents for refund claims, which vary depending on the reason for the refund.
For Refunds Due to Duplicate Contributions or Group Changes
This process can be handled through a collection agent/school or directly by the individual at the provincial/district Social Insurance Agency.
Via Collection Agent or School: Participants must complete the Participation Declaration and Information Adjustment Form (TK1-TS) and submit it to the agent. The agent will then compile the List of BHYT Participants Only (D03-TS) and submit the documents to the Social Insurance Agency via electronic services, postal mail, or in person. Within 5 days of receiving the complete documents, the agency will issue a Refund Decision (C16-TS) and disburse the refund via the chosen method (direct, bank transfer, or agent).
Direct Submission by Individual: Participants prepare the TK1-TS form and submit it directly to the managing Social Insurance Agency or their local office. Submissions can be made via the Public Service Portal (with authentication and digital signature), postal mail, or in person. Similarly, the refund will be processed within 5 working days and disbursed as requested.
For Refunds in Case of Participant’s Death
This procedure applies to household BHYT participants (including farming, forestry, fishing, and salt-making households with average living standards) who pass away before their card becomes active. Next of kin can process the refund through a collection agent or directly at the Social Insurance Agency.
Via Collection Agent: Next of kin must complete the TK1-TS form and provide a certified copy of the death certificate. The agent will compile the D03-TS list and submit the documents to the Social Insurance Agency via electronic services, postal mail, or in person.
Direct Submission by Next of Kin: Prepare the TK1-TS form and relevant death certificate documents, then submit them to the Social Insurance Agency via electronic services, postal mail, or in person. Both methods require the agency to process the refund within 5 days of receiving valid documents, resulting in a Refund Decision (C16-TS) and the corresponding payment.
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Local Social Insurance (LSI) agencies have finalized the December 2025 pension payment plan, adhering to the procedures outlined in Decision 2222/QD-BHXH of 2025. LSI offices across provinces and cities will disburse pensions and social insurance allowances through two methods: direct deposit into personal bank accounts and cash payments via authorized payment service providers.
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