Decree 188/2025/ND-CP detail Law on Health Insurance

DECREE

Detailing, and guiding the implementation of, a number of articles of the Law on Health Insurance

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Pursuant to the Law on Organization of the Government dated February 18, 2025;

Pursuant to 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; the Law Amending and Supplementing a Number of Articles of the Law on Health Insurance dated November 27, 2024;

Pursuant to Law No. 90/2025/QH15 dated June 25, 2025, Amending and Supplementing a Number of Articles of the Law on Bidding, the Law on Public-Private Partnership Investment, the Law on Customs, the Law on Value-Added Tax, the Law on Export Duty and Import Duty, the Law on Investment, the Law on Public Investment, and the Law on Management and Use of Public Property;

Pursuant to the National Assembly's Resolution No. 190/2025/QH15 dated February 19, 2025, on the settlement of a number of issues related to the rearrangement of the state apparatus;

At the proposal of the Minister of Health;

The Government hereby promulgates the Decree detailing, and guiding the implementation of, a number of articles of the Law on Health Insurance.

Chapter I

GENERAL PROVISIONS

Article 1. Scope of regulation

This Decree details, and guides the implementation of, a number of articles of Law No. 25/2008/QH12 on Health Insurance dated November 14, 2008, which has a number of articles amended and supplemented under 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 (below referred to as the Law on Health Insurance), including:

1. Detailing the following:

a) Contracts on health insurance-covered medical examination and treatment as prescribed in Article 25 of the Law on Health Insurance;

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

c) Methods of payment and the application of methods of payment of health insurance-covered medical examination and treatment costs as prescribed in Article 30 of the Law on Health Insurance;

d) Payment of health insurance-covered medical examination and treatment costs as prescribed at Points a and b, Clause 2, and Clause 3, Article 31 of the Law on Health Insurance;

dd) Allocation and use of the health insurance fund as prescribed in Clause 5, Article 35 of the Law on Health Insurance;

e) Handling of violations of the law regulations on health insurance as prescribed at Point a, Clause 2; Point a, Clause 3; and Clause 4, Article 49 of the Law on Health Insurance.

2. Prescribing the following:

a) Health insurance participants as prescribed at Point a, Clause 7, Article 12 of the Law on Health Insurance;

b) Premium rates, subsidy rates, and responsibilities for and methods of paying health insurance premiums as prescribed at Points dd and e, Clause 1, and Clause 7, Article 13 of the Law on Health Insurance;

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

d) Scope of benefits of health insurance participants as prescribed at Points a and c, Clause 3, Article 21 of the Law on Health Insurance;

dd) Levels of health insurance benefits of health insurance participants as prescribed at Point b, Clause 1; and Points e and h, Clause 4, Article 22 of the Law on Health Insurance; cases where health insurance participants use on-demand medical examination and treatment services as prescribed in Clause 6, Article 22 of the Law on Health Insurance and other cases not prescribed in Clause 1, Article 22 of the Law on Health Insurance;

e) Signing of health insurance-covered medical examination and treatment contracts as prescribed in Article 24 of the Law on Health Insurance;

g) Payment of health insurance-covered medical examination and treatment costs as prescribed at Point c, Clause 2, and Point a, Clause 4, Article 31 of the Law on Health Insurance;

h) Management of the health insurance fund, and decision on financial sources to ensure health insurance-covered medical examination and treatment in case of an imbalance between revenues and expenses of the health insurance fund as prescribed in Clause 2, Article 34 of the Law on Health Insurance;

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

k) Cases prescribed in Clause 1, Article 48b of the Law on Health Insurance which are not regarded as evasion of health insurance premium payment for plausible reasons;

l) Transitional provisions for the performance of health insurance-covered medical examination and treatment contracts which are signed before July 01, 2025, and remain valid after July 01, 2025.

3. Guiding the implementation of the following:

a) Payment of costs of medicinal products and medical equipment as prescribed in Clause 3, Article 55 of the 2023 Law on Bidding, which is amended and supplemented under Law No. 90/2025/QH15;

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

c) Tasks and powers of ministries, local authorities, agencies, and persons with competence in health insurance after the rearrangement of the apparatus;

d) Responsibilities of related parties in the organization of implementation.

Article 2. Subjects of application

1. This Decree applies to health insurance participants, health insurance-covered medical examination and treatment establishments, social security offices, and other organizations and individuals related to health insurance, including the subjects prescribed in Clause 2 of this Article.

2. Health insurance participants and health insurance-covered medical examination and treatment establishments in the following cases:

a) Health insurance participants under the management of the Ministry of National Defense or the Ministry of Public Security who take medical examination and treatment at health insurance-covered medical examination and treatment establishments not under the management of the Ministry of National Defense or the Ministry of Public Security;

b) Health insurance participants not under the management of the Ministry of National Defense or the Ministry of Public Security who take medical examination and treatment at health insurance-covered medical examination and treatment establishments under the management of the Ministry of National Defense or the Ministry of Public Security.

3. Health insurance participants in the People's Army, People's Public Security Forces, and participants engaged in cypher work who take medical examination and treatment at health insurance-covered medical examination and treatment establishments under the management of the Ministry of National Defense or the Ministry of Public Security shall be subject to separate regulations of the Government applicable to such participants.

Article 3. Cases not regarded as evasion of health insurance premium payment

Cases prescribed at Points a and c, Clause 1, Article 48b of the Law on Health Insurance are not regarded as evasion of health insurance premium payment for one of the following reasons as announced by a competent authority in charge of prevention and control of natural disasters, state of emergency, civil defense, and prevention and control of epidemics, including:

1. Storms, floods, inundation, earthquakes, major fires, prolonged droughts, and other types of natural disasters that directly and seriously affect production and business activities.

2. Dangerous epidemics announced by a competent state agency, which cause serious impacts on production and business activities and the financial capacity of agencies, organizations, and employers.

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

4. Other force majeure events as prescribed in the civil law regulations.

Article 4. Determination of amounts payable and reimbursement of costs for patients in case of delayed payment or evasion of payment of health insurance premiums

1. Agencies, organizations, and employers that delay or evade payment of health insurance premiums shall pay the amounts for such delayed payment or evasion of payment to the social security office. The amount payable for delayed payment or evasion of payment of health insurance premiums is determined as follows:

Cđt = Pst x n x 0.03%

Where:

- Cđt: The amount payable for the number of days of delayed payment or evasion of payment for month t (t=1,2,3,…,12)

- Pst: The payable amount arising in month t

- n: The number of days of delayed payment or evasion of payment.

2. Agencies, organizations, and employers that delay or evade payment of health insurance premiums shall reimburse health insurance-covered medical examination and treatment costs for employees in case of delayed payment or evasion of payment of health insurance premiums as follows:

a) The employee or his/her relative or lawful representative as prescribed by the law regulations shall directly submit a dossier with the components prescribed in Clauses 2, 3 and 4, Article 55 of this Decree to the agency, organization, or employer that has delayed or evaded payment of health insurance premiums;

b) The agency, organization, or employer shall pay the costs of medical examination and treatment to the employee or his/her relative or lawful representative as prescribed by the law regulations within 40 days after receiving a complete dossier of request for payment;

c) The medical examination and treatment establishment shall provide a statement of costs determining the amount paid by the patient to the medical examination and treatment establishment, enclosed with a lawful invoice, at the request of the patient, to serve as a basis for the patient to request reimbursement of health insurance-covered medical examination and treatment costs.

Chapter II

HEALTH INSURANCE PARTICIPANTS, PREMIUM RATES, SUPPORT RATES, AND RESPONSIBILITIES FOR PAYING HEALTH INSURANCE PREMIUMS

Article 5. Health insurance participants

In addition to those prescribed in Clauses 1, 2, 3, 4, 5 and 6, Article 12 of the Law on Health Insurance, health insurance participants also include the following persons:

1. Rubber plantation workers who are on monthly allowance as prescribed by the Government. They shall participate in health insurance as the group of health insurance participants for whom health insurance premiums shall be paid by social security offices as prescribed in Clause 2, Article 12 of the Law on Health Insurance.

2. Persons residing in communes within former revolutionary bases during the resistance war against French colonialism or the resistance war against the United States, who currently have permanent residence in such communes and have such residence updated in the National Population Database and the Residence Database. They shall participate in health insurance as the group of health insurance participants for whom health insurance premiums shall paid by the state budget as prescribed in Clause 3, Article 12 of the Law on Health Insurance.

3. Persons conferred with the title of People's Artist or Emeritus Artist who are members of households with a monthly per-capita income lower than the statutory pay rate as prescribed by the Government but are not included in the group of health insurance participants prescribed in Clauses 1, 2 and 3, Article 12 of the Law on Health Insurance. They shall participate in health insurance as the group of health insurance participants for whom health insurance premiums shall be paid by the state budget as prescribed in Clause 3, Article 12 of the Law on Health Insurance.

4. Victims of unexploded ordnance as prescribed in Clause 8, Article 3 of the Government's Decree No. 18/2019/ND-CP dated February 1, 2019 on management and clearance of unexploded ordnance, who are not included in the group of health insurance participants prescribed in Clauses 1, 2 and 3, Article 12 of the Law on Health Insurance. They shall participate in health insurance as the group of health insurance participants for whom health insurance premiums shall be subsidized by the state budget as prescribed in Clause 4, Article 12 of the Law on Health Insurance.

5. Relatives of participants engaged in other activities in cypher organizations as prescribed in the law regulations on cypher who are not included in the group of health insurance participants prescribed at Points a, b, c, d, dd, e, g, h and i, Clause 1; Clause 2 and Clause 3, Article 12 of the Law on Health Insurance. They shall participate in health insurance as the group of health insurance participants for whom health insurance premiums shall be paid by their employers, paid by themselves or jointly paid by their employers and themselves as prescribed in Clause 1, Article 12 of the Law on Health Insurance.

6. Persons who participated in resistance wars, national defense missions, or international duties and other persons for whom health insurance premiums have been paid by the state budget as prescribed in legal documents promulgated before January 1, 2025. They shall participate in health insurance as the group of health insurance participants for whom health insurance premiums shall be paid by the state budget as prescribed in Clause 3, Article 12 of the Law on Health Insurance.

7. Cadets from commune-level Military Commands undergoing full-time college- or university-level training in the field of grassroots military studies in accordance with the Prime Minister's decision and law regulations before January 1, 2025, who are entitled to cost-of-living allowance from the state budget and have not yet participated in health insurance. They shall participate in health insurance as the group of health insurance participants for whom health insurance premiums shall be paid by the state budget as prescribed in Clause 3, Article 12 of the Law on Health Insurance.

8. Those prescribed in Clauses 1, 2, 3, 4, 5, 6 and 7 of this Article who are concurrently included in different groups of health insurance participants as prescribed in Article 12 of the Law on Health Insurance. They shall participate in health insurance on the principle prescribed at Point a, Clause 5, Article 13 of the Law on Health Insurance.

9. A person prescribed in Clause 4 of this Article who is also prescribed in Clause 4, Article 12 of the Law on Health Insurance may choose to participate in health insurance as the group with the highest subsidy rate.

Article 6. Premium rates, subsidy rates, and responsibilities for paying health insurance premiums

1. Rates of health insurance premiums to be paid by employers or by employees or jointly paid by employers and employees are prescribed as follows:

a) The monthly premium rate applicable to the participants prescribed at Points a, c, d and e, Clause 1, Article 12 of the Law on Health Insurance is 4.5% of the monthly salary serving as a basis for compulsory social security contribution, with two-thirds to be paid by the employer and one-third to be paid by the employee;

b) The monthly premium rate applicable to the participants prescribed at Points b and dd, Clause 1, Article 12 of the Law on Health Insurance is 4.5% of the monthly salary serving as a basis for compulsory social security contribution and shall be paid by such participants;

c) The monthly premium rate applicable to the participants prescribed at Point g, Clause 1, Article 12 of the Law on Health Insurance is 4.5% of the statutory pay rate, with two-thirds to be paid by the employer and one-third to be paid by the employee;

d) The monthly premium rate applicable to the participants prescribed at Point h, Clause 1, Article 12 of the Law on Health Insurance is 4.5% of the monthly salary serving as a basis for compulsory social security contribution, with two-thirds to be paid by the employer and one-third to be paid by the employee;

dd) The monthly premium rate applicable to the participants prescribed at Point i, Clause 1, Article 12 of the Law on Health Insurance is 4.5% of the statutory pay rate and shall be paid by the employers of national defense workers and public employees who are serving in the Army, and the employers of public security workers who are serving in the People's Public Security forces;

e) The monthly premium rate applicable to the participants prescribed in Clause 5, Article 5 of this Decree is 4.5% of the statutory pay rate and shall be paid by the employers of participants engaged in other activities in cypher organizations as prescribed in the law regulations on cypher;

g) For an employee who is a cadre, civil servant, or public employee and is being held in temporary custody or detention, or temporarily suspended from work or position pending disciplinary action, the monthly premium rate is 4.5% of 50% of his/her monthly salary serving as a basis for compulsory social security contribution of the month preceding the month of temporary detention, custody, or suspension as prescribed by the law regulations, with two-thirds to be paid by the employer and one-third to be paid by the employee. If a competent agency concludes that he/she commits no violation of law, the employer and the employee shall retrospectively pay health insurance premiums based on the retrospectively received salary amount.

2. Rates of health insurance premiums to be paid by social security offices are prescribed as follows:

a) The monthly premium rate applicable to the participants prescribed at Point a, Clause 2, Article 12 of the Law on Health Insurance is 4.5% of pension or working capacity loss allowance;

b) The monthly premium rate applicable to the participants prescribed at Points b and c, Clause 2, Article 12 of the Law on Health Insurance and Clause 1, Article 5 of this Decree is 4.5% of the statutory pay rate;

c) The monthly premium rate applicable to the participants prescribed at Point d, Clause 2, Article 12 of the Law on Health Insurance is 4.5% of unemployment allowance.

3. Rates of health insurance premiums to be paid by the state budget are prescribed as follows:

a) The monthly premium rate applicable to the participants prescribed at Points e, g, h, i, k, l, m, o, p, q, r, s, t and u, Clause 3, Article 12 of the Law on Health Insurance and Clauses 2, 3, 6 and 7, Article 5 of this Decree is 4.5% of the statutory pay rate;

b) The monthly premium rate applicable to the participants prescribed at Point n, Clause 3, Article 12 of the Law on Health Insurance is 4.5% of the statutory pay rate, and such premiums shall be paid through scholarship-awarding agencies, organizations, or units.

4. Rates of health insurance premiums for the group of health insurance participants for whom health insurance premiums shall be subsidized by the state budget are prescribed as follows:

The monthly premium rate applicable to the participants prescribed in Clause 4, Article 12 of the Law on Health Insurance and Clause 4, Article 5 of this Decree is 4.5% of the statutory pay rate, and such premiums shall be paid by such participants with partial subsidies from the state budget as prescribed in Clause 6 of this Article.

5. The monthly premium rate applicable to the participants prescribed in Clause 5, Article 12 of the Law on Health Insurance is prescribed as follows:

a) The monthly premium rate is 4.5% of the statutory pay rate, and such premiums shall be paid by such participants by household or by themselves as individuals;

b) Household members prescribed at Point a, Clause 5, Article 12 of the Law on Health Insurance who jointly participate in health insurance in the capacity as households in a fiscal year are entitled to premium rate reduction as follows: the first member shall pay 4.5% of the statutory pay rate; the second, third and fourth members shall pay 70%, 60% and 50%, respectively, of the rate applicable to the first member; from the fifth member on, the premium rate is equal to 40% of the rate applicable to the first member.

6. The percentages of premiums subsidized by the state budget (subsidy rates) are prescribed as follows:

a) 100% of health insurance premiums, if the participant is a member of a near-poverty household currently residing in a poor commune under the Prime Minister's decision and other documents of competent agencies;

b) At least 70% of health insurance premiums, if the participant is prescribed at Point a, Clause 4, Article 12 of the Law on Health Insurance;

c) At least 70% of health insurance premiums, if the participant is prescribed at Point g, Clause 4, Article 12 of the Law on Health Insurance. The period of subsidy is 36 (thirty-six) months from the time the commune where the participant is residing is no longer regarded as a commune in an area with difficult or extremely difficult socio-economic conditions;

d) At least 50% of health insurance premiums, if the participant is prescribed at Point i, Clause 4, Article 12 of the Law on Health Insurance. The period of subsidy is 01 year from the time the participant is confirmed by a competent agency to be a victim as prescribed in the Law on Human Trafficking Prevention and Combat;

dd) At least 50% of health insurance premiums, if the participant is prescribed at Points b, c, dd, e and h, Clause 4, Article 12 of the Law on Health Insurance;

e) At least 30% of health insurance premiums, if the participant is prescribed at Point d, Clause 4, Article 12 of the Law on Health Insurance and Clause 4, Article 5 of this Decree.

Article 7. Methods and responsibilities for paying health insurance premiums for certain participants

1. For participants who are on pension or entitled to working capacity loss allowance, or monthly social security allowance from the state budget as prescribed in Clause 2, and Point q, Clause 3, Article 12 of the Law on Health Insurance and Clause 1, Article 5 of this Decree, the social security offices shall monthly transfer health insurance premiums for such participants from the funding source for payment of pension or social security allowance from the state budget.

2. For the participants prescribed at Points e, i and k, Clause 3, Article 12 of the Law on Health Insurance and Clause 6, Article 5 of this Decree, the provincial-level Departments of Home Affairs shall quarterly transfer health insurance premiums from the funding source for implementation of preferential policies toward participants with meritorious services to the revolution to the health insurance fund. By December 15 every year at the latest, the provincial-level Departments of Home Affairs shall complete the transfer of funds of that year to the health insurance fund.

3. For the participants prescribed at Point r, Clause 3, Article 12 of the Law on Health Insurance and Clause 2, Article 5 of this Decree, the provincial-level Departments of Health shall quarterly transfer health insurance premiums from the funding source for implementation of social relief policies to the health insurance fund. By December 15 every year at the latest, the provincial-level Department of Health shall complete the transfer of funds of that year to the health insurance fund.

4. For the participants prescribed at Points c, dd, e, h and i, Clause 4, Article 12 of the Law on Health Insurance and Clause 4, Article 5 of this Decree, the social security offices shall quarterly sum up the number of health insurance cards issued and the premiums and subsidies, using Form No. 1 provided in the Appendix to this Decree and send it to the provincial-level Departments of Finance for transfer of health insurance premiums from the local budget as prescribed in Clause 10 of this Article.

5. For the participants prescribed at Points g, h, l (except relatives of participants managed by the Ministry of National Defense), m, o, p, s, t and u, Clause 3; and Points a and g, Clause 4, Article 12 of the Law on Health Insurance and Clause 3, Article 5 of this Decree:

a) Every quarter, the social security offices shall sum up the number of health insurance cards issued and the premiums and subsidies, using Form No. 1 provided in the Appendix to this Decree, and send it to the provincial-level Departments of Finance for transfer of funds into the health insurance fund as prescribed in Clause 10 of this Article;

b) The time for calculating payable premiums for participants on an annual list is from January 1; for participants additionally included in the list during the year, premiums shall be calculated in accordance with Clauses 3 and 4, Article 6 of this Decree, and benefits shall be enjoyed from the date stated in the decision approving the list.

6. For pupils and students prescribed at Point b, Clause 4, Article 12 of the Law on Health Insurance:

a) Every 3 months, 6 months or 12 months, pupils and students or their parents or guardians shall pay health insurance premiums payable under Clause 2, Article 8 of this Decree to the social security offices;

b) Pupils and students of educational institutions or vocational institutions of ministries or central-level agencies are entitled to subsidies from the central budget. Every 3 months, 6 months or 12 months, the provincial-level social security office shall sum up the number of health insurance cards issued, health insurance premiums collected from pupils and students, and the premiums subsidized by the state budget, using Form No. 1 provided in the Appendix to this Decree, and send it to the Vietnam Social Security for summarization and sending to the Ministry of Finance for transfer of funds into the health insurance fund;

c) Pupils and students of other educational institutions or vocational institutions are entitled to the subsidies covered by local budget, including the part thereof subsidized by the central budget (if any), of the locality where such institutions are located, regardless of where their permanent residence is registered. Every 3 months, 6 months or 12 months, the social security offices shall sum up the number of health insurance cards issued, health insurance premiums collected from pupils and students, and the premiums subsidized by the state budget, using Form No. 1 provided in the Appendix to this Decree, and send it to the provincial-level Departments of Finance for transfer of funds into the health insurance fund as prescribed in Clause 10 of this Article.

7. For participants for whom health insurance premiums shall be partially subsidized by the state budget as prescribed at Point d, Clause 4, Article 12 of the Law on Health Insurance:

a) Every 3 months, 6 months or 12 months, a household's representative shall directly pay health insurance premiums payable under Clause 2, Article 8 of this Decree to the social security offices;

b) Every 3 months, 6 months or 12 months, the social security offices shall sum up the number of health insurance cards issued, health insurance premiums collected from the insured, and the premiums subsidized by the state budget, using Form No. 1 provided in the Appendix to this Decree, and send it to the provincial-level Departments of Finance for transfer of funds into the health insurance fund as prescribed in Clause 10 of this Article.

8. For household-based health insurance participants as prescribed in Clause 5, Article 12 of the Law on Health Insurance: every 3 months, 6 months, or 12 months, the household’s representative or a household member participating in health insurance shall pay the health insurance premiums, as prescribed in Clause 3, Article 8 of this Decree, to the social security office.

9. For the participants prescribed at Points h and i, Clause 1, Article 12 of the Law on Health Insurance and Clause 5, Article 5 of this Decree, employers shall monthly pay health insurance premiums for them together with paying health insurance premiums for other employees as prescribed from the following sources:

a) For units using state budget funds, health insurance premiums shall be covered by the state budget;

b) For non-business units, they shall use their funds to pay health insurance premiums as prescribed by the law regulations on the autonomy of public non-business units;

c) For enterprises, they shall use their funds to pay health insurance premiums.

10. Pursuant to the regulations on budget management decentralization of the competent authorities and based on the sum-up reports of the social security offices on the number of the insured and the premiums paid or subsidized by the state budget, the provincial-level Departments of Finance shall transfer funds into the health insurance fund on a quarterly basis. By December 15 every year at the latest, it shall complete the transfer of funds of the year to the health insurance fund.

11. For the participants prescribed at Point n, Clause 3, Article 12 of the Law on Health Insurance, scholarship-awarding agencies, units, or organizations shall quarterly pay health insurance premiums as prescribed into the health insurance fund.

12. For the participants prescribed at Point l, Clause 3, Article 12 of the Law on Health Insurance who are relatives of participants managed by the Ministry of National Defense and the participants prescribed in Clause 7, Article 5 of this Decree, the finance agencies of the units under the Ministry of National Defense shall quarterly pay health insurance premiums to the Army Social Security.

13. In case a health insurance participant is dead, missing or no longer resides in Vietnam, the health insurance premium shall be calculated from the time of payment to the time of cessation of payment according to the list of reduction of payment made by a competent agency.

Article 8. Determination of premiums and subsidies for certain participants when the State adjusts health insurance premium rates and the statutory pay rate

1. For the group of participants prescribed in Clause 3, Article 12 of the Law on Health Insurance and participants eligible for 100% subsidy of health insurance premiums as prescribed at Point a, Clause 6, Article 6 of this Decree for whom health insurance premiums are fully subsidized by the state budget:

a) The monthly premiums paid or subsidized by the state budget shall be calculated by multiplying (x) the health insurance premium rate by the statutory pay rate. When the State adjusts the health insurance premium rates and the statutory pay rate, the premiums paid by the state budget shall be adjusted from the date of application of the new health insurance premium rates and new statutory pay rate;

b) The health insurance premium for a participant prescribed at Point h, Clause 3, Article 12 of the Law on Health Insurance shall be calculated from his/her birthdate to the date he/she reaches full 72 months of age. For a Vietnamese child born overseas, the health insurance premium shall be calculated from the date he/she returns to reside in Vietnam as prescribed by the law regulations.

2. For the group of participants for whom health insurance premiums shall be partially subsidized by the state budget as prescribed at Points b and d, Clause 4, Article 12 of the Law on Health Insurance:

a) Monthly health insurance premiums payable by the insured and partly paid by the state budget shall be determined by multiplying (x) the health insurance premium rate by the statutory pay rate at the time of premium payment;

b) When the State adjusts the health insurance premium rate and the statutory pay rate, the insured and the state budget are neither required to pay additional premiums nor entitled to a refund of the difference arising from the adjustment for the remaining period during which the insured have paid health insurance premiums.

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

a) Their monthly health insurance premiums shall be determined by multiplying (x) the health insurance premium rate by the statutory pay rate at the time of premium payment;

b) When the State adjusts the health insurance premium rate and the statutory pay rate, the insured are neither required to pay additional premiums nor entitled to a refund of the difference arising from the adjustment for the remaining period during which they have paid health insurance premiums.

4. For participants who start to pay health insurance premiums on a date within a month, their health insurance premiums shall be determined by month counting from such date.

Chapter III

HEALTH INSURANCE CARDS

Article 9. Making of lists for grant of health insurance cards to certain participants

1. The responsibility to make lists for grant of health insurance cards must comply with Clause 3, Article 8 and Clause 1, Article 17 of the Law on Health Insurance.

2. The social security office shall make a list for grant of health insurance cards to persons who have donated their body organs as prescribed by the law regulations based on the hospital discharge forms issued by the medical examination and treatment establishments where the donors’ body organs were taken. The medical examination and treatment establishment shall guide the donor to fully declare information using Form No. 2 provided in the Appendix to this Decree on the National Public Service Portal or via the social security office's application and guide the donor to carry out procedures for grant of a health insurance card as prescribed in Article 11 of this Decree.

3. Commune-level People's Committees shall make lists for grant of health insurance cards to the participants prescribed in Clauses 1, 2, 3, 4 and 6, Article 5 of this Decree, and the participants prescribed at Points e, h, i, k, o, r, s and t, Clause 3, and Points a, d and g, Clause 4, Article 12 of the Law on Health Insurance who are living in the community.

4. Employers shall make lists for grant of health insurance cards to the participants prescribed in Clause 5, Article 5 of this Decree.

5. Establishments for nurturing and convalescence of wounded soldiers and participants with meritorious services to the revolution, and social relief establishments (below referred to as nurturing establishments) shall make lists for grant of health insurance cards to the participants prescribed at Points e, h, i, k, r and s, Clause 3, Article 12 of the Law on Health Insurance who are regularly nurtured in nurturing establishments.

6. Lists of health insurance participants shall be made using Form No. 3 and Form No. 4 provided in the Appendix to this Decree.

Article 10. Information on health insurance cards

1. An electronic or paper health insurance card shall be issued by the social security office with a health insurance code and the following basic information:

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

b) Information on the level of health insurance benefits based on the group of health insurance participants;

c) Effective date of the health insurance card;

d) Registered place of health insurance-covered primary medical examination and treatment;

dd) The date on which the participant will have completed 05 or more consecutive years of health insurance participation, applicable to participants who are required to co-pay medical examination and treatment costs.

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

3. The information on a health insurance card prescribed in Clause 1 of this Article shall be integrated and synchronized with the health insurance code and citizen identity number of the health insurance participant.

Article 11. Procedures for grant of health insurance cards

1. The social security office shall grant an electronic health insurance card to each health insurance participant. In case a health insurance participant so requests, the social security office shall grant a paper health insurance card.

2. The grant of a health insurance card (including first-time grant and re-grant) and adjustment of information on a health insurance card shall be carried out as follows:

a) A health insurance participant shall fully declare information using Form No. 2 provided in the Appendix to this Decree or the agency or organization managing participants shall fully declare information using Form No. 3 provided in the Appendix to this Decree on the National Public Service Portal or via the social security office's application or submit it directly at the single-window section of the assigned social security office or send it via the public postal service to the assigned social security office;

b) The health insurance participant or the agency or organization managing participants shall select the grant of an electronic health insurance card or a paper health insurance card on the declaration form or the list of participants. In case of change of information on relatives or change of information on benefit levels, the health insurance participant shall provide scanned copies of relevant documents to be submitted together with the declaration form on the National Public Service Portal or via the social security office's application or submit them in person at the single-window section of the assigned social security office or send them via the public postal service to the assigned social security office;

c) The National Public Service Portal or the social security office's application shall automatically return a dossier receipt slip and an appointment slip for returning the result of the grant of the health insurance card(s) to the health insurance participant or the agency or organization managing participants. In case of in-person submission of a dossier at the single-window section of the social security office, the dossier-receiving officer at the single-window section shall directly check the dossier, issue a dossier receipt slip and an appointment slip for returning the result of the grant of the health insurance card(s) to the health insurance participant or the agency or organization managing participants;

d) In case of grant of an electronic health insurance card, within 05 working days after receiving a complete dossier as prescribed at Points a, b and c of this Clause, the social security office shall return the result of the grant of an electronic health insurance card to the digital social security application (VssID), personal email, and link it to the level-2 electronic identification account (VNeID). The health insurance participant shall use an electronic device with the VNeID or VssID application installed and logged in with an Internet connection to receive the electronic health insurance card.

In case of grant of paper health insurance card(s), within 05 working days after receiving a complete dossier as prescribed at Points a, b and c of this Clause, the social security office shall transfer the paper health insurance card(s) to the health insurance participant or the organization managing participants for forwarding to the health insurance participants.

3. For children under 6 years of age, the grant of a health insurance card shall be carried out in conjunction with the procedures for birth registration and permanent residence registration as prescribed in the Government's Decree No. 63/2024/ND-CP dated June 10, 2024 prescribing online, inter-agency implementation of 02 groups of administrative procedures: birth registration, permanent residence registration, health insurance card issuance to children under 6 years; death registration, permanent residence deregistration, claim for funeral costs and survivor allowance.

4. The Army Social Security shall grant health insurance cards to the participants prescribed in Clause 7, Article 5 of this Decree.

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

1. A health insurance card shall be revoked in the cases prescribed in Clause 1, Article 20 of the Law on Health Insurance.

2. Cases of fraud in the grant of a health insurance card include:

a) Committing fraud in information on the participant and benefit level in the grant of a health insurance card;

b) Other fraudulent acts.

3. A health insurance card shall be seized or have its validity temporarily locked in the case prescribed in Clause 2, Article 20 of the Law on Health Insurance.

4. Upon detecting a violation prescribed in Clauses 1, 2 and 3 of this Article, a medical examination and treatment establishment shall notify the social security office.

5. The social security office shall revoke, seize or temporarily lock the validity of a health insurance card upon detecting or receiving a notice from a medical examination and treatment establishment of a violation prescribed in Clauses 1, 2 and 3 of this Article.

6. When revoking, seizing or temporarily locking the validity of a health insurance card, the social security office shall notify the health insurance participant.

7. A health insurance card which has its validity temporarily locked shall be unlocked, and a seized health insurance card shall be returned when the person who lends the card to another person and the person who uses another person's health insurance card have fulfilled the obligation to pay fines and take remedial measures (if any) under the decision to impose penalties on administrative violations in the case prescribed in Clause 3 of this Article.

Article 13. Effective date of health insurance cards

1. For the participants prescribed at Point d, Clause 2, Article 12 of the Law on Health Insurance: From the date of entitlement to unemployment allowance stated in the decision on entitlement to unemployment allowance issued by a competent state agency.

2. For the persons prescribed at Point h, Clause 3, Article 12 of the Law on Health Insurance:

a) For a child born on or before September 30: from the birthdate to the end of September 30 of the year when the child reaches full 72 months of age;

b) For a child born after September 30: from the birthdate to the end of the last day of the month when the child reaches full 72 months of age.

3. For the participants prescribed at Point r, Clause 3, Article 12 of the Law on Health Insurance: from the date of entitlement to social allowance stated in the decision of the People's Committee with decentralized competence.

4. For the participants prescribed at Point o, Clause 3, and Point a, Clause 4, Article 12 of the Law on Health Insurance for whom health insurance premiums shall be fully subsidized by the state budget: from the date stated in the decision approving the list of eligible participants issued by a competent state agency.

5. For the participants prescribed at Point m, Clause 3, Article 12 of the Law on Health Insurance: immediately after the donation of a body organ.

6. For the participants prescribed at Point h, Clause 4, Article 12 of the Law on Health Insurance: from the date stated in the decision approving the list of eligible participants issued by a competent state agency.

7. For pupils of general educational institutions prescribed at Point b, Clause 4, Article 12 of the Law on Health Insurance who pay health insurance premiums on an annual basis as follows:

a) For grade-1 pupils: from October 1 of the first year of the primary education level; from the last day of the month when the child reaches full 72 months of age in the case prescribed at Point b, Clause 2 of this Article;

b) For grade-12 pupils: from January 1 to the end of September 30 of that year. Grade-12 pupils are encouraged to pay health insurance premiums and are entitled to the health insurance subsidy until the end of December 31 of the final school year to ensure continuous health insurance benefits, without having to refund the health insurance premiums subsidized by the state budget in case the group of participants is changed.

8. For pupils and students of higher education institutions and vocational institutions prescribed at Point b, Clause 4, Article 12 of the Law on Health Insurance who pay health insurance premiums on an annual basis, in which:

a) For students of the first year of a training program: from the first date of their school attendance; in case the grade-12 pupil's card remains valid after the school attendance date, premiums shall be paid from the expiration date of the health insurance card;

b) For students of the last year of a training program: from January 1 to the last day of the month when the program finishes. Students of the last year of a training program are encouraged to pay health insurance premiums and are entitled to the health insurance subsidy until the end of December 31 of the final school year to ensure continuous health insurance benefits, without having to refund the health insurance premiums subsidized by the state budget in case the group of participants is changed.

9. For other participants, a health insurance card will be valid from the date of payment of health insurance premiums, unless otherwise prescribed at Point c, Clause 3, Article 16 of the Law on Health Insurance.

10. The validity period of a health insurance card prescribed in this Article corresponds to the paid health insurance premium as prescribed, except for children under 6 years of age.

Chapter IV

SCOPE AND LEVELS OF BENEFITS TO WHICH HEALTH INSURANCE PARTICIPANTS ARE ENTITLED

Article 14. Scope of benefits regarding costs of patient transport

1. Health insurance participants prescribed at Points a, b, c, d, dd, e, h, i, o and r, Clause 3, Article 12 of the Law on Health Insurance who are undergoing inpatient treatment or in an emergency and need to be transferred to another medical examination and treatment establishment shall have their transport costs covered.

2. The health insurance fund shall cover costs of patient transport to the medical examination and treatment establishment that transfers the patient based on the specific price of patient transport services as follows:

a) For a state-owned medical examination and treatment establishment, payment shall be made at the price of patient transport services approved or set by a competent authority;

b) For a private medical examination and treatment establishment, the price of patient transport services of a state-owned medical examination and treatment establishment shall be applied as a basis for requesting the health insurance fund to pay, which must comply with the principles similar to the payment of costs of technical services in health insurance-covered medical examination and treatment to private medical examination and treatment establishments as prescribed in Article 47 of this Decree.

3. In case the price of patient transport services is not yet available, the transport cost to be paid by the health insurance fund shall be determined based on the following grounds:

a) The actual distance between the two medical examination and treatment establishments;

b) The fuel cost payment level, which is calculated at a rate of 0.2 liters of commonly used gasoline per 01 kilometer. The rates and benefit levels prescribed in Article 22 of the Law on Health Insurance shall not apply. The unit price of gasoline shall be based on the common gasoline price in the locality of the medical examination and treatment establishment that transports the patient at the time of patient transport to another medical examination and treatment establishment, as stated on the patient transfer form.

4. For a medical examination and treatment establishment that provides patient transport services in case the price of patient transport services has not yet been approved or set by a competent authority, the health insurance fund shall make payment as follows:

a) It shall pay the two-way transport cost to the medical examination and treatment establishment that transfers the patient at the unit price on the invoice for purchase of gasoline or oil based on the actual type of gasoline or oil consumed by the patient transport vehicle but not exceeding the fuel cost payment level prescribed at Point b, Clause 3 of this Article;

b) In case the patient transport vehicle does not use gasoline or oil as fuel, the reimbursement rate for fuel costs prescribed at Point b, Clause 3 of this Article shall be applied;

c) In case more than 01 (one) patient is transported on the same vehicle, the reimbursement rate shall be calculated as for the transport of 01 patient;

d) The medical examination and treatment establishment that orders the patient transfer shall sum up all transport costs and settle them with the social security office. A medical worker of the medical examination and treatment establishment that receives the transferred patient shall sign for certification on the vehicle dispatch form of the patient-transferring establishment.

5. For a patient who arranges his/her own transport, the health insurance fund shall make payment as follows:

a) It shall pay the one-way transport cost (from the patient-transferring establishment to the patient-receiving establishment) according to the invoice of patient transport to the medical examination and treatment establishment that receives the patient at a payment level not exceeding the one prescribed at Points a and b, Clause 3 of this Article;

b) The medical examination and treatment establishment that orders the patient transfer shall state that the patient arranges his/her own transport on the patient transfer form to another medical examination and treatment establishment;

c) The medical examination and treatment establishment that receives the patient shall reimburse the cost to the patient based on the transport invoice provided by the patient as prescribed at Point a of this Clause and sum up the transport cost for settlement with the social security office.

Article 15. Levels of health insurance benefits for certain participants and in certain cases

1. Health insurance participants prescribed in Clauses 1, 2, 3, 4, 5, 6 and 7, Article 5 of this Decree who take medical examination and treatment as prescribed in Articles 26 and 27 of the Law on Health Insurance may have medical examination and treatment costs covered by the health insurance fund within the scope of benefits at the following levels:

a) 100% of medical examination and treatment costs, for the participants prescribed in Clauses 2 and 6, Article 5 of this Decree;

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

2. Health insurance participants prescribed at Points a, b, c, d and dd, Clause 3, Article 12 of the Law on Health Insurance who take medical examination and treatment at health insurance-covered medical examination and treatment establishments not under the management of the Ministry of National Defense or the Ministry of Public Security may have medical examination and treatment costs covered by the health insurance fund at the benefit levels prescribed in Article 11 of the Government's 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, People's Public Security forces, and participants engaged in cypher work, which is amended and supplemented by the Government's Decree No. 74/2025/ND-CP dated March 31, 2025.

Article 16. Participants to whom the payment rates prescribed at Point c, Clause 2, Article 21 of the Law on Health Insurance are not applicable

Participants, to whom the payment rates prescribed at Point c, Clause 2, Article 21 of the Law on Health Insurance are not applicable, include:

1. Persons who had taken part in revolutionary activities before January 1, 1945.

2. Persons who had taken part in revolutionary activities from January 1, 1945, to the  date of the August 1945 Uprising.

3. Vietnamese heroic mothers.

4. Wounded soldiers, persons entitled to policies like wounded soldiers, grade-B wounded soldiers, and sick soldiers suffering a working capacity decrease of 81% or more.

5. Wounded soldiers, persons entitled to policies like wounded soldiers, grade-B wounded soldiers, and sick soldiers receiving treatment of recurring injuries or diseases.

6. Persons who had taken part in resistance wars and are infected with agent orange, thereby suffering a working capacity decrease of 81% or more.

7. Children under 6 years of age.

Article 17. Application of levels of health insurance benefits in certain cases

1. A health insurance participant is determined to be entitled to 100% coverage of medical examination and treatment costs as prescribed at Point b, Clause 1, Article 22 of the Law on Health Insurance if the cost for a single session of medical examination and treatment is less than 15% of the statutory pay rate.

2. Point b, Clause 1, Article 22 of the Law on Health Insurance and Clause 1 of this Article shall apply to cases where health insurance participants take medical examination and treatment as prescribed in Clauses 1, 3, 4 and 5, Article 22 of the Law on Health Insurance.

3. Points dd and e, Clause 1, Article 22 of the Law on Health Insurance shall apply to cases where health insurance participants take medical examination and treatment as prescribed in Clauses 3, 4 and 5, Article 22 of the Law on Health Insurance, unless otherwise prescribed in Clause 2 of this Article and except for participants entitled to 100% coverage of medical examination and treatment costs.

4. A health insurance participant who falls into more than one group with different benefit levels as prescribed in Clause 1, Article 22 of the Law on Health Insurance may enjoy the highest benefit level. In case of application of the benefit levels prescribed at Points a, b, c and d, Clause 1, Article 22 of the Law on Health Insurance, the benefit levels for participants prescribed at Points dd and e, Clause 1, Article 22 of the Law on Health Insurance shall not be applied.

Article 18. Application of benefit levels for persons having participated in health insurance for 5 consecutive years or more

1. The period of health insurance participation shall be deemed consecutive in the following cases, enabling participants to be entitled to the benefit levels applicable to those who have participated in health insurance for 05 or more consecutive years, as prescribed at Point d, Clause 1, Article 22 of the Law on Health Insurance:

a) If the period of health insurance participation is interrupted for no more than 90 days, it shall be deemed consecutive;

b) A person assigned by a competent authority to go on business trips, study, work, or accompany his/her spouse, or a biological or legally adopted child under 18 years old accompanying a parent on an overseas assignment at a Vietnamese agency abroad, shall have his/her time abroad counted as health insurance participation period;

c) For an employee working abroad under the Law on Vietnamese Guest Workers and in other cases where an employee is sent to work abroad by a state agency, the period of health insurance participation before going to work abroad shall be counted if he/she resumes health insurance participation within 30 days from the date of entry into Vietnam;

d) For an employee carrying out procedures for entitlement to unemployment allowance as prescribed in the Law on Employment, the period of health insurance participation prior to the termination of the labor contract or working contract, excluding the period from the date of contract termination to the date of submission of the dossier of request for unemployment allowance, shall be counted;

dd) For participants prescribed at Points a, b and d, Clause 3, Article 12 of the Law on Health Insurance who have retired, been demobilized, changed their jobs, or quitted their jobs, the period of study or work in the People's Army, People's Public Security forces, and cypher organizations shall be counted as the period of health insurance participation. In case there is no basis to determine the period of health insurance participation, the social security office shall base itself on one of the documents issued by an army, public security, or cypher unit that shows the working process, such as: social security book, decision on demobilization, discharge, or quitting of job; resume of a military participant, national defense worker and public employee, People's Public Security participant, or cypher participant; a written certification of the working process issued by a unit of the regimental or equivalent level or higher to determine the period of health insurance participation for the participant;

e) For a participant prescribed at Point dd, Clause 3, Article 12 of the Law on Health Insurance who has stopped performing the duty of a standing militia member, the period of performance of the duty shall be counted as a period of health insurance participation.

2. Payment of medical examination and treatment costs for a patient who has participated in health insurance for 05 consecutive years or more and has a co-payment amount of medical examination and treatment costs in a year higher than 6 times the monthly statutory pay rate as prescribed at Point d, Clause 1, Article 22 of the Law on Health Insurance is as follows:

a) The health insurance fund shall cover 100% of medical examination and treatment costs within the scope of benefits of the health insurance participant from the time the patient concurrently meets the conditions of having participated in health insurance for 05 consecutive years or more and having a co-payment of medical examination and treatment costs in a fiscal year higher than 6 times the monthly statutory pay rate until the end of December 31 of that year; in case a health insurance participant takes medical examination and treatment before January 1 and finishes the session of medical examination and treatment and is discharged from the hospital on or after January 1 of the following year, the treatment costs shall be determined for each year to calculate the co-payment;

b) The social security office shall sum up information on the cumulative co-payment in a fiscal year of the patient, the date on which the patient has completed 05 or more consecutive years of health insurance participation and notify it on the data receiving portal of the Vietnam Social Security. The medical examination and treatment establishment shall base itself on the cumulative co-payment and the date on which the patient has completed 05 or more consecutive years of health insurance participation to determine the date the patient is eligible for exemption from co-payment in the patient's session of medical examination and treatment;

c) In case the statutory pay rate changes during the year, the remaining co-payment from the time the statutory pay rate changes to the end of December 31 of that year shall be determined as follows:

In cases where the co-payment from January 1 to before the date of change of the statutory pay rate in the year is sufficient or exceeds 6 times the monthly statutory pay rate, the benefits shall be enjoyed as prescribed and this formula shall not be applied.

Article 19. Schedules of implementation and benefit rates for outpatient medical examination and treatment at basic-level medical examination and treatment establishments as prescribed at Points e and h, Clause 4, Article 22 of the Law on Health Insurance

1. From January 1, 2025, when taking outpatient medical examination and treatment at a basic-level medical examination and treatment establishment with a score of less than 50 points or temporarily classified as a basic-level establishment, a health insurance participant may have 100% of the benefit level covered by the health insurance fund, unless the basic-level medical examination and treatment establishment has been determined by a competent agency to be of the provincial or central level before January 1, 2025.

2. From July 01, 2026, when taking outpatient medical examination and treatment at a basic-level medical examination and treatment establishment with a score of between 50 points and under 70 points, a health insurance participant may have 50% of the benefit level covered by the health insurance fund.

3. From July 01, 2026, when taking outpatient medical examination and treatment at a basic-level medical examination and treatment establishment which, before January 1, 2025, has been determined by a competent agency to be of the provincial or central level or equivalent to the provincial or central level, a health insurance participant may have 50% of the benefit level covered by the health insurance fund.

4. From July 01, 2026, when taking outpatient medical examination and treatment at a specialized medical examination and treatment establishment which, before January 1, 2025, has been determined by a competent agency to be of the provincial level as prescribed at Point h, Clause 4, Article 22 of the Law on Health Insurance, a health insurance participant may have 50% of the benefit level covered by the health insurance fund.

Article 20. Benefit levels for health insurance participants who take on-demand medical examination and treatment

1. A health insurance card holder who takes on-demand medical examination and treatment may have the medical examination and treatment cost covered by the health insurance fund within the scope and at the level of benefits as prescribed by the law regulations on health insurance. The difference between the cost of on-demand medical examination and treatment services and the cost covered by the health insurance fund shall be paid by the patient to the medical examination and treatment establishment.

2. A medical examination and treatment establishment shall ensure human resources and professional conditions, publicize the costs payable by patients beyond the scope and level of health insurance benefits, the difference in costs, and notify the patient in advance.

Article 21. Regulations on the time of application of health insurance benefit levels in case of multiple or changing benefit levels

1. In case a health insurance participant falls into more than one group with different benefit levels as prescribed in Article 22 of the Law on Health Insurance, the highest benefit level shall be applied.

2. In case of a change of the health insurance benefit level, the new health insurance benefit level shall be applied from the effective date of the new health insurance card. A patient holding a health insurance card who is undergoing inpatient treatment and has a change in the health insurance benefit level shall provide information on the card related to the change of the benefit level. The medical examination and treatment establishment shall check the benefits and benefit level of the health insurance participant before the end of the course of medical examination and treatment and discharge from the hospital.

Chapter V

CONTRACTS ON HEALTH INSURANCE-COVERED MEDICAL EXAMINATION AND TREATMENT

Article 22. Conditions for signing health insurance-covered medical examination and treatment contracts

1. To fully meet the operating conditions of a medical examination and treatment establishment as prescribed in Article 49 of the Law on Medical Examination and Treatment, which are suitable to the scope of provision of health insurance-covered medical examination and treatment services.

2.  To meet the standards for inter-agency connection of health insurance-covered medical examination and treatment data with the health insurance information and assessment system of the social security office as prescribed by the Minister of Health and to authenticate data on payment of medical examination and treatment costs as prescribed by the law regulations.

Article 23. Health insurance-covered medical examination and treatment contracts

1.  A health insurance-covered medical examination and treatment contract shall be signed between a medical examination and treatment establishment that fully meets the conditions prescribed in Article 22 of this Decree and a social security office assigned by a competent authority to sign contracts:

a) Each operation license shall be used to sign 01 health insurance-covered medical examination and treatment contract, unless otherwise prescribed at Points b and dd of this Clause;

b) In case a medical examination and treatment establishment additionally establishes facilities within the same province or municipality, it may either sign 01 health insurance medical examination and treatment contract with the social security office, or sign separate health insurance-covered medical examination and treatment contracts for each facility with the social security office;

c) In case a medical examination and treatment establishment additionally establishes facilities in other provinces or municipalities, each facility shall sign a health insurance-covered medical examination and treatment contract with the social security office of the locality where such facility is located;

d) A medical examination and treatment establishment that has a subordinate medical examination and treatment establishment fully meeting the conditions prescribed in Article 22 of this Decree but not being of the same professional and technical level shall sign a separate medical examination and treatment contract for the subordinate establishment;

dd) In case a health insurance-covered medical examination and treatment establishment is under the management of the Ministry of National Defense or the Ministry of Public Security, the medical examination and treatment establishment may sign 01 health insurance-covered medical examination and treatment contract with the army or public security social security office and 01 contract with a social security office of the Vietnam Social Security.

2.  A health insurance-covered medical examination and treatment contract shall be made using Form No. 5 provided in the Appendix to this Decree and contain the primary details prescribed in Article 25 of this Decree. Any addendum to the contract prescribed in Clause 2, Article 24 of this Decree and the notices as prescribed in Clause 3, Article 24 of this Decree constitute an integral part of the contract and have the same validity period as the contract.

3.  In case of a change as prescribed in Clause 2, Article 24 of this Decree, the medical examination and treatment establishment and the social security office shall sign an addendum to the contract as prescribed in Article 29 of this Decree.

4.  A health insurance-covered medical examination and treatment contract takes effect from the date of its signing or as prescribed in the contract.

5.  A health insurance-covered medical examination and treatment contract is a contract of an indefinite term or a definite term as agreed by the two parties, unless otherwise it is terminated in accordance with Points b, c, d and dd, Clause 1, Article 32 of this Decree. At the end of each fiscal year, the social security office and the health insurance-covered medical examination and treatment establishment shall jointly determine the items and the amounts of medical examination and treatment costs requested for payment, advanced, assessed, paid, unpaid, account-finalized, refused for payment, and recovered in the year and the method and time limit for settlement of each unconsolidated item, and the obligations to be performed by each party to serve as a basis for the medical examination and treatment establishment to exercise its financial rights and obligations, make account-finalization and pay taxes (if any) on time and for the social security office to make sum-up reports and account-finalization.

6.  Upon termination of a contract, the parties shall carry out procedures for contract liquidation using Form No. 6 provided in the Appendix to this Decree and the details prescribed in Article 33 of this Decree.

7.  A medical examination and treatment establishment may only provide health insurance-covered medical examination and treatment and have health insurance-covered medical examination and treatment costs paid from the effective time of the health insurance-covered medical examination and treatment contract. The contracting parties shall ensure the conditions of the contract throughout the performance of the contract.

8.  The signatory of a medical examination and treatment establishment in a health insurance-covered medical examination and treatment contract is the head of such medical examination and treatment establishment as prescribed in Clause 7, Article 2 of the Government's Decree No. 96/2023/ND-CP dated December 30, 2023, detailing a number of articles of the Law on Medical Examination and Treatment; the person named in the registration of the individual business household that owns a private medical examination and treatment establishment, the person assigned to be the head of the medical examination and treatment establishment in the charter of a cooperative or a deputy head assigned or authorized by the person prescribed in this Clause.

9.  For units and schools that are not state agencies or public non-business units, the medical examination and treatment establishments of such units and schools shall apply the regulations on health insurance-covered medical examination and treatment contracts for private medical examination and treatment establishments.

Article 24. Cases of signing an addendum and notifying changes in information in the performance of a health insurance-covered medical examination and treatment contract

1.  During performance of a contract, if there are any arising issues or changes related to the performance of the contract, the parties shall carry out procedures for signing an addendum as prescribed in Clause 2 of this Article; or notifying as prescribed in Clause 3 of this Article; or terminating the contract as prescribed in Article 32 of this Decree.

2.  In case of a change in the name, seal, account, or account holder of the medical examination and treatment establishment or the social security office, a change in the professional and technical level, a change in the number of hospital beds that requires an adjustment to the operation license, or a change in the payment method, an addendum to the contract shall be signed.

3.  In other cases where there are arising issues or changes related to the performance of the contract that do not fall into the cases prescribed in Clause 2 of this Article and Article 32 of this Decree, the parties are not required to re-sign the contract or sign an addendum to the contract. The medical examination and treatment establishment and the social security office that have signed the contract shall carry out the notification procedures as the basis for implementation as follows:

a) The medical examination and treatment establishment shall send a written notice containing information and relevant materials concerning the changes to the social insurance agency with which the contract was signed. The document issued by the medical examination and treatment establishment must be the original, and the document issued by a competent authority must be a photocopy with the seal of the medical examination and treatment establishment chopped on the top-left corner of the first page for confirmation;

b) In case the social security office has comments on the changes or arising issues of the medical examination and treatment establishment, within a maximum of 05 working days from the date of receipt of the written notice from the medical examination and treatment establishment, the social security office shall send a written response to the medical examination and treatment establishment, clearly stating their comments and reasons therefor in the response. After the time limit of 05 working days from the date of receipt of the written notice, that the social security office has sent no comments shall be seen as acceptance;

c) Within a maximum of 15 days from the date of receipt of the written response with comments from the social security office, the medical examination and treatment establishment shall send a written reply to the comments of the social security office.

4.  During the period of waiting for the signing of an addendum to the contract, the health insurance fund shall continue to pay the health insurance-covered medical examination and treatment costs for the medical examination and treatment establishment, ensuring continuity.

Article 25. Details of a health insurance-covered medical examination and treatment contract

1.  The primary details of a health insurance-covered medical examination and treatment contract as prescribed in Clause 2, Article 25 of the Law on Health Insurance shall be made using Form No. 5 provided in the Appendix to this Decree. In case a medical examination and treatment establishment has many subordinate facilities licensed to operate at different locations and signs a joint contract, the details of each subordinate facility must be clearly stated.

2.  The details regarding the persons to be served and the requirements on the scope of service provision of the medical examination and treatment establishment must be consistent with the scope of professional activities approved by a competent authority. The estimated number of cards and the structure of groups of health insurance participants for a primary health insurance-covered medical examination and treatment establishment must comply with the regulations of the Minister of Health.

3.  Depending on the conditions of the medical examination and treatment establishment, the social security office and the medical examination and treatment establishment may add other details to the contract, which must be mutually agreed upon by both parties and not contrary to the law regulations. In case no consensus is reached on the additional details, they shall not be included in the contract.

4.  The method of payment of medical examination and treatment costs shall comply with Chapter VII of this Decree.

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

6.  The term of a health insurance-covered medical examination and treatment contract shall comply with Article 23 of this Decree.

7.  The method of resolving contractual disputes shall be agreed upon by both parties. In case the parties choose to bring a lawsuit to a court to resolve a contractual dispute, it shall be implemented in accordance with civil law regulations. In case of arising problems regarding policies, laws, regulations, or professional guidance, the parties shall report and propose them to a competent state agency for resolution.

8.  Regulations on notification and feedback between the parties when there are changes or arising issues related to the performance of the contract; a mechanism for receiving and responding to information related to the extraction and sending of data for assessment and payment of health insurance-covered medical examination and treatment costs.

Article 26. Dossier for signing a health insurance-covered medical examination and treatment contract

1.  A dossier for signing a contract includes:

a) A written request for signing a health insurance-covered medical examination and treatment contract from the medical examination and treatment establishment using Form No. 7 provided in the Appendix to this Decree;

b) A photocopy of the medical examination and treatment operation license issued by a competent state agency to the medical examination and treatment establishment, of which the seal of the medical examination and treatment establishment is chopped on the top-left corner of the first page (đóng dấu treo) for confirmation;

c) A photocopy of the decision on classification or temporary classification of the professional and technical level for the medical examination and treatment establishment issued by a competent authority; in the cases prescribed at Points dd and h, Clause 4, Article 22 of the Law on Health Insurance and Clauses 3 and 4, Article 19 of this Decree, a photocopy of the document from a competent authority determining that the medical examination and treatment establishment has been assigned a professional and technical line before January 1, 2025, is also required. The seal of the medical examination and treatment establishment is chopped on the top-left corner of the first page of such documents for confirmation;

d) A photocopy of the decision approving the list of medical technical services approved by a competent authority, with the seal of the medical examination and treatment establishment chopped on the top-left corner of the first page for confirmation;

dd) A list of medicinal products and medical equipment used at the medical examination and treatment establishment;

e) A list of personnel and the total number of hospital beds of the medical examination and treatment establishment by each department, room, and specialized unit as approved by a competent authority;

g) A photocopy of the decision approving the prices of medical examination and treatment services on the list covered by the health insurance fund as approved by a competent authority, with the seal of the medical examination and treatment establishment chopped on the top-left corner of the first page for confirmation. In the case prescribed in Article 47 of this Decree, the medical examination and treatment establishment shall submit a written proposal on the applicable prices of health insurance-covered medical examination and treatment services to determine the payment level at the establishment;

h) A list of software and hardware equipment ensuring the inter-agency connection for extracting electronic data in health insurance payment using Form No. 8 provided in the Appendix to this Decree;

i) For the documents prescribed at Points b, c, d and g of this Clause, the medical examination and treatment establishment is not required to submit photocopies in case the competent authority, when issuing the documents, has sent them to the social security office or in case they can be looked up on the online system of the competent authority, but the medical examination and treatment establishment must cite the address of the website where they can be looked up in the written request for signing a health insurance-covered medical examination and treatment contract as prescribed at Point a of this Clause.

2.  In case of signing a consecutive contract when the signed contract has expired or the two parties agree to terminate the contract before its term, if the documents have not changed, the medical examination and treatment establishment is not required to resubmit them and may use the dossier submitted when signing the previous contract. In case the documents in the dossier prescribed in Clause 1 of this Article of the medical examination and treatment establishment have changed, the medical examination and treatment establishment only has to submit the documents proving the changes.

3.  Quantity: 01 dossier.

4.  The dossier shall be submitted electronically on the National Public Service Portal or via the social security office's application. During the period when the online public service system has not been completed and in administrative units in areas with difficult or particularly difficult socio-economic conditions, the dossier shall be submitted in person at the single-window section of the assigned social security office or sent via the public postal service to the assigned social security office.

Article 27. Dossier for signing an addendum to the contract

1.  A dossier for signing an addendum to the contract includes:

a) A written request for signing an addendum to the health insurance-covered medical examination and treatment contract from the medical examination and treatment establishment or the social security office using Form No. 7 provided in the Appendix to this Decree;

b) A photocopy of the document proving the change in the case prescribed in Clause 2, Article 24 of this Decree with the seal of the medical examination and treatment establishment or the social security office chopped on the top-left corner of the first page for confirmation.

2.  Quantity: 01 dossier.

3.  The dossier shall be submitted electronically on the National Public Service Portal or via the social security office's application. During the period when the online public service system has not been completed and in administrative units in areas with difficult or particularly difficult socio-economic conditions, the dossier shall be submitted in person at the single-window section of the assigned social security office or sent via the public postal service to the assigned social security office.

Article 28. Procedures for signing a health insurance-covered medical examination and treatment contract

1.  The medical examination and treatment establishment shall send a dossier as prescribed in Article 26 of this Decree to the social security office assigned by a competent authority to sign the contract.

2.  In case there is no request for amendment or supplementation of the dossier, within 10 days from the date of receipt of a complete and valid dossier and satisfaction of the conditions for signing the contract (in case of submitting a paper dossier, based on the date stamped on the incoming document), the social security office must complete the signing of the contract.

3.  In case there is a request for amendment or supplementation of the dossier, it shall be carried out as follows:

a) Within 05 working days from the date of receipt of the dossier (in case of submitting a paper dossier, based on the date stamped on the incoming document), the social security office shall reply in writing, specifically stating the details to be amended or supplemented, and send it to the medical examination and treatment establishment;

b) Within 30 days from the date of receipt of the written request for amendment or supplementation (in case of submitting a paper dossier, based on the date stamped on the incoming document), the medical examination and treatment establishment shall amend or supplement the dossier and send it to the social security office. In case, after 30 days the medical examination and treatment establishment fails to supplement and send the dossier, it must carry out the procedures again as prescribed in Clauses 1 and 2 of this Article;

c) Within 10 days from the date of receipt of the amended or supplemented dossier (in case of submitting a paper dossier, based on the date stamped on the incoming document), the social security office shall sign the contract if the conditions are met or issue a written notice of refusal to sign the contract if the conditions are not yet met, clearly stating the reasons and legal basis for determining that the conditions for signing the contract are not yet met.

4.  The appraisal for signing a health insurance-covered medical examination and treatment contract shall be carried out based on the dossier submitted by the medical examination and treatment establishment as prescribed in Article 26 of this Decree. The medical examination and treatment establishment shall take full accountability to the law for the accuracy of the dossier and for ensuring compliance with the operating conditions for medical examination and treatment as prescribed by the law regulations.

5.  In case of signing a consecutive contract when the signed contract has expired or the two parties agree to terminate the contract before its term, the parties shall carry out the procedures as follows:

a) The medical examination and treatment establishment shall send a dossier as prescribed in Clause 2, Article 26 of this Decree to the social security office assigned by a competent authority to sign the contract;

b) In case there is no request for amendment or supplementation of the dossier, within 03 working days from the date of receipt of a complete and valid dossier and satisfaction of the conditions for signing the contract (in case of submitting a paper dossier, based on the date stamped on the incoming document), the social security office must complete the signing of the contract;

c) In case there is a request for amendment or supplementation of the dossier, within 02 working days from the date of receipt of the dossier (in case of submitting a paper dossier, based on the date stamped on the incoming document), the social security office shall reply in writing, specifically stating the details to be amended or supplemented, and send it to the medical examination and treatment establishment;

d) Within 10 days from the date of receipt of the written request for amendment or supplementation (in case of submitting a paper dossier, based on the date stamped on the incoming document), the medical examination and treatment establishment shall amend or supplement the dossier and send it to the social security office. In case, after 10 days the medical examination and treatment establishment fails to supplement and send the dossier, it must carry out the procedures again as prescribed in this Article;

dd) Within 03 working days from the date of receipt of the amended or supplemented dossier (in case of submitting a paper dossier, based on the date stamped on the incoming document), the social security office shall sign the contract if the conditions are met or issue a written notice of refusal to sign the contract if the conditions are not yet met, clearly stating the reasons and legal basis for determining that the conditions for signing the contract are not yet met;

e) In case the medical examination and treatment establishment and the social security office agree to continue signing a new contract upon the expiration of the health insurance-covered medical examination and treatment contract, the signing of the new contract must ensure that the effective date of the contract is consecutive with the validity period of the former contract.

Article 29. Procedures for signing an addendum to a health insurance-covered medical examination and treatment contract

1.  Within 03 working days from the date of issuance of a document from a competent authority regarding a change in the case prescribed in Clause 2, Article 24 of this Decree, the social security office or the medical examination and treatment establishment shall send a dossier for signing an addendum to the other party.

2.  Within 05 working days from the date of receipt of the dossier, the medical examination and treatment establishment and the social security office shall complete the signing of the addendum to the contract.

Article 30. Signing of health insurance-covered medical examination and treatment contracts at health stations of communes, wards, and special zones, maternity hospitals, regional general clinics, and medical examination and treatment establishments of agencies, units, and schools

1.  For health stations of communes, wards, and special zones, maternity hospitals, and regional general clinics, the signing of a health insurance-covered medical examination and treatment contract shall be carried out in one of the following two forms:

a) The provincial-level People's Committee shall decide on 01 representative unit to sign a contract with the social security office for the health stations of communes, wards, and special zones, maternity hospitals, and regional general clinics under its management;

b) The health station of a commune, a ward, or a special zone, a maternity hospital, or a regional general clinic shall directly sign a contract with the social security office.

2.  For medical examination and treatment establishments of an agency, unit, or school (except for agencies, units, and schools that are allocated funds for medical examination and treatment in primary health care as prescribed in Article 63 of this Decree), the social security office shall sign a health insurance-covered medical examination and treatment contract directly with the agency, unit, or school.

3. The contracting unit prescribed in Clauses 1 and 2 of this Article shall ensure the operating conditions of the medical examination and treatment establishment in accordance with the signed contract.

Article 31. Suspension of a health insurance-covered medical examination and treatment contract

1. A health insurance-covered medical examination and treatment contract shall be suspended in whole or in part in case the medical examination and treatment establishment is suspended from operation in whole or in part by a decision of a competent authority.

2. When issuing a decision to suspend the operation of a medical examination and treatment establishment in whole or in part, the competent authority shall send a notice to the social security office with which the contract was signed. The suspension of the medical examination and treatment contract shall take effect from the effective date of the decision to suspend the operation of the medical examination and treatment establishment in whole or in part. When issuing a decision to allow the medical examination and treatment establishment to resume operation, the competent authority shall send a notice to the social security office with which the contract was signed.

3. In case a medical examination and treatment establishment that has been suspended from operation is allowed by a competent authority to resume operation, the medical examination and treatment establishment shall send a written notice to the social security office on the continuation of the contract and documents proving any changes compared to the dossier for signing the health insurance-covered medical examination and treatment contract before the contract was suspended.

4. When suspending a contract, the two parties must agree on a plan to ensure the rights of patients during the suspension period. When continuing to perform the contract, the medical examination and treatment establishment shall ensure the operating conditions in accordance with the signed health insurance-covered medical examination and treatment contract.

Article 32. Cases of termination of a contract and procedures for termination of a health insurance-covered medical examination and treatment contract

1. Cases of termination of a health insurance-covered medical examination and treatment contract include:

a) The contract term expires;

b) The two parties agree to terminate the contract before its term;

c) The medical examination and treatment establishment ceases operation, is dissolved, or goes bankrupt;

d) The medical examination and treatment establishment has its operation license revoked;

dd) After the 3-month suspension period, the medical examination and treatment establishment has not yet remedied the violations to resume operation.

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

3. In the case of contract termination as prescribed at Points c and d, Clause 1 of this Article, within 03 working days from the date of cessation of operation according to the decision of a competent state agency, the medical examination and treatment establishment shall notify the social security office with which the contract was signed of the contract termination. The parties shall carry out procedures for contract liquidation as prescribed in Article 33 of this Decree. The time of contract termination is from the effective date of the decision on cessation of operation or revocation of the operation license of the medical examination and treatment establishment.

4. In case after the time limit prescribed at Point dd, Clause 1 of this Article, the medical examination and treatment establishment has not yet been allowed by a competent authority as prescribed by the law regulations on medical examination and treatment to resume operation, the social security office with which the contract was signed and the medical examination and treatment establishment shall terminate the contract and liquidate the contract as prescribed in Article 33 of this Decree.

Article 33. Liquidation of a health insurance-covered medical examination and treatment contract

1. A health insurance-covered medical examination and treatment contract between a social security office and a medical examination and treatment establishment shall be liquidated after the contract is terminated as prescribed in Article 32 of this Decree. The form for liquidation of a health insurance-covered medical examination and treatment contract shall be made using Form No. 6 provided in the Appendix to this Decree.

2. The liquidation of a contract shall be carried out in accordance with the civil law regulations.

3. The two parties shall jointly check, determine, and agree on the items and the amounts of medical examination and treatment costs requested for payment, advanced, assessed, paid, unpaid, account-finalized, refused for payment, and recovered in the year and the method and time limit for settlement of each unconsolidated item, and the obligations to be performed by each party; and the amounts to be retrospectively collected or refunded (if any) to serve as a basis for contract termination. After reaching an agreement and confirming, the social security office shall pay or recover the related amounts as prescribed.

4. Rights and obligations of the social security office:

a) To check and confirm the debts and account-finalization reconciliation documents of the medical examination and treatment establishment; to request the refund of payments made in contravention of regulations (if any); to refuse to liquidate if the medical examination and treatment establishment has not yet fulfilled its financial obligations or has not yet provided sufficient documents for account-finalization;

b) To be responsible for paying unpaid costs on time; not to request the handover of original medical records, unless otherwise prescribed by the law regulations.

5. Rights and obligations of the medical examination and treatment establishment:

a) To request the social security office to fully pay the account-finalized costs; to retain medical records in accordance with regulations and only hand over documents for account-finalization; to be entitled to propose to continue signing a contract if it has the need and meets the conditions as prescribed;

b) To be responsible for completing the financial account-finalization and paying the amounts to be refunded (if any); to provide documents for reconciliation and inspection but must ensure the regulations on storage of medical records and be responsible before the law for the dossiers and documents that have been paid by the social security office; to ensure the transfer of patients to other medical examination and treatment establishments and not to affect the rights of health insurance participants.

Article 34. Rights and responsibilities of the social security office in the performance of a contract

1. Rights of the social security office

a) The rights as prescribed in Article 40 of the Law on Health Insurance;

b) To request the medical examination and treatment establishment to transfer authenticated electronic data to pay the health insurance-covered medical examination and treatment costs as prescribed by the Minister of Health;

c) To request the medical examination and treatment establishment to explain in case the social security office's statistics show that the health insurance-covered medical examination and treatment costs are higher than the average increase of medical examination and treatment establishments of the same professional and technical level, the same type of general or specialist medical examination and treatment establishment in the year in the province or municipality or nationwide or the average increase of that medical examination and treatment establishment in the same period of the preceding year;

d) To refuse to pay the health insurance-covered medical examination and treatment costs that are not in accordance with the law regulations on health insurance and medical examination and treatment.

2. Responsibilities of the social security office

a) To comply with Article 41 of the Law on Health Insurance;

b) To provide the medical examination and treatment establishment with information on the medical examination and treatment history of the health insurance participant;

c) To keep confidential the information collected during the assessment and payment of health insurance-covered medical examination and treatment costs, and the exploitation and use of medical records in accordance with the law regulations;

d) To coordinate with the medical examination and treatment establishment in verifying and clarifying the information of the health insurance participant upon request and resolving difficulties and problems in receiving and checking the procedures for health insurance-covered medical examination and treatment; to consider revoking, seizing or temporarily locking the health insurance card and handle according to its competence the violations upon receiving information reflecting the violations; to provide technical guidance and support in extracting electronic data to serve the assessment and payment of health insurance-covered medical examination and treatment costs for the medical examination and treatment establishment;

dd) To maintain the receipt and timely response to the receipt of data requested for payment, return of faulty dossiers, clearly stating the errors, the part of the requested payment cost returned due to errors, the results of the assessment of health insurance-covered medical examination and treatment costs, and incidents and problems related to the receipt of data for the medical examination and treatment establishment as prescribed;

e) To make advance payments, payments and account-finalization of health insurance-covered medical examination and treatment costs on time and in the correct quantity and rate of advance payment as prescribed by the law regulations on health insurance;

g) To agree on the number of dossiers sent for assessment and the advance payment of medical examination and treatment costs for the next period in case of incidents or problems in the receipt of data;

h) To inspect the performance of the contract and the maintenance of conditions after signing the contract by the medical examination and treatment establishment.

3. To exercise other rights and perform other responsibilities as prescribed by the law regulations on health insurance and medical examination and treatment.

4. To be responsible for explaining to the state management agency in charge of health in case of proposals or reflections that the social security office has committed acts of violating the health insurance-covered medical examination and treatment contract, paying, refusing to pay, or recovering the medical examination and treatment costs not in accordance with the law regulations.

Article 35. Rights and responsibilities of the medical examination and treatment establishment in the performance of a contract

1. Rights of a medical examination and treatment establishment

a) The rights as prescribed in Article 42 of the Law on Health Insurance and the law regulations on medical examination and treatment;

b) To be provided with timely information when the health insurance assessment information system detects an increase in the health insurance-covered medical examination and treatment costs that is higher than the average medical examination and treatment cost establishments of the same professional and technical level, the same type of general or specialist medical examination and treatment establishment in the year in the province or municipality or nationwide or the average increase of that medical examination and treatment establishment in the same period of the preceding year in order to promptly review, check, verify, and implement appropriate adjustment solutions;

c) To be entitled to request the social security office to clarify the reasons for the delay in payment and account-finalization of health insurance-covered medical examination and treatment costs;

d) To be promptly notified by the social security office of incidents of the data receiving system, and errors of the dossiers and data of health insurance-covered medical examination and treatment costs when submitting a request for payment;

dd) To be entitled to propose to the state management agency in charge of health and finance to guide and resolve arising problems during the performance of the contract;

e) To be consulted by a competent authority on the assessment procedures, and health insurance regulations and policies related to the rights and obligations of the health insurance-covered medical examination and treatment establishment.

2. Responsibilities of medical examination and treatment establishments

a) To comply with Article 43 of the Law on Health Insurance and the responsibilities as prescribed by the law regulations on medical examination and treatment;

b) To promptly review and issue professional processes and guidelines in health insurance-covered medical examination and treatment; to comply with the law regulations on medical examination and treatment, the professional guidelines of the Ministry of Health and the relevant law regulations on procurement and bidding to ensure the supply of quality, effective and economical medicinal products, chemicals, medical equipment, and medical technical services;

c) To send electronic data on the health insurance-covered medical examination and treatment costs after the end of the patient's medical examination and treatment session, digitally sign the monthly and quarterly summary of medical examination and treatment costs of the health insurance participant as prescribed by the Minister of Health; to authenticate electronic data as prescribed by the law regulations; to be responsible before the law for the accuracy of the summary of costs requested for payment against the statement of health insurance-covered medical examination and treatment costs of the patient;

d) To establish an information technology infrastructure system, upgrade and improve the hospital management software system to properly implement law regulations on input data standards, output data standards, electronic data extraction, digital transformation and electronic transactions in the health sector;

dd) To comply with the regulations on payment of health insurance-covered medical examination and treatment costs; to proactively review and check the high health insurance-covered medical examination and treatment costs at the establishment according to the proposals and warnings of the social security office; to identify subjective and objective causes, and build and organize the implementation of solutions to overcome the subjective and inadequate causes and send them to the social security office with which the contract was signed;

e) To publicize the results of the professional and technical level classification approved by a competent authority together with the score on the establishment's electronic information page and at the patient reception area. The competent authority for professional and technical level classification is responsible for publicizing the list of classified medical examination and treatment establishments together with the score on the agency's electronic information portal and on the information system for management of medical examination and treatment activities;

g) In case of providing medical examination and treatment on holidays and weekends, the medical examination and treatment establishment must arrange sufficient professional personnel, administrative and financial-accounting departments to meet the requirements of medical examination and treatment, promptly resolve the rights of patients and be consistent with the scope of medical examination and treatment on holidays and weekends;

h) To comply with the regulations on management and use of medicinal products and medical equipment to ensure quality and safety in the provision of health insurance-covered medical examination and treatment services;

i) To fully prescribe and ensure the scope of payment of the health insurance fund for health insurance participants according to professional requirements and the patient's condition; not to collect additional fees from health insurance patients and settle with the social security office the costs that have been included in the structure of the prices of medical examination and treatment services prescribed or approved by a competent authority for the medical examination and treatment establishment.

3. To be responsible for explaining to the state management agency in charge of health in case of proposals or reflections that the medical examination and treatment establishment has committed acts of violating the health insurance-covered medical examination and treatment contract.

4. To exercise other rights and perform other responsibilities as prescribed by the law regulations on health insurance and medical examination and treatment.

Article 36. Inspection of the performance of a health insurance-covered medical examination and treatment contract

1. Cases of inspection include:

a) Routine inspection according to the annual plan;

b) Ad-hoc inspection upon detection of a violation of law or signs of violation related to the performance of a health insurance-covered medical examination and treatment contract.

2. Principles of inspection:

a) Inspections must be conducted based on an inspection plan that has been approved by a competent authority;

b) Routine inspections must adhere to the principle that a medical examination and treatment establishment shall not be inspected more than once on the same matter within a year, including inspections, examinations, and audits by competent authorities, unless violations of the law are detected or there are signs of violations;

c) The inspection matters must be based on the articles, clauses, content, and responsibilities specified in the signed health insurance medical examination and treatment contract. Inspections shall not cover matters outside the scope of the signed health insurance medical examination and treatment contract or matters beyond the functions and duties of the social security office;

d) The inspection plan must be sent to the inspected entity immediately after it is approved. The inspection schedule must be notified to the inspected entity at least 07 days prior to the inspection; in case of an ad-hoc inspection, written notice must be given at least 01 day in advance;

dd) Inspection conclusions must be sent to the inspected entity. Within 03 months from the date of receipt of the inspection conclusions, the inspected entity must submit a report on the implementation of such conclusions to the inspecting agency.

3. The Minister of Finance shall prescribe the competence to inspect the performance of a health insurance-covered medical examination and treatment contract.

Chapter VI

PROCEDURES FOR HEALTH INSURANCE-COVERED MEDICAL EXAMINATION AND TREATMENT

Article 37. Procedures for health insurance-covered medical examination and treatment as prescribed in Clause 1, Article 28 of the Law on Health Insurance

1. A health insurance participant, when taking medical examination and treatment, must present information about his/her health insurance card and personal identification documents in one of the following forms:

a) Citizen identity card or citizen identity card or level-2 electronic identification account (VNeID) with integrated information about the health insurance card;

b) Electronic or paper health insurance card. For health insurance participants prescribed at Points a, b, c and d, Clause 3, Article 12 of the Law on Health Insurance who do not have information about their health insurance cards that can be looked up on the information technology system, they must present paper health insurance cards. In case of using a health insurance card without a photo or a health insurance code, one of the following personal identification documents must be presented: citizen identity card, citizen identity card, citizen identity certificate, passport, linked to a level-2 electronic identification account (VNeID) or VssID application or other personal identification documents issued by a competent agency or organization or a written certification from the commune-level public security agency.

2. For children under 6 years of age, only a paper or electronic health insurance card or a health insurance code must be presented; in case a health insurance card has not yet been issued, an original or a photocopy of the birth certificate must be presented. For a newborn, the father or mother or a relative of the child shall sign for certification on the medical record or the representative of the medical examination and treatment establishment shall certify on the medical record in case the child has no father, mother or relative.

3. A health insurance participant, during the period of waiting for the grant or change of information on the health insurance card, when taking medical examination and treatment, must present a dossier receipt slip and an appointment slip for returning the result of the grant, re-grant and exchange of the health insurance card, information about the health insurance card issued by the social security office or an organization or individual authorized by the social security office to receive the dossier for re-grant and exchange of the card, and a type of personal identification document of such person as prescribed at Point b, Clause 1 of this Article.

4. A person who has donated a human body organ must present information about his/her health insurance card as prescribed in Clause 1 or Clause 3 of this Article. In case a health insurance card has not yet been issued, a hospital discharge form issued by the medical examination and treatment establishment where the human body organ was taken for the person who has donated the human body organ and one of the following personal identification documents of such person must be presented: citizen identity card, citizen identity card, citizen identity certificate, passport, linked to a level-2 electronic identification account (VNeID) or VssID application or other personal identification documents issued by a competent agency or organization. In case a health insurance card has not yet been issued but treatment is required immediately after donation, the medical examination and treatment establishment and the patient or the patient's relative shall certify on the medical record.

5. In case of emergency, a health insurance participant must present the documents as prescribed in Clause 1 or Clause 2 or Clause 3 of this Article before the end of the treatment course.

Article 38. Procedures for health insurance-covered medical examination and treatment in some cases

1. In case a patient holding a health insurance card presents the card information late when taking medical examination and treatment, the health insurance fund shall cover the medical examination and treatment costs within the scope of benefits and the benefit level from the time the health insurance card information is presented, unless in case of emergency. The medical examination and treatment costs during the period when the patient has not yet presented the health insurance card information shall be directly paid by the health insurance fund in accordance with the procedures prescribed in Articles 55, 56 and 57 of this Decree.

2. In case a patient holding an electronic health insurance card cannot present the electronic health insurance card due to an error in the link to the level-2 electronic identification account (VNeID) or the VssID application or an Internet connection error when taking health insurance-covered medical examination and treatment, the following shall be done:

a) The patient shall provide the health insurance card code information for the medical examination and treatment establishment to look up the information on the data receiving portal of the Vietnam Social Security. In case the data receiving portal of the Vietnam Social Security cannot look up the information, the medical examination and treatment establishment shall record the health insurance card code information and receive the patient for medical examination and treatment. The medical examination and treatment establishment shall coordinate with the social security office to look up the patient's health insurance card information again to determine the scope, rights, and health insurance benefits;

b) In case at the time the patient finishes the medical examination and treatment session and is discharged from the hospital, the electronic health insurance card management data system is still faulty and cannot extract the information and the social security office has not yet verified and clarified it, the medical examination and treatment establishment shall send the entire medical examination and treatment dossier, the patient's contact information, and a screenshot of the lookup to the social security office to continue verifying the information when the system is restored and to assess and pay the medical examination and treatment costs as prescribed. The patient is responsible for providing information about the health insurance participant and the health insurance card information to the medical examination and treatment establishment and ensuring the accuracy of the provided information.

3. Medical examination and treatment establishments and social security offices are not allowed to prescribe additional procedures for health insurance-covered medical examination and treatment other than the procedures prescribed in this Article. In case a medical examination and treatment establishment or a social security office needs to photocopy a health insurance card or documents related to the patient's medical examination and treatment for management purposes, it must make the photocopy itself after obtaining the consent of the patient or the patient's guardian, and is not allowed to request the patient to make the photocopy or pay for this cost.

Chapter VII

METHODS OF PAYMENT OF HEALTH INSURANCE-COVERED MEDICAL EXAMINATION AND TREATMENT COSTS

Article 39. Fee-for-service payment

1. Fee-for-service payment is a method of payment based on the prices of medical examination and treatment services and the costs included in the structure of the prices of medical examination and treatment services as prescribed by the law regulations on medical examination and treatment but not yet included in the price used as a basis for determining the payment level of medical examination and treatment costs to be paid the health insurance fund.

2. The payment level of medical examination and treatment costs to be paid by the health insurance fund is determined as follows:

a) For a state-owned medical examination and treatment establishment, the health insurance fund shall cover the health insurance-covered medical examination and treatment costs at the prices of medical examination and treatment services on the list covered by the health insurance fund as prescribed or approved by a competent authority;

b) For a private medical examination and treatment establishment, the health insurance fund shall cover the health insurance-covered medical examination and treatment costs based on the prices of medical examination and treatment services on the list covered by the health insurance fund as prescribed or approved by a competent authority in accordance with the law regulations on medical examination and treatment for state-owned medical examination and treatment establishments in the locality on the principles prescribed at Points a, b, c and d, Clause 2, Article 47 of this Decree. The difference between the prices of medical examination and treatment services of the private medical examination and treatment establishment and the prices of medical examination and treatment services on the list covered by the health insurance fund shall be paid by the patient.

3. For the medical examination and treatment costs within the scope of benefits and the benefit level of the health insurance participant in the structure of the prices of medical examination and treatment services according to the roadmap and the law regulations on medical examination and treatment but not yet included in the price, the health insurance fund shall make payment according to the actual quantity used, the purchase price as prescribed by the law regulations on bidding or according to the payment level of medical examination and treatment costs to be paid the health insurance fund for the private medical examination and treatment establishment; the costs of blood and blood products shall be paid as prescribed by the Minister of Health.

Article 40. Capitation payment

1. Capitation payment is applied to outpatient health insurance-covered medical examination and treatment.

2. The scope of capitation payment includes the costs of outpatient medical examination and treatment within the scope of benefits and the benefit level of the health insurance card holder.

3. The Vietnam Social Security shall determine the capitation fund to be implemented in the year based on the total actual costs of outpatient health insurance-covered medical examination and treatment and the estimated health insurance-covered medical examination and treatment costs in the year as prescribed in Clause 6 of this Article for the social security office to notify the health insurance-covered medical examination and treatment establishment.

4. In case the capitation fund has a surplus in the year, the medical examination and treatment establishment may retain a part of the fund and account it as a non-business revenue of the unit; the remaining fund shall be transferred to the health insurance fund for regulation.

5. In case the capitation fund has a deficit in the year, the medical examination and treatment establishment shall balance it within its own revenue sources as prescribed; in case the medical examination and treatment establishment has a deficit in the capitation fund for 02 consecutive years, it shall be considered for adjustment for the following year.

6. The Minister of Health shall determine the diseases, groups of diseases, medical services and costs not covered by capitation payment, and guide the techniques for determining, and the organization of implementation of, capitation payment.

7. The Ministry of Health shall assume the prime responsibility for, and coordinate with the Ministry of Finance in, prescribing the assignment of the capitation fund, the regulation of the surplus fund, the determination of the surplus fund that the medical examination and treatment establishment may retain, and the roadmap for capitation payment.

Article 41. Diagnosis-related group payment

1. Diagnosis-related group (DRG) payment is a payment method based on a predetermined cost for each group of diagnoses that are similar in clinical characteristics and necessary resources, regardless of the actual costs used in health insurance-covered medical examination and treatment.

2. The scope of DRG payment includes the medical examination and treatment costs within the scope of benefits and the benefit level of the health insurance participant when taking inpatient and day-care health insurance-covered medical examination and treatment.

3. The Minister of Health shall prescribe the scope of data used in the development of the DRG payment method, the DRG list; the principles, methods, and techniques for developing and adjusting the DRG classification algorithm and cost accounting to calculate the DRG payment parameters, determine the cost level, and the total DRG fund; and guide the organization of implementation and the roadmap for DRG payment.

4. The Vietnam Social Security shall determine the DRG list, the estimated total DRG costs, the relative weight, the base rate, and the adjustment coefficient as prescribed in Clause 3 of this Article and send them to the Ministry of Health for issuance, and at the same time send the data on the medical examination and treatment costs used in the development of the DRG for storage and for appraisal and issuance purposes.

Article 42. Application of payment methods

1. The health insurance-covered medical examination and treatment costs for medical services that have been paid by one payment method shall not be paid again by another method.

2. The payment method applied at a medical examination and treatment establishment shall be prescribed in the health insurance-covered medical examination and treatment contract with the social security office as prescribed in Article 25 of this Decree.

Chapter VIII

PAYMENT OF MEDICAL EXAMINATION AND TREATMENT COSTS BETWEEN THE SOCIAL SECURITY OFFICE AND THE MEDICAL EXAMINATION AND TREATMENT ESTABLISHMENT

Article 43. Payment of costs of medicinal products and medical equipment transferred between health insurance-covered medical examination and treatment establishments

The health insurance fund shall cover the costs of medicinal products and medical equipment transferred between health insurance-covered medical examination and treatment establishments in case at the time a prescription or indication is made for the patient to use medicinal products or medical equipment that are not available and cannot be replaced by other medicinal products or medical equipment, specifically as follows:

1. The determination that a medical examination and treatment establishment does not have medicinal products or medical equipment available at the time of prescription or indication and cannot be replaced by other medicinal products or medical equipment is prescribed as follows:

a) The medical examination and treatment establishment does not have any commercial medicinal product containing the active ingredient that the patient is indicated for or has a medicinal product with the same active ingredient but a different strength or concentration or dosage form or route of administration that cannot be substituted for the patient's indication;

b) The medical examination and treatment establishment does not have the medical equipment that the patient is indicated to use and does not have a substitute medical equipment, except for in vitro diagnostic medical equipment, patient-specific medical equipment, and medical equipment on the list of medical equipment issued by the Minister of Health that can be bought and sold as ordinary goods as prescribed in the Government's Decree No. 98/2021/ND-CP dated November 8, 2021, on the management of medical equipment, which is amended and supplemented by the Government's Decree No. 07/2023/ND-CP dated March 3, 2023, and Decree No. 04/2025/ND-CP dated January 1, 2025.

2. At the time a prescription or indication is made for the patient, the medical examination and treatment establishment does not have medicinal products or medical equipment available for one of the following reasons:

a) During a group-A epidemic period for a medical examination and treatment establishment that is under lockdown or medical quarantine or located in an area implementing social distancing or performing epidemic prevention and control tasks;

b) The medical examination and treatment establishment is in the process of selecting a contractor according to the approved contractor selection plan in one of the following forms: open bidding or limited bidding or competitive offering or direct procurement or contractor selection in special cases but has not yet selected a contractor or online price quotation or online procurement and has implemented shortened direct appointment of contractor as prescribed by the law regulations on bidding but has not selected a contractor;

c) The medical examination and treatment establishment has signed a contract with a contractor to supply such medicinal product or medical equipment but at the time of indicating the medicinal product or medical equipment for the patient, there is written evidence confirming that the contractor cannot supply the medicinal product (a document on medicinal product supply from the supplier, an addendum to the contract, a record confirming that the contractor does not supply the medicinal product).

3. The competence to decide on cases of receiving transferred medicinal products and medical equipment from other health insurance-covered medical examination and treatment establishments is prescribed as follows:

a) The director of the medical examination and treatment establishment where the patient is receiving treatment shall, based on the actual situation and the conditions prescribed in Clauses 1 and 2 of this Article, select a health insurance-covered medical examination and treatment establishment that has medicinal products and medical equipment available and agrees to the transfer;

b) The decision to select a medical examination and treatment establishment to transfer medicinal products and medical equipment must be appropriate, effective, and economical; the transfer of medicinal products and medical equipment between medical examination and treatment establishments in the same province or municipality is encouraged.

4. The transfer and payment of medicinal products and medical equipment shall be carried out as follows:

a) The medical examination and treatment establishment is responsible for notifying the transfer of medicinal products and medical equipment and the costs that the health insurance patient must pay in case the patient has to pay additional costs other than the co-payment as prescribed;

b) The establishment that transfers the medicinal products and medical equipment and the establishment that receives the medicinal products and medical equipment shall have a handover and receipt document;

c) The health insurance fund shall cover the costs of medicinal products and medical equipment within the scope of benefits and the benefit level of the health insurance participant as prescribed to the receiving medical examination and treatment establishment at the health insurance payment price of the medical examination and treatment establishment that transfers the medicinal products and medical equipment. Other costs shall be paid by the patient to the medical examination and treatment establishment where the treatment is provided;

d) The medical examination and treatment establishment that receives the medicinal products and medical equipment is responsible for paying the costs of the medicinal products and medical equipment to the medical examination and treatment establishment that transfers them. The medical examination and treatment establishment where the patient is receiving treatment shall sum up the part of the costs of medicinal products and medical equipment covered by the health insurance fund into the patient's medical examination and treatment costs for settlement with the social security office;

dd) The social security office is responsible for publishing the quantity of unused medicinal products and medical equipment according to the bidding results of the health insurance-covered medical examination and treatment establishments on the data receiving portal of the Vietnam Social Security for medical examination and treatment establishments to refer to and request the transfer of medicinal products and medical equipment.

5. In case a health insurance patient does not agree to pay the costs outside the scope of benefits and the benefit level of the health insurance participant when medicinal products and medical equipment are transferred, the medical examination and treatment establishment shall transfer the patient to another medical examination and treatment establishment that can supply the medicinal products and medical equipment for the patient's treatment.

Article 44. Regulations on the transfer of patients or pathological samples to other qualified establishments to perform para-clinical services

1. Medical examination and treatment establishments shall only transfer patients or pathological samples to receiving establishments that have been approved by a competent authority to be qualified to perform para-clinical services. The establishment that receives patients or pathological samples to perform para-clinical services is not allowed to transfer the patients or pathological samples to a third (other) establishment.

2. The transfer of para-clinical services shall be carried out in accordance with the principles of being consistent with the professional and technical requirements in medical examination and treatment, ensuring the rights of health insurance participants, and falling into the following cases:

a) The para-clinical service has been approved by a competent state agency for the medical examination and treatment establishment and is being performed at the medical examination and treatment establishment, but at the time of indication for use for the patient, that medical examination and treatment establishment cannot perform it or is not sufficient to meet the entire demand for performing the para-clinical service. The medical examination and treatment establishment that transfers the patient or pathological sample shall fill in the information in Form No. 9 provided in the Appendix to this Decree to be enclosed during the process of transferring the patient or pathological sample to the establishment that performs the para-clinical service. The medical examination and treatment establishment that transfers the patient or pathological sample shall send a list of the para-clinical services that have been transferred to the establishment that performs the para-clinical service to the social security office where the health insurance-covered medical examination and treatment contract is signed to serve as a basis for payment;

b) The para-clinical service has not yet been approved by a competent state agency for the medical examination and treatment establishment but is actually necessary for professional activities and is on the list issued by the Minister of Health. The head of the health insurance-covered medical examination and treatment establishment that transfers the patient or pathological sample shall, based on the functions, tasks, and scope of professional activities approved by a competent authority, make a list of the para-clinical services to be transferred and sign a framework contract with the establishment that performs the para-clinical services. The framework contract must contain a content agreeing that the social security office where the health insurance-covered medical examination and treatment contract is signed with the transferring medical examination and treatment establishment shall assess the para-clinical services that have been received and performed at the establishment that performs the para-clinical services. The health insurance-covered medical examination and treatment establishment that transfers the patient or pathological sample shall send a list of the para-clinical services to be transferred and the framework contract to the social security office where the health insurance-covered medical examination and treatment contract is signed before implementation.

3. The medical examination and treatment establishment that transfers the patient or pathological sample is responsible for paying the costs to the medical examination and treatment establishment or the service-performing unit, and at the same time summing up the costs of the para-clinical services into the patient's medical examination and treatment costs for settlement with the social security office. The receiving establishment that performs the para-clinical services is not allowed to collect additional medical examination fees from the patient. In case the patient has to pay additional costs for performing the para-clinical service in addition to the co-payment as prescribed, the medical examination and treatment establishment that transfers the patient or pathological sample must notify and obtain the patient's consent before transferring the patient or pathological sample.

4. The health insurance fund shall cover the costs of para-clinical services according to the scope and benefit level of the health insurance participant, specifically as follows:

a) In the case prescribed at Point a, Clause 2 of this Article: the health insurance fund shall make payment at the price of the para-clinical service that has been approved by a competent authority for the establishment where the para-clinical service is performed but not exceeding the price of the medical examination and treatment service of the transferring establishment. In case the establishment where the para-clinical service is performed has not yet been approved by a competent authority or does not have a price for the health insurance-covered medical examination and treatment service, the health insurance fund shall make payment at the price of the technical service that has been approved by a competent authority for the medical examination and treatment establishment that transfers the patient or pathological sample;

b) In the case prescribed at Point b, Clause 2 of this Article: the health insurance fund shall make payment at the price of the para-clinical service that has been approved by a competent authority for the establishment where the para-clinical service is performed. In case the establishment where the para-clinical service is performed has not yet been approved by a competent authority for the price of the health insurance-covered medical examination and treatment service, the health insurance fund shall make payment at the price of the technical service that has been approved by a competent authority for a state-owned health insurance-covered medical examination and treatment establishment in accordance with the payment principles prescribed at Points a, b, c and d, Clause 2, Article 47 of this Decree.

Article 45. Payment of medical examination and treatment costs during technical transfer

1. Payment of medical examination and treatment costs during technical transfer performed by the personnel of the medical examination and treatment establishment that transfers the technique according to the technical transfer project or technical transfer contract as prescribed by the law regulations on medical examination and treatment.

2. The medical examination and treatment establishment that receives the technical transfer is responsible for notifying in writing the social security office that signs the health insurance-covered medical examination and treatment contract of the medical examination and treatment services performed under the transfer project or contract, as a basis for payment, and the written approval issued by a competent authority for special-class techniques. The health insurance fund shall make payment based on the number of medical examination and treatment services specified in the transfer project, transfer contract, or the written approval issued by a competent authority for special-class techniques.

3. The payment level is based on the price of the medical examination and treatment service on the list covered by the health insurance fund as approved by a competent authority for the medical examination and treatment establishment that transfers the technique. In case the medical examination and treatment establishment that transfers the technique is a private medical examination and treatment establishment, Point b, Clause 2, Article 39 of this Decree shall apply.

4. For the medical examination and treatment costs covered by the health insurance fund that have not yet been included in the structure of the price of the medical examination and treatment service, the health insurance fund shall make payment as prescribed in Clause 3, Article 39 of this Decree.

5. After completing the performance of the transfer contract, the medical examination and treatment establishment must submit to a competent authority for approval the list of techniques and approve the price in accordance with the law regulations on the price of medical examination and treatment services to serve as a basis for payment for such technical service.

Article 46. Payment of medical examination and treatment costs for medical examination and treatment establishments that organize health insurance-covered medical examination and treatment outside of administrative hours or on holidays and weekends

1. A health insurance card holder who comes for medical examination and treatment may have the costs covered by the health insurance fund within the scope of benefits and the health insurance benefit level.

2. The medical examination and treatment establishment is responsible for ensuring personnel and professional conditions, publicizing the costs that the patient must pay outside the scope of benefits and the health insurance benefit level, and must notify the patient in advance; and notify in writing the state management agency in charge of health in the locality and the social security office where the health insurance-covered medical examination and treatment contract is signed at least 03 working days before performing medical examination and treatment activities outside of administrative hours or on holidays and weekends to serve as a basis for implementation and payment of medical examination and treatment costs.

Article 47. Payment of costs of medical examination and treatment services in health insurance-covered medical examination and treatment for private medical examination and treatment establishments

1. The payment level of costs of medical examination and treatment services to be paid the health insurance fund shall comply with Article 39 of this Decree.

2. In case a private medical examination and treatment establishment applies the payment level of medical examination and treatment costs to be paid the health insurance fund as prescribed at Point b, Clause 2, Article 39 of this Decree, the following shall be done:

a) A specialized medical examination and treatment establishment shall be paid at the actual price but not exceeding the highest price of such medical examination and treatment service of a state-owned medical examination and treatment establishment of the same specialized level in the provincial-level locality or of a state-owned basic-level medical examination and treatment establishment in the provincial-level locality in case there is no price of a state-owned specialized medical examination and treatment establishment in the provincial-level locality;

b) A basic-level medical examination and treatment establishment shall be paid at the actual price but not exceeding the highest price of such medical examination and treatment service of a state-owned medical examination and treatment establishment of the same basic level in the provincial-level locality. In case a state-owned basic-level medical examination and treatment establishment in the provincial-level locality does not have a price for such medical examination and treatment service, it shall be paid at a maximum of the lowest price of that technical service of a state-owned specialized medical examination and treatment establishment in the provincial-level locality;

c) A primary-level medical examination and treatment establishment shall be paid at the actual price but not exceeding the highest price of such medical examination and treatment service of a state-owned medical examination and treatment establishment of the same primary level in the provincial-level locality. In case a state-owned primary-level medical examination and treatment establishment in the provincial-level locality does not have a price for such medical examination and treatment service, it shall be paid at a maximum of the lowest price of such medical examination and treatment service of a state-owned basic-level medical examination and treatment establishment in the provincial-level locality;

d) In case there is no price for such medical examination and treatment service prescribed or approved by a competent authority for a state-owned medical examination and treatment establishment in the provincial-level locality, a private medical examination and treatment establishment shall be paid on the principles prescribed at Points a, b and c of this Clause at the price of such medical examination and treatment service approved by a competent authority for a state-owned medical examination and treatment establishment in one of the neighboring provinces. In case state-owned medical examination and treatment establishments in the neighboring provinces do not have a price for such medical examination and treatment service, it shall be paid at the price of such medical examination and treatment service approved by a competent authority for a state-owned medical examination and treatment establishment in another province nationwide.

Article 48. Payment level in case a technical service has been indicated and performed by a medical examination and treatment establishment but cannot be continued due to the patient's condition or physical state

1. The health insurance fund shall make payment according to the actual quantity of medicinal products, medical equipment, medical gases, supplies, tools, instruments, and chemicals used to perform that technical service that are being paid by the health insurance fund to the medical examination and treatment establishment and the purchase price as prescribed by the law regulations on bidding; for the costs of blood and blood products, payment shall be made as prescribed by the Minister of Health.

2. The health insurance fund shall cover the part of the costs of salaries, wages, allowances, contributions, and surgery and procedure allowances (if any) actually incurred at the level prescribed by the Minister of Health on the basis of the price structure of the technical service at which the establishment is being paid by the health insurance fund.

Article 49. Payment of costs of purchasing medicinal products, chemicals, testing supplies, and medical equipment for public non-business units that self-finance their recurrent and investment expenses, public non-business units that self-finance their recurring expenses, and private medical examination and treatment establishments in the case prescribed in Clause 3, Article 55 of the 2023 Law on Bidding, which is amended and supplemented by Law No. 90/2025/QH15

In case a medical examination and treatment establishment is a public non-business unit that self-finances its recurrent and investment expenses, a public non-business unit that self-finances its recurring expenses, or a private medical examination and treatment establishment that does not choose to apply the Law on Bidding for the purchase of medicinal products, chemicals, testing supplies, and medical equipment and falls into the case of payment as prescribed in Clause 3, Article 39 of this Decree, the health insurance fund shall cover within the scope of benefits and the benefit level of the health insurance participant at the purchase unit price but not exceeding the unit price according to the contractor selection result that is still valid at the time of payment of the medicinal product with the same trade name, manufacturer, origin, strength, concentration, route of administration, same group of technical criteria, dosage form, unit of calculation or of the same chemical, testing supplies, medical equipment with the same manufacturer, origin, technical criteria according to the following principles and order of priority:

1. The results of national centralized procurement, the results of price negotiation.

2. The results of centralized procurement in the provincial-level locality.

3. The results of procurement of state-owned medical examination and treatment establishments of the same professional and technical level in the same province as that medical examination and treatment establishment.

4. In case there is no unit price prescribed in Clause 3 of this Article, the health insurance fund shall make payment on the following principles:

a) A primary-level medical examination and treatment establishment shall be paid at the lowest winning bid price of a state-owned basic-level medical examination and treatment establishment in the provincial-level locality. In case there is no winning bid price of a state-owned basic-level medical examination and treatment establishment, the medical examination and treatment establishment shall be paid at the lowest winning bid price of a state-owned specialized medical examination and treatment establishment in the provincial-level locality;

b) A basic-level medical examination and treatment establishment shall be paid at the lowest winning bid price of a state-owned primary-level medical examination and treatment establishment in the provincial-level locality. In case there is no winning bid price of a state-owned primary-level medical examination and treatment establishment, the medical examination and treatment establishment shall be paid at the lowest price of a state-owned specialized medical examination and treatment establishment in the provincial-level locality;

c) A specialized medical examination and treatment establishment shall be paid at the lowest winning bid price of a state-owned primary-level or basic-level medical examination and treatment establishment in the provincial-level locality.

5. In case there is no unit price prescribed in Clause 4 of this Article, the health insurance fund shall make payment at the winning bid price of a state-owned medical examination and treatment establishment, the results of centralized procurement in a neighboring province in the following order of priority:

a) According to the results of centralized procurement in the locality;

b) The results of procurement of state-owned medical examination and treatment establishments of the same professional and technical level as that medical examination and treatment establishment;

c) On the principles prescribed at Points a, b and c, Clause 4 of this Article.

6. In case there is no unit price prescribed in Clause 5 of this Article, the health insurance fund shall make payment at the winning bid price of a state-owned medical examination and treatment establishment, the results of centralized procurement in another province nationwide on the principles prescribed at Points a, b and c, Clause 5 of this Article.

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

1. Payment of medical examination and treatment costs for children under 6 years of age and persons who have donated human body organs but do not have health insurance cards:

a) The medical examination and treatment establishment shall use the function of looking up temporary health insurance card code information on the data receiving portal of the Vietnam Social Security to obtain temporary health insurance card code information, sum up the health insurance-covered medical examination and treatment costs according to the scope of benefits and the benefit level, and send them to the social security office for payment as prescribed. In case the patient has not yet been issued a temporary card code, the medical examination and treatment establishment shall enter full information on the data receiving portal of the Vietnam Social Security for the portal to automatically issue a temporary card code;

b) The social security office is responsible for checking the temporary health insurance card code information; and paying the medical examination and treatment costs as prescribed.

2. In case of transfer of a medical examination and treatment establishment for a patient who needs to be accompanied by a medical worker and uses medicinal products and medical equipment according to professional requirements during transportation, the costs of medicinal products and medical equipment shall be summed up into the treatment costs of the medical examination and treatment establishment that orders the transfer.

3. In case a patient, after being stabilized after inpatient treatment, needs to continue using medicinal products after being discharged from the hospital as indicated by the medical examination and treatment establishment, the health insurance fund shall cover the costs of medicinal products within the scope of benefits and the benefit level as prescribed by the Minister of Health. The medical examination and treatment establishment shall sum up this medicinal product expenditure into the patient's medical examination and treatment costs before the patient is discharged from the hospital.

4. In case a patient's health insurance card is still valid when he/she comes for medical examination and treatment but expires while he/she is undergoing inpatient treatment or day-care treatment or outpatient treatment at a medical examination and treatment establishment, the health insurance fund shall cover the medical examination and treatment costs within the scope of benefits and the benefit level until he/she is discharged from the hospital for a maximum of 15 days from the expiration date of the health insurance card. Upon being discharged from the hospital and finishing the medical examination and treatment session, the patient is responsible for paying health insurance premiums consecutively with the term of the expired health insurance card.

5. The medical examination and treatment costs for a health insurance participant who comes for medical examination and treatment before January 01 and finishes the medical examination and treatment session and is discharged from the hospital on or after January 1 of the following year shall be handled as follows:

a) In case the medical examination and treatment establishment continues to sign a health insurance-covered medical examination and treatment contract, it shall be included in the medical examination and treatment costs of the following year;

b) In case the medical examination and treatment establishment does not continue to sign a health insurance-covered medical examination and treatment contract, it shall be included in the medical examination and treatment costs of the preceding year.

6. In case a patient holding a health insurance card presents the card information late when taking medical examination and treatment, the health insurance fund shall cover the medical examination and treatment costs within the scope of benefits and the benefit level from the time the health insurance card information is presented. The medical examination and treatment costs during the period when the patient has not yet presented the health insurance card information shall be directly paid by the health insurance fund in accordance with the procedures prescribed in Article 56 and the payment level prescribed in Article 57 of this Decree.

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

1. Refusal to pay health insurance-covered medical examination and treatment costs means the social security office's refusal to pay for health insurance-covered medical examination and treatment costs that are determined to be inconsistent with the law regulations on health insurance and medical examination and treatment during the assessment process and before payment is made to the medical examination and treatment establishment.

2. The refusal to pay must clearly state the grounds, reasons for refusal, and the amount of costs refused for payment in the assessment record, including the health insurance-covered medical examination and treatment costs requested by the social security office for payment in the electronic environment, which are automatically returned when the medical examination and treatment establishment sends the data. The representative of the social security office and the representative of the medical examination and treatment establishment shall jointly sign the assessment record of health insurance-covered medical examination and treatment costs to serve as a basis for account-finalization within the period prescribed at Point b, Clause 2, Article 32 of the Law on Health Insurance.

3. The medical examination and treatment establishment has the right to propose the social security office to reconsider the refusal to pay for the health insurance-covered medical examination and treatment costs or to propose a competent authority to consider and settle the case in accordance with the law regulations.

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

1. The recovery of health insurance-covered medical examination and treatment costs shall be carried out for the health insurance-covered medical examination and treatment costs that have been paid but are found to be inconsistent with the law regulations through inspection, examination, audit, settlement of problems, and handling of violations of law by a competent authority and detected during the organization of implementation.

2. Based on the conclusions and handling results of a competent authority as prescribed in Clause 1 of this Article, the director of the social security office shall issue a document stating the recovery of health insurance-covered medical examination and treatment costs under his/her competence. The recovery document must clearly state the legal basis for recovery, the content of the violation, the amount to be recovered, the time limit for recovery, and the responsibilities of the related organizations and individuals for the recovered costs. The medical examination and treatment establishment is responsible for returning the recovered amount to the Health Insurance Fund.

3. The recovered amount shall be accounted for in the year of recovery.

4. The medical examination and treatment establishment has the right to propose the social security office to reconsider the recovery of the health insurance-covered medical examination and treatment costs or to propose a competent authority to consider and settle the case in accordance with the law regulations.

5. In case the recovery of health insurance-covered medical examination and treatment costs in the inspection, examination, audit, and handling of violations of law by a competent state agency has provisions different from those of this Article, such provisions shall apply.

Article 53. Responsibilities of related parties in the refusal to pay and recovery of health insurance-covered medical examination and treatment costs

1. The agency, organization, or individual whose payment is refused or whose health insurance-covered medical examination and treatment costs are requested to be recovered is responsible for complying with the decision of the social security office or the final settlement result of a competent authority in accordance with the law regulations.

2. When settling the refusal to pay or the recovery of health insurance-covered medical examination and treatment costs, the settling agency must clearly determine the responsibilities and the handling or propose the handling of the responsibilities of the related agencies, organizations, and individuals in accordance with the law regulations.

3. In case the refusal to pay or the recovery is not in accordance with the law regulations, the social security office that refuses to pay or recovers the costs is responsible for making additional payments and refunding the medical examination and treatment establishment.

Chapter IX

DIRECT PAYMENT OF MEDICAL EXAMINATION AND TREATMENT COSTS BETWEEN THE SOCIAL SECURITY OFFICE AND THE HEALTH INSURANCE PARTICIPANT

Article 54. Cases where the social security office directly pays health insurance-covered medical examination and treatment costs to the health insurance card holder as prescribed at Point c, Clause 2, Article 31 of the Law on Health Insurance

The social security office shall directly pay the costs to the health insurance participant within the scope of benefits and the benefit level as prescribed by the law regulations on health insurance in the following cases:

1. The patient is in an emergency, unconscious, or deceased and has not yet been able to present the health insurance card information before being discharged from the hospital.

2. The health insurance participant under the management of the Ministry of National Defense or the Ministry of Public Security has lost his/her health insurance card but has not yet been re-granted one, or the health insurance card information of the patient is faulty or incorrect and has not yet been corrected or amended by the social security office at the time of finishing the medical examination and treatment session and being discharged from the hospital.

3. The health insurance participant is a participant for whom health insurance premiums shall be paid by the state budget but has not yet been issued a health insurance card, unless otherwise prescribed in Clause 1, Article 50 of this Decree. The patient shall be paid the entire medical examination and treatment cost within the scope of benefits and the benefit level from the date he/she is determined to be a participant for whom health insurance premiums shall be paid by the state budget but has not yet been paid due to not having been issued a health insurance card.

4. The patient is admitted to a medical examination and treatment establishment that does not have a health insurance-covered medical examination and treatment contract in an emergency. The patient shall be paid the entire medical examination and treatment cost within the scope of benefits and the benefit level that has not yet been paid as prescribed by the law regulations on health insurance.

5. In case of health insurance-covered medical examination and treatment for a participant who has changed to a group of participants with a higher health insurance benefit level but has not yet been issued a new health insurance card, the social security office shall directly pay the difference between the two benefit levels to the health insurance participant.

6. In case the patient buys medicinal products or medical equipment by himself/herself as prescribed in Articles 58 and 59 of this Decree. For the participants prescribed at Points a, b, c and dd, Clause 3, Article 12 of the Law on Health Insurance, the payment of costs of medicinal products and medical equipment shall be made in accordance with the Government’s 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, People's Public Security forces, and participants engaged in cypher work, which is amended and supplemented by the Government’s Decree No. 74/2025/ND-CP dated March 31, 2025.

7. In case a health insurance participant takes medical examination and treatment during the period when his/her card is revoked, seized, or temporarily locked as prescribed in Clauses 1, 2 and 3, Article 12 of this Decree through no fault of the health insurance participant, the patient shall be paid the entire medical examination and treatment cost within the scope of benefits and the benefit level applicable to the correct group of participant.

Article 55. Dossier of request for direct payment

1. A written request for direct payment using Form No. 10 provided in the Appendix to this Decree.

2. Photocopies of the following documents:

a) Health insurance card or health insurance code in case information on the electronic health insurance card is available, and an identity document as prescribed at Point b, Clause 1, Article 37 of this Decree. In the case prescribed in Clause 5, Article 54 of this Decree, the health insurance card includes the card with the old benefit level and the card with the new, higher benefit level;

b) Hospital discharge form or medical examination card or book of the medical examination and treatment session for which payment is requested (a copy with the seal of the medical examination and treatment establishment chopped on the top-left corner of the first page;

c) Prescription (if any).

3. Invoices and a statement of costs.

4. In the case prescribed in Clause 6, Article 54 of this Decree, the dossier of request for direct payment includes, in addition to those prescribed in Clauses 2 and 3 of this Article, the following documents:

a) A form for indicating medical equipment for the patient in case of indication of medical equipment;

b) A confirmation form of the shortage of medicinal products or medical equipment made using Form No. 11 provided in the Appendix to this Decree, issued by the medical examination and treatment establishment to the patient.

Article 56. Process and procedures for direct payment

1. The patient or his/her relative as prescribed by the law regulations on medical examination and treatment shall fully declare information according to the written request for direct payment using Form No. 10 provided in the Appendix to this Decree (including selecting to receive the direct payment at the single-window section of the social security office or via the personal account number declared in Form No. 10), and at the same time submit a dossier as prescribed in Clauses 2, 3 and 4, Article 55 of this Decree on the National Public Service Portal or via the social security office's application or submit it in person at the single-window section or send it via the postal service to the social security office in the locality where the patient resides or the social security office that issued the card or the social security office that signed the health insurance-covered medical examination and treatment contract with the medical examination and treatment establishment where the patient received treatment.

2. The National Public Service Portal or the social security office's application shall automatically return a dossier receipt slip and an appointment slip for returning the result of the direct payment to the patient or his/her relative, or the dossier-receiving officer at the single-window section of the social security office shall directly check the dossier and issue a dossier receipt slip and an appointment slip for returning the result of the direct payment to the patient or his/her relative.

3. In case there is no request for amendment or supplementation of the dossier, within 25 days from the date of receipt of a complete and valid dossier (in case of submitting a paper dossier, based on the date stamped on the incoming document or the dossier receipt slip), the social security office must complete the health insurance assessment and pay the costs to the patient. The direct payment shall be made in cash or by bank transfer to the patient's account number provided in the written request for direct payment.

4. In case there is a request for amendment or supplementation of the dossier, it shall be carried out as follows:

a) Within 05 working days from the date of receipt of the dossier (in case of submitting a paper dossier, based on the date stamped on the incoming document or the dossier receipt slip), the social security office must issue a written document specifically stating the details to be amended or supplemented and send it to the patient or his/her relative;

b) Within 20 days from the date of receipt of the written request for amendment or supplementation (in case of submitting a paper dossier, based on the date stamped on the incoming document or the dossier receipt slip), the patient or his/her relative is responsible for amending or supplementing the dossier and sending it to the social security office for consideration;

c) Within 20 days from the date of receipt of the amended or supplemented dossier that meets the conditions as prescribed (in case of submitting a paper dossier, based on the date stamped on the incoming document or the dossier receipt slip), the social security office must pay the costs to the patient. The direct payment shall be made in cash or by bank transfer to the patient's account number provided in the written request for direct payment.

Article 57. Direct payment levels in the cases prescribed at Points a and b, Clause 2, Article 31 of the Law on Health Insurance

1. In case a patient takes medical examination and treatment at a basic-level medical examination and treatment establishment which, before January 1, 2025, has been determined by a competent authority to be of the district level or a basic-level medical examination and treatment establishment with a score of less than 50 or temporarily classified as a basic-level establishment, except for a basic-level medical examination and treatment establishment which, before January 1, 2025, has been determined by a competent authority to be of the provincial level and does not have a health insurance-covered medical examination and treatment contract (unless in case of emergency), the payment level is as follows:

a) In case of outpatient medical examination and treatment, the health insurance fund shall make payment for the actual costs within the scope of benefits and the health insurance benefit level as prescribed but not exceeding 0.15 times the statutory pay rate at the time of medical examination and treatment;

b) In case of inpatient medical examination and treatment, the health insurance fund shall make payment for the actual costs within the scope of benefits and the health insurance benefit level as prescribed but not exceeding 0.5 times the statutory pay rate at the time of discharge.

2. In case a patient takes inpatient medical examination and treatment at a basic-level medical examination and treatment establishment which, before January 1, 2025, has been determined by a competent authority to be of the provincial level or a basic-level medical examination and treatment establishment with a score of between 50 points and under 70 points and does not have a health insurance-covered medical examination and treatment contract (unless in case of emergency), the health insurance fund shall make payment for the actual costs within the scope of benefits and the health insurance benefit level as prescribed but not exceeding 1.0 times the statutory pay rate at the time of discharge.

3. In case a patient takes inpatient medical examination and treatment at a specialized medical examination and treatment establishment that does not have a health insurance-covered medical examination and treatment contract (unless in case of emergency), the health insurance fund shall make payment for the actual costs within the scope of benefits and the health insurance benefit level as prescribed but not exceeding 2.5 times the statutory pay rate at the time of discharge.

4. In case a patient takes medical examination and treatment not in accordance with Clause 1, Article 28 of the Law on Health Insurance, cannot present the health insurance card information or presents the card information late before the end of the medical examination and treatment session and discharge from the hospital, unless otherwise prescribed in Clause 1, Article 54 of this Decree and Clause 5 of this Article, the health insurance fund shall make payment for the actual costs within the scope of benefits and the health insurance benefit level during the period when the patient has not yet presented the health insurance card information, but not exceeding the specific level as follows:

a) In case of outpatient medical examination and treatment, the maximum level is not more than 0.15 times the statutory pay rate at the time of medical examination and treatment;

b) In case of inpatient medical examination and treatment, the maximum level is not more than 0.5 times the statutory pay rate at the time of discharge.

5. During the period when the patient has not yet presented the health insurance card information as prescribed in Clause 1, Article 38 of this Decree, for the participants prescribed at Points a, b, c, d and dd, Clause 3, Article 12 of the Law on Health Insurance, the health insurance fund shall cover the health insurance-covered medical examination and treatment costs within the scope of benefits and the benefit level.

Article 58. Medicinal products and medical equipment bought by patients themselves for which direct payment shall be made to such patients

1. Medicinal products on the list of orphan medicinal products as prescribed by the Minister of Health.

2. Class C or D medical equipment, except for in vitro diagnostic medical equipment, patient-specific medical equipment, and medical equipment on the list of medical equipment issued by the Minister of Health that can be bought and sold as ordinary goods as prescribed in the Government's Decree No. 98/2021/ND-CP dated November 8, 2021, on the management of medical equipment, which is amended and supplemented by the Government's Decree No. 07/2023/ND-CP dated March 3, 2023, and Decree No. 04/2025/ND-CP dated January 1, 2025.

Article 59. Conditions for direct payment of costs to patients who buy medicinal products or medical equipment by themselves

At the time of prescribing medicinal products or indicating the use of medical equipment, all of the following conditions must be met:

1. At the time a prescription or indication is made for the patient, the medical examination and treatment establishment does not have medicinal products or medical equipment available as prescribed at Point b, Clause 2, Article 43 of this Decree and falls into the following cases:

a) For medicinal products: there is no commercial medicinal product containing active ingredient that is prescribed for the patient or a medicinal product with the same active ingredient but a different concentration or content or dosage form or route of administration and cannot be substituted for the patient's prescription;

b) For medical equipment: there is no medical equipment that the patient is indicated to use and no substitute medical equipment.

2. The patient cannot be transferred to another medical examination and treatment establishment in one of the following cases:

a) The patient’s health condition or pathological condition is determined to be unsuitable for transfer;

b) The medical examination and treatment establishment where the patient is being examined and receiving treatment is under medical quarantine as prescribed by the law regulations on prevention and control of infectious diseases;

c) The medical examination and treatment establishment where the patient is being examined and receiving treatment is a specialized or the highest professional and technical level medical examination and treatment establishment in the province or municipality.

3. Medicinal products and medical equipment cannot be transferred between medical examination and treatment establishments.

4. The prescribed medicinal products and medical equipment must be consistent with the professional scope of the medical examination and treatment establishment.

5. The prescribed medicinal products and medical equipment must be within the scope of benefits of the health insurance participant and have been paid for by the health insurance fund at one of the medical examination and treatment establishments nationwide.

6. The medical examination and treatment establishment is responsible for providing a confirmation of the shortage of medicinal products or medical equipment using Form No. 11 provided in the Appendix to this Decree to the patient to serve as a basis for payment.

Article 60. Direct payment levels for patients who buy medicinal products or medical equipment by themselves

1. The social security office shall directly pay the patient as follows:

a) For medicinal products: the basis for calculating the payment level is the quantity and unit price stated on the invoice purchased by the patient at a pharmaceutical business establishment. In case a medicinal product is subject to prescribed payment rate and conditions, the payment shall be made according to such rate and conditions;

b) For medical equipment: the basis for calculating the payment level is the quantity and unit price stated on the invoice purchased by the patient at a medical equipment business establishment. In case a medical equipment is subject to a prescribed payment level, the payment shall not exceed the prescribed payment level for such medical equipment.

2. The unit price of medicinal products and medical equipment used as a basis for determining the payment level must not exceed the payment unit price at the latest time of payment for medicinal products and medical equipment that have won a bid at the medical examination and treatment establishment where the patient was examined and received treatment.

In case the medicinal products and medical equipment have not yet won a bid at the medical examination and treatment establishment where the patient was examined and received treatment, the unit price used as a basis for determining the health insurance payment level is the contractor selection result that is still valid at the time of payment in the following order of priority:

a) The results of national centralized procurement or the results of price negotiation;

b) The results of local centralized procurement in the locality;

c) The lowest contractor selection result of state-owned medical examination and treatment establishments of the same professional and technical level in the locality. In case there is no contractor selection result of state-owned medical examination and treatment establishments of the same professional and technical level in the locality, it shall be based on the lowest contractor selection result of other state-owned medical examination and treatment establishments in the locality;

d) The lowest contractor selection result at the time of payment of state-owned medical examination and treatment establishments of the same professional and technical level nationwide. In case there is no contractor selection result of state-owned medical examination and treatment establishments of the same professional and technical level nationwide, it shall be based on the lowest contractor selection result of other state-owned medical examination and treatment establishments nationwide.

3. The social insurance agency shall deduct health insurance payments from the costs payable to the medical examination and treatment establishment where the patient received treatment as follows:

a) In case the costs of medicinal products and medical equipment are included in the price of the medical examination and treatment service: a deduction shall be made from the health insurance-covered medical examination and treatment service cost of the medical examination and treatment establishment at the payment level prescribed in Clauses 1 and 2 of this Article;

b) In case the costs of medicinal products and medical equipment are not included in the structure of the price of the medical examination and treatment service: no deduction shall be made from the health insurance-covered medical examination and treatment service cost of the medical examination and treatment establishment;

c) The costs of medicinal products and medical equipment directly paid by the social security office to the patient shall be included in the estimated expenditure of the medical examination and treatment establishment.

Chapter X

MANAGEMENT AND USE OF THE HEALTH INSURANCE FUND

Article 61. Allocation and use of health insurance premiums

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

a) To pay for the costs within the scope of benefits of the health insurance participant as prescribed by the law regulations on health insurance;

b) To be retained at educational institutions or vocational institutions, agencies, organizations, and enterprises that fully meet the conditions prescribed in Article 63 of this Decree.

2. 8% of the health insurance premiums shall be allocated to the contingency fund and for health insurance administration and operational expenses, as follows:

a) The contingency fund shall be the remaining amount after deducting the amount allocated for health insurance administration and operations as prescribed at Point b of this Clause, and must be at least 4% of the health insurance premiums;

b) Expenses for health insurance administration and operations shall not exceed 4% of the health insurance premiums. After the Vietnam Social Security Board of Commissioners approves the annual account-finalization of expenses for social security, unemployment insurance, and health insurance administration and operations, the Vietnam Social Security shall transfer any unused funds to the contingency fund for overall adjustment. The Prime Minister shall decide on the specific level of expenses for health insurance administration and operations for each year.

Article 62. Levels of expenses for medical examination and treatment in primary health care

1. The amount to be retained at an educational institution or a vocational institution includes:

a) 5% of the collected health insurance premiums on the total number of children under 6 years of age or pupils or students enrolled in the educational institution, calculated by the following formula:

Amount to be retained = 5% x (N_{Number of people} x M_{Health insurance premium rate} x L_{statutory pay rate} x Th)

Where:

- N_{Number of people}: Total number of children under 6 years of age; pupils or students enrolled in the educational institution or vocational institution who participate in health insurance.

- M_{Health insurance premium rate}: The health insurance premium rate applicable to children under 6 years of age or pupils or students as prescribed in Clauses 3 and 4, Article 6 of this Decree.

- L_{statutory pay rate}: The statutory pay rate at the time of health insurance premium payment.

- Th: The number of months for which health insurance premiums have been paid.

Every 3 months, 6 months or 12 months, the social security office is responsible for transferring the amount prescribed at this Point to the educational institution or vocational institution and summing it up into the account-finalization of the health insurance-covered medical examination and treatment fund;

b) 1% of the monthly health insurance premiums paid for employees at the educational institution or vocational institution, and the social security office is responsible for paying this expense immediately after receiving the health insurance premiums from the educational institution or vocational institution.

2. The amount to be retained at an agency, organization, or enterprise that fully meets the conditions prescribed in Clause 1, Article 63 of this Decree is 1% of the monthly health insurance premiums paid for employees at the agency, organization, or enterprise. The social security office is responsible for paying this expense immediately after receiving the health insurance premiums from the agency, organization, or enterprise.

3. The amount to be retained for persons working on offshore fishing vessels:

a) The expense level is 10% of the collected health insurance premiums calculated on the number of people working on the vessel who participate in health insurance to purchase medicine cabinets, medicinal products, medical equipment, and other tools and instruments for first aid and initial treatment, calculated by the following formula:

Amount to be retained = 10% x (N_{Number of people} x M_{Health insurance premium rate} x L_{statutory pay rate} x Th)

Where:

- N_{Number of people}: The number of health insurance participants working on the fishing vessel.

- M_{Health insurance premium rate}: The health insurance premium rate applicable to the first person in a household as prescribed in Article 6 of this Decree.

- L_{statutory pay rate}: The statutory pay rate at the time of payment.

- Th: The number of months for which health insurance premium have been paid;

b) The chairperson of the provincial-level People's Committee shall organize the purchase and supply of medicine cabinets, medicinal products, medical equipment, and other tools and instruments to offshore fishing vessel owners. The social security office shall transfer the amount prescribed at Point a of this Clause to the agency or organization assigned by the chairperson of the provincial-level People's Committee to purchase medicine cabinets, medicinal products, medical equipment, and other tools and instruments; and sum up the transferred amount into the account-finalization of the medical examination and treatment fund.

4. Based on the actual needs and the ability to balance the health insurance fund, the Minister of Health shall propose to the Government to adjust the level of transfer of funds for medical examination and treatment in primary health care.

Article 63. Conditions, expense items, and payment and account-finalization of funds for medical examination and treatment in primary health care

1. An educational institution or a vocational institution, an agency, organization, or enterprise (except for an educational institution or a vocational institution, an agency, organization, or enterprise that has signed a health insurance-covered medical examination and treatment contract as prescribed in Article 30 of this Decree) may receive funds from the health insurance fund to perform medical examination and treatment in primary health care when fully meeting the following conditions:

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

b) Having a separate medical room or working office to perform first aid and initial treatment for the participants managed by the educational institution or vocational institution, agency, organization, or enterprise when they suffer from accidents, injuries, or common diseases during the period of studying or working at the educational institution or vocational institution, agency, organization, or enterprise.

2. Expense items:

a) To purchase medicinal products, medical equipment, supplies, tools, instruments, and chemicals for first aid and initial treatment for children, pupils, students, and the participants managed by the agency, organization, or enterprise when they suffer from accidents, injuries, or common diseases during the period of studying or working at the educational institution or vocational institution, agency, organization, or enterprise;

b) To purchase or repair common medical equipment for primary health care, and file cabinets for management of health records at the educational institution or vocational institution, agency, organization, or enterprise;

c) To purchase documents for disease prevention, hygiene, and medical examination and treatment activities in primary health care.

3. Payment and account-finalization of funds:

a) For a public educational institution or vocational institution, the expenses for medical examination and treatment in primary health care shall be accounted for as expenses for the performance of medical work at the institution and account-finalized with the superior management unit in accordance with current regulations;

b) For a non-public educational institution or vocational institution, the expenses for medical examination and treatment in primary health care shall be accounted for as expenses of the institution and account-finalized with the superior unit (if any);

c) For an enterprise or an economic organization, a separate accounting book shall be opened to record the receipt and use of funds, and shall not be included in the account-finalization of the expenses of the enterprise or economic organization;

d) For other agencies and units, the expenses for medical examination and treatment in primary health care shall be accounted for as expenses for the performance of medical work of the agency or unit and account-finalized with the superior management agency or unit (if any) or the same-level finance agency in accordance with current regulations.

4. An educational institution or a vocational institution, an agency, organization, or enterprise that is allocated funds for medical examination and treatment in primary health care as prescribed in this Decree is responsible for using them for primary health care, ensuring the availability of medicinal products and medical equipment for primary health care, and is not allowed to use them for other purposes. The funds allocated that are not used up by the end of the year may be carried forward to the following year for continued use, and shall be summed up and reported on the management and use of the funds in the annual activity report and are not subject to account-finalization with the social security office.

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

Article 64. Management and use of the contingency fund

1. Sources for setting aside the contingency fund

a) The amount to be annually set aside as prescribed at Point a, Clause 2, Article 61 of this Decree;

b) The amounts collected from delayed payment or evasion of payment of health insurance premiums;

c) The interest on delayed payment or evasion of payment of health insurance premiums;

d) The profits from health insurance investment activities;

dd) The amounts of expenses made in contravention of regulations that must be recovered.

2. The contingency fund shall be used as follows:

a) To supplement the funds for health insurance-covered medical examination and treatment in case the health insurance premiums collected for medical examination and treatment as prescribed in Clause 1, Article 61 of this Decree are smaller than the expenses for medical examination and treatment in the year. After appraising the account-finalization, the Vietnam Social Security is responsible for supplementing the entire difference from the contingency fund;

b) To make advance payments and additional payments for the health insurance-covered medical examination and treatment costs arising in the preceding year as prescribed at Point b, Clause 4, Article 65 of this Decree;

c) To refund to the state budget the funds for the grant of duplicate health insurance cards.

3. In case the contingency fund is not sufficient to supplement the funds for medical examination and treatment as prescribed in Clause 2 of this Article, the Vietnam Social Security shall report a settlement plan to the Vietnam Social Security Board of Commissioners before reporting to the Ministry of Health and the Ministry of Finance.

The Ministry of Health shall assume the prime responsibility for, and coordinate with the Ministry of Finance in, proposing to the Government settlement measures to ensure sufficient and timely funds for health insurance-covered medical examination and treatment as prescribed.

Article 65. Making of revenue and expenditure estimates, notification of estimated expenses, and account-finalization of revenues and expenses of the health insurance fund

1. Annually, the Vietnam Social Security shall coordinate with the Army Social Security and the Public Security Social Security to make revenue and expenditure estimates of the health insurance fund, including: expenses for health insurance-covered medical examination and treatment, expenses for health insurance organization and activities, expenses for setting aside the contingency fund from the revenues in the year, and expenses for setting aside the contingency fund to pay for the health insurance-covered medical examination and treatment costs of the preceding year that the medical examination and treatment establishment has spent on patients but has not yet agreed to pay due to problems (if any), and investment from the temporarily idle amounts of the health insurance fund, and submit them to the Vietnam Social Security Board of Commissioners for approval and send them to the Ministry of Finance before July 20 every year. The Ministry of Finance shall assume the prime responsibility for, and coordinate with the Ministry of Health in, summing up and submitting them to the Prime Minister before November 30 every year for assignment of revenue and expenditure estimates of the health insurance fund to the Vietnam Social Security, the Army Social Security, and the Public Security Social Security.

2. Assignment of expenditure estimates for health insurance-covered medical examination and treatment and notification of estimated expenses for health insurance-covered medical examination and treatment:

a) Within 15 days from the date of receipt of the Prime Minister's decision on the assignment of revenue and expenditure estimates of the health insurance fund, the Vietnam Social Security shall assign expenditure estimates for health insurance-covered medical examination and treatment to the provincial-level social security offices at a maximum of 92% of the estimated revenue from health insurance premiums nationwide after deducting the estimate assigned by the Prime Minister to the Army Social Security and the Public Security Social Security;

b) Based on Point c of this Clause, the medical examination and treatment establishment shall make an estimated expenditure and send it to the social security office where the health insurance-covered medical examination and treatment contract is signed. Based on the proposal of the medical examination and treatment establishment and the assigned estimate, the provincial-level social security office shall notify the estimated expenditure for health insurance-covered medical examination and treatment to the medical examination and treatment establishment. In case the medical examination and treatment establishment's estimated expenditure in the year increases or decreases compared to the notified amount, the medical examination and treatment establishment shall send a written document to the provincial-level social security office before October 15 every year for summarization and adjustment within the scope of the assigned estimate of the provincial-level social security office;

c) The estimated expenditure shall be determined on the basis of the expenditure estimate for health insurance-covered medical examination and treatment assigned by the Prime Minister and the actual expenditure for health insurance-covered medical examination and treatment of the preceding year, the estimated increase or decrease in the number of medical examination and treatment sessions, the average cost of health insurance-covered medical examination and treatment of the medical examination and treatment establishment, the prices of medical examination and treatment services, the scope of health insurance benefits, and other changes in policies and laws related to health insurance;

d) In case the total estimated expenditure for health insurance-covered medical examination and treatment of the medical examination and treatment establishments in the year increases or decreases compared to the estimate assigned by the Vietnam Social Security, the provincial-level social security office shall sum up and send it to the Vietnam Social Security before October 30 every year for consideration and adjustment among the provinces and municipalities. The Vietnam Social Security shall sum up and consider adjusting the expenditure estimate for health insurance-covered medical examination and treatment between the provincial-level social security offices within the scope of the expenditure estimate for medical examination and treatment and the expenditure estimate for setting aside the contingency fund assigned in the year before November 15 every year to serve as a basis for adjusting the estimated expenditure for health insurance-covered medical examination and treatment of the medical examination and treatment establishment.

3. In case the actual expenditure for health insurance-covered medical examination and treatment in the year of the medical examination and treatment establishment that has been assessed by the social security office exceeds the estimated expenditure (including the amount notified at the beginning of the year and the adjusted amount during the year), the medical examination and treatment establishment shall review and provide a written explanation of the causes affecting the expenditure exceeding the estimated expenditure and send it to the social security office and the provincial-level Department of Health. The provincial-level social security office shall assume the prime responsibility for, and coordinate with the provincial-level Department of Health in:

a) Coordinating with the medical examination and treatment establishment to review the causes affecting the exceeding of the estimated expenditure for health insurance-covered medical examination and treatment according to the explanation of the medical examination and treatment establishment; reviewing the costs that are higher than the average increase of medical examination and treatment establishments of the same professional and technical level, the same type of general or specialist medical examination and treatment establishment in the province or municipality or nationwide;

b) Reviewing and agreeing to determine the health insurance-covered medical examination and treatment costs exceeding the estimated expenditure that are implemented in accordance with the law regulations on medical examination and treatment and health insurance to be paid and to supplement the funds for the medical examination and treatment establishment; refusing to pay for the medical examination and treatment costs that are determined through review not to be implemented in accordance with the law regulations on medical examination and treatment and health insurance.

In case of disagreement with the refusal to pay the medical examination and treatment costs, the medical examination and treatment establishment has the right to propose the provincial-level social security office and the provincial-level Department of Health to consider or sum up and send it to the Ministry of Health for settlement in accordance with the law regulations;

c) In case the estimate assigned by the Vietnam Social Security is not sufficient to supplement the funds for the medical examination and treatment establishments, the provincial-level social security office shall send it to the Vietnam Social Security to supplement the funds for health insurance-covered medical examination and treatment within the scope of the expenditure estimate for health insurance-covered medical examination and treatment assigned by the Prime Minister.

4. In case the total actual expenditure for health insurance-covered medical examination and treatment in the year exceeds the expenditure estimate for health insurance-covered medical examination and treatment assigned by the Prime Minister, the Vietnam Social Security shall:

a) In case the amount set aside for the contingency fund from the revenues in the year according to the estimate assigned by the Prime Minister is sufficient to pay for the additional expenditure for health insurance-covered medical examination and treatment exceeding the estimate, the Vietnam Social Security shall supplement the funds for health insurance-covered medical examination and treatment from the contingency fund for payment and report to the Vietnam Social Security Board of Commissioners, the Ministry of Health, and the Ministry of Finance on the implementation results;

b) In case the amount set aside for the contingency fund from the revenues in the year according to the estimate assigned by the Prime Minister is not sufficient to pay for the additional expenditure for health insurance-covered medical examination and treatment exceeding the estimate, the Vietnam Social Security shall report to the Vietnam Social Security Board of Commissioners for approval and send it to the Ministry of Finance to assume the prime responsibility for, and coordinate with the Ministry of Health in, proposing to the Prime Minister to consider and supplement the funds for health insurance-covered medical examination and treatment exceeding the estimate from the contingency fund (if any) and to be account-finalized in the fiscal year of payment.

During the period of waiting for the Prime Minister's approval, the social security office shall make advance payments for the health insurance-covered medical examination and treatment costs that have been approved by the Vietnam Social Security Board of Commissioners.

After being approved by the Prime Minister, the social security office shall supplement the remaining funds for the medical examination and treatment establishment;

c) In case the contingency fund is not sufficient to supplement the funds for health insurance-covered medical examination and treatment, the Vietnam Social Security shall sum up and report to the Management Board for approval a plan to ensure the financial resources for health insurance-covered medical examination and treatment before sending it to the Ministry of Health to assume the prime responsibility for, and coordinate with the Ministry of Finance in, reporting to a competent authority for decision as prescribed in Clause 3, Article 64 of this Decree.

5. Advance payments, payments, and account-finalization of health insurance-covered medical examination and treatment costs for medical examination and treatment establishments shall be made on a quarterly basis in accordance with Clauses 1 and 2, Article 32 of the Law on Health Insurance.

In case the medical examination and treatment costs that have been requested for payment as prescribed have problems, the time for resolving the problems and making payment must not exceed 12 months from the date the medical examination and treatment establishment requests payment.

6. Annually, before October 1, the Vietnam Social Security is responsible for summing up and making an account-finalization report of the health insurance fund of the preceding year as prescribed in Article 32 of the Law on Health Insurance.

7. The details of the financial mechanism of the health insurance fund not yet prescribed in this Decree shall be implemented in accordance with the Government's regulations on the financial mechanism of the social security, health insurance, and unemployment insurance funds.

Chapter XI

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

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

1. To comply with the law regulations on application of information technology; the law regulations on health insurance-covered medical examination and treatment; the law regulations on protection of state secrets and related secrets; the law regulations on electronic transactions, archives, and information security.

2. To comply with technical standards and regulations, ensuring compatibility, uninterruptedness, and safety, and creating favorable conditions for electronic transactions between medical examination and treatment establishments and the social security offices.

3. To ensure the confidentiality and privacy of data and information on medical examination and treatment of health insurance participants.

4. To ensure the technical infrastructure, transmission lines, software, and personnel to meet the requirements of applying information technology and digital transformation in the implementation of health insurance.

5. To ensure the ability to connect on an inter-agency basis and share health insurance data with other information technology systems.

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

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

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

3. Application of information technology to build and establish methods of payment of health insurance-covered medical examination and treatment costs.

4. Application of information technology to serve health insurance-covered medical examination and treatment at medical examination and treatment establishments.

5. Application of information technology to serve the advance payment, assessment, payment, and account-finalization of health insurance-covered medical examination and treatment costs between the social security office and the medical examination and treatment establishment.

6. Application of information technology to serve the management and allocation of the health insurance fund, and the collection and expenditure of health insurance.

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

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

1. The Ministry of Health shall:

Build, prescribe, and issue common code lists to be applied in health insurance-covered medical examination and treatment; technical standards and formats, inter-agency connection, and extraction of electronic data in health insurance-covered medical examination and treatment, assessment, and payment of health insurance-covered medical examination and treatment costs.

2. The Ministry of Finance shall:

Direct and organize the implementation of the application of information technology and digital transformation in the management and implementation of health insurance regimes, policies, and laws, and the management and use of the Health Insurance Fund.

3. The Ministry of Public Security shall be responsible for ensuring the inter-agency connection of the National Database on Insurance with the National Population Database, and building utilities on the National Electronic Identification Application (VNeID) to serve the people and related agencies and units in the settlement of health insurance regimes, policies, and law regulations.

4. The Vietnam Social Security under the Ministry of Finance shall:

a) Apply information technology and digital transformation to create favorable conditions for and serve the people and agencies and organizations in the implementation of health insurance regimes, policies, and laws;

b) Build and deploy a monitoring and warning system in the implementation of health insurance regimes, policies, and laws;

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

d) Deploy the assessment and signing of health insurance-covered medical examination and treatment contracts with medical examination and treatment establishments in the electronic environment;

dd) Ensure the effective operation of the data receiving portal;

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

5. Medical examination and treatment establishments shall:

a) Apply information technology and digital transformation in health insurance-covered medical examination and treatment in accordance with the law regulations;

b) To maintain the compliance with the standards for inter-agency connection of authenticated health insurance-covered medical examination and treatment data with the health insurance information and assessment system of the social security office as prescribed during the performance of the health insurance-covered medical examination and treatment contract;

c) Be responsible before the law for the accuracy and legality of the data; to ensure the safety and confidentiality of information in accordance with the law regulations.

Chapter XII

IMPLEMENTATION PROVISIONS

Article 69. Transitional provisions

1. In case a patient is admitted to a medical examination and treatment establishment before the effective date of this Decree and finishes the medical examination and treatment session on or after the effective date of this Decree, this Decree or the provisions before the effective date of this Decree shall apply in the direction that is more favorable to the patient in terms of procedures and health insurance benefits.

2. In case a health insurance participant is determined by a competent authority to be a participant for whom health insurance premiums shall be paid or subsidized by the state budget before the effective date of this Decree and has a change of group due to the merger of administrative units when rearranging the political system's apparatus, the health insurance participant shall continue to have his/her health insurance premiums paid or subsidized by the state budget and enjoy the benefits applicable to the group determined in the document of the competent authority until the expiration of such document or until a new group is determined in a new document.

3. In case a health insurance-covered medical examination and treatment contract is signed before July 01, 2025, and remains valid after July 01, 2025, it shall be performed until the expiration of the signed contract, except in the case prescribed in Clause 8 of this Article.

4. In case a private medical examination and treatment establishment has signed a contract to supply medicinal products, chemicals, testing supplies, and medical equipment before July 01, 2025, in accordance with the law regulations on bidding, it may use and have the quantity of medicinal products, chemicals, testing supplies, and medical equipment paid for under the signed contract.

5. Health insurance participants prescribed at Points e, h, i, k, o, r, s and t, Clause 3, and Points a, b, d and g, Clause 4, Article 12 of the Law on Health Insurance and dossiers related to the making of lists of health insurance participants that are being handled by district-level agencies shall be transferred to commune-level People's Committees for continued implementation in accordance with the legal documents issued before the effective date of this Decree until new documents are issued.

6. Medical centers of districts, towns, and cities under provinces and municipalities, when being rearranged under new names, shall continue to apply Point c, Clause 1, Article 22 of the Law on Health Insurance in health insurance-covered medical examination and treatment.

7. To replace the phrase "island district" at Point b, Clause 4, Article 22 of the Law on Health Insurance with the phrase "special zone".

8. In case medical examination and treatment establishments are rearranged, reorganized, merged, or renamed when implementing the rearrangement of the two-level local government apparatus:

a) The medical examination and treatment establishment may continue to use the prices of health insurance-covered medical examination and treatment services that have been prescribed or approved by a competent authority and have the health insurance-covered medical examination and treatment costs paid before the date the establishments are rearranged, reorganized, merged, or renamed to pay the health insurance-covered medical examination and treatment costs until new prices are prescribed or approved by a competent authority for the new establishments;

b) In case a medical examination and treatment establishment has to be granted a new or re-granted or have its operation license adjusted, during the period of carrying out the procedures for granting a new or re-granting or adjusting the operation license as prescribed, the operation licenses that have been granted to the medical examination and treatment establishments before the date of rearrangement, reorganization, merger, or renaming shall continue to be used for the old and new establishments to perform medical examination and treatment and maintain the validity of the signed health insurance-covered medical examination and treatment contracts until a health insurance-covered medical examination and treatment contract is signed for the new establishment according to the new operation license. The medical examination and treatment establishment is responsible for ensuring the quality of medical examination and treatment services;

c) The registration of health insurance-covered primary medical examination and treatment of the health insurance participant and the number of health insurance cards that have been allocated to the primary health insurance-covered medical examination and treatment establishments before the date of rearrangement, reorganization, merger, or renaming shall continue to be used for the new establishment until there is guidance from the provincial-level Department of Health;

d) The code of the medical examination and treatment establishment, the seal of the medical examination and treatment establishment, and the seal of the establishment named in the health insurance-covered medical examination and treatment contract before the date of rearrangement, reorganization, merger, or renaming shall continue to be used until the new establishment is issued a new code and a new seal; In case the medical examination and treatment establishment has its old seal revoked but has not yet been issued a new seal, it may complete the procedures after having a new seal;

dd) Health insurance cards and health insurance card information with changed details due to rearrangement, reorganization, merger, or renaming shall continue to be used until they are adjusted by a competent authority;

e) Based on the practical requirements in the locality, the provincial-level People's Committee shall decide on solutions to handle arising situations to ensure the stable operation of the medical examination and treatment establishments during the transitional period when rearranging, reorganizing, merging, or renaming the medical examination and treatment establishments; and assign a focal point unit to be responsible for representing and handling arising issues related to the performance of contracts, payment and account-finalization of health insurance-covered medical examination and treatment costs, transfer of patients between health insurance-covered medical examination and treatment establishments, procurement, and ensuring the supply of medicinal products and medical equipment, and resolving arising problems related to the transfer until the medical examination and treatment establishments are granted new operation licenses and sign new health insurance-covered medical examination and treatment contracts.

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

Article 70. Effect

1. This Decree takes effect on August 15, 2025, unless otherwise prescribed 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, and Articles 69, 70, 71 and 72 of this Decree take effect on July 01, 2025.

3. Clause 8, Article 69 of this Decree takes effect from July 01, 2025, to the end of December 31, 2025.

4. To annul the following articles and clauses of the following documents from July 01, 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 the forms in the Appendix to the Government's 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 the Government's Decree No. 75/2023/ND-CP dated October 19, 2023, and Decree No. 02/2025/ND-CP dated January 1, 2025;

b) Clauses 3 and 4, Article 95 of the Government's Decree No. 24/2024/ND-CP dated February 27, 2024, detailing a number of articles and measures to implement the Law on Bidding regarding contractor selection;

c) Clause 5, Article 4 of the Government's Decree No. 74/2025/ND-CP dated March 31, 2025, amending and supplementing a number of articles of the Government's 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, People's Public Security forces, and persons engaged in cypher work.

5. To annul the following documents from August 15, 2025:

a) The Government's 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;

b) The Government's Decree No. 75/2023/ND-CP dated October 19, 2023, amending and supplementing a number of articles of the Government's 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) The Government's Decree No. 02/2025/ND-CP dated January 1, 2025, amending and supplementing a number of articles of the Government's 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 the Government's Decree No. 75/2023/ND-CP dated October 19, 2023.

6. In case the documents referred to in this Decree are replaced or amended or supplemented, the replacing or amended or supplemented documents shall apply.

Article 71. Responsibilities for implementation

1. The Ministry of Health shall be responsible for:

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

b) Guiding the making of lists of participants under its management; the determination and making of lists of participants prescribed at Points h, r, s and t, Clause 3, Article 12 of the Law on Health Insurance;

c) Guiding medical examination and treatment establishments to intensify the application of information technology in health insurance-covered medical examination and treatment; digitally signing, authenticating, and transferring data on requests for payment of health insurance-covered medical examination and treatment costs to the data receiving system of the Ministry of Health and the assessment information system of the Vietnam Social Security to serve the management of health insurance and the assessment and payment of health insurance-covered medical examination and treatment costs;

d) Directing medical examination and treatment establishments and centralized procurement units to strictly implement the relevant provisions on procurement and bidding to ensure the timely supply of medicinal products, chemicals, and medical equipment within the scope of benefits of health insurance participants, practice thrift, and prevent waste;

dd) Directing medical examination and treatment establishments to comply with the law regulations on medical examination and treatment, the professional guidelines of the Ministry of Health; and law related to the provision of quality, effective, and economical medical technical services;

e) Assuming the prime responsibility for, and coordinating with the Ministry of Finance in, building a report to the Government for submission to the National Assembly on the implementation of health insurance regimes and policies, including the management and use of the health insurance fund on an unscheduled, periodical, or annual basis;

g) Assuming the prime responsibility for, and coordinating with relevant agencies in, inspecting the implementation of health insurance policies and laws;

h) Issuing a document guiding the making of estimated expenses, adjustment of estimated expenses for health insurance-covered medical examination and treatment, and the determination of the amount of expenditure for health insurance-covered medical examination and treatment exceeding the estimated expenditure to be paid by the health insurance fund.

2. The Ministry of Finance shall be responsible for:

a) Balancing and allocating central budget funds to support localities that cannot balance their budgets to ensure the resources for the implementation of health insurance policies in accordance with the law regulations on the state budget;

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

c) Prescribing the competence to sign health insurance-covered medical examination and treatment contracts of the social security office in conformity with the functions, tasks, powers, and organizational structure of the Vietnam Social Security;

d) Issuing forms for summing up the payment and account-finalization of health insurance-covered medical examination and treatment costs, and prescribing the specific order and procedures for assessing the health insurance-covered medical examination and treatment costs;

dd) Reporting on the management and use of the health insurance fund annually and sending it to the Ministry of Health for summarization as prescribed.

3. The Ministry of National Defense, the Ministry of Public Security, and the Government Cypher Committee shall be responsible for guiding the implementation of health insurance for the participants under the management of the Ministry of National Defense and the Ministry of Public Security who take medical examination and treatment as prescribed in this Decree; and guiding the determination of relatives of participants engaged in other activities in cypher organizations as prescribed in Clause 5, Article 5 of this Decree.

4. The Ministry of Home Affairs shall be responsible for:

a) Guiding the determination and making of lists of participants under the management of the Ministry of Home Affairs as prescribed at Points e, i, k, and participants living in island communes and special zones at Point o, Clause 3, Article 12 of the Law on Health Insurance;

b) Inspecting the implementation of law regulations on the responsibility to participate in health insurance of employers and employees as prescribed in Clause 1, Article 12 of the Law on Health Insurance and the participants prescribed at Point a of this Clause, except for participants managed by the Ministry of National Defense and the Ministry of Public Security.

5. The Ministry of Education and Training shall be responsible for guiding the determination and making of lists of participants prescribed at Point b, Clause 4, Article 12 of the Law on Health Insurance.

6. The Ministry of Culture, Sports and Tourism shall be responsible for determining and guiding the making of lists of participants prescribed at Point h, Clause 4, Article 12 of the Law on Health Insurance and Clause 3, Article 5 of this Decree.

7. The Ministry of Agriculture and Environment shall be responsible for:

a) Studying and building the criteria for identifying poor households; near-poverty households; and households engaged in agriculture, forestry, fisheries, and salt making with average living standards suitable to the socio-economic conditions of each period, and submitting them to the Prime Minister for promulgation;

b) Guiding the determination and making of lists of participants under the management of the Ministry of Agriculture and Environment for members of poor households; ethnic minority people who are members of near-poverty households in communes and villages in ethnic minority and mountainous areas; and participants living in areas with particularly difficult socio-economic conditions at Point o, Clause 3, and Points a and d, Clause 4, Article 12 of the Law on Health Insurance.

8. The Ministry of Ethnic Affairs and Religion shall be responsible for guiding the determination and making of lists of ethnic minority people living in areas with difficult socio-economic conditions as prescribed at Point o, Clause 3, and Point g, Clause 4, Article 12 of the Law on Health Insurance.

9. The Vietnam Social Security under the Ministry of Finance shall be responsible for:

a) Directing social security offices at all levels to sign contracts with medical examination and treatment establishments that fully meet the conditions as prescribed in this Decree; providing forms and guiding commune-level People's Committees in making and managing lists of health insurance participants for participants under their management in the respective localities;

b) Directing provincial-level social security offices to proactively coordinate with provincial-level Departments of Health, Departments of Finance, and health insurance-covered medical examination and treatment establishments in the locality and neighboring localities and relevant agencies to settle according to their competence or propose to a competent authority to consider and promptly handle arising problems in the implementation of health insurance policies and law regulations;

c) Improving the information technology system to meet the requirements of receiving, assessing, and promptly and fully responding to medical examination and treatment establishments on the data requested for payment of health insurance-covered medical examination and treatment costs; ensuring accuracy, safety, and confidentiality of information and the rights of related parties;

d) Ensuring the effectiveness of assessment activities and the capacity of the health insurance assessment staff; proactively reviewing, detecting, and promptly sending warning information to health insurance-covered medical examination and treatment establishments about the health insurance-covered medical examination and treatment costs that are higher than the average medical examination and treatment cost establishments of the same professional and technical level, the same type of general or specialist medical examination and treatment establishment for the medical examination and treatment establishment to check and review in accordance with the law regulations in order to use the health insurance fund reasonably and effectively;

dd) Promptly summing up information on the cumulative co-payment in a fiscal year of the patient, the date on which the patient has completed 05 or more consecutive years of health insurance participation, and notifying it on the data receiving portal for medical examination and treatment establishments to look up and determine the time the patient is eligible for exemption from co-payment in the patient's medical examination and treatment session; ensuring that the patient's rights are not affected;

e) Summing up and reporting on a periodical, annual, or unscheduled basis at the request of the state management agency on the implementation of health insurance regimes and policies; the collection, expenditure, management, and use of the health insurance fund and sending it to the Ministry of Health and the Ministry of Finance for summarization as prescribed;

g) Sharing and transferring data on the health insurance-covered medical examination and treatment costs to the Ministry of Health fully and promptly to build and deploy payment methods and build policies in accordance with the law regulations;

h) Providing provincial-level Departments of Health with the number and structure of participants by group of health insurance participants who register for health insurance-covered primary medical examination and treatment and information on changes in the first 15 days of each quarter (if any) using Form No. 12 provided in the Appendix to this Decree;

i) Publicizing and promptly updating the requirements and guidelines on the receipt, notification of incidents and problems related to the receipt of data, and refusal to receive data on the health insurance-covered medical examination and treatment costs on the data receiving portal before applying them in health insurance assessment.

10. The People’s Committees of provinces and municipalities shall be responsible for:

a) Directing and organizing the implementation of health insurance policies and laws in the locality;

b) Proposing to the same-level People's Councils to allocate the funds for paying health insurance premiums for the participants for whom health insurance premiums shall be paid or subsidized by the state budget in accordance with current regulations;

c) Directing, urging, and facilitating the application of information technology, digital transformation, and data inter-agency connection in health insurance-covered medical examination and treatment of medical examination and treatment establishments under their management in accordance with regulations;

d) Directing and assuming the prime responsibility for resolving problems during the implementation of health insurance policies and laws between medical examination and treatment establishments and the social security office in the locality under their management;

dd) Organizing the proper implementation of the planning of the system of medical examination and treatment establishments; directing the inspection of the compliance with the operating conditions of health insurance-covered medical examination and treatment establishments; assessing the needs for health insurance-covered medical examination and treatment of the people and the response capacity of the system of medical examination and treatment establishments in the locality and implementing solutions to ensure a balance and suitability between the number of health insurance-covered medical examination and treatment establishments and the needs for medical examination and treatment of the people in the respective localities;

e) Based on the local budget capacity and other lawful funding sources, proposing to the provincial-level People's Council to decide on a health insurance subsidy higher than the minimum subsidy rate prescribed at Points b, c, d, dd and e, Clause 6, Article 6 of this Decree; a health insurance subsidy for participants not eligible for the subsidy rate prescribed at Points b, c, d, dd and e, Clause 6, Article 6 of this Decree; and the participants entitled to subsidies and the co-payment rate for health insurance-covered medical examination and treatment costs for health insurance participants when taking medical examination and treatment.

Article 72. Responsibilities for implementation

Ministers, heads of ministerial-level agencies, heads of Government-attached agencies, chairpersons of People’s Committees of provinces and municipalities, and related organizations and individuals shall be responsible for implementing this Decree.

* All Appendices are not translated herein.