Law Amending and Supplementing a Number of Articles of the Law on Health Insurance, No. 51/2024/QH15

LAW

Amending and Supplementing a Number of Articles of the Law on Health Insurance^[1]

Pursuant to the Constitution of the Socialist Republic of Vietnam;

The National Assembly promulgates the Law Amending and Supplementing a Number of Articles of Law No. 25/2008/QH12 on Health Insurance, 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, and Law No. 30/2023/QH15.

Article 1. To amend and supplement a number of articles of the Law on Health Insurance

1. To add Clause 9 below Clause 8, Article 2 as follows:

“9. Reference level means a money amount decided by the Government to be used for calculation of premium and benefit levels for a number of subjects participating in health insurance specified in this Law.”.

2. To amend and supplement Clause 2, Article 3 as follows:

“2. Health insurance premiums shall be determined in percentage of salary serving as a basis for payment of compulsory social insurance premiums in accordance with the Law on Social Insurance (below referred to as monthly salary, pension, allowance or reference level.”.

3. To amend and supplement a number of clauses of Article 6 as follows:

a/ To amend and supplement Clause 1 as follows:

“1. Promulgating according to its competence or submitting to competent authorities for promulgation policies and laws on health insurance, organization of the health system and financial sources for the people’s health protection, care, and improvement based on universal health insurance; and solutions to raise health insurance-covered medical examination and treatment capacity for grassroots health establishments;”;

b/ To amend and supplement Clauses 3 and 4 as follows:

“3. Promulgating regulations, processes and professional guidelines for medical examination and treatment; regularly reviewing and updating guidelines for diagnosis and therapy; regulations on assessment of rationality of the provision of medical examination and treatment services; regulations on application of information technology, digital transformation and data sharing in the field of health insurance, the transferability and use of transferable para-clinical results between health insurance-covered medical examination and treatment establishments up to professional requirements;  

4. Promulgating according to its competence or submitting to competent authorities for promulgation solutions to balance the health insurance fund;”.

4. To amend and supplement Article 7a as follows:

“Article 7a. Responsibilities of the Ministry of Labor, Invalids and Social Affairs

1. To direct and guide the identification and management of persons subject to its management as specified 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 this Law.

2. To inspect and examine the implementation of the provisions on the responsibility of employers and employees to participate in health insurance specified in Clause 1, Article 12 of this Law and persons subject to its management as specified 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 this Law, except those managed by the Ministry of National Defense or the Ministry of Public Security.”.

5. To amend and supplement a number of clauses of Article 7c as follows:

a/ To amend and supplement Clause 1 as follows:

“1. To direct, manage, guide and organize the identification, management and listing of heath insurance participants, for persons under their management as specified at Points a, c, e, h and i, Clause 1; Points a, b, c, d, l and n, Clause 3; and Point b, Clause 4, Article 12 of this Law.”;

b/ To amend and supplement Clause 3 as follows:

“3. To inspect and examine the implementation of the provisions on the responsibility to participate in health insurance of persons under their management as specified at Points a, c, e, h and i, Clause 1; Points a, b, c, d, l and n, Clause 3; and Point b, Clause 4, Article 12 of this Law.”.

6. To amend and supplement Clauses 2 and 3, Article 8 as follows:

“2. Provincial-level People’s Committees shall, in addition to performing the responsibilities specified in Clause 1 of this Article, direct the building of apparatus and generation of resources for performing the state management of health insurance in their localities.

3. People’s Committees of communes, wards or townships (below collectively referred to as commune-level People’s Committees) have the following responsibilities:

a/ To perform the responsibilities specified in Clause 1 of this Article;

b/ To draw up lists of health insurance participants as households for the persons specified in Clauses 2, 3, 4 and 5, Article 12 of this Law in localities, except those managed by other ministries, sectors, agencies and units as specified at Points a, b, c, d, l and n, Clause 3; and Point b, Clause 4, Article 12 of this Law;

c/ To draw up lists of children for whom health insurance cards are requested to be granted together with birth certificates.”.

7. To amend and supplement Article 9 as follows:

“Article 9. Health insurance agencies

“1. Social insurance agencies have the function to implement health insurance regimes, policies and law, and manage and use the health insurance fund.

2. The Government shall specify functions, tasks, powers and organizational structure of social insurance agencies engaged in the implementation of health insurance.”.

8. To amend and supplement Article 10 as follows:

“Article 10. Audit of the health insurance fund

1. Once every three years, the State Audit Office of Vietnam shall audit the health insurance fund and report audit results to the National Assembly; and conduct extraordinary audit of the health insurance fund at the request of the National Assembly, the National Assembly Standing Committee, the President, the Government or the Prime Minister.

2. Every year, the State Audit Office of Vietnam shall audit expenses for health insurance organization and activities upon auditing account-finalization reports on expenses for social insurance organization and activities.”.

9. To amend and supplement Clause 1, Article 11 as follows:

“1. Delaying or evading the payment of health insurance premiums.”.

10. To amend and supplement Article 12 as follows:

“Article 12. Health insurance participants

1. Groups of persons for whom health insurance premiums are paid by their employers, paid by themselves or jointly paid by their employers and themselves, including:

a/ Employees working under indefinite-term labor contracts or labor contracts of full one month or more, including also cases in which employees reach agreement with employers on other titles of contracts that have contents showing the remunerated or salaried jobs and the management, administration and supervision by either party; corporate managers, supervisors, representatives of the State’s capital amounts and representatives of enterprises’ capital amounts as specified by law; members of the Board of Directors, Chief Executive Officers, members of the Board of Supervisors, or Supervisors, and other elected holders of managerial titles of cooperatives and unions of cooperatives as specified by the Law on Cooperatives who are salaried; 

b/ Corporate managers, supervisors, representatives of the State’s capital amounts and representatives of enterprises’ capital amounts as specified by law; members of the Board of Directors, Chief Executive Officers, members of the Board of Supervisors, or Supervisors, and other elected holders of managerial titles of cooperatives and unions of cooperatives as specified by the Law on Cooperatives who are not salaried;

c/ Employees who are foreign citizens working in Vietnam under labor contracts of full 12 months or more with Vietnam-based employers, except those transferred within enterprises in accordance with the regulations on foreign employees working in Vietnam or those who have reached the retirement age by the time of signing of labor contracts under Clause 2, Article 169 of the Labor Code or unless otherwise provided by treaties to which the Socialist Republic of Vietnam is a contracting party;

d/ Employees working under indefinite-term labor contracts or labor contracts of full one month or more, including also cases in which employees reach agreement with employers on other titles of contracts that have contents showing the remunerated or salaried jobs and the management, administration and supervision by either party, or reach agreement with employers on part-time work with a monthly salary equal to or higher than the lowest salary serving as a basis for payment of compulsory social insurance premiums in accordance with the law on social insurance;

dd/ Heads of business households with business registration who are subject to compulsory social insurance in accordance with the law on social insurance;

e/ Cadres, civil servants, and public employees;

g/ Persons engaged in commune-level part-time activities as specified by law;

h/ National defense workers and public employees who are serving in the Army, public security workers who are serving in the People’s Public Security forces; and persons engaged in other activities in cypher organizations as specified in the Cypher Law;

i/ Relatives of national defense workers and public employees who are serving in the Army, relatives of public security workers who are serving in the People’s Public Security forces and not subject to health insurance as specified at Points a, b, c, d, dd, e, g and h of this Clause, and Clauses 2 and 3, of this Article.

2. Groups of persons for whom health insurance premiums are paid by social insurance agencies, including:

a/ Persons who are on pension or monthly working capacity loss allowance;

b/ Persons who have stopped working to enjoy monthly occupational accident or occupational disease allowance; persons who have stopped working to enjoy illness allowance, for those suffering diseases on the list of diseases that require prolonged treatment, or employees who have stopped working to enjoy illness allowance for 14 working days or more in a month in accordance with the law on social insurance; and persons who have stopped working to enjoy maternity allowance for 14 working days or more in a month in accordance with the law on social insurance;

c/ Cadres of communes, wards or townships who have stopped working and are on monthly social insurance allowance;

d/ Persons who are on unemployment allowance.

3. Groups of persons for whom health insurance premiums are paid from the state budget, including:

a/ On-service officers of the People’s Army and career army men; professional officers and non-commissioned officers and technical officers and non-commissioned officers who are serving in the People’s Public Security forces; and persons engaged in cypher work and salaried like army men;

b/ On-service non-commissioned officers and soldiers of the People’s Army; military-service non-commissioned officers and soldiers in the People’s Public Security forces; and army cadets, public security cadets and cypher cadets who are Vietnamese citizens and entitled to cost-of-living allowance;  

c/ Army cadets, public security cadets and cypher cadets who are foreigners and entitled to cost-of-living allowance;  

d/ Reserve officer trainees who have not paid social insurance or health insurance premiums for 3 months or more;

dd/ Standing militia members;

e/ Persons with meritorious service to the revolution as specified in the Ordinance on Preferential Treatment of Persons with Meritorious Service to the Revolution; war veterans;

g/ Incumbent National Assembly deputies and deputies to all-level People’s Council deputies;

h/ Children aged under 6 years;

i/ Relatives of fallen heroes or persons who have nurtured fallen heroes as specified in the Ordinance on Preferential Treatment of Persons with Meritorious Service to the Revolution;

k/ Relatives of persons with meritorious service to the revolution; spouses of fallen heroes who are married to other people and entitled to monthly survivorship allowance, and related individuals as specified in the Ordinance on Preferential Treatment of Persons with Meritorious Service to the Revolution, except those specified at Point i of this Clause;

l/ Relatives of the persons specified at Points a and b of this Clause as specified by law;

m/ Persons who have donated their organs in accordance with law;

n/ Foreigners who are studying in Vietnam and granted scholarships from the Vietnamese State’s budget;

o/ Members of poor households; ethnic minority people who are members of households living just above the poverty line in communes or villages in ethnic minority and mountainous areas; ethnic minority people who are living in areas with difficult socio-economic conditions; persons who are living in areas with extremely difficult socio-economic conditions; and persons who are living in island communes or districts;

p/ Cadres of communes, wards or townships who have stopped working and are entitled to monthly allowance from the state budget;

q/ Persons who are no longer entitled to working capacity loss allowance and currently entitled to monthly allowance from the state budget;

r/ Persons who are entitled to monthly social allowance; persons who are entitled to monthly alimony in accordance with relevant regulations; persons who are entitled to monthly survivorship allowance and eligible for enjoying social allowance;

s/ Persons who are aged full 75 years or older and entitled to monthly survivorship allowance; persons being members of households living just above the poverty line who are aged between full 70 years and under 75 years and entitled to monthly survivorship allowance; 

t/ Persons who are entitled to monthly social retirement allowance in accordance with the law on social insurance;

u/ Employees who are ineligible for enjoying pension and have not yet reached the age for enjoying social retirement allowance but are on monthly allowance in accordance with the law on social insurance.

4. Groups of persons for whom health insurance premiums are paid from the state budget, including:

a/ Members of households living just above the poverty line;

b/ Pupils and students;

c/ Persons joining grassroots security and order protection forces;

d/ Members of households engaged in agriculture, forestry, fisheries or salt making who have average living standards as specified by law;

dd/ Village medical workers; village midwives;

e/ Persons engaged in part-time activities in villages or street quarters as specified by law;

g/ Ethnic minority people who are living in communes no longer regarded as those in areas with difficult socio-economic conditions or extremely difficult socio-economic conditions and therefore entitled to the state budget’s payment of health insurance premiums under the Government’s regulations;

h/ Persons conferred with the title of People’s Artist or Emeritus Artist in accordance with the Law on Culture Heritage;

i/ Victims as specified in the Law on Human Trafficking Prevention and Combat.

5. Groups of persons who pay health insurance premiums by themselves, including:

a/ Household members participating in health insurance in the capacity as households;

b/ Persons living and working, or nurtured or cared for in charity or religious organizations or establishments;

c/ Employees who are taking unpaid leaves or in the period of postponed performance of labor contracts;

d/ Persons other than those specified at Points a, b and c of this Clause.

6. Persons other than those specified in Clauses 1, 2, 3, 4 and 5 of this Article as specified in relevant laws and ordinances.

7. The Government shall specify persons other than those specified in Clauses 1, 2, 3, 4, 5 and 6 of this Article, including:

a/ Persons who start paying health insurance premiums as specified by law before January 1, 2025;

b/ Persons other than those specified at Point a of this Clause after being reported to the National Assembly Standing Committee.”.

11. To amend and supplement Article 13 as follows:

“Article 13. Health insurance premium rates and responsibility to pay health insurance premiums

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

a/ The monthly premium rate applicable to the persons specified at Points a, c, d and e, Clause 1, Article 12 of this Law does not exceed 6% of the monthly salary, 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 persons specified at Point b, Clause 1, Article 12 of this Law does not exceed 6% of monthly salary serving as a basis for payment of compulsory social insurance premiums and shall be paid by such persons;

c/ The monthly premium rate applicable to the persons specified at Point dd, Clause 1, Article 12 of this Law does not exceed 6% of monthly salary serving as a basis for payment of compulsory social insurance premiums and shall be paid by such persons;

d/ The monthly premium rate applicable to the persons specified at Point g, Clause 1, Article 12 of this Law does not exceed 6% of the reference level, 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 persons specified at Point h, Clause 1, Article 12 of this Law does not exceed 6% of monthly salary, and such premiums shall be paid under the relevant regulations of the Government;

e/ The monthly premium rate applicable to the persons specified at Point i, Clause 1, Article 12 of this Law does not exceed 6% of the reference salary, and such premiums shall be paid under the relevant regulations of the Government.

2. Rates of health insurance premiums to be paid by social insurance agencies are specified as follows:

a/ The monthly premium rate applicable to the persons specified at Point a, Clause 2, Article 12 of this Law does not exceed 6% of pension or working capacity loss allowance;

b/ The monthly premium rate applicable to the persons specified at Points b and c, Clause 2, Article 12 of this Law does not exceed 6% of the reference level;

c/ The monthly premium rate applicable to the persons specified at Point d, Clause 2, Article 12 of this Law does not exceed 6% of unemployment allowance.

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

a/ The monthly premium rate applicable to the persons specified at Point a, Clause 3, Article 12 of this Law does not exceed 6% of monthly salary, and such premiums shall be paid from the state budget;

b/ The monthly premium rate applicable to the persons specified at Points b, c, d, dd, e, g, h, i, k, l, m, o, p, q, r, s, t and u, Clause 3, Article 12 of this Law does not exceed 6% of the reference level, and such premiums shall be paid from the state budget;

c/ The monthly premium rate applicable to the persons specified at Point n, Clause 3, Article 12 of this Law does not exceed 6% of the reference level, and such premiums shall be paid from the state budget through scholarship-awarding agencies, organizations or units;

d/ The monthly premium rate applicable to the persons specified in Clause 4, Article 12 of this Law does not exceed 6% of the reference level, and such premiums shall be paid by such persons with the state budget’s partial support;

4. The monthly premium rate applicable to the persons specified in Clause 5, Article 12 of this Law does not exceed 6% of the reference level, and such premiums shall be paid by such persons or their households.

5. The order of health insurance premium payment for a person who falls into different categories of health insurance participants is specified as follows:

a/ A person who falls into different categories of health insurance participants as specified in Article 12 of this Law shall pay health insurance premiums as a health insurance participant of the first category determined in the order specified in Article 12 of this Law, except the cases specified at Points c, d, dd, e and g of this Clause; 

b/ A person specified at Point a, c, d, dd or e, Clause 1, Article 12  of this Law who is working under one or more than one labor contract shall pay health insurance premiums under the labor contract serving as a basis for participation in compulsory social insurance;

c/ A person specified at Point g, Clause 1, Article 12 of this Law and falling into different categories of health insurance participants as specified in Article 12 of this Law shall pay health insurance premiums in the following order: premium payment by the social insurance agency, from the state budget, with the state budget’s support, and jointly by himself/herself and the commune-level People’s Committee;

d/ A person specified at Point a or c, Clause 2, Article 12 of this Law and falling into different categories of health insurance participants as specified in Article 12 of this Law may participate in health insurance and have health insurance premiums paid by the social insurance agency;

dd/ A person specified at Point s, t or u, Clause 3, Article 12 of this Law and falling into different categories of health insurance participants as specified in Article 12 of this Law may participate in health insurance and have health insurance premiums paid by the state budget;

e/ A person specified at Point a, c, d, dd, e, g, h or i, Clause 4, Article 12 of this Law and also specified at Point a, Clause 5, Article 12 of this Law may choose a certain category of health insurance participants;

g/ A person falling into different categories of health insurance participants and having health insurance premiums paid with the state budget’s support as specified in Clause 4, Article 12 of this Law may choose the category eligible for the highest support level;

h/ A person specified at Point b or c, Clause 5, Article 12 of this Law and also specified at Point a, Clause 5, Article 12 of this Law may choose the category of health insurance participants as households;

6. Household members specified at Point a, Clause 5, Article 12 of this Law who jointly participate in health insurance in the capacity as households in a fiscal year are entitled to premium rate reduction as follows:

a/ The first member shall pay health insurance premiums at the rate of up to 6% of the reference level;

b/ The second, third and fourth members shall pay health insurance premiums at the rate of 70%, 60% and 50%, respectively, of the rate applicable to the first member;

c/ From the fifth member on, the health insurance premium rate is equal to 40% of the rate applicable to the first member.

7. The Government shall specify:

a/ Premium rates and support levels referred to in this Article;

b/ Responsibility to pay premiums, premium rates and support levels for the persons specified in Clauses 6 and 7, Article 12 of this Law.”.

12. To amend and supplement Clauses 4 and 5, Article 14 as follows:

“4. For persons other than those specified in Clauses 1, 2 and 3 of this Article, the basis for health insurance premium payment is the reference level.

5. The maximum salary level used for calculation of health insurance premiums is 20 times the reference level.”.

13. To amend and supplement a number of clauses of Article 15 as follows:

a/ To amend and supplement Clauses 2, 3, 4 and 5 as follows:

2. For agricultural, forestry, fishery and salt-making enterprises, groups of cooperatives, cooperatives, unions of cooperatives and business households that pay salaries based on products or work volumes under contracts, health insurance premiums shall be paid once every month, every 3 months or every 6 months.

3. Every month, social insurance agencies shall pay health insurance premiums under Clause 2, Article 13 of this Law into the health insurance fund.

4. Every quarter, scholarship-awarding agencies, organizations and units shall health insurance premiums under Point c, Clause 3, Article 13 of this Law into the health insurance fund.

5. Every quarter, the state budget shall transfer health insurance premium amounts paid or partly paid under Points a, b and d, Clause 3, Article 13 of this Law into the health insurance fund.”;

b/ To add Clauses 7 and 8 below Clause 6 as follows:

“7. Persons specified at Points b and dd, Clause 1, Article 12 of this Law shall fully pay health insurance premium amounts under their charge directly to social insurance agencies or through business households, enterprises, cooperatives or unions of cooperatives, in which they participate in the management, once every month, every 3 months or every 6 months.

8. The deadline for health insurance premium payment by employers is:

a/ The last day of the subsequent month, for the method of monthly premium payment;

b/ The last day of the month following the premium payment cycle, for the method of premium payment on a 3-month or 6-month basis.”.

14. To amend and supplement a number of clauses of Article 16 as follows:

a/ To amend and supplement Clauses 1 and 2 as follows:

“1. Health insurance cards bearing health insurance codes shall be granted to health insurance participants and serve as a basis for the card holders to enjoy health insurance benefits in accordance with this Law. Health insurance cards may be granted in electronic form and paper form and have the same legal validity.

2. Each person may be granted only one health insurance card.”;

b/ To amend and supplement Point c, Clause 3 as follows:

“c/ For a health insurance participant specified in Clause 4 or 5, Article 12 of this Law who pays health insurance premiums for the first time or has paid health insurance premiums as one of the categories specified in Article 12 of this Law not consecutively for 90 days or more, his/her health insurance card will become valid 30 days after his/her health insurance premiums are fully paid;”;

c/ To amend and supplement Clause 5 as follows:

“5. The Vietnam Social Security shall issue model health insurance cards after reaching agreement with the Ministry of Health.”.

15. To amend and supplement Article 17 as follows:

“Article 17. Grant of health insurance cards

1. A dossier for grant of a health insurance card must comprise:

a/ A declaration form for health insurance participation made by the agency, organization, unit, individual or household that applies for participation in health insurance for the first time;

b/ A list of health insurance participants, for the persons specified in Clause 1, Article 12 of this Law, made by the employer within 30 days after such persons as employees become eligible for participating in health insurance. In case a health insurance participant specified at Point b or dd, Clause 1, Article 12 of this Law submits the dossier by himself/herself, the dossier is a declaration form specified at Point a of this Clause to be submitted to the social insurance agency within 30 days after he/she is determined as being eligible for participating in health insurance;

c/ A list of health insurance participants, for the persons specified in Clauses 2, 3, 4 and 5, Article 12 of this Law, made by the commune-level People’s Committee by household, except persons on the lists specified at Points d and dd of this Clause;

d/ A list of health insurance participants, for persons managed by the Ministry of Education and Training, the Ministry of Labor, Invalids and Social Affairs, or other ministries and sectors as specified at Point n, Clause 3, and Point b, Clause 4, Article 12 of this Law, made by the education institution or vocational education institution;

dd/ A list of health insurance participants, for persons managed by the Ministry of National Defense or the Ministry of Public Security as specified at Points a, c, e and h, Clause 1; Points a, b, c, d, l and n, Clause 3; and Point b, Clause 4, Article 12 of this Law, and a list of health insurance participants specified at Point i, Clause 1, Article 12 of this Law, made by the Ministry of National Defense or the Ministry of Public Security.

2. Within 5 working days after receiving a complete dossier specified in Clause 1 of this Article, the health insurance agency shall grant health insurance card(s) to health insurance participant(s) and notify or deliver such card(s) to the agency or organization managing, and drawing up the list of, health insurance participants.

3. The Government shall provide the grant of health insurance cards in paper form and electronic form.”.

16. To amend and supplement Article 21 as follows:

“Article 21. Scope of health insurance benefits

1. Health insurance participants may have the following costs/charges paid by the health insurance fund:

a/ Costs of medical examination and treatment, including also telehealth, support for telehealth, family medical practice, home-based medical examination and treatment, function rehabilitation, pregnancy checkups, and childbirth;

b/ Costs of patient transport, for the persons specified at Points a, b, c, d, dd, e, h, i, o and r, Clause 3, Article 12 of this Law, in case these persons are undergoing inpatient treatment or intensive care and in need of transferal to other medical examination and treatment establishments as specified in Article 27 of this Law;

c/ Charges for use of medical technical services, drugs, medical equipment, blood, blood preparations, medical gases, supplies, tools, instruments, and chemicals for medical examination and treatment, which are covered by the health insurance fund. 

2. The Minister of Health shall specify :

a/ Principles and criteria for drawing up lists of drugs, and principles for drawing up lists of medical equipment and technical services falling within the scope of benefits of health insurance participants;

b/ Promulgation of lists of drugs, medical equipment and medical technical services falling within the scope of benefits of  health insurance participants on the basis of the principles and criteria specified at Point a of this Clause;

c/ Rates of payment for drugs, medical equipment and medical technical services falling within the scope of benefits  of health insurance participants;

d/ Rates, conditions and performance of payment for drugs, medical equipment and medical technical services falling within the scope of benefits of  health insurance participants;

dd/ Payment for blood, blood preparations, medical gases, supplies, tools, instruments and chemicals for use in medical examination and treatment falling within the scope of benefits of  health insurance participants.

3. The Government shall specify:

a/ Payment of costs of patient transport specified at Point b, Clause 1 of this Article;

b/ Scope of benefits of the health insurance participants specified at Points a, b, c, d and dd, Clause 3, Article 12 of this Law;

c/ Persons not subject to the application of the payment rates specified at Point c, Clause 2 of this Article.”.

17. To amend and supplement Article 22 as follows:

“Article 22. Levels of health insurance benefits

1. When receiving medical examination and treatment under Articles 26 and 27 of this Law, a health insurance participant may have medical examination and treatment costs covered by the health insurance fund within the scope of benefits at the following levels:

a/ One hundred percent of medical examination and treatment costs, for the health insurance participants specified at Points a, b, c, d, dd, e, h, i, o, r and s, Clause 3, Article 12 of this Law. Medical examination and treatment costs falling beyond the scope of benefits of the persons specified at Points a, b, c, d and dd, Clause 3, Article 12 of this Law shall be paid from health insurance-related funding sources reserved for medical examination and treatment of such persons. In case such funding sources are not enough, these costs shall be covered by the state budget;

b/ One hundred percent of medical examination and treatment costs in case the cost of a single time of medical examination and treatment is lower than the level specified by the Government;

c/ One hundred percent of costs of medical examination and treatment at medical examination and treatment establishments identified as primary healthcare establishments, including health stations; family medical practice establishments; military-cum-civilian health stations and clinics; district-level medical centers engaged in medical examination and treatment and licensed to operate as clinics; healthcare divisions of agencies, units and organizations as specified by the Minister of Health; and examination and treatment establishments identified as primary healthcare establishments in the Army and the People’s Public Security forces as specified by the Minister of National Defense and the Minister of Public Security; and one hundred percent of costs of outpatient medical examination and treatment at regional general clinics;

d/ One hundred percent of medical examination and treatment costs if the patient has participated in health insurance for 5 consecutive years or more and jointly paid costs of medical examinations and treatments in a year as specified in Clause 3; Points a, b, c, dd and e, Clause 4; and Clause 5, of this Article, and Articles 26 and 27 of this Law, at a level higher than 6 times the reference level;

dd/ Ninety-five percent of medical examination and treatment costs, for the health insurance participants specified at Point a, Clause 2; Point k, Clause 3; and Points a and g, Clause 4, Article 12 of this Law;

e/ Eighty percent of medical examination and treatment costs, for other health insurance participants.

2. A person falling into more than one category of health insurance participants may enjoy the highest health insurance benefit.

3. For persons who have registered for health insurance-covered primary healthcare at specialized and basic-level medical examination and treatment establishments, if taking medical examination and treatment not at such establishments due to the change of their places of temporary residence or stay, they may take medical examination and treatment at basic-level medical examination and treatment establishments in their new places of temporary residence or stay and have medical examination and treatment costs paid by the health insurance fund under Clause 1 of this Article. The Minister of Health shall specify procedures and persons on stay who are eligible for health insurance-covered medical examination and treatment under this Clause. 

4. A health insurance participant who takes medical examination and treatment at an establishment other than the establishment where he/she has registered for health insurance-covered primary healthcare or at variance with the provisions on patient transport of Articles 26 and 27 of this Law, except the cases specified in Clauses 3 and 5 of this Article, may have medical examination and treatment costs paid by the health insurance fund at a certain percentage of the benefits specified in Clause 1 of this Article as follows:

a/ One hundred percent of the benefits, if taking medical examination and treatment at a basic-level medical examination and treatment establishment or a specialized one in case of diagnosis for identification and treatment of a rare or dangerous disease or a disease that requires operation or high techniques as specified by the Minister of Health;

b/ One hundred percent of the benefits, for ethnic minority people and members of poor households living in areas with difficult socio-economic conditions or areas with extremely difficult socio-economic conditions, and persons living in island communes or districts and taking inpatient medical examination and treatment at specialized medical examination and treatment establishments; 

c/ One hundred percent of the benefits, if taking medical examination and treatment at a primary healthcare establishment;

d/ One hundred percent of the benefits, if taking inpatient medical examination and treatment at a basic-level medical examination and treatment establishment;

dd/ One hundred percent of the benefits, if taking medical examination and treatment at a basic-level medical examination and treatment establishment or a specialized one which is determined by a competent agency to be a district-level one before January 1, 2025;

e/ Between fifty percent and one hundred percent of the benefits, if taking outpatient medical examination and treatment at a basic-level medical examination and treatment establishment, based on results of grading of technical levels according to schedules of enjoyment and rates of benefits specified by the Government, except the cases specified at Points a and dd of this Clause;

g/ Forty percent of the benefits, if taking inpatient medical examination and treatment at a specialized medical examination and treatment establishment, except the cases specified at Points a, b, dd and h of this Clause;

h/ Fifty percent of the benefits, if taking outpatient medical examination and treatment according to a schedule specified by the Government, or 100% of the benefits, if taking inpatient medical examination and treatment at a specialized medical examination and treatment establishment which is determined by a competent agency to be a provincial-level one before January 1, 2025.

5. Health insurance participants may enjoy 100% of the benefits specified in Clause 1 of this Article if taking medical examination and treatment at any medical examination and treatment establishments in case of emergency.

6. The Government shall specify benefit levels applicable to the health insurance participants specified at Points a, b, c, d and dd, Clause 3, Article 12 of this Law; and specify benefit levels applicable to health insurance participants who use on-demand medical examination and treatment services and other cases not specified in Clause 1 of this Article.”.

18. To amend and supplement Clauses 7 and 8, Article 23 as follows:

“7. Treatment of squint and eye refractive defects of persons aged full 18 years or older.

8. Use of prostheses, including artificial limbs, artificial eyes, artificial teeth, glasses, hearing aids or mobility aids in medical examination and treatment and function rehabilitation.”.

19. To amend and supplement Article 24 as follows:

“Article 24. Health insurance-covered medical examination and treatment establishments

A health insurance-covered medical examination and treatment establishment means a medical examination and treatment establishment that, under the Law on Medical Examination and Treatment, signs health insurance-covered medical examination and treatment contracts with a health insurance agency under regulations of the Government.”.

20. To amend and supplement a number of points and clauses of Article 25 as follows:

a/ To amend and supplement Point e, Clause 2 as follows:

“e/ Conditions for modification, liquidation, suspension and termination of the contract.”;

b/ To amend and supplement Clauses 3 and 4 as follows:

“3. Any agreement on conditions for modification, liquidation, suspension and termination of a contract specified at Point e, Clause 2 of this Article must not interrupt medical examination and treatment for the concerned health insurance participant.

4. The Government shall detail this Article and provide a model contract on health insurance-covered medical examination and treatment.”.

21. To amend and supplement Article 26 as follows:

“Article 26. Registration for health insurance-covered primary healthcare

1. A health insurance participant may register for health insurance-covered primary healthcare at primary healthcare establishment or basic-level medical examination and treatment establishments; and may change the health insurance-covered primary healthcare establishment within the first 15 days of every quarter.

2. The allocation of health insurance cards to establishments registered to provide health insurance-covered primary healthcare must be carried out in a balanced manner to meet the people’s health insurance-covered primary healthcare needs and the capacity of such establishments and practical capacity of localities.

3. The Minister of Health shall detail Clauses 1 and 2 of this Article; and specify cases of registration for health insurance-covered primary healthcare at specialized medical examination and treatment establishments.

4. The Minister of Public Security and the Minister of National Defense shall provide the registration for health insurance-covered primary healthcare at primary healthcare establishments, and basic-level and specialized medical examination and treatment establishments, and health insurance participants under their management.”.

22. To amend and supplement Article 27 as follows:

“Article 27. Transferal of patients between health insurance-covered medical examination and treatment establishments

1. The transferal of patients between medical examination and treatment establishments shall be carried out according to professional requirements and medical care capacity of such establishments.

2. The Minister of Health shall provide the transferal of patients to health insurance-covered primary healthcare establishments for treatment, management and monitoring, for patients suffering chronic diseases, including also the use of drugs, medical equipment and medical technical services that have been prescribed or indicated according to professional capacity of such establishments; and detail Clause 1 of this Article, except the case specified in Clause 3 of this Article.

3. The Minister of Public Security and the Minister of National Defense shall provide the transferal of patients under their management between health insurance-covered medical examination and treatment establishments under their management.”.

23. To amend and supplement Article 28 as follows:

“Article 28. Procedures for health insurance-covered medical examination and treatment

1. When taking medical examination and treatment, health insurance participants shall show information about their health insurance cards and personal identification papers; under-6 children and persons having donated their human organs who have not yet been granted health insurance cards shall produce other lawful papers. In case of emergency, patients shall show information about their health insurance cards and papers specified in this Clause before their medical treatment is completed.

The Government shall detail this Clause.

2. In case of re-examination to meet professional requirements in medical examination and treatment, health insurance participants shall be given appointments from concerned medical examination and treatment establishments according to procedures specified by the Minister of Health.

3. In case of transferal of patients to other health insurance-covered medical examination and treatment establishments to meet professional requirements during inpatient treatment, the medical examination and treatment establishments from which the patients are transferred shall send their files to new medical examination and treatment establishments under regulations of the Minister of Health.”.

24. To amend and supplement Article 30 as follows:

“Article 30. Methods of payment of costs of health insurance-covered medical examination and treatment

1. Costs of health insurance-covered medical examination and treatment shall be paid by the following methods:

a/ Ratio-based payment;

b/ Service charge-based payment;

c/ Diagnosis group-based payment.

2. The Government shall detail Clause 1 of this Article and provide the application of methods of payment of costs of health insurance-covered medical examination and treatment.”.

25. To amend and supplement Article 31 as follows:

“Article 31. Payment of costs of health insurance-covered medical examination and treatment

1. Social insurance agencies shall pay costs of health insurance-covered medical examination and treatment to establishments providing medical examination and treatment under health insurance-covered medical examination and treatment contracts.

2. Social insurance agencies shall pay costs of health insurance-covered medical examination and treatment directly to health insurance card holders who take medical examination and treatment:

a/ At establishments providing medical examination and treatment not under health insurance-covered medical examination and treatment contracts;

b/ At variance with Article 28 of this Law;

c/ In other special cases as specified by the Government.

3. At the time a patient receives an indication to use drugs, medical equipment or para-clinical services within the scope of payment by the health insurance fund, if such drugs, equipment or services are not available at a medical examination and treatment establishment and cannot be substituted by other ones, the medical examination and treatment establishment may receive drugs and medical equipment transferred from another health insurance-covered medical examination and treatment establishment to treat the patient or may transfer the patient or his/her disease specimens to another establishment qualified for providing para-clinical services.

The health insurance-covered medical examination and treatment establishment that receives drugs and medical equipment or transfers the patient or his/her disease specimens shall sum up costs of such drugs, medical equipment or para-clinical services and get them paid by the social insurance agency.

4. The Government shall specify:

a/ Conditions and competence for deciding on cases in which one medical examination and treatment establishment may receive drugs and medical equipment transferred from another health insurance-covered medical examination and treatment establishments to treat patients, and the payment of costs of transferred drugs and medical equipment under Clause 3 of this Article;

b/ Management and use of funding sources for health insurance-covered medical examination and treatment, assessment, payment and account-finalization of health insurance-covered medical examination and treatment costs for the health insurance participants specified at Points a, b, c, d and dd, Clause 3, Article 12 of this Law;

c/ Payment and account-finalization of health insurance-covered medical examination and treatment costs for health insurance participants in the people’s armed forces and people in border, sea and island areas and villages and communes in areas with extremely difficult conditions in order to realize national defense and security policies.

5. The Government shall detail Points a and b, Clause 2, and Clause 3, of this Article, except the case specified in Clause 4 of this Article.”.

26. To amend and supplement Article 32 as follows: 

“Article 32. Advance payment, payment and account-finalization of costs of health insurance-covered medical examination and treatment

1. On a quarterly basis, a social insurance agency shall make an advance payment to a health insurance-covered medical examination and treatment establishment as follows:

a/ Within 5 working days after receiving the previous quarter’s account-finalization report from the medical examination and treatment establishment, the social insurance agency shall make a one-off advance payment equal to 90% of costs of health insurance-covered medical examination and treatment based on such report;

b/ For a medical examination and treatment establishment that has signed for the first time a health insurance-covered medical examination and treatment contract, based on medical examination and treatment costs of the month preceding the month of contract signing, the social insurance agency shall make an advance payment equal to 90% of costs of health insurance-covered medical examination and treatment for the first month of contract performance. After one month of contract performance, the social insurance agency shall estimate and make an advance payment equal to 90% costs of health insurance-covered medical examination and treatment in the quarter under Point a of this Clause;

c/ In case advance payments made in a quarter to health insurance-covered medical examination and treatment establishments in a provincial-level locality exceed the amounts allowed to be paid in the quarter, the provincial-level social insurance agency shall report such to the Vietnam Social Security for additional allocation of funds.

2. The payment and account-finalization of costs between a medical examination and treatment establishment and a social insurance agency shall be carried out as follows:

a/ Within the first 15 days of every month, the health insurance-covered medical examination and treatment establishment shall send a summary of the previous month’s health insurance-covered medical examination and treatment costs to the social insurance agency for requesting payment thereof. Within the first 15 days of every quarter, the health insurance-covered medical examination and treatment establishment shall send a report on account-finalization of the previous quarter’s health insurance-covered medical examination and treatment costs to the social insurance agency;

b/ Within 30 days after receiving the report on account-finalization of the previous quarter’s health insurance-covered medical examination and treatment costs from the medical examination and treatment establishment, the social insurance agency shall notify results of the assessment and account-finalized amounts of costs of health insurance-covered medical examination and treatment, including actual medical examination and treatment costs within the scope of benefits and health insurance benefit levels, to the medical examination and treatment establishment. For the fourth quarter of a year, the time limit for notifying results of the assessment and account-finalized amounts of costs of health insurance-covered medical examination and treatment is 60 days after the social insurance agency receives the fourth quarter’s account-finalization report from the medical examination and treatment establishment;

c/ Within 10 days after notifying the account-finalized amounts of costs of health insurance-covered medical examination and treatment, the social insurance agency shall complete the payment with the medical examination and treatment establishment;

d/ The appraisal of  account-finalization of the health insurance fund of a year shall be carried out before October 1 of the subsequent year.

3. Within 40 days after receiving a complete dossier of request for cost payment from a health insurance participant in the case specified in Clause 2, Article 31 of this Law, a social insurance agency shall pay health insurance-covered medical examination and treatment costs directly to such person.”.

27. To amend and supplement Article 35 as follows:

“Article 35. Allocation and use of the health insurance fund

1. The health insurance fund shall be allocated and used as follows:

a/ Ninety-two percent of paid health insurance premiums shall be used for medical examination and treatment;

b/ Eight percent of paid health insurance premiums shall be used for the provision fund and payment of expenses for health insurance organization and activities, of which at least 4% shall be used for the provision fund.

2. Investment of the health insurance fund’s temporarily unused amounts must comply with the Law on Social Insurance’s provisions on investment principles, portfolios and methods and management of investment activities of the social insurance fund.

3. In case paid health insurance premiums used for medical examination and treatment are larger than medical examination and treatment costs actually paid in a year, the unused amount shall be fully accounted into the provision fund for overall regulation.

4. In case paid health insurance premiums used for medical examination and treatment are smaller than medical examination and treatment costs actually paid in a year, the Vietnam Social Security shall make up for the deficit with the provision fund.

5. The Government shall detail this Article and specify expenses for health insurance organization and activities.”.

28. To amend and supplement Clause 2, Article 36 as follows:

“2. To register a health insurance-covered primary healthcare establishment under Article 26 of this Law.”.

29. To amend and supplement Clause 3, Article 39 as follows:

“3. To deliver a health insurance card or notify results of the grant of a health insurance card to the health insurance participant within 3 working days after receiving such card from, or being notified of results of the grant of a health insurance card by, the social insurance agency.”.

30. To amend and supplement Clause 2, Article 40 as follows:

“2. To examine the performance of health insurance-covered medical examination and treatment contracts; to carry out health insurance assessment; to revoke or temporarily seize health insurance cards, for the case specified in Article 20 of this Law.”.

31. To amend and supplement Clause 8, Article 41 as follows:

“8. To examine the performance of health insurance-covered medical examination and treatment contracts; to carry out health insurance assessment.”.

32. To add Clause 9 below Clause 8, Article 43 as follows:

“9. To ensure sufficient conditions for health insurance-covered medical examination and treatment activities in accordance with the law on health insurance and the law on medical examination and treatment and health insurance-covered medical examination and treatment contracts.”.

33. To add Articles 48a and 48b below Article 48 as follows:

“Article 48a. Delayed payment of health insurance premiums

Delayed payment of health insurance premiums means an act of an employer that:

1. Fails to pay or to fully pay the payable health insurance premium amount after the health insurance premium payment deadline specified in Clause 8, Article 15 of this Law, except the case specified at Point c, Clause 1, Article 48b of this Law;

2. Fails to draw up a list or draws up an incomplete list of persons compelled to participate in health insurance within 60 days after the deadline specified at Point b, Clause 1, Article 17 of this Law; or,

3. Falls into the case in which it/he/she is not regarded as having evaded health insurance premium payment as specified in Clause 2, Article 48b of this Law.

Article 48b. Evasion of health insurance premium payment

1. Evasion of health insurance premium payment means an act of an employer that:

a/ Fails to draw up a list or draws up an incomplete list of persons compelled to participate in health insurance after 60 days from the deadline specified at Point b, Clause 1, Article 17 of this Law;

b/ Registers a salary for use as a basis for health insurance premium payment that is lower than the salary level specified in Article 14 of this Law;

c/ Fails to pay or to fully pay the registered amount of health insurance premiums after 60 days from the health insurance premium payment deadline specified in Clause 8, Article 15 of this Law, though having been urged by a competent agency under regulations of the Government; or,

d/ Falls into other cases in which it/he/she is regarded as having evaded health insurance premium payment under the Government’s regulations.

2. The Government shall detail this Article, and specify cases mentioned in Clause 1 of this Article in which an employer is not regarded as having evaded health insurance premium payment for plausible reasons.”.

34. To amend and supplement Article 49 as follows:

“Article 49. Handling of violations of the law on health insurance

1. Agencies, organizations and individuals that commit violations of the law on health insurance shall, depending on the nature and severity of their violations, be disciplined, administratively sanctioned or examined for penal liability; if causing damage, they shall pay compensation in accordance with law.

2. Measures to handle acts of delaying health insurance premium payment:

a/ Compelling full payment of the delayed amounts of health insurance premiums; compelling payment of a money amount equal to 0.03% of the delayed amount of health insurance premiums for every day of delayed payment;

b/ Sanctioning such acts as administrative violations in accordance with law;

c/ Refusing to consider conferring emulation titles or commendation forms.

3. Measures to handle acts of evading health insurance premium payment include:

a/ Compelling full payment of the evaded amounts of health insurance premiums; compelling payment of a money amount equal to 0.03% of the evaded amount of health insurance premiums for every day of payment evasion;

b/ Sanctioning such acts as administrative violations or examine such acts for penal liability in accordance with law;

c/ Refusing to consider conferring emulation titles or commendation forms.

4. Agencies, organizations and employers that delay or evade health insurance premium payment for their employees shall refund all medical examination and treatment costs within the scope of benefits and health insurance benefit levels already paid by employees for the period they have yet to receive health insurance cards due to premium payment delay or evasion.

5. The Government shall detail Point a, Clause 2; Point a, Clause 3; and Clause 4, of this Article.”.

35. To replace a number of phrases below:

a/ To replace the phrase “health insurance organization” in Clauses 3 and 6, Article 2; Clauses 2 and 4, Article 7c; Clause 3, Article 18; Clause 3, Article 19; Clause 1, Article 25; Clause 3, Article 29; Clause 1, Article 34; Clauses 4 and 5, Article 36; Clause 4, Article 37; Clause 1, Article 38; Clause 4, Article 39; the title and Clause 5 of Article 40; the title of Article 41; Clauses 1 and 2, Article 42; Clauses 2, 3 and 4, Article 43; Clause 1, Article 44; and Point c, Clause 1, Article 48, with the phrase “social insurance agency”;

b/ To replace the phrase “the Board of Commissioners of the Vietnam Social Security” in Clause 1, Article 34 with the phase “the Social Security Management Board”.

Article 2. To amend and supplement Law No. 30/2023/QH15 on Forces Participating in Grassroots Security and Order Protection 

To annul Clause 2, Article 32 of Law No. 30/2023/QH15 on Forces Participating in Grassroots Security and Order Protection.

Article 3. Implementation provisions 

1. This Law takes effect on July 1, 2025, except Clauses 2 and 3 of this Article.

2. The provisions on technical lines in medical examination and treatment, registration for health insurance-covered primary healthcare, transferal of patients between health insurance-covered medical examination and treatment establishments, and procedures for health insurance-covered medical examination and treatment of Clauses 3, 16, 17, 21, 22, 23 and 28, Article 1 of this Law take effect on January 1, 2025.

3. The provisions on scope of benefits of Clause 16, Article 1 of this Law, except those on telehealth, support for telehealth, family medical practice, home-based medical examination and treatment, and principles for drawing up lists of medical equipment and technical services within the scope of benefits of health insurance participants, and the provisions on benefit levels of Clause 17, Article 1 of this Law, will apply from January 1, 2025 to:

a/ The persons specified in Clause 10, Article 1 of this Law who are also specified in Article 12 of Law No. 25/2008/QH12 on Health Insurance, 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, and Law No. 30/2023/QH15;

b/ The persons mentioned at Point a of this Clause who take medical examination and treatment at medical examination and treatment establishments before January 1, 2025, and finish undergoing medical treatment on or after January 1, 2025.

4. No later than January 1, 2027, to interconnect para-clinical results and use interconnected para-clinical results between health insurance-covered medical examination and treatment establishments to meet professional requirements specified by the Government.

5. Transitional provisions:

a/ For patients other than those specified at Points a and b, Clause 3 of this Article who take medical examination and treatment at medical examination and treatment establishments before July 1, 2025, and finish undergoing medical treatment on or after July 1, 2025, this Law will apply;

b/ The reference level specified in this Law will apply based on the basic salary level. In case the salary policies change, the Government shall decide on a specific reference level;

c/ Health insurance-covered medical examination and treatment contracts that are signed before July 1, 2025, and remain valid after July 1, 2025, must comply with relevant regulations of the Government;

d/ Health insurance premiums payable by employers in accordance with Law No. 25/2008/QH12 on Health Insurance, 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, and Law No. 30/2023/QH15, which remain unpaid or not fully paid by the end of June 30, 2025, shall be handled under this Law’s provisions on premium payment delay.

This Law was passed on November 27, 2024, by the 15^th National Assembly of the Socialist Republic of Vietnam at its 8^th session.

Chairman of the National Assembly
TRAN THANH MAN