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

Pursuant to the Constitution of the Socialist Republic of Vietnam;

The National Assembly hereby promulgates the Law Amending and Supplementing a Number of the Law on Health Insurance No. 25/2008/QH12, which had 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 after Clause 8 Article 2 as follows:

“9. Reference level means a money amount prescribed by the Government for calculation of premiums and benefits applicable for a number of cases participating in health insurance specified in this Law.”.

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

“2. Levels of health insurance premiums shall be determined in percentage of the salary which serves as the basis for payment of compulsory social insurance as prescribed by 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 the competence, or submitting to the competent authorities for promulgation of policies and laws on health insurance, organizing the health care system and financial sources for the protection, care and improvement of people’s health, based on all-people health insurance; solutions to enhance the capacity of health insurance-covered medical care for grassroots health care;”;

b) To amend and supplement Clauses 3 and Clause 4 as follows:

“3. Promulgating professional regulations, process and guidance on medical care and treatment; regularly reviewing and updating guidance on diagnosis and treatment; providing regulations on assessing the reasonableness of providing medical care services; providing regulations on the application of information technology, digital transformation, data sharing in the health insurance domain, the connection and use of para-clinical results between health insurance-covered medical care providers in accordance with professional requirements;

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

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

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

1. To direct, guide and organize the identification and management of persons under its management 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 this Law.

2. To inspect and examine employers and employees in observing law regarding the responsibility to participate in health insurance prescribed in Clause 1 Article 12 of this Law and persons under its management 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 this Law, except for those under the management of the Ministry of National Defense and 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 follow:

“1. To direct, manage, guide and organize the identification, management and health insurance participation listing for persons under their management prescribed 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 persons under their management prescribed 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 in observing law regarding the responsibility to participate in health insurance.”.

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

“2. Apart from the responsibilities defined in Clause 1 of this Article, provincial-level People’s Committees shall direct the formation of the apparatus and resources to perform the state management of health insurance in their localities.

3. People’s Committees of communes, wards and townships (below referred to as commune-level People’s Committees) shall:

a) Discharge the responsibilities prescribed in Clause 1 of this Article;

b) Make lists of the insured prescribed in Clauses 2, 3, 4 and 5 Article 12 of this Law in their localities by household, except those under the management of ministries, sectors and other agencies and unit prescribed at Points a, b, c, d, l and n Clause 3, and Point b Clause 4 Article 12 of this Law;

c) Make lists of children proposed for grant of health insurance cards concurrently with the grant of birth certificates.”.

7. To amend and supplement Article 9 as follows:

“Article 9. Health insurance-implementing agencies

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

2. The Government shall specify the functions, tasks, powers and organizational structure of the social security agency in organization of health insurance operation.”.

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 shall audit the health insurance fund and report the results to the National Assembly; conduct irregular audit of the health insurance fund upon requests of the National Assembly, the National Assembly Standing Committee, the President, the Government and the Prime Minister.

2. On an annual basis, the State Audit shall audit the expenditure content for health insurance organization and operation when auditing the report on settlement of expenditures for social insurance organization and operation.”.

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

“1. Late payment, shirking of payment of health insurance premiums.”.

10. To amend and supplement Article 12 as follows:

“Article 12. Target groups of health insurance

1. Persons whose health insurance premiums are paid by employees or employers, or by both employees and employers, including:

a) Employees working under indefinite-term labor contracts or labor contracts of full one-month or longer term, including the cases where the employees and employers agree on a different name but with content showing paid work, salary and management, operation and supervision by one party; salaried corporate managers, controllers, representatives of state capital, representatives of enterprise capital as prescribed by law; salaried members of the Board of Directors, General Directors, Directors, members of the Board of Supervisors or controllers and other elected management positions of cooperatives and cooperative unions as prescribed by the Law on Cooperatives;

b) Non-salaried corporate managers, controllers, representatives of state capital, representatives of enterprise capital as prescribed by law; non-salaried members of the Board of Directors, General Directors, Directors, members of the Board of Supervisors or controllers and other elected management positions of cooperatives and cooperative unions as prescribed by the Law on Cooperatives;

c) Employees who are foreign citizens working in Vietnam for a Vietnamese employer under a definite-term labor contracts with a term of full 12 months or more, except for the case where they are intra-corporate transferees as prescribed by the law on foreign workers in Vietnam, or at the time of signing the labor contract, the employee has reached the retirement age as prescribed in Clause 2 Article 169 of the Labor Code, or otherwise prescribed by the 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 longer term, including cases where the employees and employers agree on a different name but with content showing paid work, salary and management, operation and supervision by one party, agree with the employees who work on a part-time basis and have monthly salary equal to or higher than the lowest salary on which compulsory social insurance premiums are based as prescribed by the law on social insurance;

dd) Business household owners of business households with business registration who are covered by compulsory social insurance in accordance with the law on social insurance;

e) Cadres, civil servants and public employees;

g) Persons working on a part-time basis in communes as prescribed by law;

h) Defense workers and employees who are serving in the People’s Army, public security workers who are working in the People’s Public Security Forces; and persons doing other jobs in cipher organizations as prescribed by the Law on Cipher;

i) Relatives of defense workers and employees who are serving in the People’s Army; relatives of public security workers who are working in the People’s Public Security Forces other than those covered by health insurance as prescribed at Points a, b, c, d, dd, e, g and h of this Clause, Clauses 2 and 3 of this Article.

2. Persons whose health insurance premiums are paid by social security agencies, including:

a) Persons currently on monthly pension or working capacity loss allowance;

b) Persons taking leave on monthly labor accident or occupational disease allowance; persons taking leave on sickness allowance, for employees who suffer a disease on the list of diseases requiring long-term treatment, or persons taking leave under the sickness regime for 14 working days or more in a month as prescribed by the law on social insurance; persons taking maternity leave for 14 working days or more in a month as prescribed by the law on social insurance;

c) Commune, ward or township cadres who have stopped working and are on monthly social insurance allowance;

d) Persons on unemployment allowance.

3. Persons whose health insurance premiums are paid by the state budget, comprising:

a) Officers the people’s army and professional army men on service; professional officers and non-commissioned officers and specialized and technical officers and non-commissioned officers who are working in the people’s public security force; and persons doing cipher work who are salaried as for army men;

b) Non-commissioned officers and soldiers of the people’s army on service; non-commissioned officers and soldiers on duty in the people’s public security; people’s public security trainees, army trainees, and trainee cipher officers entitled to cost-of-living allowance, who are Vietnamese;

c) People’s public security trainees, army trainees, and trainee cipher officers entitled to cost-of-living allowance, who are foreigners;

d) Cadets who have been training as reserve officers for 3 months or more, and have not participated in social insurance or health insurance;

dd) Standing militia;

e) People with meritorious services to the revolution as prescribed by the Ordinance on Preferential Treatment of People with Meritorious Services to the Revolution; war veterans;

g) Incumbent National Assembly deputies and People’s Council deputies at all levels.;

h) Children aged under 6 years;

i) Relatives of fallen heroes, persons raising fallen heroes as prescribed by the Ordinance on Preferential Treatment of People with Meritorious Services to the Revolution;

k) Relatives of people with meritorious services to the revolution, spouses of fallen heroes marrying another man or wife, who are entitled to a monthly survivorship allowance, and relevant individuals as prescribed by the Ordinance on Preferential Treatment of People with Meritorious Services to the Revolution, except for those specified at Point i of this Clause;

l) Relatives of persons specified at Points a and b of this Clause in accordance with the law;

m) Persons who have donated parts of their bodies in accordance with law;

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

o) Members of poor households; ethnic minority people of near-poor households who are living in communes and villages of ethnic minority-inhabited areas and mountainous areas; ethnic minority people living in areas with difficult socio-economic conditions; persons living in areas with exceptionally difficult socio-economic conditions; persons living in island communes and districts;

p) Commune, ward or township cadres who have stopped working and are receiving monthly allowances from the state budget;

q) People who have stopped enjoying working capacity loss allowances and are enjoying monthly allowances from the state budget;

r) Persons currently entitled to monthly social allowance; persons entitled to monthly allowance for nurture in accordance with relevant laws; persons entitled to monthly survivorship allowance who are eligible for social welfare allowance;

s) Persons aged full 75 years or older who are entitled to monthly survivorship allowance, and persons aged full 70 years to under 75 years of near-poor households, who are entitled to monthly survivorship allowance;

t) Persons on monthly social pension benefits as prescribed by the law on social insurance;

u) Employees ineligible for pension enjoyment and not old enough to receive social pension benefits who are enjoying monthly allowance as prescribed by the law on social insurance.

4. Persons whose health insurance premiums are paid with the state budget support, including:

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

b) Pupils and students.

c) Persons in the force participating protection of security and order at the grassroots level;

d) Members of agricultural, forestry, fishery and salt-making households who have average living standards as prescribed by law;

dd) Village health staff; village midwife;

e) Persons working on a part-time basis in villages and residential groups as prescribed by law;

g) Ethnic minority people living in communes no longer identified as difficult or exceptionally difficult socio-economic conditions shall receive support from the state budget for payment of health insurance premiums according to the Government's regulations;

h) Persons awarded the title of People's Artisan or Meritorious Artisan in accordance with the Law on Cultural Heritage;

i) Victims as prescribed by the Law on Human Trafficking Prevention and Combat.

5. Persons whose health insurance premiums are paid by themselves, including:

a) Persons of households participating in health insurance under the household form;

b) Persons living and working, persons being raised and cared for in charitable and religious organizations and establishments;

c) Employees on unpaid leave or suspension of their 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 prescribed by laws and ordinances.

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

a) The insured as prescribed by law before January 1, 2025;

b) Persons other than those specified at Point a of this Clause, after reporting the National Assembly Standing Committee.”.

11. To amend and supplement Article 13 as follows:

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

1. Health insurance premiums paid by employees or employers, or by both employees and employers, are prescribed as follows:

a) The monthly premium rate applicable to the persons defined at Points a, c, d and e Clause 1 Article 12 of this Law equals up to 6% of the monthly salary, with the employer paying two-thirds of the amount and the employee, one-third;

b) The monthly premium rate applicable to the persons defined at Point b Clause 1 Article 12 of this Law equals up to 6% of the monthly salary on which the compulsory social insurance premiums are based, and is paid by such persons;

c) The monthly premium rate applicable to the persons defined at Point dd Clause 1 Article 12 of this Law equals up to 6% of the monthly salary on which the compulsory social insurance premiums are based, and is paid by such persons;

d) The monthly premium rate applicable to the persons defined at Point g Clause 1 Article 12 of this Law equals up to 6% of the reference level, with the employer paying two-thirds of the amount and the employee, one-third;

dd) The monthly premium rate applicable to the persons defined at Point h Clause 1 Article 12 of this Law equals up to 6% of the monthly salary, and the payment responsibility is regulated by the Government;

e) The monthly premium rate applicable to the persons defined at Point i Clause 1 Article 12 of this Law equals up to 6% of the reference level, and the payment responsibility is regulated by the Government.

2. The premiums paid by the social security agencies are prescribed as follows:

a) The monthly premium rate applicable to the persons defined at Point a Clause 2 Article 12 of this Law equals up to 6% of the pension or working capacity loss allowance;

b) The monthly premium rate applicable to persons defined at Points b and c Clause 2 Article 12 of this Law equals up to 6% of the reference level;

c) The monthly premium rate applicable to the persons defined at Point d Clause 2 Article 12 of this Law equals up to 6% of the unemployment allowance.

3. Premiums paid and supported by the state budget are prescribed as follows:

a) The monthly premium rate applicable to the persons defined at Point a Clause 3 Article 12 of this Law equals up to 6% of the monthly salary and shall be paid by the state budget;

b) The monthly premium rate applicable to the persons defined 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 equals up to 6% of the reference level and shall be paid by the state budget;

c) The monthly premium rate applicable to the persons defined at Point n Clause 3 Article 12 of this Law equals up to 6% of the reference level and shall be paid by the state budget via scholarship-awarding agencies, organizations or units;

d) The monthly premium rate applicable to the persons defined in Clause 4 Article 12 of this Law equals up to 6% of the reference level and shall be paid by these persons with the state budget supporting part of this payment.

4. The monthly premium rate applicable to the persons defined in Clause 5 Article 12 of this Law equals up to 6% of the reference level and shall be paid by persons who pay premiums in the form of households, or pay based on the individual participant.

5. Determination of the order of health insurance premium payment if one person belongs to different categories of the insured as follows:

a) In case an insured concurrently belongs to different categories specified in Article 12 of this Law, he/she shall pay health insurance premiums like those in the first category which he/she belongs to in the order of priority defined in Article 12 of this Law, except for the cases specified at Points c, d, dd, e and g of this Clause;

b) A person specified at Points a, c, d, dd and e Clause 1 Article 12 of this Law who has one or more than one labor contract, shall pay health insurance premiums according to the contract used as a basis for payment of compulsory social insurance premiums;

c) In case a person specified at Point g Clause 1 Article 12 of this Law concurrently belongs to different categories specified in Article 12 of this Law, he/she shall pay health insurance premiums according to the following order: payment made by the social security agency, payment made by the state budget, payment supported by the state budget, payment concurrently made by such person and the commune-level People’s Committee;

d) In case a person specified at Points a and c Clause 2 Article 12 of this Law concurrently belongs to different categories specified in Article 12 of this Law, he/she shall participate like those in the category having premiums paid by the social security agency;

dd) In case a person specified at Points s, t and u Clause 3 Article 12 of this Law concurrently belongs to different categories specified in Article 12 of this Law, he/she shall participate like those in the category having premiums paid by the state budget;

e) In case a person specified at Points a, c, d, dd, e, g, h and i Clause 4 Article 12 of this Law concurrently belongs to those specified at Point a Clause 5 of this Law, he/she may choose the insured category for participating in health insurance;

g) A person concurrently belongs to different categories having premiums supported by the state budget as prescribed in Clause 4 Article 12 of this Law may choose the insured category with the highest support for participating in health insurance;

h) In case a person specified at Points b and c Clause 5 Article 12 of this Law concurrently belongs to those specified at Point a Clause 5 of this Law, he/she may choose to participate in health insurance under the form of household.

6. Members of households specified at Point a Clause 5 Article 12 of this Law who participate in health insurance under the household form in the fiscal year shall have their premium payment reduced as follows:

a) The rate applicable to the first person equals up to 6% of the reference level;

b) The rates applicable to the second, third and fourth persons equal respectively 70%, 60% and 50% of the rate paid by the first person;

c) The rate applicable to the fifth person onward equals 40% of the rate paid by the first person.

7. The Government shall prescribe the following contents:

a) Premium rate and support rate specified in this Article;

b) Premium payment responsibility, payment rate and support rate applicable to 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 health insurance premiums shall be paid based on the reference level.

5. The maximum monthly salary 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 enterprises, cooperative groups, cooperatives, cooperative unions, or business households engaged in the fields of agriculture, forestry, fishery or salt making with product-based or piecework-based salaries, payment shall be made every month, every 3 months or every 6 months.

3. On a monthly basis, social security agencies shall pay health insurance premiums to the health insurance fund in accordance with Clause 2 Article 13 of this Law.

4. Quarterly, scholarship-awarding agencies, organizations and units shall pay health insurance premiums to the health insurance fund in accordance with Point c Clause 3 Article 13 of this Law.

5. Quarterly, the state budget shall transfer to the health insurance fund the health insurance premiums paid and supported in accordance with Points a, b and d Clause 3 Article 13 of this Law.”.

b) To add Clauses 7 and 8 after Clause 6 as follows:

“7. Persons specified at Points b and dd Clause 1 Article 12 of this Law shall make full payment of payable premiums directly to the social security agencies or make full payment via households, enterprises, cooperatives and cooperative unions involved in management every month, every 3 months or every 6 months.

8. Deadlines for payment of health insurance premiums by employers shall be:

a) The last day of the following month, in case of making monthly payment;

b) The last day of the month following the payment cycle, in case of making payment every 3 months or every 6 months.”.

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. A health insurance card with code is granted to an insured as a basis for enjoying health insurance benefits under this Law. Health insurance cards are issued in electronic and paper versions with the same legal value.

2. Everyone may be granted only one health insurance code.”;

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

“c) The insured specified in Clauses 4 and 5 of this Law who has his/her health insurance premiums paid for the first time, or has already paid the health insurance premiums like one of the insured specified in Article 12 of this Law, but fails to pay health insurance premiums continuously for 90 days or more, his/her health insurance card is valid 30 days after the date of full payment of health insurance premiums;”;

c) To amend and supplement Clause 5 as follows:

“5. Vietnam Social Security shall issue the form of health insurance cards after obtaining agreement of the Ministry of Health.”.

15. To amend and supplement Article 17 as follows:

“Article 17. Grant of health insurance cards

1. A dossier of request for the grant of a health insurance card comprises:

a) A written registration of health insurance participation by an agency, unit, organization, individual or a household, for those paying health insurance premiums for the first time;

b) A list of the insured defined in Clause 1 Article 12 of this Law, made by the employer within 30 days from the date on which the employee is covered by health insurance. In case where the insured defined at Points b and dd Clause 1 Article 12 of this Law submit the dossier himself/herself, the dossier comprising the declaration specified at Point a of this Clause shall be submitted to the social security agency within 30 days from the date such person is determined as the one covered by the health insurance;

c) Lists of the insured defined in Clauses 2, 3, 4 and 5 Article 12 of this Law shall be made by household by commune-level People’s Committees, except for those on the lists defined at Points d and dd of this Clause;

d) Lists of the insured managed by the Ministry of Education and Training, the Ministry of Labor, Invalids and Social Affairs and other ministries and sectors, as prescribed at Point n Clause 3, and Point b Clause 4 Article 12 of this Law shall be made by education institutions and vocational education institutions;

dd) Lists of the insured managed by the Ministry of National Defense and the Ministry of Public Security as prescribed 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 lists of the insured prescribed at Point i Clause 1 Article 12 of this Law shall be made by the Ministry of National Defense and the Ministry of Public Security.

2. Within 5 working days from the date of receipt of the complete dossier specified in Clause 1 of this Article, the social security agency shall grant a health insurance card to the insured, and notify or deliver the card to the agency or organization managing and making the list of the insured.

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

16. To amend and supplement Article 21 as follows:

“Article 21. Scope of health insurance benefits

1. The insured has the following costs covered by the health insurance fund:

a) Costs of medical examination and treatment, including telehealth, telehealth support, family medical examination and treatment, home-based medical examination and treatment, functional rehabilitation, regular pregnancy check-ups and birth giving;

b) Costs of transferal of patients, for persons defined at Points a, b, c, d, dd, e, h, i, o and r Clause 3 Article 12 of this Law, in case of inpatient treatment or emergency, they must be transferred to a medical care provider specified in Article 27 of this Law;

c) Costs for using technical medical services, medicines, medical equipment, blood, blood products, medical gases, supplies, tools, instruments, and chemicals used in medical examination and treatment that are covered by the health insurance fund.

2. The Ministry of Health shall prescribe the following contents:

a) Principles and criteria for formulating the lists of medicines, principles for formulating the lists of medical equipment, and technical medical services covered by health insurance;

b) Promulgating the lists of medicines, medical equipment, and technical medical services covered by health insurance on the principles and criteria mentioned at Point a of this Clause;

c) The payment rates for medicines, medical equipment, and technical medical services covered by health insurance;

d) The rates, conditions and payment of medicines, medical equipment, and technical medical services covered by health insurance;

dd) Payment of blood, blood products, medical gases, supplies, tools, instruments, and chemicals used in medical examination and treatment that are covered by the health insurance.

3. The Government shall prescribe the following contents:

a) Payment of costs for patient transferal specified at Point b Clause 1 of this Article;

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

c) Those not applying 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 of the insured

1. An insured who uses medical care services under Articles 26 and 27 of this Law has medical care costs covered by the health insurance fund within the scope of benefits at the following levels:

a) 100% of the costs, for the persons defined at Points a, b, c, d, dd, e, h, i, o, r and s Clause 3 Article 12 of this Law. Medical care costs outside the scope of health insurance benefits of the persons defined at Points a, b, c, d and dd Clause 3 Article 12 of this Law shall be paid with the funds for health insurance-covered medical care for these persons. In case these funds are insufficient, such costs shall be paid by the state budget;

b) 100% of the costs, for cases in which the cost of a check-up is below the level prescribed by the Government;

c) 100% of the costs for medical care provided at the one belonging to the primary medical care provider, including health stations; family medicine establishments; military-civilian medical stations, military-civilian medical clinics; district-level medical centers with medical examination and treatment activities licensed to operate in the form of clinics; health divisions of agencies, units and organizations as prescribed by the Minister of Health; medical care providers belonging the primary medical examination and treatment level in the army and public security as prescribed by the Minister of National Defense and the Minister of Public Security. 100% of outpatient medical care costs at regional polyclinics;

d) 100% of the costs, when patients have paid health insurance premiums for 5 consecutive years or more and have the costs co-paid for medical care services specified in Clause 3, Points a, b, c, dd and e Clause 4, Clause 5 of this Article, and Articles 26 and 27 of this Law in the year of the higher than 6 times the reference level;

dd) 95% of the costs, for the persons defined at Point a Clause 2, Point k Clause 3, and Points a and g Clause 4 Article 12 of this Law;

e) 80% of the costs, for other persons.

2. If the insured belongs to different categories, he/she is eligible for the highest benefit for an insured of a category.

3. The insured who registers for health insurance-covered primary care services at a medical care provider at intensive or basic level, when use medical care services at the one other than the registered primary care service provider due to change of the temporary residence or place of stay, shall be examined and treated at a basic-level medical care provider suitable for the new temporary residence or place of stay and shall have their medical care cost covered by the health insurance fund in accordance with Clause 1 of this Article. The Minister of Health shall prescribe the procedures and cases of stay eligible for health insurance-covered medical care specified in this Clause.

4. The insured who receives medical care at a medical care provider other than the registered primary medical care provider, without following regulations on transferal of patients specified in Articles 26 and 27 of this Law, except for the cases specified in Clauses 3 and 5 of this Law, shall receive payment from the health insurance fund in percentage of the benefit level specified in Clause 1 of this Article as follows:

a) 100% of the benefits when receiving medical care at a basic-level or intensive-level medical care provider in case of definitive diagnosis and treatment of certain rare diseases, serious diseases, diseases requiring surgery or using advanced techniques as prescribed by the Minister of Health;

b) 100% of the benefits, for ethnic minority people and poor household members living in areas with difficult or exceptionally difficult socio-economic conditions, and persons living in island communes or districts when receiving inpatient medical care at an intensive-level medical care provider;

c) 100% of the benefits when receiving medical care at the primary medical care provider;

d) 100% of the benefits when receiving inpatient medical care at the basic-level medical care provider;

dd) 100% of the benefits when receiving medical care at the basic-level or intensive-level medical care provider that has been determined as district-level medical care provider before January 1, 2025 by the competent agency;

e) From 50% to 100% of the benefits when receiving outpatient medical care at the basic-level medical care provider based on the technical and professional classification results according to the roadmap and benefit rates specified by the Government, except for the cases specified at Points a and dd of this Clause;

g) 40% of the benefits when receiving inpatient medical care at the intensive-level medical care provider, except for the cases specified at Points a, b, dd and h of this Clause;

h) 50% of the benefits when receiving outpatient medical care according to the roadmap prescribed by the Government, and 100% of the benefits when receiving inpatient medical care at an intensive-level medical care provider that has been classified as provincial-level medical care provider before January 1, 2025, by the competent agency.

5. The insured shall be entitled to 100% of the benefits specified in Clause 1 of this Article when receiving medical care at any medical care provider in case of emergency.

6. The Government shall specify the benefit levels for the insured defined at Points a, b, c, d and dd Clause 3 Article of this Law; prescribe the benefit levels for the insured receiving medical care upon requests, and other cases not mentioned 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 for persons aged full 18 years or older.

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

19. To amend and supplement Article 24 as follows:

“Article 24. Health insurance-covered medical care providers

A health insurance-covered medical care provider is a health care provider prescribed by the Law on Medical Examination and Treatment which signs a medical care contract with the health social security according to the Government's regulations.”.

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 Clause 4 as follows:

“3. Any agreement on conditions for modification, liquidation, suspension and termination of a contract defined at Point e Clause 2 of this Article must not interrupt medical care for the concerned insured.

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

21. To amend and supplement Article 26 as follows:

“Article 26. Registration for health insurance-covered primary medical care services

1. The insured may register for health insurance-covered primary care services at medical care providers of primary or basic levels, and may change their health insurance-covered primary medical care providers within the first 15 days of every quarter.

2. The distribution of health insurance cards for the health insurance-covered primary medical care providers must ensure balance and alignment with the healthcare needs of the population, the capacity of the medical care providers, and the actual conditions of the locality.

3. The Minister of Health shall provide detailed regulations for Clauses 1 and 2 of this Article and specify cases in which registration for health insurance-covered primary medical care services is allowed at medical care providers of intensive level.

4. The Minister of Public Security and the Minister of National Defense shall regulate the registration for health insurance-covered primary medical care services at primary, basic-, and intensive-level medical care providers for the insured under their management.”.

22. To amend and supplement Article 27 as follows:

“Article 27. Patient transferal among health insurance-covered medical care providers

1. Patient transferal among medical care providers shall be carried out according to professional requirements and the capacity of the medical care providers.

2. The Minister of Health shall issue regulations on patient transferal to their health insurance-covered primary medical care providers for treatment, management, and monitoring of chronic diseases, including the use of prescribed medicines, medical equipment, and technical medical services, in accordance with the professional capacity of the facility providing treatment, management, and monitoring for chronic conditions. The Minister shall also provide detailed regulations for Clause 1 of this Article, except for the cases specified in Clause 3 of this Article.

3. The Minister of Public Security and the Minister of National Defense shall regulate the transferal of patients under their respective management between health insurance-covered medical care providers under their management.”.

23. To amend and supplement Article 28 as follows:

“Article 28. Procedures for health insurance-covered medical care

1. An insured seeking medical care services shall show information about his/her health insurance card and a written proof of personal identity of the card holder; for children under 6 years, and people who have donated parts of their bodies without a health insurance card, other lawful papers shall be produced. In case of emergency, the patient must show information about his/her health insurance card and papers defined in this Clause before the treatment completion.

The Government shall detail this Clause.

2. In case of re-examination to meet professional requirements in medical examination and treatment, an insured shall be scheduled for re-examination appointments by the medical care provider according to the procedures stipulated by the Minister of Health.

3. In case of changing the health insurance-covered medical care provider to meet professional requirements during inpatient treatment, the transferring medical care provider must prepare a transferal dossier in accordance with regulations set forth by the Minister of Health.”.

24. To amend and supplement Article 30 as follows:

“Article 30. Methods of payment of costs of insured medical care

1. Costs of health insurance-covered medical care shall be paid by one of the following methods:

a) Rate-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 care.”.

25. To amend and supplement Article 31 as follows:

“Article 31. Payment of costs of health insurance-covered medical care

1. Social security agencies shall pay costs of health insurance-covered medical care to medical care providers according to health insurance-covered medical care contracts.

2. Social security agencies shall pay medical care costs directly to health insurance card holders who use medical care services in the following cases:

a) At a health insurance-covered medical care provider which has no health insurance-covered medical care contract;

b) The medical care is provided not in accordance with Article 28 of this Law;

c) Other special cases as prescribed by the Government.

3. In case where a patient is prescribed medicines, medical equipment, or para-clinical services covered by the health insurance fund, but the medical care provider does not have these available and they cannot be substituted with other medicines, equipment, or services, the medical care provider may receive the necessary medicines or medical equipment transferred from another health insurance-covered medical care provider for treatment for the patient, or may transfer the patient or his/her medical specimens to another provider eligible for providing the para-clinical services.

The health insurance-covered medical care provider receiving medicines, medical equipment, or the one transferring the patient or medical specimens shall synthesize costs of such medicines, medical equipment or para-clinical services and make payment with the social security agency.

4. The Government shall prescribe the following contents:

a) Conditions, and competence to decide on the cases eligible for receiving medicines or medical equipment transferred from another health insurance-covered medical care provider for providing treatment for the patient, and the payment of costs of the transferred medicines or medical equipment specified in Clause 3 of this Article;

b) Management and use of funding for health insurance-covered medical care, assessment and payment, settlement of costs of health insurance-covered medical care for the insured specified at Points a, b, c, d and dd Clause 3 Article 12 of this Law;

c) The payment and settlement of costs of health insurance-covered medical care for the insured who are members of the armed forces or citizens living in border areas, islands, or communes with exceptionally difficult conditions, to ensure national defense and security policies.

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

26. To amend and supplement Article 32 as follows:

“Article 32. Advance, payment and settlement of costs of health insurance-covered medical care

1. The social security agency shall quarterly advance funds to health insurance-covered medical care providers as follows:

a) Within 5 working days after receiving a health insurance-covered medical care provider’s settlement report of the preceding quarter, the social security agency shall advance once funds equal to 90% of the costs of health insurance-covered medical care according to this report;

b) For a medical care provider which signs a health insurance-covered medical care contract for the first time, the social security agency shall, based on the medical care costs of the month preceding the health insurance-covered medical care contract conclusion, give an advance amount equal to 90% of the funds for health insurance-covered medical care for the first month of contract performance. After one month of contract performance, the social security agency shall estimate and advance 90% of the health insurance-covered medical care costs in the quarter in accordance with Point a of this Clause;

c) In case funds advanced to health insurance-covered medical care providers in a province exceed the funds permitted for use in a quarter, the provincial-level social security agency shall report such to Vietnam Social Security for addition of funds.

2. A health insurance-covered medical care provider and a social security agency shall make payment and settlement as follows:

a) Within the first 15 days of each month, the health insurance-covered medical care provider shall send to the to the social security agency a summary request for payment of health insurance-covered medical care costs of the preceding month; within the first 15 days of each quarter, the health insurance-covered medical care provider shall send to the social security agency a report on settlement of health insurance-covered medical care costs of the preceding quarter;

b) Within 30 days after receiving the medical care provider’s settlement report of the previous quarter, the social security agency shall notify the latter of the assessment result and the settled health insurance-covered medical care costs, which cover actual medical care costs within the scope and levels of health insurance benefits. For the fourth quarter of the year, the assessment result and the settled health insurance-covered medical care costs shall be notified within 60 days from the date on which the social security agency receives the settlement report of the fourth quarter from the medical care provider;

c) Within 10 days after notifying the settled health insurance-covered medical care costs, the social security agency shall complete payment to the medical care provider;

d) The appraisal of annual settlement for the health insurance fund and payment must be conducted before October 1 of the subsequent year.

3. Within 40 days after receiving a complete dossier of request for payment from an insured in the cases specified in Clause 2 Article 31 of this Law, the social security agency shall pay the health insurance-covered medical care costs directly to that person.”.

27. To amend and supplement Article 35 as follows:

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

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

a) 92% of health insurance premiums shall be used for medical care;

b) 8% of health insurance premiums shall be used for setting up a provision fund and spending for health insurance organization and operation, including at least 4% for the provision fund.

2. The use of temporarily idle money of the health insurance fund for investment shall comply the Law on Social Insurance regarding investment principles, lists and methods and management of social insurance fund operation.

3. In case the collected health insurance premiums for medical care are higher than paid medical care costs in a year, the unused funds shall be fully accounted into the provision fund for overall regulation.

4. In case the collected health insurance premiums for medical care are less than paid medical care costs in a year, Vietnam Social Security shall supplement the shortfall from the provision fund.

5. The Government shall detail this Article, and provide regulations on spending for health insurance organization and operation.”.

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

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

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

“3. To hand health insurance cards, or notify the results of issuance of health insurance cards to the insured within 3 working days from the date of receiving the cards or receiving the notification of the health insurance card issuance results from the social security agency.”.

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

“2. To inspect the performance of health insurance-covered medical care contracts; to conduct health insurance assessment; to revoke or seize health insurance cards, for cases defined in Article 20 of this Law.”.

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

“8. To inspect the performance of health insurance-covered medical care contracts; to conduct health insurance assessment.”.

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

“9. To ensure sufficient conditions for the provision of health insurance-covered medical care services in accordance with the law on health insurance, the law on medical examination and treatment, and the terms of health insurance-covered medical care contracts.”.

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

“Article 48a. Late payment of health insurance premiums

Late payment of health insurance premiums means one of the following acts committed by an employer:

1. Failing to make payment or making insufficient payment of the required health insurance premiums after the latest payment deadline stipulated in Clause 8 Article 15 of this Law, except for the cases specified at Point c Clause 1 Article 48b of this Law;

2. Failing to make the lists, or listing insufficient number of persons covered by health insurance within 60 days from the deadline specified at Point b Clause 1 Article 17 of this Law;

3. Not being considered shirking the payment of health insurance premiums under Clause 2 Article 48b of this Law.

Article 48b. Shirking the payment of health insurance premiums

1. Shirking the payment of health insurance premiums means one of the following acts committed by an employer:

a) The employer fails to make a list or lists insufficiently the number of persons covered by health insurance after 60 days from the deadline specified at Point b Clause 1 Article 17 of this Law;

b) Registering the salary on which health insurance premiums are based, lower than the one specified in Article 14 of this Law;

c) Failing to make payment or paying insufficient amount registered for health insurance after 60 days from the latest date of paying health insurance premiums as prescribed in Clause 8 Article 15 of this Law and having been urged by the competent agency according to the Government's regulations;

d) Other cases considered shirking the payment of health insurance premiums according to the Government’s regulations.

2. The Government shall detail this Article, and prescribe the cases specified in Clause 1 of this Article with plausible reasons, which are not considered shirking the payment of health insurance premiums.”.

34. To amend and supplement Article 49 as follows:

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

1. Agencies, organizations or persons violating provisions of the law on health insurance shall, depending on the nature and seriousness of their violations, be disciplined, administratively handled or examined for penal liability; or if causing damage, they shall pay compensations therefor in accordance with law.

2. Measures for handling of late payment of health insurance premiums include:

a) Forcible payment of late payment amount in full; payment of an amount equal to 0.03%/day calculated on the amount of late payment of health insurance premiums and the number of days of late payment to the health insurance fund.

b) Handling of administrative violations in accordance with law;

c) Not considering awarding emulation titles or forms of reward.

3. Measures for handling of shirking the payment of health insurance premiums include:

a) Forcible payment of the evaded payment amount in full; payment of an amount equal to 0.03%/day calculated on the amount of evaded payment of health insurance premiums and the number of days of evaded payment to the health insurance fund;

b) Handling of administrative violations, or pursuing criminal liability in accordance with law;

c) Not considering awarding emulation titles or forms of reward.

4. Agencies, organizations and employers making late payment or shirking the payment of health insurance premiums for their employees must fully reimburse all medical care costs within the scope of benefits and benefit levels that the employees have paid during the period they did not have a health insurance card due to late or evaded payment.

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

35. To replace the phrases in a number of points and clauses as follows:

a) To replace the phrase “health insurance institution” with the phrase “social security agency” 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, title of Article 40 and Clause 5 Article 40, 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;

b) To replace the phrase “the Vietnam Social Insurance Management Council” with the phrase “Social Insurance Management Council” in Clause 1 Article 34.

Article 2. To amend and supplement the Law on the Force Participating in the Protection of Security and Order at the Grassroots Level, No. 30/2023/QH15

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

Article 3. Implementation provisions

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

2. Provisions relating to professional and technical levels in medical care, registration for health insurance-covered primary medical care services, patient transferal among health insurance-covered medical care providers, procedures for health insurance-covered medical care defined in Clauses 3, 16, 17, 21, 22, 23 and 28 Article 1 of this Law, take effect on January 1, 2025.

3. Provisions on scope of health insurance benefits specified in Clause 16 Article 1 of this Law, except for provisions on telehealth, telehealth support, family medical examination and treatment, home-based medical examination and treatment, and principles for formulating the lists of medical equipment technical services within the scope of health insurance benefits of the insured, and provisions on the benefit levels specified in Clause 17 Article 1 of this Law that apply to the following cases, take effect on January 1, 2025:

a) The insured specified in Clause 10 Article 1 of this Law as defined in Article 12 of the Law on Health Insurance No. 25/2008/QH12, which had 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 insured defined at Point a of this Clause, who receiving medical care at medical care providers before January 1, 2025, and having their treatment completed from January 1, 2025.

4. No later than January 1, 2027, the interconnection and utilization of shared para-clinical results among health insurance-covered medical care providers must be implemented in accordance with professional requirements as stipulated by the Government.

5. Transitional provisions:

b) The patient other than those defined at Points a and b Clause 3 of this Article, who receiving medical care at medical care providers before July 1, 2025, and having their treatment completed from July 1, 2025, shall comply with this Law;

b) The reference level specified in this Law shall comply with the basic salary. In case of change to the salary policy, the Government shall specify the reference level;

c) Health insurance-covered medical care contracts signed before July 1, 2025, that remain effective after July 1, 2025, shall comply with the Government's regulations;

d) The health insurance premiums payable by employers under the Law on Health Insurance No. 25/2008/QH12 (which had 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 are not paid or are unfully paid until June 30, 2025, shall be handled in accordance with the provisions on late payment under this Law.

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