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THE
NATIONAL ASSEMBLY
OF VIETNAM
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THE
SOCIALIST REPUBLIC OF VIETNAM
INDEPENDENCE - FREEDOM – HAPPINESS
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Law
No. 51/2024/QH15
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Hanoi,
November 27, 2024
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LAW
AMENDMENTS TO SOME ARTICLES OF THE LAW ON HEALTH INSURANCE
Pursuant to the Constitution of
the Socialist Republic of Vietnam;
The National Assembly
promulgates the Law on Amendments to some Articles of the Law on Health
Insurance No. 25/2008/QH12, which is amended by 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.
Amendments to some Articles of the Law on Health Insurance
1. Addition of Clause 9 after
Clause 8 of Article 2:
“9. Reference level is an amount
decided by the Government to calculate the premiums and payouts
(reimbursements) of certain types of health insurance specified in this Law.”.
2. Amendments to Clause 2 of
Article 3:
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3. Amendments to some Clauses of
Article 6:
a) Amendments to Clause 1:
“1. Promulgating or propose
promulgation of health insurance policies and law, organizing the health care
system, financial sources for the protection, care and improvement of the people’s
health based on universal health coverage;
b) Amendments to Clause 3 and
Clause 4:
“3. Promulgate regulations,
procedures, professional instructions on medical examination and treatment
(hereinafter referred to as “medical care” or “medical services”); frequently
review and update instructions on diagnosis and treatment; regulations on
assessment of rationality of provision of medical services; regulations on
application of information technology, digital transformation, sharing of
information about health insurance, synchronization of paraclinical results
among health insurance-covered health facilities in a manner that satisfies
professional requirements;
4. Implement or propose
implementation of solutions for balancing the health insurance fund;”.
4. Amendments to Article 7a:
Article 7a. Responsibilities of
the Ministry of Labor, War Invalids and Social Affairs
1. Provide instructions on the
determination and management of health insurance participants under the
management of the Ministry of Labor, War Invalids and Social Affairs that are
prescribed in Points e, h, i, k, o, r, s and t Clause 3, Points a, b, d and g
Clause 4 Article 12 of this Law.
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5. Amendments to some Clauses of
Article 7c:
a) Amendments to Clause 1:
“1. Administer and provide
instructions on the determination, management and compilation of the list of
health insurance participants under the management of the Ministry of National
Defense and the Ministry of Public Security prescribed in Points a, c, e, h and
i Clause 1, Points a, b, c, d, l and n Clause 3, Point b Clause 4 Article 12 of
this Law.”;
b) Amendments to Clause 3:
“3. Carry out inspection of the
implementation of regulations of law on the responsibility to participate in
health insurance of persons under the management of the Ministry of National
Defense and the Ministry of Public Security prescribed in Points a, c, e, h and
i Clause 1, Points a, b, c, d, l and n Clause 3, Point b Clause 4 Article 12 of
this Law.”.
6. Amendments to Clause 2 and
Clause 3 of Article 8:
“2. The People’s Committees of
central-affiliated cities and provinces (hereinafter referred to as
“provinces”), in addition to fulfillment of the responsibilities specified in
Clause 1 of this Article, shall provide instructions on development of
apparatus and resources to serve state management of health insurance in their
provinces.
3. The People’s Committees of
communes, wards and commune-level towns (hereinafter referred to as “communes”)
shall:
a) Fulfill the responsibilities
specified in Clause 1 of this Article;
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c) Compile a list of health
insurance card issuance for children as the same time as issuance of birth
certificates.”.
7. Amendments to Article 9:
“Article 9. Health insurance
authorities
1. Social insurance authorities are
responsible for implementation of health insurance policies and laws,
management and use of the health insurance funds.
2. The Government shall elaborate
the functions, tasks, powers and organizational structure of social insurance
authorities with regard to implementation of health insurance.”.
8. Amendments to Article 10:
“Article 10. Audit of the health
insurance fund
1. State Audit Office of Vietnam
shall carry out audit of the health insurance fund every three years and submit
reports to the National Assembly; carry out ad hoc audit of the health
insurance fund at the request of the National Assembly, Standing committee of
the National Assembly, the President of Vietnam, the Government, the Prime
Minister of Vietnam.
2. Annually, State Audit Office of
Vietnam shall carry out audit of the expenditures on organization and operation
of health insurance during audit of the statement of organization and operation
of social insurance.”.
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“1. Late payment, evasion of health
insurance premiums.”.
10. Amendments to Article 12:
“Article 12. Eligible
participants in health insurance (insured individuals)
1. Participants whose insurance
premiums are paid by the employers, the employees, or both:
a) Employees working under
indefinite-term contracts or fixed-term contracts with duration of at least 01
month, even if these contracts are referred to as other names by employees and
employers as long as they have contents about payment of wage or salary, the
management and supervision by a party; business executives, controllers, state
capital representatives, enterprise’s capital representative prescribed by law;
members of the Board of Directors, General Director, Director, members of the
Board of Controllers or controllers and other elected managerial positions of
cooperatives, cooperative unions under regulations of the Law on Cooperatives
who receive salaries;
b) Business executives, state
capital representatives, enterprise’s capital representative prescribed by law;
salaried members of the Board of Directors, General Director, Director, members
of the Board of Controllers or controllers and other elected managerial
positions of cooperatives, cooperative unions under regulations of the Law on
Cooperatives who do not receive salaries;
c) Employees who are foreign
citizens working in Vietnam under fixed-term employment contracts that last at
least 12 months with employers in Vietnam, except persons reassigned within an
enterprise according to regulations of law on foreign workers in Vietnam or
those ho have reached the retirement age upon the conclusion of the employment
contracts according to Clause 2 Article 169 of the Labor Code, or otherwise
prescribed by an international treaty to which the Socialist Republic of
Vietnam is a signatory;
d) Employees working under
indefinite-term contracts or fixed-term contracts with duration of at least 01
month, even if these contracts are referred to as other names by employees and
employers as long as they have contents about payment of wage or salary, the
management and supervision by a party; having agreements with employers on
part-time work and receiving a monthly salary that is equal to or higher
than the lowest salary as the basis for compulsory social insurance payment
according to social insurance laws;
dd) Owners of registered household
businesses that are compulsory social insurance participants according to
social insurance laws;
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g) Part-time workers of
commune-level agencies as prescribed by law;
h) National defense workers and
public employees who are serving in the army, police workers who are working
for the police; people doing other works in cipher organizations as prescribed
by the Law on Cipher;
h) Family of national defense
workers and public employees who are serving in the army, family of police
workers who are working for the police who are not eligible participants
specified in Points a, b, c, d, dd, e, g and h of this Clause, Clause 2 and
Clause 3 of this Article.
2. Participants whose insurance
premiums are paid by the social insurance authorities:
a) People who are receiving monthly
retirement pensions, incapacity allowances;
b) People who are taking leave and
receiving monthly occupational accident or occupational disease allowance;
people who are taking leave and receiving sickness benefits due to diseases on
the list of diseases requiring long-term treatment or employees who are taking
leave and receiving sickness benefits for at least 14 working days in the month
according to social insurance laws; people who are taking leave and receiving
maternity benefits for at least 14 working days in the month according to
social insurance laws;
c) Retired officials of communes
who are receiving monthly social insurance benefits;
d) People who are receiving
unemployment benefits.
3. Participants whose insurance
premiums are paid by the State budget:
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b) Non-commissioned officers and
soldiers of the people’s army; non-commissioned officers and conscripts of the
police; military, police and cipher cadets who are receiving subsistence
allowances and are Vietnamese citizens;
c) Military cadets, police cadets,
cipher cadets who are receiving subsistence allowances and are foreigners;
d) Reserve officer trainees for at
least 03 months who have not participated in social insurance or health
insurance;
dd) Standing militia personnel;
e) Revolutionary contributors as
prescribed by the Ordinance on preferential treatment for revolutionary
contributors; veterans;
g) Incumbent deputies of the
National Assembly or the People’s Councils at all levels;
h) Children under the age of 6;
i) Family of martyrs or caregivers
of martyrs according to the Ordinance on preferential treatment for
revolutionary contributors;
k) Family of revolutionary
contributors, spouses of martyrs who have remarried and are receiving monthly
death benefits, and relevant individuals according to the Ordinance on
preferential treatment for revolutionary contributors, except for those specified
in Point i of this Clause;
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m) Persons who have donated body
parts under the regulations of the law;
m) Foreigners who are studying in
Vietnam and granted scholarships funded by the state budget of Vietnam;
o) Poor household members, ethnics
who are near-poor household members living in communes, villages in ethnic
regions and mountainous regions; ethnics living in economically and socially
disadvantaged areas; people living in particularly disadvantaged areas; people
living on commune-level and district-level islands;
p) Retired officials of communes
who are receiving monthly allowances from state budget;
q) People who have stopped
receiving incapacity allowances and are receiving monthly allowances from state
budget;
r) People who are receiving monthly
social allowances; people who are receiving monthly nursing allowances
according to relevant laws; people who are receiving monthly death benefits and
are also eligible for social allowances;
s) People aged 75 or older who are
receiving monthly death benefits; people aged 70 to under 75 who are members of
near-poor households and receiving monthly death benefits;
t) People receiving social
retirement benefits according to social insurance laws;
u) Employees who are not eligible
for pension, have not reached the age for social retirement benefits and are
receiving monthly allowances according to social insurance laws.
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a) Members of near-poor households;
b) Students;
c) Participants in internal
security forces;
d) Members of households doing
agriculture, forestry, aquaculture and salt production with average living
standards as prescribed by law;
dd) Health workers of villages;
midwives of villages;
e) Part-time workers of villages
and neighborhoods as prescribed by law;
g) Ethnics living in communes that
are no longer disadvantaged or exceptionally disadvantaged areas will have
health insurance premiums subsidized by state budget according to regulations
of the Government.
h) People who are awarded the title
of “Nghệ nhân nhân dân” (“People's Craftsperson”) or “Nghệ nhân ưu tú”
(“Eminent Craftsperson”) according to the Law on Cultural Heritage;
i) Human trafficking victims
defined by the Law on Prevention of Human Trafficking.
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a) Members of households that buy
health insurance for the entire household;
b) People living and working, being
raised or cared for in charitable or religious organizations;
c) Employees during unpaid leave or
suspension of their employment contracts;
d) People who are not in the cases
specified in Points a, b and c of this Clause.
6. Participants other than those
specified in Clause 1, 2, 3, 4 and 5 of this Article according to regulations
of Laws and Ordinances.
7. The Government shall specify
participants other than those specified in Clause 1, 2, 3, 4, 5 and 6 of this
Article, including:
a) Eligible health insurance
participants prescribed by law before January 1st 2025;
b) Participants other than those
mentioned in Point a of this Clause after reporting to Standing committee of
the National Assembly.”.
11. Amendments to Article 13:
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1. Health insurance premiums paid
by the employers, the employees, or both:
a) The monthly premium of a
participant prescribed in Points a, c, d and e Clause 1 Article 12 of this Law
must not exceed 6% of the monthly salary, two thirds of which is paid by the
employer and the remaining one third is paid by the employee;
b) The monthly premium of a
participant prescribed in Point b Clause 1 Article 12 of this Law must not
exceed 6% of the monthly salary as the basis for payment of compulsory social
insurance and shall be paid by the participant;
c) The monthly premium of a
participant prescribed in Point dd Clause 1 Article 12 of this Law must not
exceed 6% of the monthly salary as the basis for payment of compulsory social
insurance and shall be paid by the participant;
d) The monthly premium of a
participant prescribed in Point g Clause 1 Article 12 of this Law must not
exceed 6% of the reference level, two thirds of which is paid by the employer
and the remaining one third is paid by the employee;
d) The monthly premium of a
participant prescribed in point h Clause 1 Article 12 of this Law must not
exceed 6% of the monthly salary and the liability prescribed by the Government;
e) The monthly premium of a
participant prescribed in point i Clause 1 Article 12 of this Law must not
exceed 6% of the reference level and the liability prescribed by the
Government.
2. Health insurance premiums paid
by social insurance authorities:
a) The monthly premium of a
participant prescribed in Point a Clause 2 Article 12 of this Law must not
exceed 6% of the pension or incapacity allowance;
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c) The monthly premium of a
participant prescribed in Point d Clause 2 Article 12 of this Law must not
exceed 6% of the unemployment benefit.
3. Health insurance premiums paid
and subsidized by state budget:
a) The monthly premium of a
participant prescribed in Point a Clause 3 Article 12 of this Law must not
exceed 6% of the monthly salary and shall be paid by state budget;
b) The monthly premium of a
participant prescribed in 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 must not exceed 6% of the reference
level and shall be paid by state budget;
c) The monthly premiums of the participants
prescribed in Point n Clause 3 Article 12 of this Law must not exceed 6% of the
reference level and shall be paid by state budget via the scholarship
providers;
d) The monthly premiums of the
participants prescribed in Clause 4 Article 12 of this Law must not exceed 6%
of the reference level and shall be paid by the participants and subsidized by
state budget.
4. The monthly premiums of the
participants prescribed in Clause 5 Article 12 of this Law must not exceed 6%
of the reference level and shall be paid for the entire household or each
individual.
5. Order of health insurance
payment in case an individual is eligible for more than one form of health
insurance participation:
a) In case an individual is an
eligible participant under multiple scenarios prescribed in Article 12 of this
law, he/she shall pay health insurance according to the first applicable
scenario listed in Article 12, except in the cases specified in Points c, d,
dd, e and g of this Clause;
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c) In case a participant prescribed
in Point g Clause 1 Article 12 of this Law is also an eligible participant in
multiple cases specified in Article 12 of this Law, health insurance premiums
shall be paid in the following order: paid by social insurance authority, paid
by state budget, subsidized by state budget, shared between the participant and
the People’s Committee of the commune;
c) In case a participant prescribed
in Point a and Point c Clause 2 Article 12 of this Law is also an eligible
participant in multiple cases specified in Article 12 of this Law, health
insurance premiums shall be paid by the social insurance authority;
dd) In case a participant
prescribed in Points s, t and u Clause 3 Article 12 of this Law is also an
eligible participant in multiple cases specified in Article 12 of this Law,
health insurance premiums shall be paid by state budget;
e) In case a participant prescribed
in Points a, c, d, dd, e, g, h and i Clause 4 Article 12 of this Law is also an
eligible participant prescribed in Point a Clause 5 Article 12 of this Law,
he/she may choose a form of health insurance participation according to his/her
preference;
g) Participants whose health
insurance premiums are subsidized by state budget as prescribed in Clause 4
Article 12 of this Law may choose the form of participation with the highest
rate of subsidization;
e) In case a participant prescribed
in Point b and Point c Clause 5 Article 12 of this Law is also an eligible
participant prescribed in Point a Clause 5 Article 12 of this Law, he/she may
choose to participate in health insurance as a household.
6. Members of a household
prescribed in Point a Clause 5 Article 12 of this Law who participate in health
insurance as a household in a fiscal year will be eligible for the following
reductions:
a) The first participant shall pay
up to 6% of the reference level;
b) The second, third, fourth
participants shall pay 70%, 60%, 50% of the premiums paid by the first
participant respectively;
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7. The Government shall elaborate
the following regulations:
a) Rates of health insurance
premiums and subsidization mentioned in this Article;
b) Responsibility for payment,
rates of health insurance premiums and subsidization for the participants
specified in Clause 6 and Clause 7 Article 12 of this Law.”.
12. Amendments to Clause 4 and
Clause 5 of Article 14:
“4. The basis for health insurance
payment by participants other than those prescribed in Clauses 1, 2 and 3 of
this Article is the reference level.
5. The maximum monthly salary for
calculation of health insurance payment shall be 20 times the reference
level.”.
13. Amendments to some Clauses of
Article 15:
a) Amendments to Clauses 2, 3, 4
and 5:
“2. Enterprises, artels,
cooperatives, cooperative unions, household businesses that operate in the
fields of agriculture, forestry, fishery, salt production and pay piece-rate or
project-based salaries, health insurance premiums shall be paid every 01, 03 or
06 months.
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4. Scholarship providers shall pay
quarterly health insurance premiums prescribed in Point c Clause 3 Article 13
of this Law to the health insurance fund.
5. The State budget shall transfer
quarterly health insurance premiums and health insurance subsidies prescribed
in Points a, b and d Clause 3 Article 13 of this Law to the health insurance
fund.”;
b) Addition of Clause 7 and Clause
8 after Clause 6:
“7. The participants prescribed in
Point b and Point c Clause 1 Article 12 of this Law shall fully pay the amounts
payable by themselves directly to the social security authorities or via the
household businesses, enterprises, cooperatives, cooperative unions every 01,
03 or 06 months.
8. Deadlines for health insurance
payment by employers:
a) The last day of the succeeding
month for monthly payment;
b) The last day of the month
succeeding the payment cycle for quarterly or biannual payment.”.
14. Amendments to some Clauses of
Article 16:
a) Amendments to Clause 1 and
Clause 2:
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2. Each individual has only one
health insurance number.”;
b) Amendments to Point c of Clause
3:
“c) In case a health insurance
participant prescribed in Clause 4 and Clause 5 Article 12 of this Law either
participates in health insurance for the first time or has participated
intermittently for at least 90 days under any of the scenarios specified in
Article 12 of this Law, the health insurance card will become effective after
30 days from the day on which health insurance is fully paid;”;
c) Amendments to Clause 5:
“5. Vietnam Social Security shall
issue the health insurance card template after reaching a consensus with the
Ministry of Health.”.
15. Amendments to Article 17:
“Article 17. Issuance of health
insurance cards
1. 1. Applications for the issuance
of health insurance cards include:
a) Declaration forms submitted by
agencies, organizations, units, individuals, households participating in social
insurance for the first time;
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c) The list of health insurance
participants prescribed in Clauses 2, 3, 4 and 5 Article 12 which is compiled
by the People’s Committee of the commune by household, except for the
participants on the list mentioned in Point d and Point dd of this Clause;
d) The list of health insurance
participants under the management of The Ministry of Education and Training,
the Ministry of Labor, War Invalids and Social Affairs, other Ministries and
central authorities prescribed in Point n Clause 3 and Point b Clause 4 Article
12 of this Law compiled by educational institutions and vocational education
institutions;
dd) The list of health insurance
participants under the management of the Ministry of National Defense and the
Ministry of Public Security Points a, c, e and h Clause 1, Points a, b, c, d, l
and n Clause 3, Point b Clause 4 Article 12 of this Law compiled by the
Ministry of National Defense and the Ministry of Public Security.
2. Within 05 working days from the
receipt of the valid application prescribed in Clause 1 of this Article, the
social security authority shall issue health insurance cards to participants
and notify or send the cards to the applying organization.
3. The Government shall promulgate
regulations on issuance of physical and electronic health insurance cards.”.
16. Amendments to Article 21:
“Article 21. Health insurance
coverage
1. Health insurance participants
shall have the following costs covered by the health insurance fund:
a) Costs of medical care, including
telemedicine services, telemedicine assistance, family medicine services,
at-home medical care, rehabilitation, regular prenatal care check-ups and
childbirth;
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c) Costs of medical services,
medicines, use of medical devices, blood, blood products, medical gas,
supplies, tools, instruments, chemicals for medical services covered by the
health insurance fund.
2. The Minister of Health shall
elaborate the following regulations:
a) Rules and criteria for
compilation of lists of medicines, rules for compilation of lists of medical
devices and services covered by health insurance;
b) The promulgation of lists of medicines,
rules for compilation of lists of medical devices and services covered by
health insurance on the basis of the rules and criteria mentioned in Point a of
this Clause;
c) Ratios of payment for medicines,
medical devices and medical services covered by health insurance;
c) Rates and conditions for payment
for medicines, medical devices and medical services covered by health
insurance;
dd) The payment for blood, blood
products, medical gas, supplies, tools, instruments, chemicals for medical
services covered by the health insurance fund.
3. The Government shall elaborate
the following regulations:
a) The payment for patient
transport mentioned in Point b Clause 1 of this Article;
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c) Participants to whom the
co-payment rates mentioned in Point c Clause 2 of this Article do not apply.”.
17. Amendments to Article 22:
“Article 22. Health insurance
reimbursement rates
1. When health insurance
participants receives medical care as prescribed in Article 26 and Article 27
of this Law, they will be reimbursed by the health insurance fund for the
covered medical costs as follows:
a) 100% of the medical costs for
the participants prescribed in Points a, b, c, d, dd, e, h, i, o, r and s
Clause 3 Article 12 of this Law. The uncovered medical costs incurred by the
participants prescribed in Points a, b, c, d and dd Clause 3 Article 12 of this
Law shall be paid by the health insurance budget for medical care of these
participants; in case this budget is insufficient, they will be covered by
state budget;
b) 100% of the medical costs if the
cost of one medical examination/treatment occasion is lower than the level
prescribed by the Government;
c) 100% of the medical costs at
primary healthcare facilities, including: health stations, family medicine
facilities; civil – military health station, civil – military health clinics;
medical centers of districts that provide medical care and are licensed to
operate as clinics; health departments of agencies, units and organizations
prescribed by the Minister of Health; primary healthcare facilities of the army
and the police prescribed by the Minister of National Defense and the Minister
of Public Security. 100% of the costs outpatient care at local general clinics;
d) 100% of the medical costs when
the patient has a period of health insurance participation of at least 5
consecutive years and has paid a co-payment of more than 6 times the reference
level in the year prescribed in Clause 3, points a, b, c, dd and e Clause 4,
Clause 5 of this Article, Article 26 and Article 27 of this Law;
d) 95% of the medial costs for the
participants prescribed in Point a Clause 2, Point k Clause 3, Point a and
Point g Clause 4 Article 12 of this Law;
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2. An individual who is eligible
for multiple forms of health insurance participation will be entitled to the
most advantageous health insurance benefits.
3. In case an individual registers
a tertiary health facility or secondary health facility as a health
insurance-covered primary care provider but receives medical care at another
health facility due to change of the temporary residence or accommodation,
he/she may receive medical care at a secondary health facility that is suitable
for the new temporary residence or accommodation and have the costs covered by
the health insurance fund in accordance with Clause 1 of this Article. The
Minister of Health shall specify procedures and the cases mentioned in this
Clause.
4. In case a health insurance
participant visits a health facility that is not the registered primary care
provider or against regulations on referral prescribed in Article 26 and
Article 27 of this Law, except for the cases specified in Clause 3 and Clause 5
of this Article, he/she will be reimbursed by the health insurance funds at the
rates specified in Clause 1 of this Article. To be specific:
a) 100% reimbursement when
receiving medical care at a secondary health facility or tertiary health
facility in case of definitive diagnosis and treatment of certain rare
diseases, terminal diseases, diseases that require surgery or high technology
prescribed by the Minister of Health;
b) 100% reimbursement for ethnics
and poor household members living in disadvantaged and extremely disadvantaged
areas; people living on commune-level and district-level islands when they
receive inpatient care at tertiary health facilities;
c) 100% reimbursement when using
receiving medical care at primary healthcare facilities;
d) 100% reimbursement when
receiving inpatient care at secondary health facilities;
dd) 100% reimbursement when using
medical services at secondary and tertiary health facilities that have been
classified as district-level health facilities by competent authorities before
January 1st 2025;
e) 50% - 100% reimbursement when
receiving outpatient care at secondary health facilities according to their
professional classification and specific reimbursement rates prescribed by the
Government, except in the cases specified in Point a and Point dd of this
Clause;
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h) 50% reimbursement when receiving
outpatient care following the road map of the Government and 100% reimbursement
when receiving inpatient care at tertiary health facilities that have been
classified as province-level health facilities by competent authorities before
January 1st 2025.
5. Health insurance participants
will be entitled to 100% reimbursement prescribed in Clause 1 of this Article
when receiving emergency care at any health facility.
6. The Government shall specify the
reimbursement rates for the participants prescribed in Points a, b, c, d and dd
Clause 3 Article 12 of this Law; reimbursement rates for health insurance
participants using medical service on demand and other cases not specified in
Clause 1 of this Article.”.
18. Amendments to Clause 7 and
Clause 8 of Article 23:
“7. Treatment of squint and
refractive errors for people aged 18 and older.
8. Use of prostheses including
artificial limbs, eyes, teeth, glasses, hearing aids or movement aids in medical
examination, treatment and function rehabilitation.”.
19. Amendments to Article 24:
“Article 24. Covered facilities
Health insurance-covered facilities
(hereinafter referred to as “covered facilities”) are health facilities that
have signed health insurance-covered medical care contracts with the social
security authority as per regulations of the Government.”.
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a) Amendments to Point e of Clause
2:
“e) Conditions for revision,
finalization, suspension and termination of the contract.”;
b) Amendments to Clause 3 and
Clause 4:
“3. Any agreement on conditions for
revision, finalization, suspension and termination of a contract prescribed in
Point e Clause 2 of this Article must not interrupt the provision of medical
care for the participant.
4. The Government shall elaborate
this Article and provide a model contract for covered medical services.”.
21. Amendments to Article 26:
“Article 26. Registration of
health insurance-covered primary care providers
1. Health insurance participants
may register a primary healthcare facility or secondary health facility as a
health insurance-covered primary care provider, and may change this primary
care provider within the first 15 days of each quarter.
2. The distribution of health
insurance card to health insurance-covered primary care providers must be
balanced, appropriate for the primary care demand of the people, capacity of
the health facilities and the local area.
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4. The Minister of Public Security
and the Minister of National Defense shall elaborate regulations on
registration of primary healthcare facilities, secondary health facility and
tertiary health facilities as health insurance-covered primary care providers,
and health insurance participants under their management.”.
22. Amendments to Article 27:
“Article 27. Patient referral
among covered facilities
1. The patient referral among
health facilities shall be carried out according to the professional
requirements and capacity of the involved health facilities.
2. The Minister of Health shall
promulgate regulations on referral of patients to health insurance-covered
primary care providers for treatment, management and monitoring of chronic
diseases, including the use of medicines, medical devices and medical services
that have been prescribed according to the capacity of the facilities treating,
managing and monitoring chronic diseases; elaborate Clause 1 of this Article,
except the cases specified in Clause 3 of this Article.
3. The Minister of Public Security
and the Minister of National Defense shall promulgate regulations on referral
of patients under their management among covered facilities under their
management.”.
23. Amendments to Article 28:
“Article 28. Procedures for
health insurance-covered medical care
1. When receiving medical care, the
health insurance participant shall present information about the health
insurance card, his/her identification; children under 6 and people who have
donated human organs and have not been issued with health insurance cards shall
present other valid documents. In case of emergency, the patient must present
the information specified in this Clause before the end of the treatment.
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2. In case of follow-up examination
according to professional requirements, health insurance participants shall get
appointments following the procedures established by the Minister of Health.
3. In case of referral according to
professional requirements during inpatient care, the referring facility shall
prepare referral documents in accordance with regulations of the Minister of
Health.”.
24. Amendments to Article 30:
“Article 30. Methods of payment
of costs of health insurance-covered 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 price-based payment;
c) Diagnosis-related group payment.
2. The Government shall elaborate
Clause 1 of this Article and regulations on application of methods of payment
of health insurance-covered medical care costs.”.
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“Article 31. Payment of health
insurance-covered medical care costs
1. Social security authorities
shall pay the costs of health insurance-covered medical care to health
facilities under health insurance-covered medical care contracts.
2. social security authorities
shall pay the costs of health insurance-covered medical care directly to health
insurance card holders when they receive medical care in the following cases:
a) Medical care is provided at a
health facility without a health insurance-covered medical care contract;
b) Medical care is provided against
Article 28 of this Law;
c) Other cases prescribed by the
Government.
3. In case the medicine, medical
device or paraclinical service which is prescribed for the patient and covered
by health insurance is not available at the health facility and cannot be
replaced by any other medicine, medical device or paraclinical service, the
health facility may receive medicine, medical device or paraclinical service
transferred from another covered facility to serve the treatment of the
patient, or refer the patient or send the specimen to another facility capable
of providing the paraclinical service.
The covered facility that receives
the medicine, medical device, refers the patient or sends the specimen shall
prepare a statement of the costs of these medicine, medical device or
paraclinical service and receive payment from the social security authority.
4. The Government shall elaborate
the following regulations:
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b) Management, use of funds for
health insurance-covered medical care, assessment, payment and statement of
health insurance-covered medical care costs incurred by the participants prescribed
in Points a, b, c, d and dd Clause 3 Article 12 of this Law;
c) Payment and statement of health
insurance-covered medical care costs incurred by participants in the people’s
armed forces, the people living in bordering areas, on islands, particularly
disadvantaged villages and communes in order to ensure defense and security.
5. The Government shall elaborate
Point a and Point b Clause 2, Clause 3 of this Article, except the cases
specified in Clause 4 of this Article.”.
26. Amendments to Article 32:
”Article 32. Advance payment,
payment, statement of health insurance-covered medical care costs
1. The advance payment by social
security authorities to covered facilities shall be carried out quarterly as
follows:
a) Within 05 working days from the
receipt of the previous quarter’s statement from the health facility, the
social security authority shall advance a lump sum of 90% of the health
insurance-covered medical care costs in the statement;
b) In case a health facility that
signs the first contract for health insurance-covered medical care, the social
security authority shall, on the basis of the medical costs of the month
preceding the month in which the contract is signed, advance 90% of the costs
for the first month of executing the contract; after one month, the social
security authority shall estimate and advance 90% of the health
insurance-covered medical care costs in the quarter according to Point a of
this Clause;
c) If the total advanced payment to
covered facilities in province are advanced exceeds the quarterly budget, the
social security authority of the province shall send a report to Vietnam Social
Security for provision of extra funds.
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a) Within the first 15 days of
every month, covered facilities shall send a written request for payment of
health insurance-covered medical care costs of the previous month to the social
security authority; within the first 15 days of every quarter, covered
facilities shall submit the statements of health insurance-covered medical care
costs of the previous quarter to the social security authority;
b) Within 30 days from the receipt
of the previous quarter’s statement from each covered facility, the social
security authority shall notify the verification result and the agreed payment
for health insurance-covered medical care, including the covered medical costs.
For the fourth quarter of the year, the time limit for notifying the verification
result and the agreed payment for health insurance-covered medical care shall
be 60 days from the day on which the social security authority receives the
fourth quarter’s statement from the health facility;
c) Within 10 days from the
notification of the verification result, the social security authority must
fully pay the health facility;
d) The annual statement of the
health insurance fund shall be verified before October 01 of the next year.
3. Within 40 days from the receipt
of the satisfactory application for the payment from the health insurance
participant in the cases specified in Clause 2 Article 31 of this Law, the
social security authority shall pay the health insurance-covered medical care
costs directly to the participant.”.
27. Amendments to Article 35:
“Article 35. Allocation and use
of the health insurance fund
1. The health insurance fund shall
be allocated and used as follows:
a) 92% of the health insurance
premiums shall be used to pay for medical care;
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2. Investment of the temporarily
idle money of the health insurance fund shall comply with regulations of the
Law on Social Insurance on the principles, portfolio, methods and management of
investment of the social insurance fund.
3. In case the collected health
insurance premiums are greater than the payment for medical care in the year,
the remainder shall be transferred in full to the reserve fund for general use.
4. In case the collected health
insurance premiums are smaller than the payment for medical care in the year,
Vietnam Social Security shall provide extra funds from the reserve fund.
5. The Government shall elaborate
this Article and regulations on health insurance organization and operation.”.
28. Amendments to Clause 2 of
Article 36:
“2. Select a health
insurance-covered primary care provider according to Article 26 of this Law.”.
29. Amendments to Clause 3 of
Article 39:
“3. Provide the health insurance
card or notify the health insurance card issuance result to the health
insurance participant within 03 working days from the receipt of the card or
the notification from the social security authority.”.
30. Amendments to Clause 2 of
Article 40:
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31. Amendments to Clause 8 of
Article 41:
“8. Inspect the execution of health
insurance-covered medical care contract; carry out health insurance
assessment.”.
32. Addition of Clause 9 after Clause
8 of Article 43:
“9. Maintain the fulfillment of
conditions for health insurance-covered medical care in accordance with
regulations of law on health insurance, medical care, and health
insurance-covered medical care contracts.”.
33. Addition of Article 48a and
Article 48b after Article 48:
“Article 48a. Late payment
of health insurance premiums
Late payment of health insurance
premiums is the act of the employer in one of the following cases:
1. Failure to pay or fully pay the
health insurance premiums payable after the deadline for payment of health
insurance premiums specified in Clause 8 Article 15 of this Law, except the
cases specified in Point c Clause 1 Article 48b of this Law;
2. Failure to compile a list or a
full list of health insurance participants within 60 days from the deadline
specified in Point b Clause 1 Article 17 of this Law;
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Article 48b. Evasion of health
insurance payment
1. Evasion of health insurance
payment is the act of the employer in one of the following cases:
a) Failure to compile a list or a
full list of health insurance participants after 60 days from the deadline
specified in Point b Clause 1 Article 17 of this Law;
b) Registering a lower salary as
the basis for health insurance payment than that specified in Article 14 of
this Law;
c) Failure to pay or fully pay the
registered health insurance premiums after the 60 days from the deadline for
health insurance payment specified in Clause 8 Article 15 of this Law despite
being reminded by the competent authority according to regulations of the
Government;
d) Other cases in which it is
considered evasion of health insurance payment according to regulations of the
Government.
2. The Government shall elaborate
this Article and specifies the cases mentioned in Clause 1 of this Article that
are not considered evasion of health insurance payment for justifiable
reasons.”.
34. Amendments to Article 49:
“Article 49. Actions against
violations of health insurance laws
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2. Actions against late payment of
health insurance premiums:
a) Enforced payment of the arrears
plus an interest of 0,03%/day on the arrears multiplied by (x) the number of
days of late payment to the health insurance fund;
b) Administrative penalties as
prescribed by law;
c) Disqualification from
commendation and awards.
3. Actions against evasion of
health insurance payment:
a) Enforced payment of the arrears
plus an interest of 0,03%/day on the arrears multiplied by (x) the number of
days of late payment to the health insurance fund;
b) Administrative penalties or
criminal prosecution as prescribed by law;
c) Disqualification from commendation
and awards.
4. Agencies, organizations,
employers that commit evasion or late payment of health insurance for employees
shall return all the covered medical costs to the employees which accrue over
the time health insurance cards are not issued due to such evasion or late
payment.
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35. Replacement of certain phrases:
a) The phrase “health insurance
organization” is replaced with “social security authority” in Clause 3 and
Clause 6 Article 2, Clause 2 and Clause 4 Article 7c, Clause 3 Article 18,
Clause 3 Article 19, Clause 1 Article 25, Clause 3 Article 29, Clause 1 Article
34, Clause 4 and Clause 5 Article 36, Clause 4 Article 37, Clause 1 Article 38,
Clause 4 Article 39, the title of Article and Clause 5 Article 40, the title of
Article 41, Clause 1 and Clause 2 Article 42, Clauses 2, 3 and 4 Article 43,
Clause 1 Article 44, Point c Clause 1 Article 48;
b) The phrase “Vietnam Social
Security Management Council” is replaced with “Social Insurance Management
council” in Clause 1 Article 34.
Article 2.
Amendments to the Law on Internal Security Forces No. 30/2023/QH15
Clause 2 Article 32 of the Law on
Internal Security Forces No. 30/2023/QH15 is annulled.
Article 3.
Implementation clauses
1. This Law comes into force from
July 1st 2025, except regulations of Clause 2 and Clause 3 of this
Article.
2. Regulations on healthcare
levels, registration of health insurance-covered primary care providers,
patient referral among covered facilities, procedures for health
insurance-covered medical care in Clauses 3, 16, 17, 21, 22, 23 and 28 Article
1 of this Law comes into force from January 1st 2025.
3. Regulations on health insurance
coverage in Clause 16 Article 1 of this Law, except regulations on
telemedicine, telemedicine assistance, family medicine services, at-home
medical care, rules for compilation of covered medical devices and medical
services and health insurance reimbursement rates in Clause 17 Article 1 applied
to the following participants shall come into force from January 1st
2025:
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b) The participants prescribed in
Point a of this Clause when they receive medical care at health facilities
before January 1st 2025 and end their treatment from January 1st
2025.
4. Paraclinical results shall be
synchronized among covered facilities by January 1st 2027 in
accordance with regulations of the Government.
5. Transition clauses:
a) Participants that are not
prescribed in Point a and Point b Clause 3 of this Article, receive medical
care at health facilities before July 1st 2025 and end their
treatment from July 1st 2025 shall apply the regulations of this
Law;
b) The reference level prescribed
in this Law shall be the statutory pay rate. In case salary policies are
changed, the Government shall prescribe a specific reference level;
c) Health insurance-covered medical
care contracts that are signed before July 1st 2025 and enter into
force after July 1st 2025 shall be executed in accordance with
regulations of the Government;
d) Health insurance premiums that
are payable the employers according to the Law on Health insurance No.
25/2008/QH12, which is amended by 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 but are not paid or fully paid by the end of June 30th
2025 shall be handled in accordance with regulations on late payment of this
Law.
This Law was passed by the 15th
National Assembly of the Socialist Republic of Vietnam during the 8th
session on November 27th 2024.
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PRESIDENT
OF THE NATIONAL ASSEMBLY
Tran Thanh Man