From July 1, 2025, what expenses are covered by the health insurance fund when participating in health insurance in Vietnam?

From July 1, 2025, what expenses are covered by the health insurance fund when participating in health insurance in Vietnam?

According to the provisions in Clause 1, Article 21 of the Health Insurance Law 2008 (amended and supplemented by Clause 16, Article 1 of the Amended Health Insurance Law 2024), participants in health insurance programs will have the following costs covered by the Health Insurance Fund in Vietnam:

(1) Medical examination and treatment, including telemedicine care, remote medical support, family medicine healthcare, home healthcare, rehabilitation, regular prenatal check-ups, and childbirth.

(2) Patient transportation costs for the following groups in cases of inpatient treatment or emergency transfers needing a healthcare facility change:

- Active-duty People's Army officers, professional soldiers; officers, non-commissioned officers in professional work or technical expertise working in the People's Police force; individuals working in cipher positions entitled to salaries similar to military personnel.

- Active-duty People's Army non-commissioned officers, soldiers; conscription non-commissioned officers, soldiers in the People's Police; military academy cadets, police officers, cipher trainees receiving stipends as Vietnamese nationals.

- Military, police, and cipher trainees receiving allowances as foreign foreign nationals.

- Officer reserve trainees undergoing training for 03 months or more, having not yet participated in social insurance, health insurance.

- Permanent militia members.

- Individuals recognized for their services to the revolution under the ordinance on preferential treatment for people with meritorious services to the revolution; war veterans.

- Children under 6 years old.

- Relatives of martyrs or those fostering martyrs as per the ordinance on preferential treatment for people with meritorious services to the revolution.

- Individuals from impoverished households; ethnic minorities from near-poverty households residing in ethnic minority, mountainous areas; ethnic minorities residing in economically challenging areas; individuals residing in extremely difficult economic-social areas; individuals living on island communes or districts.

- Individuals receiving monthly social welfare benefits; individuals receiving monthly foster care allowances as stipulated by relevant laws; individuals receiving monthly survivorship benefits that qualify for social welfare allowances.

(3) Expenses for using medical technical services, medications, medical equipment, blood, blood products, medical gases, materials, tools, instruments, chemicals used in medical examination and treatment within the coverage scope of the Health Insurance Fund.

What are the procedures for medical examination and treatment when changing residence or temporary residence in Vietnam in 2025?

According to the provisions of Clause 2, Article 4 of Circular 01/2025/TT-BYT, the procedures for health insurance medical examination and treatment when changing residence or temporary residence in Vietnam are as follows:

Article 4. Residence cases, procedures for health insurance medical examination and treatment as regulated in Clause 3, Article 22 of the Health Insurance Law

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2. The procedures for health insurance medical examination and treatment when changing residence or temporary residence are as follows:

a) Health insurance participants in cases of residence change as stipulated in Clause 1 of this Article and in cases of temporary residence change shall follow the procedures as prescribed in Article 28 of the Health Insurance Law and Article 15 of Decree 146/2018/ND-CP dated October 17, 2018, by the Government of Vietnam detailing and guiding the implementation measures of several provisions of the Health Insurance Law;

b) In cases of residence change as stipulated in Clause 1, participants in health insurance must also follow the procedures as prescribed in Clause 3 of this Article;

c) In case of temporary residence change, health insurance participants must also follow procedures as prescribed in Clause 4 of this Article.

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Accordingly, from 2025, the procedures for health insurance medical examination and treatment when changing residence or temporary residence will be implemented as follows:

(1) Health insurance participants who fall under the circumstances of residence change stipulated in Clause 1, Article 4 of Circular 01/2025/TT-BYT and Article 28 Health Insurance Law 2008 and Article 15 Decree 146/2018/ND-CP.

(2) In the case of a residence change stipulated in Clause 1, Article 4 of Circular 01/2025/TT-BYT, health insurance participants must also follow the procedures stipulated in Clause 3, Article 4 of Circular 01/2025/TT-BYT as follows:

- Official documentation of assignments for business trips and residency information updated on a level 2 electronic identification account on the VNeID application for the case stipulated in Point a, Clause 1, Article 4 of Circular 01/2025/TT-BYT.

- Student card, trainee card, and residency information updated on a level 2 electronic identification account on the VNeID application for the case stipulated in Point b, Clause 1, Article 4 of Circular 01/2025/TT-BYT.

- Document regarding leave of absence confirmed by the managing agency or unit of the health insurance participant and residency information updated on a level 2 electronic identification account on the VNeID application for the case stipulated in Point c, Clause 1, Article 4 of Circular 01/2025/TT-BYT.

- Assignment or work assignment documentation for mobile work by the managing agency or unit of the health insurance participant and residency information updated on a level 2 electronic identification account on the VNeID application for the case stipulated in Point d, Clause 1, Article 4 of Circular 01/2025/TT-BYT.

- Documentation demonstrating family member relationships in accordance with laws on marriage and family and residency information updated on a level 2 electronic identification account on the VNeID application for cases stipulated in Point đ, Clause 1, Article 4 of Circular 01/2025/TT-BYT.

(3) In the case of a temporary residence change, health insurance participants must present to the health insurance medical facility one of the documents proving information on temporary residence change, including a receipt of temporary residence registration application or notice from the competent authority for the registrant of temporary residence about updated temporary residence registration information or registration information on temporary residence updated on a level 2 electronic identification account on the VNeID application.

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