Guidelines for implementing Circular 01/2025/TT-BYT on medical examination and treatment under health insurance in Vietnam

Guidelines for implementing Circular 01/2025/TT-BYT on medical examination and treatment under health insurance in Vietnam​ (Image from the internet)

On January 14, 2025, the Ministry of Health of Vietnam issued Official Dispatch 252/BYT-BH regarding the implementation of Circular 01/2025/TT-BYT.

Guidelines for implementing Circular 01/2025/TT-BYT on medical examination and treatment under health insurance in Vietnam​

The Ministry of Health of Vietnam has issued Circular 01/2025/TT-BYT detailing and guiding the implementation of certain provisions of the Law on Health Insurance effective from January 1, 2025. In response to feedback from some medical examination and treatment facilities and participants of  about the implementation of procedures for medical examination and treatment under health insurance and referrals under the Circular, the Ministry of Health requests agencies and units to strictly adhere to the provisions of the Circular as follows:

- Point d, Clause 5, Article 15 of Circular 01/2025/TT-BYT stipulates as follows:

“Appointment slips for follow-up examinations and referral slips for health insurance medical examination and treatment as prescribed in Decree No. 146/2018/ND-CP amended and supplemented by Decree No. 75/2023/ND-CP continue to be used until Vietnam Social Security and medical examination and treatment facilities complete the update and submission of health insurance medical examination and treatment cost data according to the new forms stipulated in this Circular but no later than December 31, 2025.”

Thus, during the software update and completion process, both forms of the referral slip as regulated by Circular 01/2025/TT-BYT and the health insurance medical examination referral slip pursuant to Decree 75/2023/ND-CP dated October 19, 2023, of the Government of Vietnam, are concurrently used and have equal validity as the basis for medical examination and treatment under health insurance, payment of medical examination and treatment under health insurance costs, and do not require patients to return to the referring medical examination and treatment facility to obtain the new referral slip form.

Simultaneously, the medical examination and treatment facilities are urged to promptly update and complete the management software for medical examination and treatment under health insurance operations in order to issue appointment slips for follow-up examinations and referral slips for medical examination and treatment under health insurance, update, and submit payment data for medical examination and treatment under health insurance costs using the new forms.

- Point c, Clause 5, Article 15 of Circular 01/2025/TT-BYT stipulates as follows:

“Follow-up examination appointment slips and referral slips issued before this Circular takes effect are used until their effective period ends as regulated by this Circular. If the referral slip within the calendar year expires on or after January 1, 2025, while the patient is still receiving treatment at the medical examination and treatment facility, the referral slip remains valid until the end of the treatment period;”

Thus, for referral slips concerning specific diseases and disease groups listed in Appendix 01 issued with Circular 40/2015/TT-BYT regarding initial registration and referral of health insurance medical examination and treatment, such slips remain valid for one year from the signing date as per Point c, Clause 5, Article 15 of Circular 01/2025/TT-BYT, or until the end of the treatment period if the referral slip’s calendar year validity expires starting January 1, 2025.

- The supervisory entity's name on the follow-up examination appointment slip and medical examination and treatment under health insurance referral slip should match the supervisory entity of the medical examination and treatment facility. For instance: a medical examination and treatment facility under the Department of Health should list the Department of Health as the supervising entity; a medical examination and treatment facility under the management of a district People's Committee should list the district-level People's Committee as the supervising entity; a private hospital under Company A should list Company A as the supervising entity.

- For follow-up examination appointment slips and referral slips issued before the effective date of Circular 01/2025/TT-BYT and continued use, recalculating the disease code and re-establishing the referral validity period for one year in the previously issued slip is not mandatory. The medical examination and treatment under health insurance receiving facility bases its actions on the disease name in the patient’s referral slip to determine the correct disease code and benefits according to Circular 40/2015/TT-BYT.

- From January 1, 2025, any new issuance of medical examination and treatment under health insurance referral slips must follow the disease names and codes issued in Appendix III of Circular 01/2025/TT-BYT to ensure the patient's rights and the conformity of current regulations for medical examination and treatment control, and cost payment under BHYT.

- The Ministry of Health requests:

+ Vietnam Social Security to direct the social insurance agencies in provinces and centrally-governed cities to evaluate, pay, and settle health insurance medical examination and treatment costs in accordance with Circular 01/2025/TT-BYT, including the payment of medical examination and treatment under health insurance costs according to both the new and old form slips during the transition period.

+ Departments of Health to disseminate, direct, guide, monitor, and supervise the medical examination and treatment facilities within their jurisdiction to comply with the provisions of Circular 01/2025/TT-BYT.

+ Agencies and units to earnestly implement the provisions of Circular 01/2025/TT-BYT and the above-mentioned content to ensure the rights of Health Insurance participants and comply with current regulations.

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