Vietnam: Summary of levels of health insurance benefits (latest)

19:44, 09/07/2024

To support our Customers and Members in understanding the levels of health insurance benefits when undergoing medical examinations and treatments in each case, LawNet respectfully presents to Customers and Members the latest summary of health insurance benefit levels in the table below.

According to Regulation in Article 22 of the Health Insurance Law 2008, Clause 15, Article 1 of the Amended Health Insurance Law 2014, participants in health insurance when going for medical examination and treatment on registering for health insurance medical examination and treatment, or upon referral for treatment will have medical examination and treatment costs covered by the health insurance fund within the benefit range as follows:

Cases of correct medical treatment route	Benefit level
- Officers, professional soldiers, non-commissioned officers, active-duty military soldiers; officers, non-commissioned officers in service and officers, non-commissioned officers in specialized technical work in the People’s Public Security forces, public security students, non-commissioned officers, fixed-term service soldiers in the People’s Public Security; individuals engaged in cipher work receiving wages similar to military personnel; cipher students enjoying policies similar to students in military and public security schools; - People with meritorious service to the revolution, war veterans; - Children under 6 years old; - Individuals entitled to monthly social protection subsidies; - People from poor households; ethnic minorities residing in economically difficult areas; people living in extremely difficult economic areas; individuals residing in island communes, island districts; - Relatives of people with meritorious service to the revolution are parents, spouses, children of martyrs; people nurturing martyrs.	100% of medical examination and treatment costs
Costs for one medical examination, treatment lower than the level stipulated by the Government of Vietnam and examination, treatment at the commune level	100% of medical examination and treatment costs
Patients participating in health insurance for 5 consecutive years or more and having a co-payment amount exceeding 6 months’ statutory pay rate (8,940,000 VND)	100% of medical examination and treatment costs
- Recipients of monthly retirement pensions, loss of labor capacity subsidies; - Relatives of people with meritorious service to the revolution (excluding particularly classified relatives such as parents, spouses, children of martyrs, and people nurturing martyrs); - Individuals from near-poor households.	95% of medical examination and treatment costs
Other beneficiaries	80% of medical examination and treatment costs
Cases of incorrect medical treatment route
At central hospital level	40% of inpatient treatment costs
At provincial hospital level nationwide	- Until December 31, 2020: 60% of inpatient treatment costs; - From January 1, 2021: 100% of inpatient treatment costs.
At district hospital level	100% of medical examination and treatment costs
Ethnic minorities and individuals from poor households participating in health insurance residing in economically difficult areas, extremely difficult economic areas; individuals participating in health insurance living in island communes, island districts traveling independently for incorrect medical treatment will have their medical examination and treatment costs covered by the health insurance fund for district hospitals, inpatient treatment at provincial and central hospitals	Benefit level as in the case of a correct medical treatment route
Cases not covered by Health Insurance	0%
Patients participating in health insurance for 5 consecutive years or more and having a co-payment amount exceeding 6 months’ statutory pay rate (8,940,000 VND) when seeking incorrect medical examination and treatment.
Costs already covered by the state: - Medical examination, treatment, rehabilitation, periodic pregnancy exams, childbirth; - Transporting patients from district to higher levels in cases of emergency or during inpatient treatment needing a specialized referral.
Recuperation at convalescent facilities.
Health check-ups.
Tests, prenatal diagnoses not for treatment purposes.
Use of reproductive support techniques, family planning services, abortion services except in cases requiring termination due to pathological reasons of the fetus or mother.
Cosmetic services.
Treatment for squints, nearsightedness, and refractive errors of the eye, except for children under 6 years old.
Use of replacement medical supplies, including prosthetic limbs, prosthetic eyes, false teeth, eyeglasses, hearing aids, mobility aids during medical examination, treatment, and rehabilitation.
Medical examination, treatment, rehabilitation in disaster cases.
Medical examination, treatment for drug addiction, alcohol addiction, or other addictive substances.
Forensic, psychiatric forensic examination.
Participation in clinical trials, scientific research.

Some notes:

- If an individual belongs to multiple health insurance categories, they will receive health insurance benefits according to the category with the highest benefits.

- Participants registering for initial medical examination and treatment at the commune health station level or the general clinic or district hospital level are entitled to health insurance medical examination and treatment at the commune health station level, the general clinic, or the district hospital within the same province with equal benefit levels per the regulation.

Hai Thanh

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- The legal regulations in this article are according to Vietnamese Law;
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