Joint Circular No. 22/2005/TTLT-BYT-BTC guides the implementation of voluntary health insurance.

 CIRCULAR

Joint Circular No. 22/2005/TTLT-BYT-BTC dated August 24, 2005 of the Ministry of Health and the Ministry of Finance guiding the implementation of voluntary health insurance

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- Based on the Health Insurance Regulation issued together with Government Decree No. 63/2005/NĐ-CP dated May 16, 2005.

- The Ministry of Health and the Ministry of Finance guide the implementation of voluntary health insurance according to inpatient and outpatient treatment models as follows:

I. SCOPE, OBJECTS AND CONDITIONS FOR IMPLEMENTING VOLUNTARY HEALTH INSURANCE

Thông tư này quy định chi tiết khoản 4 Điều 38 Luật Thủy sản số 18/2017/QH14 đã được sửa đổi, bổ sung tại điểm c khoản 21 Điều 14 Luật số 146/2025/QH15.

a. This circular guides the implementation of Voluntary Health Insurance (VHI) according to inpatient and outpatient treatment models.

b. VHI applies to all Vietnamese citizens (except those already holding mandatory health insurance cards and children under six years old) in accordance with the objectives and principles stipulated in the Health Insurance Regulation issued together with Government Decree No. 63/2005/NĐ-CP dated May 16, 2005.

Thông tư này áp dụng đối với tổ chức, cá nhân có liên quan đến hoạt động kinh doanh đối tượng thủy sản nuôi chủ lực trên lãnh thổ Việt Nam.

a. Members of a household;

b. Students enrolled at educational institutions within the national education system;

c. Members of associations, organizations, trade unions, religious groups, etc. (hereinafter referred to collectively as associations);

d. Relatives of civil servants, public officials, employees, etc. (hereinafter referred to collectively as relatives of employees) who participate in mandatory health insurance; relatives of association members participating in voluntary health insurance.

Relatives of employees and association members include: biological father, mother; father, mother-in-law or legal guardian of the individual, spouse; spouse; biological child, legally adopted child as prescribed by law; brother, sister, or sibling of the individual, spouse.

3. Conditions for Implementation

a. For household members: Implementation shall be carried out at the commune, ward, town level (hereinafter referred to collectively as commune) when the following conditions are met:

- All members listed in the household registration book and residing in the same province or centrally-administered city have registered to participate in voluntary health insurance (excluding those already holding mandatory health insurance cards, voluntary health insurance cards under other categories defined in this circular, and children under six years old); in cases where individuals are not listed in the household registration book but have temporary residence registration and live together in the same household, they may join the household's voluntary health insurance program if desired.

- At least 10% of households within the commune's jurisdiction have registered to participate in voluntary health insurance.

b. For students: Implementation shall be carried out at the school level provided that at least 10% of students on the school's student list have registered to participate in voluntary health insurance (excluding students already holding mandatory health insurance cards, voluntary health insurance cards under other categories defined in this circular).

c. For association members: Implementation shall be carried out at the association level provided that at least 30% of the total number of association members have registered to participate (excluding those already holding mandatory health insurance cards, voluntary health insurance cards under other categories defined in this circular).

d. For relatives of employees and association members: Implementation shall be carried out at the workplace or association where the employee or member is employed or active; the condition being that the employee or association member purchases health insurance cards for 100% of their relatives living in the same province or centrally-administered city (excluding those already holding mandatory health insurance cards, voluntary health insurance cards under other categories defined in this circular, and children under six years old).

II. FRAMEWORK OF CONTRIBUTION AMOUNTS AND METHODS OF PAYMENT FOR VOLUNTARY HEALTH INSURANCE

1. Framework of Contribution Amounts

a. The framework of contribution amounts for voluntary health insurance is specified according to region and group; specifically as follows:

Unit of calculation: VND/person/year

- Urban areas include wards of cities and towns under provinces; rural areas include the remaining regions.

- The above framework of contribution amounts shall apply from January 1, 2006. Prior to January 1, 2006, the framework of contribution amounts prescribed in Joint Circular No. 77/2003/TTLT-BTC-BYT dated August 7, 2003 of the Ministry of Finance and the Ministry of Health guiding the implementation of voluntary health insurance shall apply.

b. Based on the framework of contribution amounts for voluntary health insurance stipulated in this circular, the Social Insurance Corporation of Vietnam shall determine specific contribution amounts for each group and region upon the proposal of the Social Insurance Corporation of the province or centrally-administered city, taking into account economic and social conditions, service prices, and the utilization of services in each locality.

c. Determining the contribution amount for voluntary health insurance based on urban or rural areas depends on the initial healthcare facility registration location; individuals residing in rural areas but registering for initial healthcare services at facilities in urban areas shall pay contributions based on urban rates, and vice versa.

d. In cases where students enrolled at schools do not participate in health insurance through their school but instead through their household or as relatives, they shall be subject to the contribution rate for students.

e. When the contribution amount for voluntary health insurance reaches the maximum level set by the joint ministries and the Health Insurance Fund for voluntary health insurance has less income than expenditure, the Social Insurance Corporation of Vietnam shall report to the joint ministries to adjust the contribution framework for voluntary health insurance accordingly.

2. Methods of Payment for Voluntary Health Insurance Contributions

a. Collection and payment of voluntary health insurance contributions shall be conducted as follows:

- Household members, association members, relatives of employees and association members: Registration and payment of health insurance contributions shall be made at least once every six months.

- Students enrolled at educational institutions within the national education system: Registration and payment of health insurance contributions shall be made per class or school, either once or twice per academic year or for the entire duration of study.

b. The Social Insurance Corporation shall organize systems for collecting payments and issuing voluntary health insurance cards suitable for different groups, ensuring convenience, security, and compliance with the law.

3. The People's Committees of provinces and centrally governed cities shall balance within their local budgets and mobilize contributions from agencies, organizations, and individuals to support voluntary health insurance contributions for local residents, particularly those near the poverty line, with the aim of promoting voluntary health insurance participation among the populace. The provincial People's Committee shall submit to the Provincial People's Council for decision on the target groups and levels of support that are commensurate with the budget balancing capacity of the locality.

4. Encourage agencies, units, and organizations to utilize legitimate welfare funds to support health insurance premiums for dependents of employees and members of associations or mass organizations under their own units.

III. SCOPE OF RIGHTS AND BENEFITS FOR HOLDERS OF VOLUNTARY HEALTH INSURANCE CARDS

1. Rights and benefits of holders of voluntary health insurance cards

a. Individuals participating in voluntary health insurance are issued a voluntary health insurance card for medical treatment and enjoy benefits as stipulated in this Circular.

- The voluntary health insurance card becomes valid for use thirty days after payment of health insurance premiums in the case of initial enrollment or re-enrollment following a period of interruption due to any reason.

- The voluntary health insurance card becomes valid for use immediately upon payment of health insurance premiums in the case of continuous enrollment.

b. Holders of valid voluntary health insurance cards are entitled to outpatient and inpatient care at public and private healthcare facilities that have contracts with the Social Insurance Agency for providing services to insured persons (hereinafter referred to as healthcare facilities providing health insurance services) and are entitled to the following benefits:

- Diagnosis, treatment, and rehabilitation functions (as specified in the list issued by the Ministry of Health) during the treatment period at healthcare facilities;

- Laboratory tests, imaging diagnostics, functional examinations;

- Medications and intravenous fluids listed according to regulations of the Ministry of Health;

- Blood and blood products;

- Surgical procedures and interventions;

- Prenatal care and childbirth;

- Medical supplies, equipment, and hospital beds.

c. Holders of voluntary health insurance cards when receiving medical treatment at the initially registered healthcare facility and at other referral healthcare facilities in accordance with the technical level regulations of the Ministry of Health or in emergency situations at healthcare facilities providing health insurance services, shall have their costs covered by the Social Insurance Agency at the current state hospital fee rates; however, in cases of high-cost advanced medical services, the costs will be reimbursed according to the provisions set forth in point (d) below.

d. Patients holding voluntary health insurance cards when using high-cost advanced medical services (as listed by the Ministry of Health after coordination with the Ministry of Finance) shall have their costs reimbursed according to the following provisions:

- For high-cost advanced medical services with fees below seven million dong (VND 7,000,000) shall be fully reimbursed for the cost of one service usage.

- For high-cost advanced medical services with fees of seven million dong (VND 7,000,000) or more shall be reimbursed sixty percent of the cost but not exceeding twenty million dong (VND 20,000,000) for one service usage, with the remainder to be paid directly by the patient to the healthcare facility. If sixty percent of the cost is less than seven million dong (VND 7,000,000), the Social Insurance Agency shall reimburse seven million dong (VND 7,000,000).

đ. Holders of voluntary health insurance cards when receiving medical treatment based on personal requests and at initially registered healthcare facilities which are non-public healthcare facilities providing health insurance services, shall have their costs covered by the Social Insurance Agency according to the guidelines set forth in Clause 5, Clause 6 Section I Part II of Circular No. 21/2005/TTLT-BYT-BTC dated July 27, 2005, jointly issued by the Ministry of Health and the Ministry of Finance regarding mandatory health insurance implementation.

e. For students and pupils: In addition to the medical treatment benefits stipulated in points (b), (c), (d), and (đ) above, they also enjoy primary healthcare services at school clinics and a compensation of one million dong (VND 1,000,000) in the event of death due to any illness or accident. Primary healthcare services at school clinics are implemented according to current regulations of the Ministry of Health and the Ministry of Education and Training.

2. Cases Not Entitled to Health Insurance Benefits

a. Treatment for leprosy;

b. Specific drugs for treating tuberculosis, malaria, schizophrenia, epilepsy, and other diseases if already covered by the state budget through national health programs, projects, or other funding sources;

c. Diagnosis and treatment of HIV/AIDS (except for HIV tests required by professional instructions and specific groups defined in Decision No. 265/2003/QĐ-TTg dated December 16, 2003 of the Prime Minister concerning the treatment of individuals exposed to HIV, infected with HIV/AIDS due to occupational accidents); gonorrhea, syphilis;

d. Vaccination, convalescence, early pregnancy testing, health check-ups including regular health check-ups, employment physicals, school admissions, military conscription physicals; family planning services and infertility treatments;

đ. Cosmetic surgery and aesthetic reconstruction, prosthetic limbs, eyes, teeth, glasses, hearing aids;

e. Treatment of occupational diseases, war injuries, or accidental injuries;

g. Treatment of self-inflicted injuries, intentional bodily harm, drug addiction, or actions violating the law;

h. Costs associated with medical examinations, forensic medicine, and forensic psychiatric evaluations;

i. Outpatient and inpatient care, rehabilitation, and childbirth at home;

k. Use of medications outside the prescribed list, medications requested by patients; unapproved medical methods by the Ministry of Health; participation in research and clinical trials.

IV. MANAGEMENT AND USE OF THE VOLUNTARY HEALTH INSURANCE FUND

1. The voluntary health insurance fund is formed from the following sources:

a. Voluntary health insurance premiums paid by participants;

b. State budget, agency funds, sponsorships, and donations from organizations and individuals to pay voluntary health insurance premiums;

c. Income generated from implementing measures to preserve and grow the voluntary health insurance fund;

d. Sponsorship and donations from domestic and foreign organizations and individuals;

đ. Other lawful revenues (if any).

2. The voluntary health insurance fund shall be managed centrally, uniformly, democratically, and transparently according to the current financial management regulations for the Vietnam Social Insurance.

Any temporarily unused funds (if any) of the Voluntary Health Insurance Fund shall be mobilized to implement measures for the conservation and growth of the Fund in accordance with the provisions.

3. Management of the Voluntary Health Insurance Fund

a. The amount of voluntary health insurance revenue (as stipulated in points (a) and (b) Clause 1 Section IV above) in the planning year shall be allocated and utilized as follows:

- 87% to establish the Voluntary Health Insurance Outpatient Treatment Fund;

- 2% to establish the Voluntary Health Insurance Outpatient Treatment Reserve Fund;

- 8% reserved for expenses related to agents performing fee collection, issuance of voluntary health insurance cards;

- 3% reserved for training agents and supplementing promotional, mobilization, and reward activities.

b. The amount of revenue specified in points (c), (d), and (đ) Clause 1 Section IV above (if any) shall be recorded in the Voluntary Health Insurance Outpatient Treatment Reserve Fund.

4. The Voluntary Health Insurance Outpatient Treatment Fund shall be used to pay for outpatient treatment costs, inpatient treatment costs, individual demand treatment costs, initial healthcare costs at schools, and death benefit payments for students and trainees in accordance with this Circular.

5. Fund regulation

a. The Vietnam Social Security has the responsibility to allocate and regulate the collected revenue for use in the year for provincial social security agencies under the central government, ensuring payment of voluntary health insurance outpatient treatment costs.

b. The annual Voluntary Health Insurance Outpatient Treatment Fund that is not fully spent shall be transferred to the Voluntary Health Insurance Outpatient Treatment Reserve Fund.

c. If the voluntary health insurance outpatient treatment expenditure exceeds the outpatient treatment fund available for use in the year, the Vietnam Social Security may use the voluntary health insurance outpatient treatment reserve fund, the compulsory health insurance outpatient treatment reserve fund, or other sources of support as prescribed to ensure full and timely payment of benefits to eligible recipients.

6. The Voluntary Health Insurance Fund shall be recorded, statistically reported, and accounted for according to the current financial management regulations of the Vietnam Social Security.

V. ORGANIZATION OF HEALTH EXAMINATION AND TREATMENT AND PAYMENT OF HEALTH INSURANCE EXPENSES FOR VOLUNTARY HEALTH INSURANCE

1. Organization of health examination and treatment

The organization of voluntary health insurance treatment shall be carried out in accordance with the provisions of Section 1 Part IV of Joint Circular No. 21/2005/TTLT-BYT-BTC dated July 27, 2005, issued by the Ministry of Health and the Ministry of Finance. Additionally, for student beneficiaries, the social security agency is responsible for guiding and coordinating with schools and local healthcare facilities to implement treatment procedures and methods of paying treatment costs for students and trainees holding health insurance cards during periods of authorized absence from school, ensuring full rights and convenience for the beneficiaries.

2. Forms of payment for health insurance examination and treatment expenses

2.1. Payment between the social security agency and healthcare facilities

a. Principles:

- The social security agency pays healthcare costs to healthcare facilities based on health insurance treatment contracts for cases of correct-line medical technical treatment or emergency situations.

- Healthcare facilities choose either service fee payment or fixed-rate payment according to the guidance provided in Clause 1 Section II Part IV of Circular No. 21/2005/TTLT-BYT-BTC dated July 27, 2005, issued by the Ministry of Health and the Ministry of Finance regarding mandatory health insurance implementation.

- The social security agency and healthcare facilities only execute one health insurance treatment contract and agree on a unified method of payment for all compulsory and voluntary health insurance participants.

b. Method of determining the voluntary health insurance outpatient treatment fund for treatment contracts:

- For household members, association members, trade union members, dependents of workers, and dependents of association and trade union members: The voluntary health insurance outpatient treatment fund is calculated based on the number of registered treatment cards at the healthcare facility and the average fee of voluntary health insurance participants in the respective groups at the local level.

- For students and trainees: The voluntary health insurance outpatient treatment fund is calculated based on the number of registered cards and the average fee of voluntary health insurance student and trainee participants at the local level. Twenty percent of the voluntary health insurance outpatient treatment fund for students and trainees is reserved for initial school health care services as stipulated in point 2.2 below; eighty percent of the remaining voluntary health insurance outpatient treatment fund serves as the basis for signing contracts with healthcare facilities and providing death benefits.

2.2. Payment between the social security agency and schools implementing primary health care for students and trainees: The budget for primary health care is twenty percent of the voluntary health insurance outpatient treatment fund calculated based on the voluntary health insurance revenue of students and trainees at the school. This budget is transferred to the school to provide primary health care and support the implementation of certain health education activities for students and trainees according to the guidelines of the Ministry of Health and the Ministry of Education and Training on school health work. The school is responsible for managing and using this budget according to the guidance of the social security agency and will be settled periodically at the end of the fiscal year.

2.3. Direct payment between the social security agency and patients holding health insurance cards: Implemented according to the guidance provided in Clause 2 Section II Part IV of Circular No. 21/2005/TTLT-BYT-BTC dated July 27, 2005, issued by the Ministry of Health and the Ministry of Finance regarding mandatory health insurance implementation. In the case of student or trainee death, the social security agency will pay death benefits to the relatives of the deceased student or trainee.

VI. RIGHTS AND RESPONSIBILITIES OF THE SOCIAL SECURITY AGENCY AND HEALTHCARE FACILITIES

1. Rights and responsibilities of the social security agency and healthcare facilities in implementing voluntary health insurance:

The social security agency and healthcare facilities have the responsibility to fulfill their obligations and rights as prescribed in the Health Insurance Charter and the guidance provided in Part V of Circular No. 21/2005/TTLT-BYT-BTC dated July 27, 2005, issued by the Ministry of Health and the Ministry of Finance regarding mandatory health insurance implementation.

2. In addition, within its scope of responsibility, the social security agency shall perform the following tasks:

a. Implement information dissemination, promotional, and training activities for agents to expand the target group of voluntary health insurance participants.

b. Develop inter-departmental cooperation plans to implement voluntary health insurance for various beneficiary groups.

c. Allocate resources from operational funds to strengthen activities aimed at developing and expanding voluntary health insurance.

VII. IMPLEMENTATION PROVISIONS

1. This Circular shall take effect fifteen days from the date of publication in the Official Gazette. The Joint Circular No. 77/2003/TTLT-BTC-BYT dated August 7, 2003 of the Ministry of Finance and the Ministry of Health guiding the implementation of voluntary health insurance is hereby repealed; however, Clause 1, Section III of Joint Circular No. 77/2003/TTLT-BTC-BYT shall remain in force until December 31, 2005.

2. In cases where individuals voluntarily join health insurance before this Circular takes effect and their health insurance cards are still valid for use, they shall enjoy health insurance benefits as prescribed in this Circular (from the date the Circular takes effect) until the expiration date indicated on the card.

During the process of implementation, if there are difficulties or obstacles, units are requested to report them to the joint ministries for consideration and resolution.