Joint Circular No. 22/2005/TTLT/BYT-BTC guides the implementation of voluntary health insurance (VHI) for Vietnamese citizens not falling under mandatory health insurance (MHI), applicable to groups such as household members, students, trainees, association members, and dependents of workers. It specifies contribution levels, benefits, fund management, and organization of medical examinations and treatments.
Scope of application
Vietnamese citizens not falling under mandatory health insurance (excluding children under six years old) include: household members, students, trainees, association members, dependents of workers, and dependents of association members and organizations.
Key points
- Household members → contribute VHI fees from 100,000 to 160,000 VND/person/year (urban areas) or 70,000 to 120,000 VND/person/year (rural areas), depending on the region.
- Students, trainees → contribute VHI fees from 40,000 to 70,000 VND/person/year (urban areas) or 30,000 to 50,000 VND/person/year (rural areas).
- Individuals with voluntary VHI cards → are entitled to outpatient and inpatient medical services at public and private healthcare facilities that have contracts with the Social Insurance.
- The voluntary VHI fund → is centrally managed, uniformly, democratically, and transparently according to current financial regulations.
- Patients using high-cost technical services → will be reimbursed 100% of costs if below 7,000,000 VND or 60% (maximum 20,000,000 VND) if 7,000,000 VND or more.
🌐 Social impact of this document
- Positive: Enhances health protection for citizens, reduces financial burden when facing illness.
- Negative: Voluntary VHI contributions may impose financial pressure on certain individuals.
- Students and trainees benefit from initial health care services at schools and death allowances.
- Citizens have additional options to join health insurance, increasing access to medical services.
- Enterprises and social insurance agencies must adjust fee collection, card issuance, and cost reimbursement procedures.
❓ Frequently asked questions
How much money do citizens need to pay to participate in voluntary health insurance?
Household members, dependents of workers, and association members must contribute from 100,000 to 160,000 VND/person/year (urban areas) or 70,000 to 120,000 VND/person/year (rural areas). Students and trainees contribute from 40,000 to 70,000 VND/person/year (urban areas) or 30,000 to 50,000 VND/person/year (rural areas).
How will patients using high-cost technical services be reimbursed?
If the cost of high-cost technical services is below 7,000,000 VND, patients will be reimbursed 100% of the cost. If it is 7,000,000 VND or more, they will be reimbursed 60% (maximum 20,000,000 VND) and the remainder will be paid by the patient.
Where can citizens participate in voluntary health insurance?
Household members, students, trainees, association members, and dependents of workers can register to participate in their place of residence or workplace/activities.
What benefits do patients receive when participating in voluntary health insurance?
Patients are entitled to outpatient and inpatient medical services at public and private healthcare facilities that have contracts with the Social Insurance. Additionally, patients using high-cost technical services will be reimbursed according to regulations.
When do citizens need to pay voluntary health insurance fees?
Voluntary VHI fees are paid at least once every six months. Students and trainees pay for the entire academic year or one school year.
Full text
JOINT CIRCULAR
Guidelines for Voluntary Health Insurance
Based on the Health Insurance Regulations issued together with Decree No. 63/2005/NĐ-CP dated May 16, 2005 of the Government;
The Ministry of Health and the Ministry of Finance provide guidance on implementing voluntary health insurance according to inpatient and outpatient treatment models as follows:
I. SCOPE, OBJECTS AND CONDITIONS FOR IMPLEMENTATION
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) These Circulars guide the implementation of voluntary health insurance (BHYT) according to inpatient and outpatient treatment models.
b) Voluntary health insurance applies to all Vietnamese citizens (except those who already have mandatory health insurance cards and children under six years old) in accordance with the objectives and principles stipulated in the Health Insurance Regulations issued together with Decree No. 63/2005/NĐ-CP dated May 16, 2005 of the Government.
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 and trainees studying at educational and training institutions within the national education system;
c) Members of associations, organizations, trade unions, religious groups... (hereinafter referred to collectively as associations);
d) Relatives of civil servants, public officials, employees... (hereinafter referred to collectively as relatives of employees) participating 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 oneself, spouse; spouse; legitimate child, legally adopted child according to the law; brother, sister, blood relative of oneself, spouse.
3. Conditions for Implementation
a) For household members: Implemented at the commune, ward, town level (hereinafter referred to collectively as commune) when the following conditions are met:
- 100% of members listed in the household registration book and residing in the same province or centrally-administered city register to participate in voluntary health insurance (excluding those who already have mandatory health insurance cards, voluntary health insurance cards according to other groups defined in this Circular, children under six years old); in cases where they are not listed in the household registration book but have registered temporary residence and live together in the same household, they can join the household's voluntary health insurance program (if desired).
- At least 10% of households in the commune's area register to participate in voluntary health insurance.
b) For students and trainees: Implemented at the school level with the condition that at least 10% of students and trainees on the school's student list participate in voluntary health insurance (excluding students and trainees who already have mandatory health insurance cards, voluntary health insurance cards according to other groups defined in this Circular).
c) For association members: Implemented at the association level with the condition that at least 30% of association members out of the total number of association members participate (excluding those who already have mandatory health insurance cards, voluntary health insurance cards according to other groups defined in this Circular).
d) For relatives of employees and association members: Implemented at the workplace or association where the employee or member works or participates; with the condition that employees and association members purchase health insurance cards for 100% of their relatives living in the same province or centrally-administered city (excluding those who already have mandatory health insurance cards, voluntary health insurance cards according to other groups defined in this Circular, children under six years old).
II. CONTRIBUTION RATES AND PAYMENT METHODS
VOLUNTARY HEALTH INSURANCE
1. Contribution Rates
a) The contribution rates for voluntary health insurance are specified according to region and group; specifically as follows:
Unit of measurement: VND/person/year
|
Borrowing and returning area |
||
|
Urban areas |
Rural areas |
|
|
Household members |
100.000 - 160.000 |
70.000 - 120.000 |
|
Relatives of employees and association members |
100.000 - 160.000 |
70.000 - 120.000 |
|
Association members |
100.000 - 160.000 |
70.000 - 120.000 |
|
Students and trainees |
40.000 - 70.000 |
30.000 - 50.000 |
- Urban areas include wards of cities and towns in provinces; rural areas include the remaining regions.
- The contribution rates above apply from January 1, 2006. Before January 1, 2006, the contribution rates specified 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 were applied.
b) Based on the contribution rates for voluntary health insurance stipulated in this Circular, upon the proposal of the Social Insurance (BHXH) provincial or centrally-administered city, the Vietnam Social Insurance decides specific contribution rates for each group and region, in line with economic and social conditions, service prices, and the use of services by people in each locality.
c) Determining the contribution rate for voluntary health insurance in urban or rural areas is based on the initial registration for medical care; individuals residing in rural areas but registering for initial medical care at facilities in urban areas will be subject to urban contribution rates, and vice versa.
d) In cases where students and trainees enrolled in schools do not participate in health insurance through their school but through their household or as relatives, they shall be subject to the contribution rate for students and trainees.
đ) When the voluntary health insurance contribution rate has reached the maximum set by the joint ministries and the Health Insurance Fund for voluntary health insurance has less income than expenditure, the Vietnam Social Insurance reports to the joint ministries to adjust the contribution rate for voluntary health insurance accordingly.
2. Payment Methods for Voluntary Health Insurance Contributions
a) Collection and payment of voluntary health insurance contributions are carried out as follows:
- Household members, association members, relatives of employees and association members: Register to participate and pay health insurance contributions at least once every six months.
- Students and trainees studying at educational and training institutions within the national education system: Register to participate by class or school and pay health insurance contributions once or twice during the academic year or for the entire course.
b) The Social Insurance agency organizes systems for collecting fees and issuing voluntary health insurance cards suitable for different groups, ensuring convenience, safety, and compliance with the law.
3. The People's Committees of provinces and centrally governed cities shall allocate from local budget sources and mobilize contributions from agencies, organizations, and individuals to support voluntary health insurance premium payments 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 level of support that align with the local budget balancing capacity.
4. Encourage agencies, units, and organizations to utilize legitimate welfare funds to support health insurance premiums for dependents of employees and members of associations under their jurisdiction.
III. SCOPE OF RIGHTS AND BENEFITS FOR CARD HOLDERS
VOLUNTARY HEALTH INSURANCE
1. Rights of voluntary health insurance card holders
a) Individuals participating in voluntary health insurance are issued a voluntary health insurance card for medical services and enjoy benefits as stipulated in this Circular.
- The voluntary health insurance card becomes valid for use thirty days after payment of the health insurance premium in the case of initial enrollment or re-enrollment following a period of interruption for any reason.
- The voluntary health insurance card becomes valid for use immediately upon payment of the health insurance premium in the case of continuous enrollment.
b) Voluntary health insurance card holders may use the card for outpatient and inpatient care at public and private healthcare facilities that have contracts with the Social Insurance Agency for providing services to health insurance card holders (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 Ministry of Health's list) during treatment at healthcare facilities;
- Laboratory tests, imaging diagnostics, functional examinations;
- Medications and intravenous fluids within the scope defined by the Ministry of Health;
- Blood and blood products;
- Surgical procedures and interventions;
- Prenatal care and childbirth;
- Medical supplies, equipment, and hospital beds.
c) When voluntary health insurance card holders receive medical care at their designated primary healthcare facility or at other healthcare facilities according to referral due to specialized technical levels as prescribed by the Ministry of Health or in emergency situations at healthcare facilities providing health insurance services, the Social Insurance Agency will reimburse costs based on current state hospital fees; however, for high-cost advanced medical services, reimbursement will be made according to the provisions set forth in point (d) below.
d) When voluntary health insurance card holders use high-cost advanced medical services (as listed by the Ministry of Health after coordination with the Ministry of Finance), the Social Insurance Agency will reimburse costs according to the following provisions:
- For high-cost advanced medical services with fees below seven million dong (VND 7,000,000) will be fully reimbursed for each service use.
- For high-cost advanced medical services with fees of seven million dong (VND 7,000,000) or more will be reimbursed sixty percent of the cost but not exceeding twenty million dong (VND 20,000,000) for each service use, with the remaining amount to be paid 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 will reimburse seven million dong (VND 7,000,000).
đ) When voluntary health insurance card holders receive medical care according to personal requests and at primary healthcare facilities which are non-public healthcare facilities providing health insurance services, the Social Insurance Agency will reimburse costs according to the guidelines set out in Clause 5 and 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 care benefits stipulated in points (b), (c), (d), and (đ) above, they also enjoy initial health care services at school clinics and receive a subsidy of one million dong (VND 1,000,000) in cases of death due to illness or accidents. Initial health care services at school clinics are carried out 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 diseases such as 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 as stipulated in Decision No. 265/2003/QĐ-TTg dated December 16, 2003, of the Prime Minister concerning the regime for people exposed to HIV, infected with HIV/AIDS due to occupational accidents, gonorrhea, syphilis);
d) Vaccination, convalescence, early pregnancy testing, general health check-ups including regular health check-ups, pre-employment, pre-military service examinations; family planning services and infertility treatments;
đ) Cosmetic surgery and reconstructive surgery, artificial limbs, eyes, teeth, glasses, hearing aids;
e) Treatment of occupational diseases, war injuries, natural disaster 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, forensic psychiatry examinations;
i) Home-based medical care, rehabilitation, and childbirth;
k) Use of medications outside the prescribed list, medications requested by patients, unapproved medical methods by the Ministry of Health, and 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) Premiums paid voluntarily by participants;
b) State budget, agency funds, and financial support from organizations and individuals for voluntary health insurance premiums;
c) Income generated from implementing measures to preserve and grow the voluntary health insurance fund;
d) Financial support and aid from domestic and foreign organizations and individuals;
đ) Other lawful revenues (if any).
2. The voluntary health insurance fund is managed centrally, uniformly, democratically, and transparently according to the current financial management regulations applicable to the Vietnam Social Insurance.
Any temporarily unused funds of the Voluntary Health Insurance Fund (if any) shall be mobilized to implement measures to conserve and grow the Fund in accordance with the provisions.
3. Management of the Voluntary Health Insurance Fund
a) The revenue from voluntary health insurance (as stipulated in points (a) and (b) Clause 1 Section IV above) for 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% to cover expenses for agents implementing fee collection and issuance of voluntary health insurance cards;
- 3% to cover training costs for agents and supplementary expenses for promotional activities and rewards.
b) The 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, special requests for treatment, initial healthcare costs at schools, and death benefits for students and trainees as prescribed in this Circular.
5. Regulation of the Outpatient Treatment Fund
a) The Vietnam Social Security is responsible for allocating and regulating the revenue to be used in the year for social security agencies in provinces and centrally-administered cities to ensure payment of outpatient treatment costs under voluntary health insurance.
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 outpatient treatment costs under voluntary health insurance exceed the amount available in the Voluntary Health Insurance Outpatient Treatment Fund for the year, the Vietnam Social Security may use the funds from the Voluntary Health Insurance Outpatient Treatment Reserve Fund, the Compulsory Health Insurance Outpatient Treatment Reserve Fund, or other sources as prescribed to ensure full and timely payment of benefits to eligible recipients.
6. The Voluntary Health Insurance Fund shall be recorded, statistically reported, accounted for according to the current financial management regulations of the Vietnam Social Security.
V. ORGANIZATION OF MEDICAL EXAMINATION AND TREATMENT AND COST REIMBURSEMENT
VOLUNTARY HEALTH INSURANCE MEDICAL EXAMINATION AND TREATMENT
1. Organization of medical examination and treatment
The organization of voluntary health insurance medical examination and 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 of the Ministry of Health and the Ministry of Finance. Additionally, for students and trainees, the social security agency has the responsibility to guide and coordinate with schools and local healthcare facilities to implement medical examination and treatment and the method of cost reimbursement for students and trainees holding health insurance cards during their study break period as prescribed, ensuring full rights and convenience for the beneficiaries.
2. Forms of cost reimbursement for medical examination and treatment under voluntary health insurance
2.1. Reimbursement between the social security agency and healthcare facilities
a) Principles:
- The social security agency reimburses the cost of medical examination and treatment to healthcare facilities based on the health insurance medical examination and treatment contract for cases of correct-line medical examination and treatment or emergency situations.
- Healthcare facilities choose the reimbursement form either based on service fees or fixed rates as guided in Clause 1 Section II Part IV of Circular No. 21/2005/TTLT-BYT-BTC dated July 27, 2005 of the Ministry of Health and the Ministry of Finance guiding the implementation of compulsory health insurance.
- The social security agency and healthcare facilities only execute one health insurance medical examination and treatment contract and agree on a unified reimbursement form for both compulsory and voluntary health insurance participants.
b) Method of determining the voluntary health insurance outpatient treatment fund for the medical examination and treatment contract
- For members of household groups, association members, relatives of workers, and relatives of association members: The voluntary health insurance outpatient treatment fund is calculated based on the number of registration cards for initial medical examination and treatment at the healthcare facility and the average fee of voluntary health insurance participants in the household group, association member, relative of worker, and relative of association member categories in the locality.
- For students and trainees: The voluntary health insurance outpatient treatment fund is calculated based on the number of registration cards and the average fee of voluntary health insurance student and trainee participants in the locality. Twenty percent of the voluntary health insurance outpatient treatment fund for students and trainees is reserved for initial school health care 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 paying death benefits.
2.2. Reimbursement 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 revenue from voluntary health insurance of students and trainees in the school. This amount is transferred to the school to provide primary health care and support the implementation of certain health education contents for students and trainees as guided by the Ministry of Health and the Ministry of Education and Training regarding 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 reimbursement between the social security agency and patients holding health insurance cards: Implemented according to the guidance in Clause 2 Section II Part IV of Circular No. 21/2005/TTLT-BYT-BTC dated July 27, 2005 of the Ministry of Health and the Ministry of Finance guiding the implementation of compulsory health insurance. In the case of student or trainee death, the social security agency pays death benefits to the relatives of the student or trainee.
VI. RIGHTS AND RESPONSIBILITIES OF THE AGENCIES
SOCIAL SECURITY 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 obligations and exercise rights as prescribed in the Health Insurance Charter and the guidance in Part V of Circular No. 21/2005/TTLT-BYT-BTC dated July 27, 2005 of the Ministry of Health and the Ministry of Finance guiding the implementation of compulsory health insurance.
2. In addition, within its scope of responsibility, the social security agency performs the following tasks:
a) Implementing information dissemination, promotional, and training activities for agents to expand the target group participating in voluntary health insurance.
b) Developing inter-departmental cooperation plans to implement voluntary health insurance for various groups.
c) Allocating resources from operational funds to strengthen activities aimed at developing and expanding voluntary health insurance.
VII. IMPLEMENTATION PROVISIONS
1. This Circular takes effect fifteen days after its publication in the Official Gazette. The Circular jointly issued on August 7, 2003, under Decision No. 77/2003/TTLT-BTC-BYT by 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 Decision 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, 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 relevant ministries for consideration and resolution./.
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