Circular No. 24/2025/TT-BYT amends Circular No. 04/2017/TT-BYT on the List and Proportions, Conditions for Payment of Medical Supplies within the Scope of Benefit for Health Insurance Participants issued by the Minister of Health.

 

CIRCULAR

Amending and supplementing some articles of Circular No. 04/2017/TT-BYT dated April 14, 2017, issued by the Minister of Health on the List and ratio, conditions for payment of medical supplies within the scope of benefit for insured persons under health insurance

Pursuant to the Health Insurance Law 2008, amended in 2014 and 2024;

Pursuant to Decree No. 146/2018/NĐ-CP dated October 17, 2018, promulgated by the Government detailing and guiding methods to implement certain provisions of the Health Insurance Law, which has been amended and supplemented by Decree No. 75/2023/NĐ-CP dated October 19, 2023;

Pursuant to Decree No. 42/2025/NĐ-CP dated February 27, 2025 of the Government stipulating the functions, tasks, powers, and organizational structure of the Ministry of Health;

At the proposal of the Director of the Health Insurance Department, Ministry of Health,

The Minister of Health hereby issues this Circular amending and supplementing some articles of Circular No. 04/2017/TT-BYT dated April 14, 2017, issued by the Minister of Health on the List and ratio, conditions for payment of medical supplies within the scope of benefit for insured persons under health insurance.

Article 1. Amending and supplementing some articles of Circular No. 04/2017/TT-BYT dated April 14, 2017, issued by the Minister of Health on the List and ratio, conditions for payment of medical supplies within the scope of benefit for insured persons under health insurance

1. Amend and supplement Article 1 as follows:

"Article 1. List of medical equipment within the scope of benefit for insured persons under health insurance

 The list of medical equipment within the scope of benefit for insured persons under health insurance is specified in Appendix 01 attached hereto and serves as the basis for the health insurance fund to pay costs for using medical equipment in diagnosis and treatment in accordance with the laws on health insurance."

2. Amending and supplementing Clause 3, Article 2 as follows:

"3. In cases where private healthcare facilities do not choose to apply the legal provisions on tendering to purchase medical equipment, such facilities shall prepare a list of medical equipment that have not been included in the cost of technical services, outpatient visits, and hospitalization days at such facilities according to the prescribed form in Appendix 03 attached hereto and submit it to the social insurance agency."

3. Amending and supplementing Point b and Point c, Clause 2, Article 3 as follows:

a) Amend and supplement Point b as follows:

"b) The total payment for medical equipment expenses for one use of a technical service shall not exceed 45 months of the minimum wage.

This provision shall not apply to medical equipment with a payment ratio specified in Column 5 of Appendix 01 attached hereto, for example:

Example 1: The total payment for medical equipment expenses of patients in one use of a technical service at the time when the minimum wage is 2,340,000 VND, specifically as follows:

- For patients who are insured subjects entitled to 100% coverage of diagnosis and treatment costs: The total payment for medical equipment expenses of patients in one use of a technical service = 45 x 100% x 2,340,000 = 105,300,000 VND;

- For patients who are insured subjects entitled to 95% coverage of diagnosis and treatment costs but have not participated in health insurance continuously for more than five years: The total payment for medical equipment expenses of patients in one use of a technical service = 45 x 95% x 2,340,000 = 100,035,000 VND;

- For patients who are insured subjects entitled to 95% coverage of diagnosis and treatment costs and have participated in health insurance continuously for more than five years:

+ For patients who have not reached the co-payment limit of six months' minimum wage for diagnosis and treatment costs in the year up to the time of using the technical service: The total payment for medical equipment expenses of patients in one use of a technical service = 45 x 95% x 2,340,000 = 100,035,000 VND;

+ For patients who have reached the co-payment limit of six months' minimum wage for diagnosis and treatment costs in the year up to the time of using the technical service: The total payment for medical equipment expenses of patients in one use of a technical service = 45 months' minimum wage = 105,300,000 VND;

- For patients who are insured subjects entitled to 80% coverage of diagnosis and treatment costs but have not participated in health insurance continuously for more than five years: The total payment for medical equipment expenses of patients in one use of a technical service = 45 x 80% x 2,340,000 = 84,240,000 VND;

- For patients who are insured subjects entitled to 80% coverage of diagnosis and treatment costs and have participated in health insurance continuously for more than five years:

+ For patients who have not reached the co-payment limit of six months' minimum wage for diagnosis and treatment costs in the year up to the time of using the technical service: The total payment for medical equipment expenses of patients in one use of a technical service = (45 x 80% x 2,340,000) + (45 x 20% - 6) x 2,340,000 = 91,260,000 VND;

+ For patients who have reached the co-payment limit of six months' minimum wage for diagnosis and treatment costs in the year up to the time of using the technical service: The total payment for medical equipment expenses of patients in one use of a technical service = 45 months' minimum wage = 105,300,000 VND.

Example 2: (In case the total cost of medical equipment exceeds 45 months' minimum wage):

At the time when the minimum wage is 2,340,000 VND, a patient uses one piece of medical equipment A and two pieces of medical equipment B in one use of a technical service. Medical equipment A has a purchase price of 72,000,000 VND, with a payment ratio specified in Column 5 of Appendix 01 attached hereto of 70,000,000 VND; medical equipment B has a purchase price of 20,000,000 VND, without a payment ratio specified in Column 5 of Appendix 01 attached hereto.

The total cost of medical equipment for the patient (where medical equipment A is calculated based on the payment ratio specified in Column 5 of Appendix 01 attached hereto, and medical equipment B is calculated based on the purchase price) for one use of a technical service is calculated as follows: 70,000,000 x 1 + 20,000,000 x 2 = 110,000,000 VND. This cost exceeds 45 months' minimum wage (105,300,000 VND), therefore, the health insurance fund will pay the total cost of medical equipment for patients belonging to different entitlement categories according to the total payment for medical equipment expenses as specified in Example 1 at Point b, Clause 2 above.

Example 3: (Case where the total cost of medical equipment is less than 45 months of the minimum wage): The patient uses 01 unit of medical equipment A, 02 units of medical equipment B, and 03 units of medical equipment C in one service usage.

Medical equipment A has a purchase price of 72,000,000 VND, with the payment level specified in column 5 of Appendix 01 issued together with this Circular being 70,000,000 VND; medical equipment B has a purchase price of 10,000,000 VND, without a payment level specified in column 5 of Appendix 01 issued together with this Circular; medical equipment C has a purchase price of 4,000,000 VND, without a payment level specified in column 5 of Appendix 01 issued together with this Circular.

The total cost of medical equipment for the patient (where medical equipment A is calculated based on the payment level specified in column 5 of Appendix 01 issued together with this Circular, and medical equipment B and C are calculated based on their purchase prices) for one service usage is calculated as follows: 70,000,000 x 1 + 10,000,000 x 2 + 4,000,000 x 3 = 102,000,000 VND. This cost is lower than 45 months of the minimum wage (105,300,000 VND). The health insurance fund will pay the patient as follows:

- In the case where the patient is an insured person entitled to 100% coverage of medical examination and treatment costs: The health insurance fund will pay the total cost of medical equipment for the patient in one service usage = 102,000,000 x 100% = 102,000,000 VND;

- In the case where the patient is an insured person entitled to 95% coverage of medical examination and treatment costs but has not participated in health insurance continuously for more than five years: The health insurance fund will pay the total cost of medical equipment for the patient in one service usage = 102,000,000 x 95% = 96,900,000 VND;

- For patients who are insured subjects entitled to 95% coverage of diagnosis and treatment costs and have participated in health insurance continuously for more than five years:

+ In the case where the patient has not reached the co-payment amount for medical examination and treatment costs within the year up to the time of service usage: The health insurance fund will pay the total cost of medical equipment for the patient in one service usage = 102,000,000 x 95% = 96,900,000 VND;

+ In the case where the patient's co-payment amount for medical examination and treatment costs within the year up to the time of service usage has reached six months of the minimum wage: The health insurance fund will pay the total cost of medical equipment for the patient in one service usage = 102,000,000 VND;

- In the case where the patient is an insured person entitled to 80% coverage of medical examination and treatment costs but has not participated in health insurance continuously for more than five years: The health insurance fund will pay the total cost of medical equipment for the patient in one service usage = 102,000,000 x 80% = 81,600,000 VND;

- For patients who are insured subjects entitled to 80% coverage of diagnosis and treatment costs and have participated in health insurance continuously for more than five years:

+ In the case where the patient has not reached the co-payment amount for medical examination and treatment costs within the year up to the time of service usage: The health insurance fund will pay the total cost of medical equipment for the patient in one service usage = (102,000,000 x 80%) + (102,000,000 x 20% - 6 x 2,340,000) = 87,960,000 VND;

+ In the case where the patient's co-payment amount for medical examination and treatment costs within the year up to the time of service usage has reached six months of the minimum wage: The health insurance fund will pay the total cost of medical equipment for the patient in one service usage = 102,000,000 VND.";

b) Amend and supplement Point c as follows:

"c) For coronary artery stenting procedures that require the use of more than one drug-coated stent, the payment for the total cost of medical equipment including the first stent and other medical equipment outside the stent in one service usage shall be made according to the payment guidance at point b clause 2 of this Article, and an additional half (1/2) of the cost of the second stent based on the purchase price of the healthcare facility, but not exceeding 18,000,000 VND, an additional one-third (1/3) of the cost of the third stent and one-third (1/3) of the cost of the fourth stent based on the purchase price of the healthcare facility, but not exceeding 12,000,000 VND for each third and fourth stent.

Example: Drug-coated stent A has a purchase price at a healthcare facility of 40,000,000 VND; the payment level for drug-coated stents as specified in column 5 of Appendix 01 issued together with this Circular is 36,000,000 VND. The patient is admitted to this healthcare facility to undergo coronary artery stenting with the indication of placing 05 drug-coated stent A. The cost of other medical equipment outside the stent that is not included in the service fee, examination fee, bed day charge, or bundled package fee according to the case (hereinafter referred to as other medical equipment) of the patient is 50,000,000 VND; these pieces of equipment do not have a payment level specified in column 5 of Appendix 01 issued together with this Circular.

- In the case where the patient is an insured person entitled to 100% coverage of medical examination and treatment costs, the total payment for the cost of medical equipment in one service usage of the patient according to Example 1 at point b clause 2 of Article 3 of this Circular is 105,300,000 VND. The total cost of one drug-coated stent A calculated based on the payment level in column 5 of Appendix 01 issued together with this Circular and other medical equipment is 36,000,000 + 50,000,000 = 86,000,000 VND; this cost is lower than 105,300,000 VND. The health insurance fund will pay the patient: (i) the first stent and the cost of other medical equipment is 86,000,000 VND; (ii) the second stent is 18,000,000 VND; (iii) the third stent, the fourth stent, each stent is 12,000,000 VND; (iv) the fifth stent is not paid.

Therefore, the health insurance fund will pay the total cost of medical equipment in one service usage for the patient as follows: 86,000,000 + 1 x (½ x 36,000,000) + 2 x (1/3 x 36,000,000) = 128,000,000 VND;

- In cases where the patient is an insured healthcare participant entitled to 80% coverage for medical examination and treatment costs but has not yet accumulated continuous health insurance participation for over five years, the total payment for medical equipment expenses in one service usage according to Example 1 at point b Clause this Article is 84,240,000 VND. The total cost of one drug-coated stent A calculated based on the payment level in column 5 of Appendix 1 issued together with this Circular and other medical equipment is 36,000,000 + 50,000,000 = 86,000,000 VND; this cost exceeds 84,240,000 VND.

Therefore, the health insurance fund will pay the total cost of medical equipment in one service usage for the patient as follows: 84,240,000 + 1 x (½ x 36,000,000) + 2 x (1/3 x 36,000,000) = 126,240,000 VND."

4. Amend and supplement Clause 4 of Article 4 as follows:

"4. For types of medical equipment measured in units such as sets or systems (hereinafter referred to as a set), the health insurance fund shall pay for medical equipment as follows:"

a) In case all parts within the set are used: Pay according to the full package price of the set;"

b) In case the medical equipment is purchased as a set but only some parts within the set are used, and the remaining parts cannot be used for other purposes, then pay the full package price of the set. Healthcare facilities must record cases where the remaining parts of the medical equipment cannot be used and notify the social insurance agency in writing;"

c) In case one or some parts within the set are used and the remaining parts can be used for other purposes: Pay according to the price of each part used within the set."

5. Amend and supplement some clauses of Article 6 as follows:

a) Amend and supplement Clause 1 as follows:

"1. The Health Insurance Department under the Ministry of Health shall be responsible for:"

a) Organizing the implementation and inspection of the enforcement of this Circular throughout the country;"

b) Taking the lead and coordinating with relevant agencies to resolve any issues arising during the implementation process; updating and proposing amendments to the list of medical equipment in Appendix 1 issued together with this Circular;"

b) Supplementing point c after point b of Clause 2 as follows:"

"c) Providing complete and timely information and data related to the payment of medical examination and treatment costs under health insurance to the Ministry of Health for building and updating the list of medical equipment;"

c) Supplementing point c after point b of Clause 3 as follows:"

"c) Directing healthcare facilities in their jurisdiction to establish a list of medical equipment used in accordance with this Circular and implementing measures to ensure adequate and timely supply of medical equipment of good quality to meet treatment needs and protect the rights of health insurance participants;"

d) Supplementing Clause 6 after Clause 5 as follows:

"6. Based on actual professional needs, healthcare facilities, centralized procurement units, and price negotiation shall develop plans to select contractors and organize bidding and purchasing of medical equipment in sets or individual parts to suit usage at the unit and avoid waste."

6. Amend and supplement the list of medical equipment within the scope of benefits for health insurance participants specified in Appendix 1 issued together with Circular No. 04/2017/TT-BYT as follows:"

a) Amend and supplement medical equipment with serial number 31, 153, 183, 195, 228, 279, 304, 330 as follows:"

b) Add the following medical equipment:"

7. Amend the phrase "medical supplies" and the phrase "healthcare equipment" to the phrase "medical equipment" throughout all articles, clauses, points, and appendices of Circular No. 04/2017/TT-BYT."

Article 2. Implementation clause

1. This Circular takes effect from September 1, 2025.

2. Repeal Clause 6 of Article 3 and the phrase "Not to be paid separately" in the "Note" column of Appendix 1 issued together with Circular No. 04/2017/TT-BYT.

Article 3. Transitional Provisions

1. Materials that are not medical devices but are included in Appendix 01 issued together with Circular No. 04/2017/TT-BYT shall continue to be subject to the provisions of Circular No. 04/2017/TT-BYT and this Circular until the Minister of Health issues regulations on material reimbursement, except for the provisions regarding registration for circulation.

2. Patients holding health insurance cards who are admitted for inpatient treatment or day treatment before the effective date of this Circular and complete their inpatient treatment or day treatment (discharge) from the effective date of this Circular shall implement the provisions of this Circular for the entire treatment period.

During the process of implementation, if there are difficulties or obstacles, suggestions for amendments or supplements should be reported to the Ministry of Health (Health Insurance Department) for consideration and resolution./.