Law Amending the Health Insurance Law 2024, Law No. 51/2024/QH15

LAW

AMENDMENTS AND SUPPLEMENTS TO CERTAIN PROVISIONS OF THE HEALTH INSURANCE LAW

On the basis of the Constitution of the Socialist Republic of Vietnam;

The National Assembly enacts this Law to amend and supplement certain provisions of the Health Insurance Law No. 25/2008/QH12, which has been amended and supplemented by Laws No. 32/2013/QH13, No. 46/2014/QH13, No. 97/2015/QH13, No. 35/2018/QH14, No. 68/2020/QH14, and No. 30/2023/QH15.

Article 1. Amendments and supplements to certain provisions of the Health Insurance Law

1. Add Clause 9 following Clause 8 of Article 2 as follows:

"9. The reference level is the amount of money determined by the Government for calculating the contribution and benefit levels for certain cases participating in health insurance as stipulated in this Law."

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

"2. The health insurance contribution rate is determined as a percentage of the salary used as the basis for compulsory social insurance contributions under the Social Insurance Law (hereinafter referred to as monthly salary), pension, allowance, or reference level."

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

a) Amend and supplement Clause 1 as follows:

"1. To promulish policies and laws on health insurance, organize the healthcare system, financial resources serving the protection, care, and improvement of people's health based on universal health insurance; solutions to enhance the capacity of primary healthcare services under health insurance;"

b) Amend and supplement Clause 3 and Clause 4 as follows:

"3. To issue regulations, procedures, and professional guidelines for medical examination and treatment; review and update regularly diagnostic and treatment guidelines; regulations on the evaluation of the appropriateness of health insurance service provision; regulations on the application of information technology, digital transformation, and data sharing in the field of health insurance, and the interoperability and utilization of clinical laboratory results between health insurance facilities in accordance with professional requirements;"
"4. To promulish measures to ensure the balance of the health insurance fund;"

4. Amend and supplement Article 7a as follows:

"Article 7a. Responsibilities of the Ministry of Labor, Invalids, and Social Affairs
1. To direct and guide the implementation of the identification and management of subjects managed by the Ministry of Labor, Invalids, and Social Affairs as stipulated in Points e, h, i, k, o, r, s, and t of Clause 3, and Points a, b, d, and g of Clause 4 of Article 12 of this Law."
"2. To inspect and check the implementation of legal provisions regarding the responsibility to participate in health insurance of employers and employees as stipulated in Clause 1 of Article 12 of this Law, and subjects managed by the Ministry of Labor, Invalids, and Social Affairs as stipulated in Points e, h, i, k, o, r, s, and t of Clause 3, and Points a, b, d, and g of Clause 4 of Article 12 of this Law, except for subjects managed by the Ministry of Defense and the Ministry of Public Security."

5. Amend and supplement some clauses of Article 7c as follows:

a) Amend and supplement Clause 1 as follows:

"1. To direct, manage, guide, and implement the identification and management of lists for participation in health insurance for subjects managed by the Ministry of Defense and the Ministry of Public Security as stipulated in Points a, c, e, h, and i of Clause 1, and Points a, b, c, d, l, and n of Clause 3, and Point b of Clause 4 of Article 12 of this Law;"

b) Amend and supplement Clause 3 as follows:

"3. To inspect and check the implementation of legal provisions regarding the responsibility to participate in health insurance of subjects managed by the Ministry of Defense and the Ministry of Public Security as stipulated in Points a, c, e, h, and i of Clause 1, and Points a, b, c, d, l, and n of Clause 3, and Point b of Clause 4 of Article 12 of this Law;"

6. Amend and supplement Clause 2 and Clause 3 of Article 8 as follows:

"2. Provincial People's Committees, in addition to implementing the responsibilities prescribed in Clause 1 of this Article, shall be responsible for directing the establishment of organizational structures and resources to manage health insurance at the local level;"
"3. Commune-level People's Committees (hereinafter referred to as Commune-level People's Committees) shall have the following responsibilities:"
"a) To implement the responsibilities prescribed in Clause 1 of this Article;"
"b) To establish lists for participation in health insurance for subjects within their jurisdiction as stipulated in Clauses 2, 3, 4, and 5 of Article 12 of this Law according to household units, except for subjects under the management of other Ministries, sectors, agencies, and units as stipulated in Points a, b, c, d, l, and n of Clause 3, and Point b of Clause 4 of Article 12 of this Law;"
"c) To establish lists for applying for health insurance cards for children simultaneously with issuing birth certificates."

6 ||| 7. Amend and supplement Article 9 as follows:

"Article 9. Agencies Implementing Health Insurance
1. Social Insurance Agencies shall have the function of implementing health insurance systems, policies, and laws, managing, and utilizing the health insurance fund;"
"2. The Government shall specify in detail the functions, tasks, powers, and organizational structure of Social Insurance Agencies in implementing health insurance."

8. Amending and supplementing Article 10 as follows:

"Article 10. Audit of the Health Insurance Fund
1. The State Audit Office shall conduct periodic audits of the health insurance fund every three years and report the results to the National Assembly; conduct ad hoc audits of the health insurance fund upon request of the National Assembly and the Standing Committee of the National Assembly;"

"9. Amend and supplement Clause 1 of Article 11 as follows:"

"1. Late payment or evasion of health insurance contributions."

10. Amend and supplement Article 12 as follows:

"Article 12. Subjects Participating in Health Insurance
1. Groups for whom employers contribute, employees contribute, or both contribute include:"
"a) Employees working under indefinite-term labor contracts, fixed-term labor contracts with a duration of at least one month, including cases where employees and employers agree on different names but the content reflects paid work, wages, and management, direction, and supervision by one party; business managers, supervisors, state capital representatives, enterprise capital representatives as stipulated by law; members of the Board of Directors, General Managers, Directors, members of the Supervisory Board or supervisors, and other elected management positions in cooperatives and cooperative unions as stipulated by the Cooperative Law who receive salaries;"
"b) Business managers, supervisors, state capital representatives, enterprise capital representatives as stipulated by law; members of the Board of Directors, General Managers, Directors, members of the Supervisory Board or supervisors, and other elected management positions in cooperatives and cooperative unions as stipulated by the Cooperative Law who do not receive salaries;
c) A foreign worker who works in Vietnam under a fixed-term labor contract with a duration of at least twelve months with an employer in Vietnam, except in cases where the worker is internally transferred within a business enterprise in accordance with the laws on foreign workers working in Vietnam or at the time of entering into the labor contract, the worker has reached the retirement age as stipulated in Clause 2, Article 169 of the Labor Code or international treaties to which the Socialist Republic of Vietnam is a party provide otherwise;
d) Workers under an indefinite-term labor contract or a fixed-term labor contract with a duration of at least one month, including cases where the worker and the employer agree by another name but the content reflects work for remuneration and management, direction, supervision by one party, and agreements with employers working part-time with monthly wages equal to or higher than the minimum wage basis for mandatory social insurance contributions as prescribed by the laws on social insurance;
đ) The head of a household business registered for business activities that fall under the category required to participate in mandatory social insurance according to the laws on social insurance;
e) Civil servants and public officials;
g) Non-professional staff at the commune level as provided by law;
h) Military personnel and defense civil servants serving in the military, police workers serving in the police force; other personnel working in confidential organizations as prescribed by the Confidentiality Law;
i) Relatives of military personnel and defense civil servants serving in the military, relatives of police workers serving in the police force who do not fall under the categories required to participate in mandatory health insurance as stipulated in Points a, b, c, d, đ, e, g, and h of this clause, Clause 2, and Clause 3 of this Article;
2. The group for which social insurance contributions are made by the social insurance agency includes:
a) Persons currently receiving monthly pension or disability benefits;
b) Persons who have stopped working and are receiving monthly compensation for work-related accidents or occupational diseases; persons who have stopped working and are receiving monthly sick leave compensation for workers suffering from long-term treatable diseases or workers who have stopped working and are receiving sick leave benefits for fourteen working days or more in a month as prescribed by the laws on social insurance; persons who have stopped working and are receiving maternity benefits for fourteen working days or more in a month as prescribed by the laws on social insurance;
c) Commune-level civil servants who have retired and are currently receiving monthly social insurance benefits;
d) Persons currently receiving unemployment benefits;
3. The group for which contributions are made by the state budget includes:
a) Active officers of the People's Army and professional soldiers; active officers, non-commissioned officers, and technical officers in the People's Public Security Force; personnel engaged in confidential work receiving salaries equivalent to those of military personnel;
b) Active non-commissioned officers and conscript soldiers of the People's Army; non-commissioned officers and conscript police officers in the People's Public Security Force; Vietnamese students at military academies, public security academies, and confidentiality academies receiving living expenses;
c) Foreign students at military academies, public security academies, and confidentiality academies receiving living expenses;
d) Students training as reserve officers for three months or more who have not participated in social insurance or health insurance;
đ) Full-time militia members;
e) Persons who have contributed to the revolution as defined by the Preferential Treatment Ordinance for Persons Contributing to the Revolution; former combatants;
g) Current members of the National Assembly and People's Councils at all levels;
h) Children under six years old;
i) Relatives of martyrs and persons raising martyrs' children as defined by the Preferential Treatment Ordinance for Persons Contributing to the Revolution;
k) Relatives of persons contributing to the revolution, widows or widowers of martyrs who are remarried and are currently receiving monthly pensions and related individuals as defined by the Preferential Treatment Ordinance for Persons Contributing to the Revolution, excluding the category defined in Point i of this clause;
l) Relatives of the subjects defined in Points a and b of this clause as prescribed by law;
m) Persons who have donated organs as prescribed by law;
n) Foreign students studying in Vietnam and receiving scholarships funded by the Vietnamese state budget;
o) Members of poor households; ethnic minority members of near-poor households residing in communes, villages in ethnic minority and mountainous areas; ethnic minorities residing in areas with difficult economic and social conditions; residents in areas with extremely difficult economic and social conditions; residents in island communes and counties;
p) Commune-level civil servants who have retired and are currently receiving monthly allowances from the state budget;
q) Persons who have ceased to receive disability benefits and are currently receiving monthly allowances from the state budget;
r) Persons currently receiving monthly social assistance benefits; persons currently receiving monthly care benefits as prescribed by relevant laws; persons currently receiving monthly pensions who are also entitled to social assistance benefits;
s) Persons aged seventy-five or older currently receiving monthly pensions, persons aged seventy or older but under seventy-five belonging to near-poor households currently receiving monthly pensions;
t) Persons currently receiving monthly social pension benefits as prescribed by the laws on social insurance;
u) Workers who do not meet the conditions for receiving a pension and have not yet reached the age for receiving social pension benefits and are currently receiving monthly benefits as prescribed by the laws on social insurance;
4. The group for which the state budget provides support for contribution levels includes:
a) Members of near-poor households;
b) Students;
c) Personnel participating in forces for maintaining public security and order at the grassroots level;
d) Members of households engaged in agriculture, forestry, fisheries, and salt production with average living standards as prescribed by law;
đ) Health workers in villages; village midwives;
e) Non-professional staff at the village and neighborhood levels as provided by law;
g) Members of ethnic minority groups residing in communes no longer classified as areas with difficult socio-economic conditions shall be supported by the state budget to pay for health insurance premiums in accordance with the Government's regulations;
h) Individuals awarded the title of National Artist or Outstanding Artist in accordance with the Law on Cultural Heritage;
i) Victims as defined by the Law on Prevention and Combating Trafficking in Persons;
5. The group that pays for health insurance themselves includes:
a) Members of households participating in health insurance under the household form;
b) Individuals living and working, or being cared for and nurtured in charitable organizations and religious institutions;
c) Workers during periods of unpaid leave or temporary suspension of labor contracts;
d) Individuals not falling within the categories specified in points a, b, and c of this clause;
6. Other subjects outside those specified in clauses 1, 2, 3, 4, and 5 of this Article as provided by laws and ordinances;
7. The Government shall specify other subjects outside those specified in clauses 1, 2, 3, 4, 5, and 6 of this Article including:
a) Subjects participating in health insurance as prescribed by law before January 1, 2025;
b) Other subjects outside those specified in point a of this clause after reporting to the Standing Committee of the National Assembly.";

11. Amend and supplement Article 13 as follows:

"Article 13. Contribution Levels and Responsibility for Health Insurance Contributions
1. The contribution levels paid by employers or employees or jointly paid are stipulated as follows:
a) The monthly contribution level for subjects specified in points a, c, d, and e of clause 1 of Article 12 of this Law shall be a maximum of 6% of the monthly salary, of which the employer contributes two-thirds and the employee contributes one-third;
b) The monthly contribution level for subjects specified in point b of clause 1 of Article 12 of this Law shall be a maximum of 6% of the monthly salary serving as the basis for mandatory social insurance contributions and shall be paid by the subject;
c) The monthly contribution level for subjects specified in point đ of clause 1 of Article 12 of this Law shall be a maximum of 6% of the monthly salary serving as the basis for mandatory social insurance contributions and shall be paid by the subject;
d) The monthly contribution level for subjects specified in point g of clause 1 of Article 12 of this Law shall be a maximum of 6% of the reference amount, of which the employer contributes two-thirds and the employee contributes one-third;
đ) The monthly contribution level for subjects specified in point h of clause 1 of Article 12 of this Law shall be a maximum of 6% of the monthly salary and the responsibility for payment shall be in accordance with the Government's regulations;
e) The monthly contribution level for subjects specified in point i of clause 1 of Article 12 of this Law shall be a maximum of 6% of the reference amount and the responsibility for payment shall be in accordance with the Government's regulations.
2. The contribution levels paid by the social insurance agency are stipulated as follows:
a) The monthly contribution level for subjects specified in point a of clause 2 of Article 12 of this Law shall be a maximum of 6% of the pension or disability allowance;
b) The monthly contribution level for subjects specified in points b and c of clause 2 of Article 12 of this Law shall be a maximum of 6% of the reference amount;
c) The monthly contribution level for subjects specified in point d of clause 2 of Article 12 of this Law shall be a maximum of 6% of the unemployment benefit.
3. The contribution levels paid by the state budget and the support for contribution levels are stipulated as follows:
a) The monthly contribution level for subjects specified in point a of clause 3 of Article 12 of this Law shall be a maximum of 6% of the monthly salary and shall be paid by the state budget;
b) The monthly contribution level for subjects specified in points b, c, d, đ, e, g, h, i, k, l, m, o, p, q, r, s, t, and u of clause 3 of Article 12 of this Law shall be a maximum of 6% of the reference amount and shall be paid by the state budget;
c) The monthly contribution level for subjects specified in point n of clause 3 of Article 12 of this Law shall be a maximum of 6% of the reference amount and shall be paid by the state budget through scholarship-granting agencies, organizations, or units;
d) The monthly contribution level for subjects specified in clause 4 of Article 12 of this Law shall be a maximum of 6% of the reference amount, with the subject paying and receiving partial support from the state budget;
4. The monthly contribution level for subjects specified in clause 5 of Article 12 of this Law shall be a maximum of 6% of the reference amount and shall be paid by the subject according to the household or individual participation form;
5. Determination of the order of health insurance contributions for cases where an individual simultaneously belongs to multiple different health insurance participation categories as follows:
a) An individual who simultaneously belongs to multiple different health insurance participation categories specified in Article 12 of this Law shall pay health insurance according to the first category they are determined to belong to in the order of the categories specified in Article 12 of this Law, except for the cases specified in points c, d, đ, e, and g of this clause;
b) An individual belonging to the categories specified in points a, c, d, đ, and e of clause 1 of Article 12 of this Law who also has one or more employment contracts shall pay health insurance according to the employment contract serving as the basis for mandatory social insurance participation;
c) An individual belonging to the category specified in point g of clause 1 of Article 12 of this Law who also belongs to multiple different health insurance participation categories specified in Article 12 of this Law shall pay health insurance according to the order of contributions made by the social insurance agency, the state budget, the state budget supporting the contribution level, the subject, and the commune people's committee;
d) An individual belonging to the categories specified in points a and c of clause 2 of Article 12 of this Law who also belongs to multiple different health insurance participation categories specified in Article 12 of this Law shall participate according to the category contributed by the social insurance agency;
đ) An individual belonging to the categories specified in points s, t, and u of clause 3 of Article 12 of this Law who also belongs to multiple different health insurance participation categories specified in Article 12 of this Law shall participate according to the category funded by the state budget;
e) An individual belonging to the categories specified in points a, c, d, đ, e, g, h, and i of clause 4 of Article 12 of this Law who also belongs to the category specified in point a of clause 5 of Article 12 of this Law may choose the category to participate in health insurance;
g) An individual belonging to multiple categories supported by the state budget for contribution levels specified in clause 4 of Article 12 of this Law may choose to participate according to the category with the highest support level.
h) A person who falls under the categories specified in points b and c, Clause 5, Article 12 of this Law and simultaneously falls under the category specified in point a, Clause 5, Article 12 of this Law shall be entitled to choose to participate in health insurance under the household registration form.
6. Members of a household specified in point a, Clause 5, Article 12 of this Law participating in health insurance under the household registration form during the fiscal year shall be subject to the following deductions from their contributions:
a) The first person contributes up to 6% of the reference level;
b) The second, third, and fourth persons contribute successively at 70%, 60%, and 50% of the first person's contribution rate;
c) From the fifth person onwards, they contribute at 40% of the first person's contribution rate.
7. The Government shall specify the following contents:
a) Contribution rates and support contribution rates as stipulated in this Article;
b) Responsibility for contributions, contribution rates, and support contribution rates for the categories specified in Clauses 6 and 7, Article 12 of this Law."

12. Amend and supplement Clauses 4 and 5 of Article 14 as follows:

"4. For those not falling under the provisions of Clauses 1, 2, and 3 of this Article, the basis for health insurance contributions shall be the reference level.
5. The maximum monthly salary for calculating health insurance contributions is 20 times the reference level."

13. Amend and supplement some clauses of Article 15 as follows:

a) Amend and supplement Clauses 2, 3, 4, and 5 as follows:

"2. For enterprises, cooperatives, cooperatives, associations of cooperatives, and individual businesses operating in agriculture, forestry, fisheries, and salt production that pay wages based on products or contracts, contributions shall be made monthly, every three months, or every six months.
3. Monthly, the social insurance agency shall make health insurance contributions according to Clause 2, Article 13 of this Law into the health insurance fund.
4. Quarterly, organizations, units providing scholarships shall make health insurance contributions according to point c, Clause 3, Article 13 of this Law into the health insurance fund.
5. Quarterly, the state budget shall transfer the amount of contributions and support contributions according to points a, b, and d, Clause 3, Article 13 of this Law into the health insurance fund;"

b) Supplement Clauses 7 and 8 after Clause 6 as follows:

"7. Persons specified in points b and đ, Clause 1, Article 12 of this Law shall directly pay their full contribution responsibility to the social insurance agency or through individual businesses, enterprises, cooperatives, associations of cooperatives managing them according to monthly, every three months, or every six months payment methods.
8. The latest deadline for making health insurance contributions for employers is as follows:
a) The last day of the month following the contribution period for monthly payments;
b) The last day of the month immediately following the contribution cycle for payments every three months or six months."

14. Amend and supplement some clauses of Article 16 as follows:

a) Amend and supplement Clause 1 and Clause 2 as follows:

"1. Health insurance cards with health insurance numbers are issued to health insurance participants and serve as the basis for enjoying health insurance benefits as stipulated in this Law. Health insurance cards are issued in electronic and paper formats and have equal legal validity.
2. Each person is only issued one health insurance number."

b) Amend and supplement Point c of Clause 3 as follows:"

"c) Health insurance participants specified in Clauses 4 and 5, Article 12 of this Law who are participating in health insurance for the first time or have participated in health insurance under one of the categories specified in Article 12 of this Law but not continuously for 90 days or more, their health insurance card will be valid for use 30 days after fully paying the health insurance;"

c) Amending and supplementing Clause 5 as follows:

"5. The Vietnam Social Security shall issue a model health insurance card after obtaining the unified opinion of the Ministry of Health."

15. Amend and supplement Article 17 as follows:

"Article 17. Issuance of Health Insurance Cards
1. Application dossier for issuing health insurance cards as follows:
a) Health insurance participation declaration forms of agencies, organizations, units, individuals, and households for new health insurance participants;
b) Health insurance participant lists of the categories specified in Clause 1, Article 12 of this Law, established by employers within 30 days from the date employees become eligible for health insurance. In cases where participants belong to the categories specified in points b and đ, Clause 1, Article 12 of this Law and self-submit, the application dossier is the declaration form specified in point a of this clause submitted to the social insurance agency within 30 days from the date of being determined as eligible for health insurance;
c) Health insurance participant lists of the categories specified in Clauses 2, 3, 4, and 5, Article 12 of this Law, established by People's Communes according to households, except for the categories specified in points d and đ of this clause;
d) Health insurance participant lists of the categories managed by the Ministry of Education and Training, the Ministry of Labor, Invalids and Social Affairs, and other ministries and sectors specified in point n, Clause 3, point b, Clause 4, Article 12 of this Law, established by educational institutions and vocational training institutions;
đ) Health insurance participant lists of the categories managed by the Ministry of Defense and the Ministry of Public Security specified in points a, c, e, and h, Clause 1, points a, b, c, d, 1, and n, Clause 3, point b, Clause 4, Article 12 of this Law, and the list of the category specified in point i, Clause 1, Article 12 of this Law, established by the Ministry of Defense and the Ministry of Public Security.
2. Within five working days from the date of receiving complete application dossiers as stipulated in Clause 1 of this Article, the social insurance agency must issue health insurance cards to health insurance participants and notify or deliver the cards to the management agencies or entities establishing the participant lists.
3. The Government shall specify the issuance of health insurance cards in both paper and electronic formats."

16. Amend and supplement Article 21 as follows:

"Article 21. Scope of Benefits for Health Insurance Participants
1. Health insurance participants shall be reimbursed by the health insurance fund for the following expenses:
a) Medical examinations, treatments, including remote medical examinations, remote treatment support, family medicine examinations, home medical examinations, rehabilitation, regular prenatal examinations, childbirth;
b) Patient transportation for the categories specified in points a, b, c, d, đ, e, h, i, o, and r, Clause 3, Article 12 of this Law when undergoing inpatient treatment or emergency care requiring transfer to medical facilities specified in Article 27 of this Law;
c) Costs for using medical technical services, medicines, medical equipment, blood, blood products, medical gases, materials, tools, instruments, chemicals used in diagnosis and treatment within the scope of payment by the health insurance fund.
2. The Minister of Health shall prescribe the following contents:
a) Principles and criteria for building the list of medicines, principles for building the list of medical equipment, medical technical services within the scope of benefits for health insurance participants;
b) Issuing the list of medicines, medical equipment, medical technical services within the scope of benefits for health insurance participants based on the principles and criteria prescribed in point a of this clause;
c) Payment ratios for medicines, medical equipment, medical technical services within the scope of benefits for health insurance participants;
d) Levels, conditions, and payment procedures for medicines, medical equipment, medical technical services within the scope of benefits for health insurance participants;
đ) Payment procedures for blood, blood products, medical gases, materials, tools, instruments, chemicals used in diagnosis and treatment within the scope of benefits for health insurance participants.
3. The Government shall prescribe the following contents:
a) Payment procedures for patient transportation costs as prescribed in point b of Clause 1, Article 17 of this Law;
b) Scope of benefits for the subjects prescribed in points a, b, c, d, and đ of Clause 3, Article 12 of this Law;
c) Subjects not subject to the payment ratio prescribed in point c of Clause 2, Article 17 of this Law."

17. Amend and supplement Article 22 as follows:

"Article 22. Level of health insurance benefits for health insurance participants
1. When health insurance participants undergo diagnosis and treatment as prescribed in Articles 26 and 27 of this Law, they shall be reimbursed by the health insurance fund for diagnosis and treatment costs within the scope of benefits at the following levels:
a) 100% of diagnosis and treatment costs for the subjects prescribed in points a, b, c, d, đ, e, h, i, o, r, and s of Clause 3, Article 12 of this Law. Diagnosis and treatment costs outside the scope of health insurance benefits for the subjects prescribed in points a, b, c, d, and đ of Clause 3, Article 12 of this Law shall be paid from the health insurance fund's budget allocated for diagnosis and treatment of this group; if the budget is insufficient, it shall be covered by the state budget;
b) 100% of diagnosis and treatment costs when the cost for one diagnosis and treatment session is lower than the level prescribed by the Government;
c) 100% of diagnosis and treatment costs at primary healthcare facilities, including: health stations; family medicine clinics; military-civilian health stations, military-civilian outpatient clinics; district health centers with outpatient activities licensed under the form of an outpatient clinic; health facilities of agencies, units, organizations prescribed by the Minister of Health; primary healthcare facilities in the military and police prescribed by the Ministers of National Defense and Public Security respectively; 100% of outpatient diagnosis and treatment costs at multi-disciplinary clinics in regions;
d) 100% of diagnosis and treatment costs when patients have continuously participated in health insurance for five years or more and the total amount of co-payment for diagnosis and treatment costs during the year, as prescribed in Clause 3, points a, b, c, đ, and e of Clause 4, Clause 5 of this Article, Articles 26 and 27 of this Law exceeds six times the reference level;
đ) 95% of diagnosis and treatment costs for the subjects prescribed in point a of Clause 2, point k of Clause 3, points a and g of Clause 4, Article 12 of this Law;
e) 80% of diagnosis and treatment costs for other subjects.
2. Participants who belong to multiple categories of health insurance shall enjoy health insurance benefits according to the category with the highest benefits.
3. Individuals who register for initial diagnosis and treatment at specialized and basic-level healthcare facilities but undergo diagnosis and treatment at a different facility due to changes in temporary residence or stay shall be entitled to diagnosis and treatment at a suitable basic-level healthcare facility corresponding to their new place of residence or stay and shall be reimbursed by the health insurance fund as prescribed in Clause 1 of this Article. The Minister of Health shall prescribe the procedures and cases of residence eligible for health insurance diagnosis and treatment as prescribed in this Clause.
4. Health insurance participants who self-register for diagnosis and treatment at a facility other than the initially registered facility, or who do not comply with the patient transfer regulations prescribed in Articles 26 and 27 of this Law, except as provided in Clauses 3 and 5 of this Article, shall be reimbursed by the health insurance fund at the percentage of the benefit level prescribed in Clause 1 of this Article as follows:
a) 100% of the benefit level when undergoing diagnosis and treatment at a basic-level or specialized healthcare facility in cases of confirmed diagnosis, treatment of rare diseases, serious illnesses, surgeries, or high-tech procedures prescribed by the Minister of Health;
b) 100% of the benefit level for ethnic minority people and poor households living in areas with difficult socio-economic conditions, extremely difficult socio-economic conditions, and those living on islands when undergoing inpatient diagnosis and treatment at specialized healthcare facilities;
c) 100% of the benefit level when undergoing diagnosis and treatment at a primary healthcare facility;
d) 100% of the benefit level when undergoing inpatient diagnosis and treatment at a basic-level healthcare facility;
đ) 100% of the benefit level when undergoing diagnosis and treatment at a basic-level or specialized healthcare facility that was designated as a district-level facility before January 1, 2025 by the competent authority;
e) From 50% to 100% of the benefit level when undergoing outpatient diagnosis and treatment at a basic-level healthcare facility based on the results of professional technical classification according to the prescribed schedule and specific reimbursement rate prescribed by the Government, except as provided in points a and đ of this Clause;
g) 40% of the benefit level when undergoing inpatient diagnosis and treatment at a specialized healthcare facility, except as provided in points a, b, đ, and h of this Clause;
h) Fifty percent of the benefit level for outpatient medical examination and treatment according to the schedule prescribed by the Government, and one hundred percent of the benefit level for inpatient medical examination and treatment when receiving medical examination and treatment at a specialized medical facility that was determined by the competent authority to be at the provincial level before January 1, 2025.
5. The insured person shall enjoy one hundred percent of the benefit level prescribed in Clause 1 of this Article when receiving medical examination and treatment at any medical facility in case of emergency.
6. The Government shall provide detailed regulations on the benefit levels for the subjects specified in Points a, b, c, d, and đ of Clause 3 of Article 12 of this Law; and shall prescribe the benefit levels for cases where the insured person uses demand-based medical examination and treatment services and other cases not covered by Clause 1 of this Article.

18. Amend and supplement Clause 7 and Clause 8 of Article 23 as follows:

"7. Treatment of squint and refractive errors of the eye for persons aged eighteen years or older.
8. Use of prosthetic devices including artificial limbs, artificial eyes, dentures, glasses, hearing aids, and mobility aids in medical examination and treatment and rehabilitation."

19. Amend and supplement Article 24 as follows:

"Article 24. Medical facilities providing health insurance medical examination and treatment. A medical facility providing health insurance medical examination and treatment is a medical facility as prescribed by the Law on Medical Examination and Treatment which has entered into a contract for health insurance medical examination and treatment with the social insurance agency as prescribed by the Government."

20. Amend and supplement some Points and Clauses of Article 25 as follows:

a) Amending and supplementing Point e of Clause 2 as follows:

"e) Conditions for changing, terminating, suspending, or ending the contract;"

b) Amend and supplement Clause 3 and Clause 4 as follows:

"3. The agreement on conditions for changing, terminating, suspending, or ending the contract as prescribed in Point e of Clause 2 of this Article must ensure that it does not interrupt the medical examination and treatment of insured persons.
4. The Government shall provide detailed regulations on this matter and prescribe the model contract for health insurance medical examination and treatment."

21. Amend and supplement Article 26 as follows:

"Article 26. Registration for initial health insurance medical examination and treatment
1. Insured persons have the right to register for initial health insurance medical examination and treatment at primary or basic-level medical facilities; they also have the right to change the initial health insurance medical facility within the first fifteen days of each quarter.
2. The allocation of health insurance cards to initial registration medical facilities must ensure balance and suitability with the needs for initial health insurance medical examination and treatment of the population, the capacity of the medical facilities, and the actual situation in the locality.
3. The Minister of Health shall provide detailed regulations on Clause 1 and Clause 2 of this Article; and shall prescribe the cases of registering for initial health insurance medical examination and treatment at specialized medical facilities.
4. The Minister of Public Security and the Minister of National Defense shall prescribe the registration for initial health insurance medical examination and treatment for primary, basic, and specialized medical facilities and insured persons under their jurisdiction."

22. Amend and supplement Article 27 as follows:

"Article 27. Transfer of patients between health insurance medical facilities
1. The transfer of patients between medical facilities shall be carried out based on professional requirements and the capacity of the medical facilities.
2. The Minister of Health shall prescribe the transfer of patients back to the initial health insurance medical facility for treatment, management, and follow-up of chronic diseases, including the use of medications, medical equipment, and medical technical services prescribed according to the professional capacity of the treating, managing, and following-up facility; and shall provide detailed regulations on Clause 1 of this Article, except for the cases prescribed in Clause 3 of this Article.
3. The Minister of Public Security and the Minister of National Defense shall prescribe the transfer of patients under their jurisdiction between health insurance medical facilities under their jurisdiction."

23. Amend and supplement Article 28 as follows:

"Article 28. Procedures for health insurance medical examination and treatment
1. When receiving medical examination and treatment, insured persons must present information about their health insurance card and identity documents; children under six years old and organ donors who have not yet been issued a health insurance card must present other lawful documents. In case of emergency, patients must present information about their health insurance card and the documents stipulated in this Clause before the end of the treatment period. The Government shall provide detailed regulations on this matter.
2. In cases of re-examination required during medical examination and treatment, insured persons may be scheduled for re-examination according to procedures prescribed by the Minister of Health.
3. In cases of transferring to another health insurance medical facility during inpatient treatment due to professional requirements, the transferring medical facility must have a transfer file as prescribed by the Minister of Health."

24. Amend and supplement Article 30 as follows:

"Article 30. Methods of paying medical examination and treatment costs under health insurance
1. Payment of medical examination and treatment costs under health insurance shall be made through the following methods:
a) Payment based on fixed rates;
b) Payment based on service prices;
c) Payment based on diagnostic groups.
2. The Government shall provide detailed regulations on Clause 1 of this Article and prescribe the application of payment methods for medical examination and treatment costs under health insurance."

25. Amend and supplement Article 31 as follows:

"Article 31. Payment of medical examination and treatment costs under health insurance
1. The social insurance agency shall pay medical examination and treatment costs under health insurance to medical facilities according to the health insurance medical examination and treatment contract.
2. The social insurance agency shall directly pay medical examination and treatment costs under health insurance to insured persons holding health insurance cards in the following cases:
a) At medical facilities without a health insurance medical examination and treatment contract;
b) Receiving medical examination and treatment not in accordance with the provisions of Article 28 of this Law;
c) Other special cases prescribed by the Government."
3. In the case where at the time when the patient is prescribed to use medicines, medical devices, or clinical auxiliary services within the scope of payment by the health insurance fund, but the healthcare facility does not have them available and cannot replace them with other medicines, medical devices, or clinical auxiliary services, the healthcare facility is allowed to receive medicines, medical devices transferred from another healthcare facility under the health insurance program for treating the patient, or transfer the patient or biological samples to another facility that meets the conditions to perform clinical auxiliary services. Healthcare facilities under the health insurance program

26. Amend and supplement Article 32 as follows:

"Article 32. Advance payment, settlement, and finalization of costs for health insurance medical examination and treatment
1. The advance payment of funds by the social insurance agency to healthcare facilities under the health insurance program shall be carried out quarterly as follows:
a) Within five working days from the date of receiving the previous quarter's finalization report from the healthcare facility, the social insurance agency shall make a one-time advance payment equal to 90% of the health insurance medical examination and treatment costs reported in the previous quarter's finalization report of the healthcare facility;
b) For healthcare facilities signing their first health insurance medical examination and treatment contract, based on the medical examination and treatment costs of the month before signing the health insurance medical examination and treatment contract, the social insurance agency shall make an advance payment of 90% of the health insurance medical examination and treatment funds for the first month of implementing the contract; after one month of implementing the contract, the social insurance agency shall forecast and make an advance payment of 90% of the health insurance medical examination and treatment funds for the quarter according to point a of this clause;
c) In cases where the advance payment funds for healthcare facilities under the health insurance program in the province exceed the amount of funds used in the quarter, the provincial or centrally-administered municipal social insurance agency shall report to the Vietnam Social Security to replenish the funds.
2. The settlement and finalization between healthcare facilities and the social insurance agency shall be carried out as follows:
a) Within the first fifteen days of each month, healthcare facilities under the health insurance program shall be responsible for sending a consolidated statement requesting the settlement of the previous month's health insurance medical examination and treatment costs to the social insurance agency; within the first fifteen days of each quarter, healthcare facilities under the health insurance program shall be responsible for sending a finalization report of the previous quarter's health insurance medical examination and treatment costs to the social insurance agency;
b) Within thirty days from the date of receiving the previous quarter's finalization report from the healthcare facility, the social insurance agency shall be responsible for notifying the results of the review and the amount of the finalization of health insurance medical examination and treatment costs, including actual medical examination and treatment costs within the scope of benefits and the level of health insurance coverage, to the healthcare facility. For the fourth quarter of the year, the notification period for the results of the review and the amount of the finalization of health insurance medical examination and treatment costs shall not exceed sixty days from the date the social insurance agency receives the fourth quarter's finalization report from the healthcare facility;
c) Within ten days from the date of notifying the amount of the finalization of health insurance medical examination and treatment costs, the social insurance agency must complete the settlement with the healthcare facility;
d) The annual finalization audit of the health insurance fund must be completed before October 1st of the following year.
3. Within forty days from the date of receiving the full payment request documents from health insurance participants as stipulated in Clause 2 of Article 31 of this Law, the social insurance agency must directly settle the health insurance medical examination and treatment costs for these individuals."

27. Amend and supplement Article 35 as follows:

"Article 35. Allocation and utilization of the health insurance fund
1. The health insurance fund shall be allocated and utilized as follows:
a) 92% of the health insurance contributions shall be allocated for medical examination and treatment;
b) 8% of the health insurance contributions shall be allocated for the reserve fund and organizational and operational expenses of health insurance, of which a minimum of 4% of the health insurance contributions shall be allocated for the reserve fund.
2. The investment of temporarily idle funds of the health insurance fund shall be governed by the provisions of the Social Insurance Law regarding the principles, investment portfolio, investment methods, and management of the social insurance fund's investment activities.
3. In cases where the health insurance revenue allocated for medical examination and treatment exceeds the expenditure on medical examination and treatment in the year, the unused portion of the funds shall be fully recorded in the reserve fund for overall regulation.
4. In cases where the health insurance revenue allocated for medical examination and treatment is less than the expenditure on medical examination and treatment in the year, the Vietnam Social Security shall be responsible for replenishing from the reserve fund.
5. The Government shall provide detailed regulations on this matter and regulations on organizational and operational expenses of health insurance."

28. Amend and supplement Clause 2 of Article 36 as follows:

"2. Registering primary healthcare facilities under the health insurance program in accordance with Article 26 of this Law."

29. Amend and supplement Clause 3 of Article 39 as follows:

"3. Delivering the health insurance card or informing about the result of issuing the health insurance card to health insurance participants within three working days from the date of receiving the card or receiving the notification about the result of issuing the health insurance card from the social insurance agency."

30. Amend and supplement Clause 2 of Article 40 as follows:

"2. Inspecting the implementation of health insurance medical examination and treatment contracts; conducting health insurance reviews; recovering or temporarily withholding health insurance cards in cases stipulated in Article 20 of this Law."

31. Amend and supplement Clause 8 of Article 41 as follows:

"8. Inspecting the implementation of health insurance medical examination and treatment contracts; conducting health insurance reviews."

32. Supplement Clause 9 after Clause 8 of Article 43 as follows:

"9. Ensuring the necessary conditions for health insurance medical examination and treatment activities in accordance with the laws on health insurance, laws on medical examination and treatment, and health insurance medical examination and treatment contracts."

33. Supplement Article 48a and Article 48b after Article 48 as follows:

"Article 48a. Late Payment of Health Insurance Contributions

Late payment of health insurance contributions refers to the act of employers in any of the following situations:"
1. Has not paid or has not fully paid the amount of health insurance premium due from the date specified in Clause 8, Article 15 of this Law as the latest payment deadline, except for cases provided for in Point c, Clause 1, Article 48b of this Law;
2. Has not established a list or has established an incomplete list of persons required to participate in health insurance within sixty days from the date of the deadline prescribed in Point b, Clause 1, Article 17 of this Law;
3. Belongs to the case that is not considered as evading health insurance contributions as provided for in Clause 2, Article 48b of this Law.

Article 48b. Evading Health Insurance Contributions
1. Evading health insurance contributions is the act of the employer falling under one of the following circumstances:
a) After sixty days from the date of the deadline prescribed in Point b, Clause 1, Article 17 of this Law, the employer has not established a list or has established an incomplete list of persons required to participate in health insurance;
b) Registers wages as the basis for health insurance contributions lower than the wages stipulated in Article 14 of this Law;
c) Has not paid or has not fully paid the amount of health insurance contributions registered after sixty days from the latest payment deadline prescribed in Clause 8, Article 15 of this Law and has been urged by the competent authority according to the Government's regulations;
d) Other cases considered as evading health insurance contributions as prescribed by the Government.
2. The Government shall provide detailed regulations on this matter; prescribe cases under Clause 1 of this Article but with legitimate reasons, they will not be considered as evading health insurance contributions."

34. Amends and supplements Article 49 as follows:

"Article 49. Handling Violations of Laws on Health Insurance
1. Organizations, individuals who violate laws on health insurance shall be subject to disciplinary action, administrative penalties, or criminal responsibility pursuit, if causing damage, they must compensate according to the law.
2. Measures to handle late payment of health insurance contributions include:
a) Compelling full payment of overdue amounts; paying an amount equal to 0.03%/day calculated on the amount of overdue health insurance contributions and the number of overdue days into the health insurance fund;
b) Administrative penalty according to the law;
c) Not considering for commendation titles or awards.
3. Measures to handle evasion of health insurance contributions include:
a) Compelling full payment of evaded amounts; paying an amount equal to 0.03%/day calculated on the amount of evaded health insurance contributions and the number of evaded days into the health insurance fund;
b) Administrative penalty or criminal responsibility pursuit according to the law;
c) Not considering for commendation titles or awards.
4. Organizations, employers who delay or evade health insurance contributions for employees must refund all costs of medical examination and treatment within the scope of health insurance benefits and entitlements that employees have paid during the period without a health insurance card due to delayed or evaded health insurance contributions.
5. The Government shall provide detailed regulations on Point a, Clause 2, Point a, Clause 3, and Clause 4 of this Article."

35. Replaces phrases at some points and clauses as follows:

a) Replaces the phrase "health insurance organization" with the phrase "social insurance agency" in Clause 3 and Clause 6, Article 2, Clause 2 and Clause 4, Article 7c, Clause 3, Article 18, Clause 3, Article 19, Clause 1, Article 25, Clause 3, Article 29, Clause 1, Article 34, Clause 4 and Clause 5, Article 36, Clause 4, Article 37, Clause 1, Article 38, Clause 4, Article 39, the name of Article and Clause 5, Article 40, the name of Article 41, Clause 1 and Clause 2, Article 42, Clauses 2, 3 and 4, Article 43, Clause 1, Article 44, Point c, Clause 1, Article 48;

b) Replaces the phrase "Vietnam Social Security Management Council" with the phrase "Social Security Management Council" in Clause 1, Article 34.

Article 2. Amend and supplement Law on Forces Participating in Security and Order Protection at the Grassroots Level No. 30/2023/QH15

Repeal Clause 2 of Article 32 of Law on Forces Participating in Security and Order Protection at the Grassroots Level No. 30/2023/QH15.

Article 3. Implementation Provisions

1. This Law shall take effect from July 1, 2025, except for the provisions of Clause 2 and Clause 3 of this Article.

2. The provisions related to technical professional levels in medical examination and treatment, registration for initial medical examination and treatment under health insurance, transfer of patients between health facilities providing medical examination and treatment under health insurance, and procedures for medical examination and treatment under health insurance as stipulated in Clauses 3, 16, 17, 21, 22, 23, and 28 of Article 1 of this Law shall take effect from January 1, 2025.

3. The provisions regarding the scope of benefits as stipulated in Clause 16 of Article 1 of this Law, excluding the provisions on remote medical examination and treatment, support for remote medical examination and treatment, family medicine medical examination and treatment, home-based medical examination and treatment, and principles for compiling the list of medical equipment and technical services within the scope of benefits for health insurance participants, and the provisions regarding the level of benefit as stipulated in Clause 17 of Article 1 of this Law shall be applicable to the following cases and shall take effect from January 1, 2025:

a) Subjects as stipulated in Clause 10 of Article 1 of this Law, where such subjects have been defined in Article 12 of the Health Insurance Law No. 25/2008/QH12, which has been amended and supplemented by Laws No. 32/2013/QH13, No. 46/2014/QH13, No. 97/2015/QH13, No. 35/2018/QH14, No. 68/2020/QH14, and No. 30/2023/QH15,

b) Subjects as stipulated in point a of this clause who undergo medical examination and treatment at health facilities before January 1, 2025 and conclude their treatment period from January 1, 2025.

4. By no later than January 1, 2027, implement interoperability and utilize interlinked diagnostic results among health facilities providing medical examination and treatment under health insurance in accordance with professional requirements as prescribed by the Government.

5. Transitional provisions:

a) In the case where patients not falling under the subjects specified in points a and b of Clause 3 of this Article undergo medical examination and treatment at health facilities before July 1, 2025 and conclude their treatment period from July 1, 2025, this Law shall apply;

b) The reference level stipulated in this Law shall be based on the minimum wage. In cases where salary policies change, the Government shall decide on specific reference levels;

c) Medical examination and treatment health insurance contracts signed before July 1, 2025 that remain valid after July 1, 2025 shall be implemented according to the regulations of the Government;

d) For the amount of health insurance that employers are responsible for paying according to the Health Insurance Law No. 25/2008/QH12, which has been amended and supplemented by Laws No. 32/2013/QH13, No. 46/2014/QH13, No. 97/2015/QH13, No. 35/2018/QH14, No. 68/2020/QH14, and No. 30/2023/QH15 but remains unpaid or not fully paid by June 30, 2025, shall be handled according to the late payment provisions of this Law.

This Law was passed by the National Assembly of the Socialist Republic of Vietnam, 15th term, 8th session, on November 27, 2024.