Decree No. 74/2025/NĐ-CP amends and supplements some articles of Decree No. 70/2015/NĐ-CP dated September 1, 2015, of the Government detailing and guiding the implementation of certain provisions of the Health Insurance Law concerning the People's Army, the People's Public Security, and personnel engaged in confidential work.

DECREE

Amending and supplementing certain Articles of Decree No. 70/2015/NĐ-CP

dated September 1, 2015 of the Government detailing and guiding the implementation of certain provisions of the Health Insurance Law for the People's Army, the People's Public Security, and personnel engaged in confidential work

implement certain Articles of the Health Insurance Law for the People's Army,

the People's Public Security Force and persons engaged in cryptographic work

Pursuant to the Government Organization Law on February 18, 2025;

Pursuant to the Health Insurance Law on November 14, 2008; the Law amending and supplementing certain provisions of the Health Insurance Law on June 13, 2014 and the Law amending and supplementing certain provisions of the Health Insurance Law on November 27, 2024;

At the proposal of the Minister of National Defense,

The Government promulgates this Decree amending and supplementing certain provisions of Decree No. 70/2015/NĐ-CP dated September 1, 2015 of the Government detailing and guiding the implementation of certain provisions of the Health Insurance Law for the People's Army, the People's Public Security, and personnel engaged in confidential work.

Article 1. Amending and supplementing certain provisions of Decree No. 70/2015/NĐ-CP dated September 1, 2015 of the Government detailing and guiding the implementation of certain provisions of the Health Insurance Law for the People's Army, the People's Public Security, and personnel engaged in confidential work

1. Amend and supplement Article 1 as follows:

"Article 1. Scope of Regulation

1. This Decree details and guides the implementation of certain provisions of the Health Insurance Law No. 25/2008/QH12 dated November 14, 2008, which has been amended and supplemented by Law No. 46/2014/QH13 dated June 13, 2014 and Law No. 51/2024/QH15 dated November 27, 2024 (hereinafter referred to collectively as the Health Insurance Law) for the subjects specified in points a, b, c, d, and đ Clause 3, Article 12 of the Health Insurance Law, including the following contents: Contribution levels, contribution obligations, and contribution methods for health insurance; health insurance cards; scope of benefits, benefit levels of health insurance, and reimbursement of transportation costs for patients undergoing inpatient treatment or emergency care requiring transfer to another healthcare facility; health insurance medical examination and treatment; management and utilization of funds allocated for health insurance medical examination and treatment; health insurance review; health insurance payment and settlement; payment and settlement of health insurance medical examination and treatment costs for subjects as stipulated in point c, Clause 4, Article 31 of the Health Insurance Law.

2. The health insurance fund ensures regular medical examination and treatment for the subjects specified in Clauses 1, 2, 3, and 4 of Article 2 of this Decree. The state budget guarantees the cost of medical examination and treatment outside the scope covered by the health insurance fund in remote coastal areas.

Other tasks related to military medicine, health of the army, public security, and confidential work shall be carried out in accordance with the regulations of the Government on material standards for logistics support for military personnel, public security personnel, and personnel engaged in confidential work.

3. Ensuring health care for combat readiness, natural disasters, epidemics classified as Group A, or emergency situations and wartime for the army, public security, and confidential work shall be implemented in accordance with relevant laws.

2. Amending and supplementing Article 2 as follows:

"Article 2. Scope of Application

1. Persons participating in health insurance under the Ministry of National Defense include:

a) Officers and professional soldiers of the People's Army who are currently serving;

b) Non-commissioned officers and conscripts of the People's Army who are currently serving, and cadets receiving subsistence allowances who are Vietnamese citizens;

c) Cadets undergoing reserve officer training for three months or more who have not participated in social insurance or health insurance;

d) Cadets receiving subsistence allowances who are foreign nationals.

2. Persons participating in health insurance under the Ministry of Public Security include:

a) Officers and non-commissioned officers in operational roles and officers and non-commissioned officers in technical roles currently working in the public security forces;

b) Non-commissioned officers and conscripts in the public security forces;

c) Students at the Public Security Academy receiving subsistence allowances who are Vietnamese citizens;

d) Students at the Public Security Academy receiving subsistence allowances who are foreign nationals.

3. Personnel engaged in confidential work participating in health insurance include:

a) Personnel engaged in confidential work receiving salaries equivalent to those of military personnel currently working at the Government Confidential Service Bureau;

b) Students engaged in confidential work receiving subsistence allowances who are Vietnamese citizens;

c) Personnel engaged in confidential work receiving salaries equivalent to those of military personnel currently working at confidential organizations under various Ministries, sectors, and localities except the Ministry of National Defense and the Ministry of Public Security;

d) Students engaged in confidential work receiving subsistence allowances who are foreign nationals.

4. Full-time Militia.

5. Agencies and units under the Ministry of National Defense, the Ministry of Public Security, and the Government Confidential Service Bureau; agencies and organizations involved in implementing health insurance for the People's Army, the People's Public Security, and personnel engaged in confidential work and the people as stipulated in point c, Clause 4, Article 31 of the Health Insurance Law.

3. Amending and supplementing Clause 1 of Article 4 as follows:

"1. The monthly health insurance contribution rate is determined based on a percentage of the salary used as the basis for mandatory social insurance contributions according to the Social Insurance Law or the reference level prescribed by the Health Insurance Law, specifically:

a) 4.5% of the monthly salary for the subjects specified in point a, Clause 1, point a, Clause 2, point a, and point c, Clause 3 of Article 2 of this Decree;

b) 4.5% of the reference level for the subjects specified in points b, c, and đ, Clause 1, points b, c, and d, Clause 2, points b and d, Clause 3, and Clause 4 of Article 2 of this Decree;

c) 4.5% of the reference level for the subjects specified in point a, Clause 1, point a, Clause 2, point a, and point c, Clause 3 of Article 2 of this Decree when they take leave due to illness for 14 working days or more in a month or take maternity leave for 14 working days or more in a month according to the laws on social insurance.

4. Amending and supplementing Article 5 as follows:

"Article 5. Obligations for Contributions and Methods of Payment for Health Insurance

1. The state budget shall fully cover the funding for health insurance contributions for the subjects specified in Clauses 1, 2, 3, and 4 of Article 2 of this Decree according to the current budget allocation system. The management, use, and settlement of health insurance contribution funds shall be carried out in accordance with the laws on the state budget.

2. Each year, ministries, ministerial-level agencies, and local agencies shall prepare the budget for health insurance contributions for the managed subjects as stipulated in Article 2 of this Decree, to be included in their unit's state budget proposal and submitted to the financial authority at the same level in accordance with the State Budget Law and the implementing regulations thereof.

3. Annually, the Military Social Insurance, the People's Public Security Social Insurance, and the Social Insurance of provinces and centrally governed cities shall aggregate the amount of health insurance contributions according to the cases specified at point c, Clause 1, Article 4 of this Decree and send them to the Vietnam Social Insurance to ensure the funding for health insurance contributions.

4. The management, utilization, and settlement of the collected and paid health insurance premiums in accordance with the laws on health insurance and related laws:

a) Before the last day of the first month of each quarter, the agencies and units managing the subjects according to their classification level shall implement the payment of health insurance premiums for the previous quarter at the contribution rate stipulated by the Military Social Insurance, the People's Public Security Social Insurance, and the Social Insurance of provinces and centrally governed cities;

b) Annually, the Military Social Insurance is responsible for reporting and settling the portion of collected and paid health insurance premiums of the subjects specified in Clause 1 and points a, b, and d, Clause 3, Article 2 of this Decree; the People's Public Security Social Insurance is responsible for reporting and settling the portion of collected and paid health insurance premiums of the subjects specified in Clause 2, Article 2 of this Decree; the Social Insurance of provinces and centrally governed cities is responsible for reporting and settling the portion of collected and paid health insurance premiums of the subjects specified in point c, Clause 3, and Clause 4, Article 2 of this Decree to the Vietnam Social Insurance.

5. The subjects specified in points a, b, and c of Clauses 1, 2, and 3, Article 2 of this Decree, when sent abroad for study or work, are exempt from paying health insurance premiums; the time during which they are not required to pay health insurance premiums will be counted as the period of participation in health insurance until the date of the decision to return issued by the sending agency or organization.

5. Amend and supplement point c, Clause 1 and Clause 2, Article 6 as follows:

a) Amend and supplement point c, Clause 1, Article 6 as follows:

"c) The model and blank cards of health insurance of the subjects specified in point c, Clause 3 and Clause 4, Article 2 of this Decree shall be issued and managed by the Vietnam Social Insurance."

b) Amend and supplement Clause 2, Article 6 as follows:

"2. Health insurance cards issued by the Military Social Insurance and the People's Public Security Social Insurance have a maximum validity period of no more than 60 months, specifically as follows:

a) For the subjects specified in Clauses 1, 2, and 3, Article 2 of this Decree participating in health insurance for the first time, the health insurance card has a validity period starting from the date they become eligible for health insurance contributions.

When the subjects specified in Clauses 1, 2, and 3, Article 2 of this Decree cease service in the military, public security, or cryptology or transfer to another category according to the decision of the competent authority, the health insurance card remains valid until the last day of the month they cease service or transfer to another category and the cases specified in Clause 2, Article 9 of this Decree.

In case the competent authority extends the term of service or sends them for training, the validity period of the card will be extended to the end of the extended service or training period.

b) The health insurance cards of military students, public security students, and cryptology students receiving living expenses who are Vietnamese citizens have a validity period from the date of enrollment to December 31 of the graduation year at military, public security, and cryptology schools.

c) The health insurance cards of foreign military students, public security students, and cryptology students receiving living expenses have a validity period from the date they become eligible for health insurance contributions to the end of their study or work period at military, public security, and cryptology institutions."

6. Amend and supplement Article 7 as follows:

"Article 7. Issuance of health insurance cards

1. Health insurance cards of the subjects specified in Clauses 1, 2, 3, and 4, Article 2 of this Decree shall be issued by the Military Social Insurance, the People's Public Security Social Insurance, or the Social Insurance of provinces and centrally governed cities according to the subject management. The Military Social Insurance and the People's Public Security Social Insurance issue health insurance cards to participants in both paper and electronic form, both having equal legal validity.

The timing for issuing electronic health insurance cards is determined by the Minister of National Defense.

2. The dossier and timeframe for issuing health insurance cards shall be implemented in accordance with Article 17 of the Health Insurance Law and the regulations of the Government.

3. Procedures for issuing health insurance cards within the Ministry of National Defense:

a) Within thirty days from the date the subject becomes eligible for health insurance, the unit responsible for management must complete the issuance of health insurance cards for specific subjects.

Within five working days from the date the subject becomes eligible for health insurance, the unit responsible for management must guide the subject to fill out the health insurance registration form, check its legality and accuracy, compile a list of health insurance participants in the unit along with electronic data, and submit a written request to the personnel unit at the brigade level or equivalent. If the registration form is not valid, the direct management unit must guide the subject to complete it according to regulations.

Within five working days from the date of receipt of the application dossier from the direct management unit, the brigade-level or equivalent unit must submit a written request and list along with electronic data to the personnel unit at the division level or equivalent.

Within five working days from the date of receipt of the written request from the brigade-level or equivalent unit along with the list of health insurance participants and valid registration forms, the division-level or equivalent unit must compile a report and submit it to the personnel unit under the direct control of the Ministry of National Defense for management, while also submitting a written request for health insurance cards along with the list and electronic data file to the Military Social Insurance.

Within five working days from the date of receipt of the complete dossier, the Military Social Insurance must issue health insurance cards and deliver them to the units for the participants; if the cards are not issued, the Military Social Insurance must provide a written response to the unit explaining the reasons.

b) The dossier for issuing health insurance cards can be submitted directly, through military postal services, or via military data transmission to the Military Social Insurance.

c) In health insurance cards in cases where individuals switch from being part of a different group covered under this Decree to those specified in Clause 1 and Point a, Point b, Clause 3, Article 2 of this Decree, shall be carried out as follows: Upon receipt, the unit shall guide the declaration and list for issuing health insurance cards, report to the division equivalent to a corps-level unit for consolidation and transfer to the Military Social Insurance Fund along with the old health insurance card (if any) for recovery. The new health insurance card will have a usage period starting from the date the recruitment, selection, promotion, or transfer decision of the competent authority becomes effective.

d) In cases of issuing health insurance cards for the second time onwards, it shall be carried out as follows: Thirty days before the expiration date of the current health insurance card, the division equivalent to a corps-level unit shall be responsible for sending a document to the Military Social Insurance Fund requesting extension and printing of the card. Within five working days from the date of receiving the request, the Military Social Insurance Fund shall print the card and send the list back to the unit. If the card is not issued, a written response must be provided with clear reasons.

đ) Every six months or annually, agencies and units shall compile reports on the results of issuing, managing, and using health insurance cards according to the prescribed procedures and submit them to the Military Social Insurance Fund.

4. Procedures for issuing health insurance cards within the Ministry of Public Security:

a) Within thirty days from the date when the individual becomes eligible for health insurance coverage, the directly managing unit shall guide the individual to fill out the initial health insurance registration form, send it to the organizational personnel department of the provincial public security agency or a subordinate unit of the Ministry of Public Security for consolidation and preparation of a list to request issuance of health insurance cards to the Police Social Insurance Fund, accompanied by electronic data and a request letter. If the directly managing unit has been delegated authority, it shall prepare the list and send it to the Police Social Insurance Fund, accompanied by electronic data and a request letter.

b) For the issuance of health insurance cards for the second time onwards, it shall be carried out as follows: Thirty days before the expiration date of the current health insurance card, the directly managing unit shall be responsible for reviewing and updating information and implementing the provisions stipulated in Point a of this clause.

c) Within five working days from the date of receiving complete files as prescribed, the Police Social Insurance Fund shall issue health insurance cards and send them to the requesting unit for distribution to the individuals. If the card is not issued, a written response must be provided with clear reasons.

d) Health insurance card application files shall be sent directly, through postal service, or via internal electronic channels to the Police Social Insurance Fund.

đ) Immediately upon receiving individuals switching from another group to those specified in Clause 2, Article 2 of this Decree, the directly managing unit shall guide the declaration and preparation of a list for issuing health insurance cards and implement the provisions stipulated in Point a of this clause, accompanied by the old health insurance card (if any) for recovery and issuance of a new health insurance card. The new health insurance card will have a usage period starting from the date the recruitment or transfer decision of the competent authority becomes effective.

5. Provincial Social Insurance Funds shall issue health insurance cards to individuals specified in Point c, Clause 3, and Clause 4, Article 2 of this Decree according to the provisions of the Law on Health Insurance.

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

a) Amend and supplement Clause 2 of Article 8 as follows:

"2. The replacement of health insurance cards shall be carried out in accordance with the provisions of Article 19 of the Law on Health Insurance.

In cases where insured persons are transferred to work in areas with difficult economic and social conditions, extremely difficult areas, or island communes and counties and vice versa, they may replace their health insurance cards."

b) Supplement Clause 3 of Article 8 as follows:

"3. Documents, procedures for reissuing and replacing health insurance cards

When individuals require reissuing or replacing health insurance cards, the management unit authorized to manage shall be responsible for guiding the individuals to submit a request, while preparing a list accompanied by electronic data and a request letter to be sent to the social insurance agency.

The procedures for reissuing and replacing health insurance cards shall be carried out in accordance with the provisions of Clause 3 and Clause 4 of Article 7 of this Decree. Within seven working days from the date of receiving complete files as prescribed, the Military Social Insurance Fund, the Police Social Insurance Fund, and the Provincial Social Insurance Funds must reissue or replace the health insurance cards; if reissuance or replacement is not carried out, these funds must provide a written response with clear reasons. During the waiting period for reissuance or replacement of health insurance cards, insured individuals shall follow the provisions of Clause 5, Article 15 of this Decree when seeking medical treatment and shall enjoy full health insurance benefits.

8. Amend the name of Article 9 and supplement Clause 4 of Article 9 as follows:

a) Amend the name of Article 9 as follows:

"Article 9. Management, Recovery, and Temporary Seizure of Health Insurance Cards".

b) Supplement Clause 4 of Article 9 as follows:

"4. Management of health insurance cards:

a) For individuals specified in Point a, Clause 1, Point a, and Point c, Clause 3, Article 2 of this Decree, the following shall apply: The military medical office shall establish a registration book and monitor individuals seeking medical treatment according to regulations;

b) For other individuals specified in Clause 1 and Clause 3, Article 2 of this Decree, excluding those assigned to study at non-military schools, the following shall apply: The military medical office of the managing unit; if the unit does not have a medical office, the head of the directly managing unit shall designate a person to manage the health insurance cards. When there is a need for medical treatment, the managing unit shall hand over the health insurance card to the individual for use. After completing the medical treatment session, the individual shall be responsible for reporting the results and returning the health insurance card to the unit for management;

c) For individuals specified in Point c, Clause 3, and Clause 4, Article 2 of this Decree, the management of health insurance cards shall be carried out according to the regulations of the province or centrally-administered city and local social insurance agencies regarding the management of health insurance cards.".

9. Amend and supplement Clause 1 and Clause 2 of Article 10 as follows:

a) Amend and supplement Clause 1 of Article 10 as follows:

"1. The scope of health insurance coverage for the subjects specified in Clauses 1, 2, 3, and 4 of Article 2 of this Decree shall be implemented in accordance with the provisions of Article 21 of the Health Insurance Law."

b) Amend and supplement Clause 2 of Article 10 as follows:

"2. In addition to the scope of health insurance coverage prescribed in Clause 1 of this Article, the subjects specified in Clauses 1, 2, 3, and 4 of Article 2 of this Decree shall also be reimbursed for medical examination and treatment costs as provided for in Article 22 of the Health Insurance Law, including: medicines, chemicals, medical equipment permitted for circulation in Vietnam, and medical technical services approved by competent authorities according to professional indications and not falling within the cases prescribed in Article 23 of the Health Insurance Law."

10. Amend and supplement Article 11 as follows:

"Article 11. Level of health insurance benefits:

1. The subjects specified in Clauses 1, 2, 3, and 4 of Article 2 of this Decree shall have the health insurance fund pay 100% of the costs of medical examinations and treatments within the scope prescribed in this Decree's Article 10, without applying the payment ratio and level as prescribed in Point c and d, Clause 2 of Article 21 of the Health Insurance Law in the following cases:

a) Medical examinations and treatments conducted in compliance with Articles 26 and 27 of the Health Insurance Law;

b) Inpatient medical examinations and treatments at specialized medical facilities for the subjects specified in Point b, Clause 4 of Article 22 of the Health Insurance Law;

c) Medical examinations and treatments at primary-level medical facilities; inpatient medical examinations and treatments at basic-level medical facilities;

d) Medical examinations and treatments at basic-level or specialized medical facilities that were determined as district-level facilities before January 1, 2025 by competent authorities; inpatient medical examinations and treatments at specialized medical facilities that were determined as provincial-level facilities before January 1, 2025 by competent authorities;

đ) Cases where individuals travel for work, study, or leave on vacation and receive medical examinations and treatments at convenient and suitable health insurance medical facilities;

2. The subjects specified in Clauses 1, 2, and 3 of Article 2 of this Decree under the management of the Central Government, the Ministry of National Defense, the Ministry of Public Security, or provinces/cities directly under the Central Government shall, in addition to health insurance benefits, be subject to regulations of the Central Government, the Ministry of National Defense, the Ministry of Public Security, or provinces/cities directly under the Central Government;

3. The subjects specified in Clauses 1, 2, 3, and 4 of Article 2 of this Decree who self-register for medical examinations and treatments at non-designated primary medical facilities and in violation of the regulations on transferring medical facilities shall have their health insurance fund reimburse them according to the scope of benefits prescribed in this Decree's Article 10, without applying the payment ratio and level for certain medicines, chemicals, medical equipment, and medical technical services as prescribed by the Minister of Health in Point c and d, Clause 2 of Article 21 of the Health Insurance Law, with the following levels of reimbursement:

a) 100% of the costs of medical examinations and treatments at basic or specialized medical facilities for confirmed diagnoses, treatment of certain dangerous diseases, serious illnesses, or surgeries requiring high-tech procedures as prescribed by the Minister of Health or based on mission requirements;

b) From January 1, 2025, when receiving outpatient medical examinations and treatments at basic medical facilities scoring below 50 points or not yet scored, health insurance participants shall have their health insurance fund reimburse 100% of the costs of medical examinations and treatments, except for the cases stipulated in Point d of this Clause;

c) From July 1, 2026, when receiving outpatient medical examinations and treatments at basic medical facilities scoring from 50 to less than 70 points, health insurance participants shall have their health insurance fund reimburse 50% of the costs of medical examinations and treatments;

đ) From July 1, 2026, when receiving outpatient medical examinations and treatments at basic medical facilities that were determined as provincial-level or central-level facilities or equivalent to provincial-level or central-level facilities before January 1, 2025 by competent authorities, health insurance participants shall have their health insurance fund reimburse 50% of the costs of medical examinations and treatments;

đ) From July 1, 2026, when receiving outpatient medical examinations and treatments at specialized medical facilities that were determined as provincial-level facilities or equivalent to provincial-level facilities before January 1, 2025 by competent authorities as prescribed in Point h, Clause 4 of Article 22 of the Health Insurance Law, health insurance participants shall have their health insurance fund reimburse 50% of the costs of medical examinations and treatments;

e) 40% of the costs of inpatient medical examinations and treatments at specialized medical facilities, except for the cases stipulated in Points b and d, Clause 1 of this Article and Point a of this Clause;

g) The remaining portion of the costs of medical examinations and treatments prescribed in Clause 3 of this Article (if any) shall be paid by the patient to the medical facility;

4. For cases where health insurance participants seek medical examinations and treatments on demand:

a) The health insurance fund shall pay the costs of medical examinations and treatments within the scope prescribed in Clause 1 of Article 21 of the Health Insurance Law and the benefit level as prescribed in Article 22 of the Health Insurance Law. The difference between the price of on-demand medical examination and treatment services and the health insurance fund's payment level shall be borne by the patient and paid to the medical facility;

b) Medical facilities shall ensure human resources, professional conditions, medical equipment, and service supply capacity in accordance with the health insurance medical examination and treatment contracts signed with social insurance agencies and publicly disclose the expenses that patients must pay outside the scope of benefits, the level of health insurance benefits, the cost difference, and must notify the patient in advance;

5. Transportation Costs

a) The health insurance fund shall cover transportation costs for the subjects specified in Clauses 1, 2, 3, and 4 of Article 2 of this Decree in cases where they are undergoing inpatient treatment or emergency care and need to transfer to another medical facility according to professional indications or mission requirements.

b) The level of payment for transportation costs for the subjects specified in Clauses 1, 2, 3, and 4 of Article 2 of this Decree shall be implemented according to the provisions of Government Decree No. 146/2018/NĐ-CP dated October 17, 2018, detailing and guiding methods for implementing certain articles of the Health Insurance Law, which has been amended and supplemented with some articles by Government Decrees No. 75/2023/NĐ-CP dated October 19, 2023, and No. 02/2025/NĐ-CP dated January 1, 2025.

c) The transportation of subjects specified in Article 2 of this Decree who are injured or ill in marine islands, remote, and mountainous areas by military aircraft shall be reimbursed from the state budget and carried out according to the regulations of the Minister of National Defense.

"11. Amend and supplement Clause 2 of Article 15 as follows:"

"2. In cases of business trips, study, leave, in addition to the provisions of Clause 1 of this Article, the patient must present a dispatch letter for a business trip or a notification of enrollment or a leave certificate or an introduction letter from a unit head at the brigade level or higher, at the latest before being discharged from the hospital."

12. Supplement Clause 4 and Clause 5 of Article 16 as follows:

"4. The competent authority responsible for ranking technical expertise levels for medical examination and treatment facilities under the management of the Ministry of National Defense and the Ministry of Public Security shall publicly disclose the list of medical examination and treatment facilities ranked with their scores on the electronic portal of the Ministry of National Defense and the Ministry of Public Security and on the information system for managing medical examination and treatment activities.

5. Medical examination and treatment facilities shall publicly disclose the results of ranking technical expertise levels with their scores on their electronic website and at the reception area for patients."

13. Amend and supplement Clause 2 and Clause 3 of Article 17 as follows:

a) Amend and supplement Clause 2 of Article 17 as follows:

"2. The Military Social Insurance and the Social Insurance for People's Police shall organize health insurance examinations for insured persons participating in health insurance when they seek medical examination and treatment at medical examination and treatment facilities that have signed contracts for health insurance medical examination and treatment with the Military Social Insurance and the Social Insurance for People's Police, and send the examination results for those not under the management of the Ministry of National Defense and the Ministry of Public Security to the Vietnam Social Insurance."

b) Amend and supplement Clause 3 of Article 17 as follows:

"3. Provincial and municipal social insurances shall examine health insurance for the subjects specified in Clauses 1, 2, 3, and 4 of Article 2 of this Decree when they seek medical examination and treatment at medical examination and treatment facilities that have signed contracts for health insurance medical examination and treatment with provincial and municipal social insurances, and report the examination results to the Vietnam Social Insurance."

14. Amend and supplement Clause 1, Point c Clause 3, and Clause 4 of Article 18 as follows:

a) Amend and supplement Clause 1 of Article 18 as follows:

"1. The method of paying medical examination and treatment costs under health insurance for the subjects specified in Article 2 of this Decree shall be implemented according to the laws on health insurance."

b) Amend and supplement Point c Clause 3 of Article 18 as follows:

"c) Quarterly, based on the settlement reports of medical examination and treatment costs under health insurance of the previous quarter for the subjects specified in Clauses 1, 2, 3, and 4 of Article 2 of this Decree, the Military Social Insurance, the Social Insurance for People's Police, and provincial and municipal social insurances shall temporarily advance funds for medical examination and treatment under health insurance for medical examination and treatment facilities that have signed contracts for health insurance medical examination and treatment with the Military Social Insurance, the Social Insurance for People's Police, and provincial and municipal social insurances."

c) Amend and supplement Clause 4 of Article 18 as follows:

"4. Settlement of medical examination and treatment costs under health insurance for the Vietnam Social Insurance

a) Annually, provincial and municipal social insurances shall compile the medical examination and treatment costs of the subjects specified in Clauses 1, 2, 3, and 4 of Article 2 of this Decree when they seek medical examination and treatment at medical examination and treatment facilities that have signed contracts for health insurance medical examination and treatment with provincial and municipal social insurances, and report the settlement to the Vietnam Social Insurance;

b) Annually, the Military Social Insurance and the Social Insurance for People's Police shall compile and submit to the Vietnam Social Insurance the settlement data of medical examination and treatment costs under health insurance for the subjects specified in Clauses 1, 2, and Points a, b, and d of Clause 3 of Article 2 of this Decree when they seek medical examination and treatment at medical examination and treatment facilities that have signed contracts for health insurance medical examination and treatment with the Military Social Insurance and the Social Insurance for People's Police; direct payment medical examination and treatment costs under health insurance reported by provincial and municipal social insurances for multi-level claims; direct payment medical examination and treatment costs under health insurance; and initial health care costs at military units, agency health services, and medical examination and treatment facilities assigned the task of providing initial health care."

15. Amend and supplement Clause 1, Clause 4, and supplement Clause 6 of Article 19 as follows:

a) Amend and supplement Clause 1 of Article 19 as follows:

"1. Direct payments shall be made according to the provisions of Clause 2 of Article 31 of the Health Insurance Law and the regulations of the Government or cases not covered by the provisions of Articles 10 and 11 of this Decree."

b) Amend and supplement Clause 4 of Article 19 as follows:

"4. Level of direct payment

a) In cases of seeking medical examination and treatment in accordance with Articles 26 and 27 of the Health Insurance Law at medical examination and treatment facilities with health insurance medical examination and treatment contracts: Payment shall be made within the scope and level of health insurance benefits as stipulated in Articles 10 and 11 of this Decree;

b) In cases where patients seek medical examination and treatment at medical examination and treatment facilities without health insurance medical examination and treatment contracts except in emergency situations, the provisions of the Government shall apply."

c) Supplement Clause 6 of Article 19 as follows:

"6. In the case where the patient is an object under the management of the Ministry of National Defense or the Ministry of Public Security as stipulated in Article 2 of this Decree and receives inpatient treatment at healthcare facilities not managed by the Ministry of National Defense or the Ministry of Public Security, such patients shall be guaranteed the difference between the medical meal allowance and the basic infantry meal allowance or the basic meal allowance prescribed by laws on material standards for logistics support for military personnel and public security officers. The agency or unit managing the object shall directly settle the medical meal allowance difference for the patient based on the actual number of days of hospitalization confirmed in the discharge certificate."

16. Supplement Article 19a as follows:

"Article 19a. Medical examination, treatment, and settlement of costs for health insurance medical examination and treatment for objects specified in Article 2 of this Decree at healthcare facilities in border areas, island areas, and particularly difficult communes and villages

1. Settlement of costs for health insurance medical examination and treatment for objects specified in Article 2 of this Decree at healthcare facilities in border areas, island areas, and particularly difficult communes and villages that have signed health insurance contracts shall be implemented in accordance with the provisions of the Health Insurance Law and Articles 18 and 19 of this Decree.

2. Settlement of costs for health insurance medical examination and treatment for objects specified in Article 2 of this Decree at healthcare facilities in border areas, island areas, and particularly difficult communes and villages that have not signed health insurance contracts:

a) Healthcare facilities in border areas, particularly difficult communes and villages, and near-shore islands shall be responsible for conducting medical examinations and treatments for objects specified in Article 2 of this Decree;

b) Social Insurance agencies shall directly settle the costs for medical examinations and treatments and transportation expenses according to the provisions of the Health Insurance Law and Articles 18 and 19 of this Decree. The transfer of patients shall be carried out in accordance with the provisions of Article 11 of this Decree.

3. Settlement of costs for health insurance medical examination and treatment for objects specified in Article 2 of this Decree at healthcare facilities in far-off island areas that have not signed health insurance contracts:

a) Healthcare facilities of the Ministry of National Defense and localities in far-off island areas shall be responsible for conducting medical examinations and treatments for military forces and civilians working, studying, and living in these areas;

b) The funding for medical examinations and treatments for military personnel and civilians working, studying, and living in far-off island areas shall be extracted from the income from health insurance medical examinations and treatments of these objects. The annual amount of funding for medical examinations and treatments shall be 92% of the health insurance income of military personnel and civilians working, studying, and living in far-off island areas who participate in health insurance. If the extracted funds are insufficient to cover medical examinations and treatments, the State budget shall ensure the shortfall;

c) Each year, the Social Insurance provincial branch or municipal branch under the central government shall prepare a budget for health insurance income and extract funds from the health insurance income of civilians working, studying, and living in far-off island areas as stipulated in subpoint b of this clause and send it to the Vietnam Social Insurance for transferring funds to the Ministry of National Defense;

d) The Ministry of National Defense shall use the funds for medical examinations and treatments for military personnel and civilians as stipulated in subpoint b of this clause to purchase medicines and medical equipment and distribute them to healthcare facilities in far-off island areas; consolidate and settle the transferred funds into the medical examination and treatment fund. The Minister of National Defense shall decide on the content, level, mechanism for use, and settlement of medicines and medical equipment distributed to healthcare facilities in far-off island areas;

đ) Transportation costs for patients from healthcare facilities in far-off island areas back to the mainland as stipulated in subpoint c of Clause 5, Article 11 of this Decree shall be covered by the State budget."

17. Amend and supplement Article 20 as follows:

"Article 20. Allocation and Management of Health Insurance Income

1. The total health insurance income of objects specified in Clauses 1, 2, and 3 of Article 2 of this Decree under the management of the Ministry of National Defense and the Ministry of Public Security shall be allocated and managed as follows:

a) 92% of the health insurance premium shall be allocated for medical examination and treatment (hereinafter referred to as the medical examination and treatment fund) and managed and used by the Military Social Insurance and the Public Security Social Insurance;

b) 8% of the health insurance premium shall be transferred to the Vietnam Social Insurance to reserve for the contingency fund, organizational and operational costs of health insurance, of which at least 4% of the health insurance premium shall be reserved for the contingency fund.

2. The allocation, management, and use of the health insurance fund of objects specified in point c of Clause 3 and Clause 4 of Article 2 of this Decree shall be carried out by the Social Insurance provincial branch or municipal branch under the central government issuing health insurance cards in accordance with the provisions of Government Decree No. 146/2018/ND-CP dated October 17, 2018, detailing and guiding the implementation of certain articles of the Health Insurance Law, amended and supplemented by Government Decrees No. 75/2023/ND-CP dated October 19, 2023, and No. 02/2025/ND-CP dated January 1, 2025. The ratio of the amount transferred to implement primary healthcare services at agencies and units according to point a of Clause 1 of Article 21 of this Decree.

3. The Military Social Insurance and the Public Security Social Insurance may open bank accounts for health insurance income and expenditure in accordance with the Government's regulations on financial mechanisms for social insurance, unemployment insurance, and health insurance."

18. Amend and supplement Clause 1 of Article 21 as follows:

"1. The health insurance medical examination and treatment fund specified in point a of Clause 1 of Article 20 of this Decree shall be used to settle costs for health insurance medical examinations and treatments within the scope and level of benefits specified in Articles 10 and 11 of this Decree for military personnel, public security officers, and personnel engaged in confidential work holding health insurance cards issued by the Military Social Insurance and the Public Security Social Insurance, including:"

a) Allocate 12% of the total revenue from health insurance to provide primary healthcare at military medical units, agency healthcare facilities, and healthcare establishments authorized by competent authorities to provide primary healthcare.

The expenditure includes: purchasing medicines and medical equipment for emergency care and initial treatment for individuals who suffer from accidents, injuries, or common illnesses; paying for technical service fees for medical examinations and treatments at military medical units, agency healthcare facilities, and healthcare establishments authorized by competent authorities to provide primary healthcare; purchasing, repairing medical equipment and office equipment; software management and ensuring information security for medical examination and treatment activities.

Annually, the Ministry of National Defense and the Ministry of Public Security allocate budgets to subordinate units under their ministries to distribute to agencies and units providing primary healthcare at military medical units, agency healthcare facilities, and healthcare establishments authorized by competent authorities to provide primary healthcare, and organize settlement and finalization according to regulations. Unspent funds will be carried over to the next year.

b) The remainder shall be used to pay for health insurance medical examination and treatment costs and transportation expenses.

19. Amend and supplement Clause 2 of Article 22 as follows:

"2. The content of expenditures for organizing and operating health insurance shall be implemented in accordance with the laws on health insurance."

Article 2. Supplement, replace, and abolish certain phrases and some articles and clauses of Decree No. 70/2015/NĐ-CP dated September 1, 2015 of the Government detailing and guiding the implementation of certain provisions of the Health Insurance Law for the People's Army, the People's Public Security Force, and personnel engaged in confidential work.

1. Add the phrase "central city" after the phrase "Social Insurance Department of the province" in Clause 2 and Clause 3 of Article 16; point b of Clause 2 and point b of Clause 3 of Article 18.

2. Add the phrase "Clauses 1, 2, 3, and 4" before the phrase "Article 2 of this Decree" in Article 9; Clause 3 of Article 10; Clause 4 of Article 15.

3. Replace the phrase "Social Insurance Department of the Ministry of Public Security" with "Social Insurance Department of the People's Public Security Force" and the phrase "Social Insurance Department of the Ministry of National Defense" with "Social Insurance Department of the People's Army" in Clause 1 of Article 6; Clause 2 and Clause 3 of Article 16; Clause 2 and Clause 3 of Article 18; Clause 2 and Clause 3 of Article 21; Article 22; Article 23.

Replace the phrase "Clause 1 and 2, points a and b of Clause 3" with "Clauses 1, 2, 3, and 4" and the phrase "points a and b of Clause 3" with "points a, b, and d of Clause 3" in Clause 1 of Article 6.

4. Replace the phrase "medical equipment" with "medical devices" in Clause 2 of Article 21.

5. Abolish the phrase "Multi-level Health Insurance Review and Payment Center" in Clause 2 and Clause 3 of Article 16; point b of Clause 2 and point b of Clause 3 of Article 18.

6. Abolish Articles 3, 13, and 14, and Clause 4 of Article 17.

Article 3. Transitional Provisions

1. Appointment letters for rescheduling medical appointments, referral letters for health insurance medical examinations and treatments, receipt and result notification letters for issuing, reissuing, and replacing health insurance cards issued before January 1, 2025 and still valid after that date may continue to be used until these documents expire.

2. Health insurance medical examination and treatment contracts signed before July 1, 2025 and still valid after that date shall be implemented in accordance with the regulations of the Government.

Article 4. Effective date

1. This Decree takes effect from July 1, 2025.

2. The following articles and clauses shall take effect from January 1, 2025:

a) Clauses 1, 11, and 12 of Article 1, Article 2, Clause 1 of Article 3, Clauses 4 and 5 of Article 4 of this Decree;

b) Clauses 9 and 10 of Article 1 of this Decree, except for the benefit levels and scope of health insurance coverage for the subjects specified in point c, d of Clause 1, point đ of Clause 2, point đ of Clause 3, and Clause 4 of Article 2 of Decree No. 70/2015/NĐ-CP amended and supplemented in Clause 2 of Article 1 of this Decree.

3. Circular Joint No. 85/2016/TTLT-BQP-BYT-BTC dated June 20, 2016 of the Ministry of National Defense, the Ministry of Health, and the Ministry of Finance guiding the implementation of health insurance for military personnel and personnel engaged in confidential work shall cease to be effective from the date this Decree takes effect.

4. In cases where the referenced documents in this Decree are amended, supplemented, or replaced, they shall be applied according to the amended, supplemented, or replaced documents.

5. Amend and supplement point a of Clause 5 of Article 14 of Decree No. 146/2018/NĐ-CP dated October 17, 2018 of the Government detailing and guiding measures to implement the Health Insurance Law, which has been amended and supplemented by Decree No. 75/2023/NĐ-CP dated October 19, 2023 and Decree No. 02/2025/NĐ-CP dated January 1, 2025 of the Government as follows:

"a) From January 1, 2025, when receiving outpatient medical services at basic-level healthcare establishments scoring below 50 points or temporarily classified as basic-level, insured persons shall be reimbursed 100% of the benefit level by the health insurance fund, except for basic-level healthcare establishments as stipulated in point c of this clause;"

Article 5. Responsibilities for Implementation

Ministers, Heads of ministerial-level agencies, Heads of government-affiliated agencies, Chairpersons of provincial and central city People's Committees, and related organizations and individuals are responsible for implementing this Decree.