Luật Bảo hiểm y tế sửa đổi 2024 số 51/2024/QH15

LAW

AMENDMENTS TO SOME ARTICLES OF THE LAW ON HEALTH INSURANCE

Pursuant to the Constitution of the Socialist Republic of Vietnam;

The National Assembly promulgates the Law on Amendments to some Articles of the Law on Health Insurance No. 25/2008/QH12, which is amended by Law No. 32/2013/QH13, Law No. 46/2014/QH13, Law No. 97/2015/QH13, Law No. 35/2018/QH14, Law No. 68/2020/QH14 and Law No. 30/2023/QH15.

Article 1. Amendments to some Articles of the Law on Health Insurance

1. Addition of Clause 9 after Clause 8 of Article 2:

“9. Reference level is an amount decided by the Government to calculate the premiums and payouts (reimbursements) of certain types of health insurance specified in this Law.”.

2. Amendments to Clause 2 of Article 3:

“2. Health insurance premium rates shall be a percentage (%) of the salary as the basis for paying for the compulsory health insurance in accordance with the Law on Health insurance (hereinafter referred to as “monthly salary”), retirement pensions, allowances or reference level.”.

3. Amendments to some Clauses of Article 6:

a) Amendments to Clause 1:

“1. Promulgating or propose promulgation of health insurance policies and law, organizing the health care system, financial sources for the protection, care and improvement of the people’s health based on universal health coverage;

b) Amendments to Clause 3 and Clause 4:

“3. Promulgate regulations, procedures, professional instructions on medical examination and treatment (hereinafter referred to as “medical care” or “medical services”); frequently review and update instructions on diagnosis and treatment; regulations on assessment of rationality of provision of medical services; regulations on application of information technology, digital transformation, sharing of information about health insurance, synchronization of paraclinical results among health insurance-covered health facilities in a manner that satisfies professional requirements;

4. Implement or propose implementation of solutions for balancing the health insurance fund;”.

4. Amendments to Article 7a:

Article 7a. Responsibilities of the Ministry of Labor, War Invalids and Social Affairs

1. Provide instructions on the determination and management of health insurance participants under the management of the Ministry of Labor, War Invalids and Social Affairs that are prescribed in Points e, h, i, k, o, r, s and t Clause 3, Points a, b, d and g Clause 4 Article 12 of this Law.

2. Carry out inspection of the implementation of regulations of the law on the responsibilities of employers and employees to participate in health insurance prescribed in Clause 1 Article 12 of this Law and participants under the management of the Ministry of Labor, War Invalids and Social Affairs prescribed in Points e, h, i, k, o, r, s and t Clause 3, and Points a, b, d and g Clause 4 Article 12 of this Law, except for those under the management of the Ministry of National Defense and the Ministry of Public Security.”.

5. Amendments to some Clauses of Article 7c:

a) Amendments to Clause 1:

“1. Administer and provide instructions on the determination, management and compilation of the list of health insurance participants under the management of the Ministry of National Defense and the Ministry of Public Security prescribed in Points a, c, e, h and i Clause 1, Points a, b, c, d, l and n Clause 3, Point b Clause 4 Article 12 of this Law.”;

b) Amendments to Clause 3:

“3. Carry out inspection of the implementation of regulations of law on the responsibility to participate in health insurance of persons under the management of the Ministry of National Defense and the Ministry of Public Security prescribed in Points a, c, e, h and i Clause 1, Points a, b, c, d, l and n Clause 3, Point b Clause 4 Article 12 of this Law.”.

6. Amendments to Clause 2 and Clause 3 of Article 8:

“2. The People’s Committees of central-affiliated cities and provinces (hereinafter referred to as “provinces”), in addition to fulfillment of the responsibilities specified in Clause 1 of this Article, shall provide instructions on development of apparatus and resources to serve state management of health insurance in their provinces.

3. The People’s Committees of communes, wards and commune-level towns (hereinafter referred to as “communes”) shall:

a) Fulfill the responsibilities specified in Clause 1 of this Article;

b) Compile the list of health insurance participants in their communes as prescribed in Clause 2, 3, 4 and 5 Article 12 of this Law by households; except for those under the management of Ministries, central authorities and other units prescribed in points a, b, c, d, l and n Clause 3, Point b Clause 4 Article 12 of this Law;

c) Compile a list of health insurance card issuance for children as the same time as issuance of birth certificates.”.

7. Amendments to Article 9:

“Article 9. Health insurance authorities

1. Social insurance authorities are responsible for implementation of health insurance policies and laws, management and use of the health insurance funds.

2. The Government shall elaborate the functions, tasks, powers and organizational structure of social insurance authorities with regard to implementation of health insurance.”.

8. Amendments to Article 10:

“Article 10. Audit of the health insurance fund

1. State Audit Office of Vietnam shall carry out audit of the health insurance fund every three years and submit reports to the National Assembly; carry out ad hoc audit of the health insurance fund at the request of the National Assembly, Standing committee of the National Assembly, the President of Vietnam, the Government, the Prime Minister of Vietnam.

2. Annually, State Audit Office of Vietnam shall carry out audit of the expenditures on organization and operation of health insurance during audit of the statement of organization and operation of social insurance.”.

9. Amendments to Clause 1 of Article 11:

“1. Late payment, evasion of health insurance premiums.”.

10. Amendments to Article 12:

“Article 12. Eligible participants in health insurance (insured individuals)

1. Participants whose insurance premiums are paid by the employers, the employees, or both:

a) Employees working under indefinite-term contracts or fixed-term contracts with duration of at least 01 month, even if these contracts are referred to as other names by employees and employers as long as they have contents about payment of wage or salary, the management and supervision by a party; business executives, controllers, state capital representatives, enterprise’s capital representative prescribed by law; members of the Board of Directors, General Director, Director, members of the Board of Controllers or controllers and other elected managerial positions of cooperatives, cooperative unions under regulations of the Law on Cooperatives who receive salaries;

b) Business executives, state capital representatives, enterprise’s capital representative prescribed by law; salaried members of the Board of Directors, General Director, Director, members of the Board of Controllers or controllers and other elected managerial positions of cooperatives, cooperative unions under regulations of the Law on Cooperatives who do not receive salaries;

c) Employees who are foreign citizens working in Vietnam under fixed-term employment contracts that last at least 12 months with employers in Vietnam, except persons reassigned within an enterprise according to regulations of law on foreign workers in Vietnam or those ho have reached the retirement age upon the conclusion of the employment contracts according to Clause 2 Article 169 of the Labor Code, or otherwise prescribed by an international treaty to which the Socialist Republic of Vietnam is a signatory;

d) Employees working under indefinite-term contracts or fixed-term contracts with duration of at least 01 month, even if these contracts are referred to as other names by employees and employers as long as they have contents about payment of wage or salary, the management and supervision by a party; having agreements with employers on part-time work and receiving a monthly salary that is equal to or higher than the lowest salary as the basis for compulsory social insurance payment according to social insurance laws;

dd) Owners of registered household businesses that are compulsory social insurance participants according to social insurance laws;

e) Officials and public employees;

g) Part-time workers of commune-level agencies as prescribed by law;

h) National defense workers and public employees who are serving in the army, police workers who are working for the police; people doing other works in cipher organizations as prescribed by the Law on Cipher;

h) Family of national defense workers and public employees who are serving in the army, family of police workers who are working for the police who are not eligible participants specified in Points a, b, c, d, dd, e, g and h of this Clause, Clause 2 and Clause 3 of this Article.

2. Participants whose insurance premiums are paid by the social insurance authorities:

a) People who are receiving monthly retirement pensions, incapacity allowances;

b) People who are taking leave and receiving monthly occupational accident or occupational disease allowance; people who are taking leave and receiving sickness benefits due to diseases on the list of diseases requiring long-term treatment or employees who are taking leave and receiving sickness benefits for at least 14 working days in the month according to social insurance laws; people who are taking leave and receiving maternity benefits for at least 14 working days in the month according to social insurance laws;

c) Retired officials of communes who are receiving monthly social insurance benefits;

d) People who are receiving unemployment benefits.

3. Participants whose insurance premiums are paid by the State budget:

a) Officers and career military personnel of the people's army; officers and non-commissioned officers in police forces; and people doing cipher work and receiving the same salaries as military personnel;

b) Non-commissioned officers and soldiers of the people’s army; non-commissioned officers and conscripts of the police; military, police and cipher cadets who are receiving subsistence allowances and are Vietnamese citizens;

c) Military cadets, police cadets, cipher cadets who are receiving subsistence allowances and are foreigners;

d) Reserve officer trainees for at least 03 months who have not participated in social insurance or health insurance;

dd) Standing militia personnel;

e) Revolutionary contributors as prescribed by the Ordinance on preferential treatment for revolutionary contributors; veterans;

g) Incumbent deputies of the National Assembly or the People’s Councils at all levels;

h) Children under the age of 6;

i) Family of martyrs or caregivers of martyrs according to the Ordinance on preferential treatment for revolutionary contributors;

k) Family of revolutionary contributors, spouses of martyrs who have remarried and are receiving monthly death benefits, and relevant individuals according to the Ordinance on preferential treatment for revolutionary contributors, except for those specified in Point i of this Clause;

l) Family of the persons specified in Point a and Point b of this Clause as prescribed by law;

m) Persons who have donated body parts under the regulations of the law;

m) Foreigners who are studying in Vietnam and granted scholarships funded by the state budget of Vietnam;

o) Poor household members, ethnics who are near-poor household members living in communes, villages in ethnic regions and mountainous regions; ethnics living in economically and socially disadvantaged areas; people living in particularly disadvantaged areas; people living on commune-level and district-level islands;

p) Retired officials of communes who are receiving monthly allowances from state budget;

q) People who have stopped receiving incapacity allowances and are receiving monthly allowances from state budget;

r) People who are receiving monthly social allowances; people who are receiving monthly nursing allowances according to relevant laws; people who are receiving monthly death benefits and are also eligible for social allowances;

s) People aged 75 or older who are receiving monthly death benefits; people aged 70 to under 75 who are members of near-poor households and receiving monthly death benefits;

t) People receiving social retirement benefits according to social insurance laws;

u) Employees who are not eligible for pension, have not reached the age for social retirement benefits and are receiving monthly allowances according to social insurance laws.

4. Participants whose insurance premiums are subsidized by state budget:

a) Members of near-poor households;

b) Students;

c) Participants in internal security forces;

d) Members of households doing agriculture, forestry, aquaculture and salt production with average living standards as prescribed by law;

dd) Health workers of villages; midwives of villages;

e) Part-time workers of villages and neighborhoods as prescribed by law;

g) Ethnics living in communes that are no longer disadvantaged or exceptionally disadvantaged areas will have health insurance premiums subsidized by state budget according to regulations of the Government.

h) People who are awarded the title of “Nghệ nhân nhân dân” (“People's Craftsperson”) or “Nghệ nhân ưu tú” (“Eminent Craftsperson”) according to the Law on Cultural Heritage;

i) Human trafficking victims defined by the Law on Prevention of Human Trafficking.

5. Participants who pay health insurance premiums themselves:

a) Members of households that buy health insurance for the entire household;

b) People living and working, being raised or cared for in charitable or religious organizations;

c) Employees during unpaid leave or suspension of their employment contracts;

d) People who are not in the cases specified in Points a, b and c of this Clause.

6. Participants other than those specified in Clause 1, 2, 3, 4 and 5 of this Article according to regulations of Laws and Ordinances.

7. The Government shall specify participants other than those specified in Clause 1, 2, 3, 4, 5 and 6 of this Article, including:

a) Eligible health insurance participants prescribed by law before January 1^st 2025;

b) Participants other than those mentioned in Point a of this Clause after reporting to Standing committee of the National Assembly.”.

11. Amendments to Article 13:

“Article 13. Health insurance premium rates and responsibilities to pay health insurance premiums

1. Health insurance premiums paid by the employers, the employees, or both:

a) The monthly premium of a participant prescribed in Points a, c, d and e Clause 1 Article 12 of this Law must not exceed 6% of the monthly salary, two thirds of which is paid by the employer and the remaining one third is paid by the employee;

b) The monthly premium of a participant prescribed in Point b Clause 1 Article 12 of this Law must not exceed 6% of the monthly salary as the basis for payment of compulsory social insurance and shall be paid by the participant;

c) The monthly premium of a participant prescribed in Point dd Clause 1 Article 12 of this Law must not exceed 6% of the monthly salary as the basis for payment of compulsory social insurance and shall be paid by the participant;

d) The monthly premium of a participant prescribed in Point g Clause 1 Article 12 of this Law must not exceed 6% of the reference level, two thirds of which is paid by the employer and the remaining one third is paid by the employee;

d) The monthly premium of a participant prescribed in point h Clause 1 Article 12 of this Law must not exceed 6% of the monthly salary and the liability prescribed by the Government;

e) The monthly premium of a participant prescribed in point i Clause 1 Article 12 of this Law must not exceed 6% of the reference level and the liability prescribed by the Government.

2. Health insurance premiums paid by social insurance authorities:

a) The monthly premium of a participant prescribed in Point a Clause 2 Article 12 of this Law must not exceed 6% of the pension or incapacity allowance;

b) The monthly premium of a participant prescribed in Point b and Point c Clause 2 Article 12 of this Law must not exceed 6% of the reference level;

c) The monthly premium of a participant prescribed in Point d Clause 2 Article 12 of this Law must not exceed 6% of the unemployment benefit.

3. Health insurance premiums paid and subsidized by state budget:

a) The monthly premium of a participant prescribed in Point a Clause 3 Article 12 of this Law must not exceed 6% of the monthly salary and shall be paid by state budget;

b) The monthly premium of a participant prescribed in Points b, c, d, dd, e, g, h, i, k, l, m, o, p, q, r, s, t and u Clause 3 Article 12 of this Law must not exceed 6% of the reference level and shall be paid by state budget;

c) The monthly premiums of the participants prescribed in Point n Clause 3 Article 12 of this Law must not exceed 6% of the reference level and shall be paid by state budget via the scholarship providers;

d) The monthly premiums of the participants prescribed in Clause 4 Article 12 of this Law must not exceed 6% of the reference level and shall be paid by the participants and subsidized by state budget.

4. The monthly premiums of the participants prescribed in Clause 5 Article 12 of this Law must not exceed 6% of the reference level and shall be paid for the entire household or each individual.

5. Order of health insurance payment in case an individual is eligible for more than one form of health insurance participation:

a) In case an individual is an eligible participant under multiple scenarios prescribed in Article 12 of this law, he/she shall pay health insurance according to the first applicable scenario listed in Article 12, except in the cases specified in Points c, d, dd, e and g of this Clause;

b) A participant specified in Points a, c, d, dd and e Clause 1 Article 12 of this Law who has one or multiple employment contracts shall pay health insurance under the employment contract used as the basis for compulsory social insurance participation;

c) In case a participant prescribed in Point g Clause 1 Article 12 of this Law is also an eligible participant in multiple cases specified in Article 12 of this Law, health insurance premiums shall be paid in the following order: paid by social insurance authority, paid by state budget, subsidized by state budget, shared between the participant and the People’s Committee of the commune;

c) In case a participant prescribed in Point a and Point c Clause 2 Article 12 of this Law is also an eligible participant in multiple cases specified in Article 12 of this Law, health insurance premiums shall be paid by the social insurance authority;

dd) In case a participant prescribed in Points s, t and u Clause 3 Article 12 of this Law is also an eligible participant in multiple cases specified in Article 12 of this Law, health insurance premiums shall be paid by state budget;

e) In case a participant prescribed in Points a, c, d, dd, e, g, h and i Clause 4 Article 12 of this Law is also an eligible participant prescribed in Point a Clause 5 Article 12 of this Law, he/she may choose a form of health insurance participation according to his/her preference;

g) Participants whose health insurance premiums are subsidized by state budget as prescribed in Clause 4 Article 12 of this Law may choose the form of participation with the highest rate of subsidization;

e) In case a participant prescribed in Point b and Point c Clause 5 Article 12 of this Law is also an eligible participant prescribed in Point a Clause 5 Article 12 of this Law, he/she may choose to participate in health insurance as a household.

6. Members of a household prescribed in Point a Clause 5 Article 12 of this Law who participate in health insurance as a household in a fiscal year will be eligible for the following reductions:

a) The first participant shall pay up to 6% of the reference level;

b) The second, third, fourth participants shall pay 70%, 60%, 50% of the premiums paid by the first participant respectively;

c) The premiums paid by the fifth participant onwards shall be equal to 40% of the premiums paid by the first participant.

7. The Government shall elaborate the following regulations:

a) Rates of health insurance premiums and subsidization mentioned in this Article;

b) Responsibility for payment, rates of health insurance premiums and subsidization for the participants specified in Clause 6 and Clause 7 Article 12 of this Law.”.

12. Amendments to Clause 4 and Clause 5 of Article 14:

“4. The basis for health insurance payment by participants other than those prescribed in Clauses 1, 2 and 3 of this Article is the reference level.

5. The maximum monthly salary for calculation of health insurance payment shall be 20 times the reference level.”.

13. Amendments to some Clauses of Article 15:

a) Amendments to Clauses 2, 3, 4 and 5:

“2. Enterprises, artels, cooperatives, cooperative unions, household businesses that operate in the fields of agriculture, forestry, fishery, salt production and pay piece-rate or project-based salaries, health insurance premiums shall be paid every 01, 03 or 06 months.

3. Social security authorities shall pay monthly health insurance premiums prescribed in Clause 2 Article 13 of this Law to the health insurance fund.

4. Scholarship providers shall pay quarterly health insurance premiums prescribed in Point c Clause 3 Article 13 of this Law to the health insurance fund.

5. The State budget shall transfer quarterly health insurance premiums and health insurance subsidies prescribed in Points a, b and d Clause 3 Article 13 of this Law to the health insurance fund.”;

b) Addition of Clause 7 and Clause 8 after Clause 6:

“7. The participants prescribed in Point b and Point c Clause 1 Article 12 of this Law shall fully pay the amounts payable by themselves directly to the social security authorities or via the household businesses, enterprises, cooperatives, cooperative unions every 01, 03 or 06 months.

8. Deadlines for health insurance payment by employers:

a) The last day of the succeeding month for monthly payment;

b) The last day of the month succeeding the payment cycle for quarterly or biannual payment.”.

14. Amendments to some Clauses of Article 16:

a) Amendments to Clause 1 and Clause 2:

“1. A health insurance card has a unique health insurance number, is issued to a participant and used as a basis for enjoying health insurance benefits prescribed by this Law. Health insurance cards are issued in electronic and physical forms with equal legal value.

2. Each individual has only one health insurance number.”;

b) Amendments to Point c of Clause 3:

“c) In case a health insurance participant prescribed in Clause 4 and Clause 5 Article 12 of this Law either participates in health insurance for the first time or has participated intermittently for at least 90 days under any of the scenarios specified in Article 12 of this Law, the health insurance card will become effective after 30 days from the day on which health insurance is fully paid;”;

c) Amendments to Clause 5:

“5. Vietnam Social Security shall issue the health insurance card template after reaching a consensus with the Ministry of Health.”.

15. Amendments to Article 17:

“Article 17. Issuance of health insurance cards

1. 1. Applications for the issuance of health insurance cards include:

a) Declaration forms submitted by agencies, organizations, units, individuals, households participating in social insurance for the first time;

b) The list of health insurance participants prescribed in Clause 1 Article 12 of this Law which is compiled by the employer within 30 days from the day on which the employees are eligible for health insurance participation. In case of participants prescribed in Point b and Point dd Clause 1 Article 12 of this Law, the application shall be the declaration form mentioned in Point a of this Clause submitted to the social security authority within 30 days from the day on which the individual is eligible for health insurance participation;

c) The list of health insurance participants prescribed in Clauses 2, 3, 4 and 5 Article 12 which is compiled by the People’s Committee of the commune by household, except for the participants on the list mentioned in Point d and Point dd of this Clause;

d) The list of health insurance participants under the management of The Ministry of Education and Training, the Ministry of Labor, War Invalids and Social Affairs, other Ministries and central authorities prescribed in Point n Clause 3 and Point b Clause 4 Article 12 of this Law compiled by educational institutions and vocational education institutions;

dd) The list of health insurance participants under the management of the Ministry of National Defense and the Ministry of Public Security Points a, c, e and h Clause 1, Points a, b, c, d, l and n Clause 3, Point b Clause 4 Article 12 of this Law compiled by the Ministry of National Defense and the Ministry of Public Security.

2. Within 05 working days from the receipt of the valid application prescribed in Clause 1 of this Article, the social security authority shall issue health insurance cards to participants and notify or send the cards to the applying organization.

3. The Government shall promulgate regulations on issuance of physical and electronic health insurance cards.”.

16. Amendments to Article 21:

“Article 21. Health insurance coverage

1. Health insurance participants shall have the following costs covered by the health insurance fund:

a) Costs of medical care, including telemedicine services, telemedicine assistance, family medicine services, at-home medical care, rehabilitation, regular prenatal care check-ups and childbirth;

b) Costs of patient transports for participants prescribed in Points a, b, c, d, dd, e, h, i, o and r Clause 3 Article 12 of this Law who are undergoing inpatient treatment or have to be referred to another health facility as prescribed in Article 27 of this Law;

c) Costs of medical services, medicines, use of medical devices, blood, blood products, medical gas, supplies, tools, instruments, chemicals for medical services covered by the health insurance fund.

2. The Minister of Health shall elaborate the following regulations:

a) Rules and criteria for compilation of lists of medicines, rules for compilation of lists of medical devices and services covered by health insurance;

b) The promulgation of lists of medicines, rules for compilation of lists of medical devices and services covered by health insurance on the basis of the rules and criteria mentioned in Point a of this Clause;

c) Ratios of payment for medicines, medical devices and medical services covered by health insurance;

c) Rates and conditions for payment for medicines, medical devices and medical services covered by health insurance;

dd) The payment for blood, blood products, medical gas, supplies, tools, instruments, chemicals for medical services covered by the health insurance fund.

3. The Government shall elaborate the following regulations:

a) The payment for patient transport mentioned in Point b Clause 1 of this Article;

b) Coverage for the participants prescribed in Points a, b, c, d and dd Clause 3 Article 12 of this Law;

c) Participants to whom the co-payment rates mentioned in Point c Clause 2 of this Article do not apply.”.

17. Amendments to Article 22:

“Article 22. Health insurance reimbursement rates

1. When health insurance participants receives medical care as prescribed in Article 26 and Article 27 of this Law, they will be reimbursed by the health insurance fund for the covered medical costs as follows:

a) 100% of the medical costs for the participants prescribed in Points a, b, c, d, dd, e, h, i, o, r and s Clause 3 Article 12 of this Law. The uncovered medical costs incurred by the participants prescribed in Points a, b, c, d and dd Clause 3 Article 12 of this Law shall be paid by the health insurance budget for medical care of these participants; in case this budget is insufficient, they will be covered by state budget;

b) 100% of the medical costs if the cost of one medical examination/treatment occasion is lower than the level prescribed by the Government;

c) 100% of the medical costs at primary healthcare facilities, including: health stations, family medicine facilities; civil – military health station, civil – military health clinics; medical centers of districts that provide medical care and are licensed to operate as clinics; health departments of agencies, units and organizations prescribed by the Minister of Health; primary healthcare facilities of the army and the police prescribed by the Minister of National Defense and the Minister of Public Security. 100% of the costs outpatient care at local general clinics;

d) 100% of the medical costs when the patient has a period of health insurance participation of at least 5 consecutive years and has paid a co-payment of more than 6 times the reference level in the year prescribed in Clause 3, points a, b, c, dd and e Clause 4, Clause 5 of this Article, Article 26 and Article 27 of this Law;

d) 95% of the medial costs for the participants prescribed in Point a Clause 2, Point k Clause 3, Point a and Point g Clause 4 Article 12 of this Law;

e) 80% of the medial costs for other participants.

2. An individual who is eligible for multiple forms of health insurance participation will be entitled to the most advantageous health insurance benefits.

3. In case an individual registers a tertiary health facility or secondary health facility as a health insurance-covered primary care provider but receives medical care at another health facility due to change of the temporary residence or accommodation, he/she may receive medical care at a secondary health facility that is suitable for the new temporary residence or accommodation and have the costs covered by the health insurance fund in accordance with Clause 1 of this Article. The Minister of Health shall specify procedures and the cases mentioned in this Clause.

4. In case a health insurance participant visits a health facility that is not the registered primary care provider or against regulations on referral prescribed in Article 26 and Article 27 of this Law, except for the cases specified in Clause 3 and Clause 5 of this Article, he/she will be reimbursed by the health insurance funds at the rates specified in Clause 1 of this Article. To be specific:

a) 100% reimbursement when receiving medical care at a secondary health facility or tertiary health facility in case of definitive diagnosis and treatment of certain rare diseases, terminal diseases, diseases that require surgery or high technology prescribed by the Minister of Health;

b) 100% reimbursement for ethnics and poor household members living in disadvantaged and extremely disadvantaged areas; people living on commune-level and district-level islands when they receive inpatient care at tertiary health facilities;

c) 100% reimbursement when using receiving medical care at primary healthcare facilities;

d) 100% reimbursement when receiving inpatient care at secondary health facilities;

dd) 100% reimbursement when using medical services at secondary and tertiary health facilities that have been classified as district-level health facilities by competent authorities before January 1^st 2025;

e) 50% - 100% reimbursement when receiving outpatient care at secondary health facilities according to their professional classification and specific reimbursement rates prescribed by the Government, except in the cases specified in Point a and Point dd of this Clause;

g) 40% reimbursement when receiving inpatient care at tertiary health facilities, except in the cases specified in Points a, b, dd and h of this Clause;

h) 50% reimbursement when receiving outpatient care following the road map of the Government and 100% reimbursement when receiving inpatient care at tertiary health facilities that have been classified as province-level health facilities by competent authorities before January 1^st 2025.

5. Health insurance participants will be entitled to 100% reimbursement prescribed in Clause 1 of this Article when receiving emergency care at any health facility.

6. The Government shall specify the reimbursement rates for the participants prescribed in Points a, b, c, d and dd Clause 3 Article 12 of this Law; reimbursement rates for health insurance participants using medical service on demand and other cases not specified in Clause 1 of this Article.”.

18. Amendments to Clause 7 and Clause 8 of Article 23:

“7. Treatment of squint and refractive errors for people aged 18 and older.

8. Use of prostheses including artificial limbs, eyes, teeth, glasses, hearing aids or movement aids in medical examination, treatment and function rehabilitation.”.

19. Amendments to Article 24:

“Article 24. Covered facilities

Health insurance-covered facilities (hereinafter referred to as “covered facilities”) are health facilities that have signed health insurance-covered medical care contracts with the social security authority as per regulations of the Government.”.

20. Amendments to some Points and Clauses of Article 25:

a) Amendments to Point e of Clause 2:

“e) Conditions for revision, finalization, suspension and termination of the contract.”;

b) Amendments to Clause 3 and Clause 4:

“3. Any agreement on conditions for revision, finalization, suspension and termination of a contract prescribed in Point e Clause 2 of this Article must not interrupt the provision of medical care for the participant.

4. The Government shall elaborate this Article and provide a model contract for covered medical services.”.

21. Amendments to Article 26:

“Article 26. Registration of health insurance-covered primary care providers

1. Health insurance participants may register a primary healthcare facility or secondary health facility as a health insurance-covered primary care provider, and may change this primary care provider within the first 15 days of each quarter.

2. The distribution of health insurance card to health insurance-covered primary care providers must be balanced, appropriate for the primary care demand of the people, capacity of the health facilities and the local area.

3. The Minister of Health shall elaborate Clause 1 and Clause 2 of this Article; specify the cases in which tertiary health facilities may be registered as health insurance-covered primary care providers.

4. The Minister of Public Security and the Minister of National Defense shall elaborate regulations on registration of primary healthcare facilities, secondary health facility and tertiary health facilities as health insurance-covered primary care providers, and health insurance participants under their management.”.

22. Amendments to Article 27:

“Article 27. Patient referral among covered facilities

1. The patient referral among health facilities shall be carried out according to the professional requirements and capacity of the involved health facilities.

2. The Minister of Health shall promulgate regulations on referral of patients to health insurance-covered primary care providers for treatment, management and monitoring of chronic diseases, including the use of medicines, medical devices and medical services that have been prescribed according to the capacity of the facilities treating, managing and monitoring chronic diseases; elaborate Clause 1 of this Article, except the cases specified in Clause 3 of this Article.

3. The Minister of Public Security and the Minister of National Defense shall promulgate regulations on referral of patients under their management among covered facilities under their management.”.

23. Amendments to Article 28:

“Article 28. Procedures for health insurance-covered medical care

1. When receiving medical care, the health insurance participant shall present information about the health insurance card, his/her identification; children under 6 and people who have donated human organs and have not been issued with health insurance cards shall present other valid documents. In case of emergency, the patient must present the information specified in this Clause before the end of the treatment.

The Government shall elaborate this Clause.

2. In case of follow-up examination according to professional requirements, health insurance participants shall get appointments following the procedures established by the Minister of Health.

3. In case of referral according to professional requirements during inpatient care, the referring facility shall prepare referral documents in accordance with regulations of the Minister of Health.”.

24. Amendments to Article 30:

“Article 30. Methods of payment of costs of health insurance-covered medical care

1. Costs of health insurance-covered medical care shall be paid by one of the following methods:

a) Rate-based payment;

b) Service price-based payment;

c) Diagnosis-related group payment.

2. The Government shall elaborate Clause 1 of this Article and regulations on application of methods of payment of health insurance-covered medical care costs.”.

25. Amendments to Article 31:

“Article 31. Payment of health insurance-covered medical care costs

1. Social security authorities shall pay the costs of health insurance-covered medical care to health facilities under health insurance-covered medical care contracts.

2. social security authorities shall pay the costs of health insurance-covered medical care directly to health insurance card holders when they receive medical care in the following cases:

a) Medical care is provided at a health facility without a health insurance-covered medical care contract;

b) Medical care is provided against Article 28 of this Law;

c) Other cases prescribed by the Government.

3. In case the medicine, medical device or paraclinical service which is prescribed for the patient and covered by health insurance is not available at the health facility and cannot be replaced by any other medicine, medical device or paraclinical service, the health facility may receive medicine, medical device or paraclinical service transferred from another covered facility to serve the treatment of the patient, or refer the patient or send the specimen to another facility capable of providing the paraclinical service.

The covered facility that receives the medicine, medical device, refers the patient or sends the specimen shall prepare a statement of the costs of these medicine, medical device or paraclinical service and receive payment from the social security authority.

4. The Government shall elaborate the following regulations:

a) Conditions, authority for deciding the cases in which a health facility may receive medicines and medical devices from other covered facilities for treatment of patients and the payment of these medicines and medical devices prescribed in Clause 3 of this Article;

b) Management, use of funds for health insurance-covered medical care, assessment, payment and statement of health insurance-covered medical care costs incurred by the participants prescribed in Points a, b, c, d and dd Clause 3 Article 12 of this Law;

c) Payment and statement of health insurance-covered medical care costs incurred by participants in the people’s armed forces, the people living in bordering areas, on islands, particularly disadvantaged villages and communes in order to ensure defense and security.

5. The Government shall elaborate Point a and Point b Clause 2, Clause 3 of this Article, except the cases specified in Clause 4 of this Article.”.

26. Amendments to Article 32:

”Article 32. Advance payment, payment, statement of health insurance-covered medical care costs

1. The advance payment by social security authorities to covered facilities shall be carried out quarterly as follows:

a) Within 05 working days from the receipt of the previous quarter’s statement from the health facility, the social security authority shall advance a lump sum of 90% of the health insurance-covered medical care costs in the statement;

b) In case a health facility that signs the first contract for health insurance-covered medical care, the social security authority shall, on the basis of the medical costs of the month preceding the month in which the contract is signed, advance 90% of the costs for the first month of executing the contract; after one month, the social security authority shall estimate and advance 90% of the health insurance-covered medical care costs in the quarter according to Point a of this Clause;

c) If the total advanced payment to covered facilities in province are advanced exceeds the quarterly budget, the social security authority of the province shall send a report to Vietnam Social Security for provision of extra funds.

2. The payment and statement between the heath facilities and the social security authorities shall be carried out as follows:

a) Within the first 15 days of every month, covered facilities shall send a written request for payment of health insurance-covered medical care costs of the previous month to the social security authority; within the first 15 days of every quarter, covered facilities shall submit the statements of health insurance-covered medical care costs of the previous quarter to the social security authority;

b) Within 30 days from the receipt of the previous quarter’s statement from each covered facility, the social security authority shall notify the verification result and the agreed payment for health insurance-covered medical care, including the covered medical costs. For the fourth quarter of the year, the time limit for notifying the verification result and the agreed payment for health insurance-covered medical care shall be 60 days from the day on which the social security authority receives the fourth quarter’s statement from the health facility;

c) Within 10 days from the notification of the verification result, the social security authority must fully pay the health facility;

d) The annual statement of the health insurance fund shall be verified before October 01 of the next year.

3. Within 40 days from the receipt of the satisfactory application for the payment from the health insurance participant in the cases specified in Clause 2 Article 31 of this Law, the social security authority shall pay the health insurance-covered medical care costs directly to the participant.”.

27. Amendments to Article 35:

“Article 35. Allocation and use of the health insurance fund

1. The health insurance fund shall be allocated and used as follows:

a) 92% of the health insurance premiums shall be used to pay for medical care;

b) 8% of the health insurance premiums shall be used to contribute to the reserve fund, cover the expenditures on health insurance organization and operation, at least 4% of which shall be contributed to the reserve fund.

2. Investment of the temporarily idle money of the health insurance fund shall comply with regulations of the Law on Social Insurance on the principles, portfolio, methods and management of investment of the social insurance fund.

3. In case the collected health insurance premiums are greater than the payment for medical care in the year, the remainder shall be transferred in full to the reserve fund for general use.

4. In case the collected health insurance premiums are smaller than the payment for medical care in the year, Vietnam Social Security shall provide extra funds from the reserve fund.

5. The Government shall elaborate this Article and regulations on health insurance organization and operation.”.

28. Amendments to Clause 2 of Article 36:

“2. Select a health insurance-covered primary care provider according to Article 26 of this Law.”.

29. Amendments to Clause 3 of Article 39:

“3. Provide the health insurance card or notify the health insurance card issuance result to the health insurance participant within 03 working days from the receipt of the card or the notification from the social security authority.”.

30. Amendments to Clause 2 of Article 40:

“2. Inspect the execution of health insurance-covered medical care contracts; carry out health insurance assessment; revoke, suspend health insurance cards in the cases specified in Article 20 of this Law.”.

31. Amendments to Clause 8 of Article 41:

“8. Inspect the execution of health insurance-covered medical care contract; carry out health insurance assessment.”.

32. Addition of Clause 9 after Clause 8 of Article 43:

“9. Maintain the fulfillment of conditions for health insurance-covered medical care in accordance with regulations of law on health insurance, medical care, and health insurance-covered medical care contracts.”.

33. Addition of Article 48a and Article 48b after Article 48:

“Article 48a. Late payment of health insurance premiums

Late payment of health insurance premiums is the act of the employer in one of the following cases:

1. Failure to pay or fully pay the health insurance premiums payable after the deadline for payment of health insurance premiums specified in Clause 8 Article 15 of this Law, except the cases specified in Point c Clause 1 Article 48b of this Law;

2. Failure to compile a list or a full list of health insurance participants within 60 days from the deadline specified in Point b Clause 1 Article 17 of this Law;

3. It will be considered evasion of health insurance payment in the case specified in Clause 2 Article 48b of this Law.

Article 48b. Evasion of health insurance payment

1. Evasion of health insurance payment is the act of the employer in one of the following cases:

a) Failure to compile a list or a full list of health insurance participants after 60 days from the deadline specified in Point b Clause 1 Article 17 of this Law;

b) Registering a lower salary as the basis for health insurance payment than that specified in Article 14 of this Law;

c) Failure to pay or fully pay the registered health insurance premiums after the 60 days from the deadline for health insurance payment specified in Clause 8 Article 15 of this Law despite being reminded by the competent authority according to regulations of the Government;

d) Other cases in which it is considered evasion of health insurance payment according to regulations of the Government.

2. The Government shall elaborate this Article and specifies the cases mentioned in Clause 1 of this Article that are not considered evasion of health insurance payment for justifiable reasons.”.

34. Amendments to Article 49:

“Article 49. Actions against violations of health insurance laws

1. Agencies, organizations and individuals that commit violations against health insurance laws shall, depending on the nature and severity of the violations, face disciplinary actions, administrative penalties, or criminal prosecution, and pay recompense for any damage caused.

2. Actions against late payment of health insurance premiums:

a) Enforced payment of the arrears plus an interest of 0,03%/day on the arrears multiplied by (x) the number of days of late payment to the health insurance fund;

b) Administrative penalties as prescribed by law;

c) Disqualification from commendation and awards.

3. Actions against evasion of health insurance payment:

a) Enforced payment of the arrears plus an interest of 0,03%/day on the arrears multiplied by (x) the number of days of late payment to the health insurance fund;

b) Administrative penalties or criminal prosecution as prescribed by law;

c) Disqualification from commendation and awards.

4. Agencies, organizations, employers that commit evasion or late payment of health insurance for employees shall return all the covered medical costs to the employees which accrue over the time health insurance cards are not issued due to such evasion or late payment.

5. The Government shall elaborate Point a Clause 2, Point a Clause 3 and Clause 4 of this Article.”.

35. Replacement of certain phrases:

a) The phrase “health insurance organization” is replaced with “social security authority” 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 title of Article and Clause 5 Article 40, the title 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) The phrase “Vietnam Social Security Management Council” is replaced with “Social Insurance Management council” in Clause 1 Article 34.

Article 2. Amendments to the Law on Internal Security Forces No. 30/2023/QH15

Clause 2 Article 32 of the Law on Internal Security Forces No. 30/2023/QH15 is annulled.

Article 3. Implementation clauses

1. This Law comes into force from July 1^st 2025, except regulations of Clause 2 and Clause 3 of this Article.

2. Regulations on healthcare levels, registration of health insurance-covered primary care providers, patient referral among covered facilities, procedures for health insurance-covered medical care in Clauses 3, 16, 17, 21, 22, 23 and 28 Article 1 of this Law comes into force from January 1^st 2025.

3. Regulations on health insurance coverage in Clause 16 Article 1 of this Law, except regulations on telemedicine, telemedicine assistance, family medicine services, at-home medical care, rules for compilation of covered medical devices and medical services and health insurance reimbursement rates in Clause 17 Article 1 applied to the following participants shall come into force from January 1^st 2025:

a) Participants prescribed in Clause 10 Article 1 of this Law that are also prescribed in Article 12 of the Law on Health Insurance No. 25/2008/QH12, which is amended by Law No. 32/2013/QH13, Law No. 46/2014/QH13, Law No. 97/2015/QH13, Law No. 35/2018/QH14, Law No. 68/2020/QH14 and Law No. 30/2023/QH15.

b) The participants prescribed in Point a of this Clause when they receive medical care at health facilities before January 1^st 2025 and end their treatment from January 1^st 2025.

4. Paraclinical results shall be synchronized among covered facilities by January 1^st 2027 in accordance with regulations of the Government.

5. Transition clauses:

a) Participants that are not prescribed in Point a and Point b Clause 3 of this Article, receive medical care at health facilities before July 1^st 2025 and end their treatment from July 1^st 2025 shall apply the regulations of this Law;

b) The reference level prescribed in this Law shall be the statutory pay rate. In case salary policies are changed, the Government shall prescribe a specific reference level;

c) Health insurance-covered medical care contracts that are signed before July 1^st 2025 and enter into force after July 1^st 2025 shall be executed in accordance with regulations of the Government;

d) Health insurance premiums that are payable the employers according to the Law on Health insurance No. 25/2008/QH12, which is amended by Law No. 32/2013/QH13, Law No. 46/2014/QH13, Law No. 97/2015/QH13, Law No. 35/2018/QH14, Law No. 68/2020/QH14 and Law No. 30/2023/QH15 but are not paid or fully paid by the end of June 30^th 2025 shall be handled in accordance with regulations on late payment of this Law.

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

PRESIDENT OF THE NATIONAL ASSEMBLY




Tran Thanh Man

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