Regulations on cases eligible for 100% health insurance from July 1, 2025

According to the provisions of the amended Law on Health Insurance, effective from July 1, 2025, there will be cases where patients are entitled to health insurance to pay 100% of medical examination and treatment costs. Compared to before, this new regulation has many notable additions, specifically including:

(1) Enjoy 100% of medical examination and treatment costs for subjects specified in points a, b, c, d, đ, e, h, i, o, r and s, Clause 3, Article 12 of the Law on Health Insurance, including:

People's army officers, professional soldiers on active duty; professional officers, non-commissioned officers and technical officers and non-commissioned officers working in the people's police force; people doing cryptographic work receiving salaries as military personnel;

Cadets training as reserve officers for 3 months or more who have not participated in social insurance or health insurance (new addition);

Illustration photo.

Regular militia (this group is a new addition compared to previous regulations);

People with revolutionary contributions according to the provisions of the Ordinance on Preferential Treatment of People with Revolutionary Contributions; war veterans;

Children under 6 years old;

Relatives of martyrs and people who have raised martyrs according to the provisions of the Ordinance on Preferential Treatment of People with Revolutionary Contributions;

People from poor households; ethnic minorities from near-poor households residing in communes and villages in ethnic minority and mountainous areas; ethnic minorities residing in areas with difficult socio-economic conditions; people residing in areas with especially difficult socio-economic conditions; people living in island communes and island districts;

People receiving monthly social allowances; people receiving monthly foster care allowances according to relevant laws; people receiving monthly death benefits who are eligible for social allowances;

People aged 75 and over who are receiving monthly pensions, people aged 70 to under 75 who are in near-poor households who are receiving monthly pensions (this group is a new addition compared to before);

(2) Enjoy 100% of medical examination and treatment costs in case the cost for one medical examination and treatment is lower than the level prescribed by the Government (currently, this level is determined to be lower than 15% of the basic salary);

(3) Enjoy 100% of medical examination and treatment costs at primary medical examination and treatment facilities, including:

Medical stations; family medicine examination and treatment facilities; military-civilian medical stations, military-civilian medical clinics; district-level medical centers with medical examination and treatment activities licensed to operate in the form of clinics; medical facilities of agencies, units, and organizations as prescribed by the Minister of Health; initial medical examination and treatment facilities in the army and police as prescribed by the Minister of National Defense and the Minister of Public Security.

(4) Enjoy 100% of the cost of outpatient examination and treatment at the regional polyclinic;

(5) Enjoy 100% of medical examination and treatment costs for patients who have participated in health insurance for 5 consecutive years or more and have the co-payment amount in the year for medical examinations and treatments greater than 6 times the reference level (the current reference level is the basic monthly salary).

Will 5 consecutive years of health insurance cover 100% of the cost of treating critical illnesses?

5 consecutive years of health insurance is understood as a person who has participated continuously for 5 years or more without interruption of more than 3 months.

According to the above regulations, people who participate in health insurance for 5 consecutive years will enjoy 100% of medical examination and treatment costs if they meet an additional condition: the co-payment amount in the year exceeds 6 times the reference level.

Conclude:

Health insurance benefits for 5 consecutive years regardless of whether the treatment is critical or non-critical;

Health insurance for 5 consecutive years does not automatically entitle you to 100%, but only if you meet the condition that the co-payment amount in the year exceeds 6 times the reference level. If you have participated in health insurance for 5 consecutive years but the co-payment amount has not exceeded this threshold, you will still only be entitled to the level stated on the card (80%, 95%).

Source: https://doanhnghiepvn.vn/tin-tuc/tin-vui-tu-1-7-2025-nguoi-tham-gia-bhyt-du-5-nam-lien-tuc-co-the-duoc-thanh-toan-100-chi-phi-kham-chua-benh/20250429112012084