Ms. Duong Thi Minh Chau - Head of the Department of Propaganda and Support for Social Insurance Participants Region I (Hanoi) - advised:
Decree No. 02/2025/ND-CP amends and supplements regulations on health insurance benefits for cases specified in Article 22 of the Law on Health Insurance. Specifically:
1. The subjects specified in Clauses 3, 4, 5, 8, 9, 11, 17 and 20, Article 3 of this Decree are entitled to 100% of medical examination and treatment costs as prescribed in Point a, Clause 1, Article 22 of the Law on Health Insurance.
2. The subjects are entitled to 100% of the cost of medical examination and treatment as prescribed in Point a, Clause 1, Article 22 of the Law on Health Insurance and do not apply the payment rate as prescribed in Point c, Clause 2, Article 21 of the Law on Health Insurance, including:
a) Revolutionary activists before January 1, 1945;
b) Revolutionary activists from January 1, 1945 to the August 1945 uprising;
d) War invalids and people enjoying policies such as war invalids, type B war invalids, and sick soldiers with a working capacity reduction of 81% or more;
d) War invalids and people enjoying policies such as war invalids, type B war invalids, and sick soldiers when treating wounds and recurring diseases;
e) Resistance fighters infected with toxic chemicals have a rate of reduced working capacity of 81% or more;
g) Children under 6 years old.
3. 100% of medical examination and treatment costs for cases where the cost for one medical examination and treatment is lower than 15% of the basic salary.
4. 95% of medical examination and treatment costs for subjects specified in Clause 1, Article 2, Clauses 12, 18 and 19, Article 3 and Clauses 1, 2 and 5, Article 4 of this Decree.
5. Implementation roadmap and rate of benefits when examining and treating outpatients at basic medical examination and treatment facilities as prescribed in Point e and Point h, Clause 4, Article 22 of the Law on Health Insurance
a) From January 1, 2025, when an outpatient medical examination and treatment at a basic medical examination and treatment facility achieves a score of less than 50 points or is temporarily classified as a basic level, the health insurance participant will be paid 100% of the benefit level by the health insurance fund.
b) From July 1, 2026, when outpatient medical examination and treatment at a basic medical examination and treatment facility achieves a score of 50 points to less than 70 points, health insurance participants will be paid 50% of the benefit level by the health insurance fund;
c) From July 1, 2026, when examining and treating outpatients at basic medical examination and treatment facilities that have been identified by competent authorities as provincial or central levels or equivalent to provincial or central levels before January 1, 2026, health insurance participants will be paid 50% of the benefit level by the health insurance fund;
d) From July 1, 2026, when examining and treating outpatients at specialized medical examination and treatment facilities that have been identified by competent authorities as provincial level or equivalent to provincial level before January 1, 2025, according to Point h, Clause 4, Article 22 of the Law on Health Insurance, health insurance participants will be paid 50% of the benefit level by the health insurance fund.
