According to current regulations, a person who has participated in health insurance for 5 consecutive years is a person who has participated in health insurance for 5 consecutive years, of which a maximum interruption of 3 months is allowed.
The time when a health insurance participant has participated in health insurance for 5 consecutive years will be recorded in the health insurance participation process of that person.
According to Clause 17, Article 1, Law amending and supplementing a number of articles of the Law on Health Insurance, amending Point d, Clause 1, Article 22 of the Law on Health Insurance 2008 (effective from July 1, 2025), health insurance participants will receive 100% of medical examination and treatment costs when they have participated in health insurance for 5 consecutive years or more and have the same amount of money to pay for medical examination and treatment during the year for medical examination and treatment as prescribed in Clause 3, Points a, b, c, dd and e Clause 4, Clause 5 of this Article, Articles 26 and 27 of the Law on Health Insurance 6 times higher than the reference level.
According to this regulation, to enjoy the above, it is necessary to simultaneously meet the following conditions:
Having participated in health insurance for 5 consecutive years or more;
The amount of money spent on medical examination and treatment costs in the year is 6 times larger than the reference level (According to Clause 5, Article 3 of the Law amending and supplementing the Law on Health Insurance 2024, the reference level calculated from July 1, 2025 is 14.04 million VND until new regulations are issued - PV)
Go to the right medical examination and treatment facility, follow the process of transferring patients between health insurance medical examination and treatment facilities or go to the wrong medical examination facility according to regulations or provide emergency care in all cases.
Ho Chi Minh City Social Insurance also said that the reference level is the amount of money decided to be used to calculate the contribution and enjoyment of some social insurance regimes according to the provisions of Article 7 of the Social Insurance Law 2024.
Thus, instead of based on the basic salary to calculate the payment and enjoyment of some social insurance regimes, from July 1, 2025, the calculation of health insurance benefits for those who have participated in health insurance for 5 consecutive years or more will be based on the reference level.
Currently, according to the provisions of Decree 73/2024/ND-CP, the current basic salary is 2.34 million VND.
Therefore, patients who have to have the same amount of money to pay for medical examination and treatment costs in the year of more than 14.04 million VND (6 months of basic salary) and medical examination and treatment at the right level will enjoy health insurance benefits for 5 consecutive years according to the above regulations.
