From August 15, Decree 188/2025/ND-CP detailing and guiding the implementation of a number of articles of the Law on Health Insurance takes effect, clearly stipulating 5 cases where even if they do not have or have not presented a health insurance card, the health insurance fund will still pay for medical examination and treatment costs.
Children under 6 years old who have not been issued a health insurance card, whose family presents a birth certificate or birth certificate will be subject to medical examination and treatment procedures and enjoy the same rights as those with the card.
Those waiting for reissuance, card exchange or information adjustment are allowed to use an appointment letter from the Social Insurance agency with personal documents for health insurance examination and treatment.
Emergency care, loss of consciousness or death have not yet presented their cards.
People with cards are lost, damaged, or have incorrect information but have not been adjusted.
People in the group whose health insurance is paid by the state budget but have not been granted a card.
In the above cases, patients or relatives must present their identification documents, birth certificates, appointment papers or verification documents for the health facility and the Social Insurance agency to check and confirm the valid health insurance code. Payment will be made according to the corresponding benefit level for the subject.
The new Decree overcomes previous shortcomings when situations such as card loss, incorrect information or not being granted a card are not clearly regulated, causing difficulties in payment approval.
7 cases of health insurance cards being revoked or temporarily locked
According to Decree 188, the health insurance card will be revoked if:
Committing fraud in issuing cards (disclose false information about the subject, benefit level or other fraudulent acts).
People with names on the card do not continue to participate in health insurance.
The health insurance card will be temporarily detained or temporarily locked if the person going to the doctor or treatment uses another person's health insurance card. When being detained, the cardholders must come to receive it and pay the fine according to regulations.
Medical examination and treatment facilities are responsible for notifying the social insurance agency when detecting violations. The Social Insurance Agency will revoke, temporarily detain or temporarily lock the card and notify health insurance participants. The locked card will be reopened, or the detained card will be returned when both the lender and the card borrower have fulfilled their obligations to pay the fine and remedy the consequences (if any).
