According to Decree 188/2025, health insurance participants in the following 5 cases will still be paid by the health insurance fund for medical examination and treatment within the scope of benefits and benefits, even if they do not have or have not presented their cards.
Children under 6 years old who have not been issued cards:
Clause 2, Article 37 clearly states: Children under 6 years old, even if they do not have a health insurance card, only need a birth certificate or birth certificate, can still be examined and treated and enjoy the same rights as those with a card. Parents or relatives present the original birth certificate or photocopy. If the child does not have a parent or relative, the representative of the medical facility must sign the confirmation on the medical record. This regulation ensures that children receive medical care right from birth.
People waiting to issue, change or adjust cards:
While waiting for a new issuance or adjustment of health insurance card information, patients only need to present a receipt of the application and an appointment to return the results from the Social Insurance agency along with identification documents. Medical facilities will compare information to pay for costs, without interrupting medical examination and treatment.
Emergency patients, people who are unconscious or have died before presenting their cards:
Clause 1, Article 54 stipulates: If a patient is given emergency care, loses consciousness or dies without presenting a health insurance card, the medical facility will still be paid the cost when verifying the health insurance code or health insurance participation status. This regulation takes effect from July 1, helping to handle timely in emergency situations.
People with cards who have lost, damaged or incorrect information:
People who have participated in health insurance but have lost, damaged or entered incorrect information will still be paid if the valid health insurance code is verified, according to Clause 2, Article 54.
People in the group who are covered by the state budget for health insurance but have not been granted a card:
Clause 3, Article 54 stipulates: People whose names are on the list of health insurance participants paid by the state budget, even if they have not been granted a card, if confirmed by the Social Insurance agency, will still be paid for medical examination and treatment costs.
To enjoy the benefits in the above 5 cases, patients need to present appropriate identification documents (CMND/CCCD, birth certificate, birth certificate, appointment letter...) and the medical facility must coordinate with the Social Insurance agency to verify the health insurance code. This new regulation helps ensure the rights of medical examination and treatment for people, avoiding interruption of medical services due to administrative procedures.
