According to regulations, health insurance participants are often covered by the fund from 80% to 100% of medical examination and treatment costs. Of which, only some specific groups are paid 95% or 100%, while the majority are in the 80% group, patients must pay 20%.
Health insurance participants in the group that is only paid 80% can still receive a rate of 100% if they meet the condition of having participated in health insurance continuously for 5 years or more.
Point d Clause 1 Article 22 of the Law on Health Insurance stipulates: Health insurance participants who have participated in health insurance for 5 consecutive years and have the same amount of money paid in the year that is 6 times greater than the basic salary will be paid 100% of medical examination and treatment costs by the fund.
The basic condition is to have a continuous participation process. However, in reality, there are cases where workers stop paying or participate in interruptions but are still counted as continuous to ensure this right. Specific regulations are stated in Article 18 of Decree 188/2025/ND-CP.
There are 6 cases where even if the participants do not pay health insurance, it will still be counted as the continuous period of health insurance participation to apply the 100% benefit level prescribed in Point d, Clause 1, Article 22 of the Law on Health Insurance.
- Health insurance participants who have been interrupted for no more than 90 days.
- People sent by a competent authority to work, study, or work abroad; or a wife, conscript, or child under 18 years old who follows a father/mother working for a term at a Vietnamese agency abroad. Time abroad is still included in the time participating in health insurance.
- Employees working abroad under contracts or under decisions of state agencies. If after returning home, they continue to participate in health insurance within 30 days from the date of entry, the previous period will be counted consecutively.
- Employees during the unemployment benefit application period. The time spent participating in health insurance before is also counted continuously, except for the period from the date of termination of the contract to the date of submission of documents.
- Three groups of armed forces upon retirement, discharge, career change or termination of employment include:
Officers, professional soldiers, police officers, people working in secret services receive salaries like soldiers;
Sub-officers, soldiers, military, police, and cryptography students studying or serving;
Trainees who have been trained as reserve officers for 3 months or more have not participated in social insurance and health insurance.
The time spent working and studying in these forces is all counted as time participating in health insurance. If there are not enough direct documents, the insurance agency will base on the social insurance book, the decision on demobilization, discharge, residence record or work process confirmation for calculation.
- After the standing militia ceases to perform their duties, the time to perform that duty will also be accumulated in the health insurance participation process.
