Social insurance clarifies the case of one person belonging to multiple health insurance participants

Xuyên Đông |

Vietnam Social Security has just responded to the case of one person simultaneously belonging to multiple subjects participating in health insurance.

On the Ministry of Finance's Information Portal, readers reflected the case of Mr. T.N. A. K (permanently residing in Ninh Hai commune, Khanh Hoa province). This is a locality recognized by the Khanh Hoa Provincial People's Committee as a safe zone commune.

Mr. K was issued a health insurance card paid by the state budget, with a validity period from December 1, 2025 to June 30, 2026 with a benefit level of 100%.

On July 8, 2026, when receiving emergency care at Ninh Thuan General Hospital, the system announced that his health insurance card was expired while he was receiving inpatient treatment.

By July 9, 2026, after the family contacted the Social Insurance agency, this agency determined that Mr. K had gone to work and was covered by the business with health insurance, and issued a new card according to the group of workers.

At the same time, the Social Insurance agency has supported the adjustment of the benefit code from number 4 to number 2 with a validity period from July 9, 2026 to December 31, 2026.

The family is concerned that if they have to receive inpatient treatment, who will pay the 20% cost and payment on July 8, 2026, because Mr. K still resides in a safe commune, does not change the conditions for enjoying the State's preferential policies but only changes the method of participating in health insurance when going to work.

Answering this content, Vietnam Social Security said that, according to the provisions of point a, clause 5, clause 11 and point 2, clause 17, Article 1 of Law No. 51/2024/QH15 amending and supplementing a number of articles of the Law on Health Insurance, in case one person simultaneously belongs to multiple subjects participating in health insurance, health insurance contributions according to the first subject are determined in accordance with the order specified in Article 12 of the Law on Health Insurance.

At the same time, people belonging to many subjects participating in health insurance are entitled to benefits according to the subject with the highest benefits.

Vietnam Social Security also cited Official Dispatch No. 1781/BYT-BH dated March 18, 2026 of the Ministry of Health on resolving problems in organizing the implementation of laws on health insurance.

Accordingly, people from revolutionary safe zone communes during the resistance war against France or the US who are permanently residing in safe zone communes and have been updated information in the National Population Database, Residence Database and belong to many health insurance participants are entitled to health insurance benefits according to the highest beneficiaries according to the provisions of the Law on Health Insurance.

Regarding Mr. K's case, Vietnam Social Security said that he worked at a business and was issued a health insurance card according to the worker group with the first payment order.

At the same time, because he is a resident living in a safe zone commune, he was adjusted to a higher level of health insurance benefits for people in a safe zone commune with benefit code No. 2 and was paid 100% of the medical examination and treatment costs under his benefit scope by the health insurance fund.

According to the results of searching on the database of the Social Insurance agency, Mr. K's health insurance card is valid from July 1, 2026 to December 31, 2026, which is in accordance with regulations.

Regarding health insurance benefits for the treatment at Ninh Thuan General Hospital from July 8, 2026, Vietnam Social Security said that, according to data from the social insurance agency, Mr. K fully enjoys health insurance benefits of people living in safe communes, with a benefit level of 100% of medical examination and treatment costs within the scope of health insurance benefits.

For cases where health insurance participants are undergoing inpatient treatment and have changes in the benefit level, Vietnam Social Security refers to Clause 2, Article 21 of Decree No. 188/2025/ND-CP stipulating that the new health insurance benefit level is calculated from the time the new health insurance card is valid. Patients are responsible for providing information about the card related to the change in benefit level for medical examination and treatment facilities to check benefits before the end of the treatment and discharge.

Vietnam Social Security said that during inpatient treatment, if there are changes in the health insurance benefit level, patients need to provide information about the card for medical examination and treatment facilities to check and ensure they fully enjoy health insurance benefits right at the medical examination and treatment facility.

Xuyên Đông
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