According to the new regulations of the Law on Health Insurance, there are 3 special cases in which patients are covered by health insurance for 100% of medical examination and treatment costs, applicable to all groups participating in health insurance. These cases are clearly stated in Point b, Point c and Point d, Clause 1, Article 22 of the Law on Health Insurance 2024.
The first case is when the cost for one medical examination and treatment is 15% lower than the basic salary. With the current basic salary, this cost threshold is equivalent to 351,000 VND/examination. At that time, health insurance participants will be paid 100% of the costs by the health insurance fund, not have to pay at the same time.
The second case is a patient coming to a primary level medical examination and treatment facility for examination and treatment. This is a group of medical facilities near the people, playing an important role in primary health care.
Facilities under the initial medical examination and treatment level include:
Commune, ward and town health stations
Family medicine examination and treatment facilities
Military-civilian health stations, military-civilian clinics
District-level health centers operate medical examination and treatment according to the clinic model
Health of agencies, units, and organizations
Initial medical examination and treatment facilities in the army and police
When patients receive medical examination and treatment at these facilities properly, health insurance will cover the entire cost according to regulations.
Participating in health insurance for 5 consecutive years or more and exceeding the threshold for the same payment
The third case applies to health insurance participants who have participated in health insurance for 5 consecutive years or more and have the same amount of money paid for medical examination and treatment costs in the year that is 6 times higher than the reference level.
According to regulations applied from 2026, the reference level is 2,340,000 VND, therefore the maximum co-payment threshold for the year is 14,040,000 VND. When the patient has paid more than this level, health insurance will pay 100% of the cost of medical examination and treatment for the next treatments during the year.
Maintaining cases eligible for 100% payment shows that the health insurance policy continues to aim at reducing the burden of medical costs, encouraging people to participate in long-term health insurance and prioritizing primary health care right from the grassroots level.
