11 groups enjoy 100% of medical examination and treatment costs
According to point a, clause 1, Article 22 of the Health Insurance Law of 2024, starting from January 1, 2026, 11 groups of subjects will be paid 100% of medical examination and treatment costs by the health insurance fund, including:
First, officers of the People's Army, professional soldiers in active service; officers, professional under-officiers and technical officers and under-officiers working in the People's Police force; people working in key jobs are paid as for soldiers.
Second, non-commissioned officers and soldiers of the People's Army; non-commissioned officers and soldiers on duty in the People's Police; military students, police students, and basic education students enjoying living expenses are Vietnamese people.
Third, military students, police students, and basic education students who enjoy living expenses are foreigners.
Fourth, trainees training reserve officers for 3 months or more who have not participated in social insurance or health insurance.
Fifth, militia on duty.
Sixth, people with meritorious services to the revolution according to the provisions of the Ordinance on Preferential treatment for people with meritorious services to the revolution; veterans.
Saturday, children under 6 years old.
Eighth, relatives of martyrs, people with meritorious services raising martyrs according to the provisions of law on preferential treatment for people with meritorious services.
Ninth, people from poor households; ethnic minorities from near-poor households residing in ethnic minority and mountainous areas; ethnic minorities living in areas with difficult socio-economic conditions; people residing in areas with particularly difficult socio-economic conditions; people living in island communes and island districts.
Tenth, people who are receiving monthly social allowances; people who receive monthly nurturing allowances; people who receive monthly death benefits are eligible for social allowances.
Finally, people aged 75 and over who are receiving monthly survivor's allowance; people aged 70 to under 75 who are near-poor households and are receiving monthly survivor's allowance.
3 more cases enjoy 100% payment
In addition to the above 11 groups, other health insurance participants currently enjoy a payment level of 80% to 95% of medical examination and treatment costs. However, according to points b, c and d, clause 1, Article 22 of the 2024 Health Insurance Law, health insurance participants are still paid 100% of the costs in 3 cases.
First, the cost for one medical examination and treatment is 15% lower than the base salary (currently equivalent to 351,000 VND).
Second, patients are examined and treated at medical examination and treatment facilities under the initial level, including health stations; family medical facilities; military-civilian medical stations, military-civilian medical clinics; district-level health centers operating according to the clinic model; agency and unit health; initial medical examination and treatment facilities in the army and police.
Third, patients who have participated in health insurance for 5 consecutive years or more and have the amount of money jointly paid for medical examination and treatment costs in the year exceeding 6 times the reference level. In 2026, this level is equivalent to 14.04 million VND.
Reducing pocket money, towards sustainable health insurance coverage
Increasing the level of enjoyment, expanding the scope of payment and prioritizing vulnerable groups shows the clear orientation of health insurance policy from 2026 is to drastically reduce patient pocket money, aiming to bring the direct payment ratio down to below 30% in the period 2028-2030, thereby limiting the risk of poverty due to medical expenses.
According to the orientation of the National Assembly and the Government, expanding health insurance benefits from 2026 is the foundation for a long-term roadmap to adjust the contribution level appropriately, increase the benefit level, expand the list of drugs and techniques, and gradually move towards sustainable universal health insurance coverage.
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