The National Assembly has issued Resolution No. 261/2025/QH15 on a number of special mechanisms and policies to create breakthroughs in the work of protecting, caring for and improving people's health.
According to the provisions of Article 2 of the Resolution, health insurance participants belonging to near-poor households and elderly people aged 75 and over who are receiving social pension allowances are entitled to a benefit level of 100% of medical examination and treatment costs within the scope of health insurance benefits.
To ensure timely benefits for health insurance participants according to new regulations, the Ministry of Health has requested Vietnam Social Security to urgently implement the conversion of health insurance benefit codes for the above-mentioned groups of subjects in the management system.
Specifically, for health insurance participants belonging to near-poor households, with the participating subject code being workers, the social insurance agency will convert the benefit code from number 3 (benefit level of 95%) to benefit code number 2 (benefit level of 100%), applicable from 01.01.2026.
For the group of elderly people aged 75 and over who are receiving social pension benefits, with the participating subject code being LH, the health insurance benefit code is also adjusted from number 4 (benefit level 80%) to benefit code number 2 (benefit level 100%), starting to be implemented from 01.01.2026.
Along with adjusting the benefit code, the Ministry of Health requests medical examination and treatment facilities nationwide to fully look up health insurance card information, ensuring that participants enjoy the right and full benefits according to the provisions of law.
In the process of implementation, in case of difficulties and obstacles arising, medical examination and treatment facilities need to proactively exchange and coordinate with health insurance assessors and social insurance agencies to agree on handling plans, ensuring timely medical examination and treatment benefits for health insurance participants.
