The Ministry of Health has just announced a list of codes for subjects coming to see a doctor for health insurance examination and treatment and fuel codes for sending electronic data on medical examination and treatment costs. This new decision clearly stipulates that some cases are entitled to 50-100% of medical examination and treatment costs according to the scope of benefits and benefit levels.
Abolish old appendices
According to the Ministry of Health, Appendix 5 of the petroleum code issued with Decision 824/QD-BYT dated February 15, 2023 and Appendix 5 of the code of subjects coming for medical examination and treatment issued with Decision 2010/QD-BYT dated June 19, 2025 have both been officially abolished.
Medical examination and treatment facilities that have used other source codes from July 1, 2025 to October 17, 2025 will have to extract electronic data on medical examination and treatment costs and send replacement documents to the Data Receipt Portal of the Social Insurance agency, ensuring the correct scope of benefits and benefit levels according to the new regulations.
Vietnam Social Insurance receives and synchronizes data
Vietnam Social Insurance under the Ministry of Finance will receive electronic data from medical examination and treatment facilities to ensure consistency and unity nationwide.
If the medical facility does not extract and re-send the replacement documents, the Social Insurance agency will appraise according to the subject code that the facility has used, but must ensure the scope of benefits and the benefit level are in accordance with regulations.
During the transition period until December 31, 2025, if the application of the new code encounters objective difficulties, the medical examination and treatment facility can still extract data and submit replacement documents, as long as the rights of health insurance participants are guaranteed.
Subject groups and benefit levels
According to the new list, patients coming for health insurance examination and treatment will be identified with specific subject codes with corresponding benefits. Some notable cases include:
Check the correct place of initial registration: receive 100% of the cost within the scope of health insurance benefits.
Examination at other initial-level facilities (health stations, family medicine, military - civil medicine...): still receive 100% of the cost, regardless of the benefit level on the card.
Exam by referral form or re-examination appointment form: receive 100% of the cost.
Body donors, newborns treated immediately after birth: receive 100% of the cost.
Outpatient examination at a basic level level reaches 50-70 points: from July 1, 2026, they will receive 50% of the cost, and will not previously receive health insurance.
Exam at the central level when not on the correct route: only receive 40% of boarding costs, not outpatient.
Emergency examination or ethnic minorities, poor households in disadvantaged areas, island communes: receive 100% of the cost.
For cases of receiving medicine according to appointment papers, authorization to receive medicine or medical facilities to deliver medicine to patients in the context of group A epidemics or cases of force majeure, patients are still entitled to 100% of medical examination and treatment costs according to regulations.
In cases where patients do not have health insurance or do not go to the doctor according to regulations, they will not be paid for medical examination and treatment costs.
The Ministry of Health notes that the subject code is determined by the medical examination and treatment facility after finishing the examination or treatment, before sending XML data to the reception portal of the Social Insurance agency. If a patient can apply many subject codes, the medical facility will choose codes in order of priority from top to bottom in the new list.
