What conditions do you need to meet to enjoy health insurance benefits for 5 consecutive years?
Participating in health insurance continuously for 5 years or more helps people have the opportunity to be 100% reimbursed by the health insurance fund for medical examination and treatment costs within the scope of benefits. However, not every 5 years of participation automatically enjoys this benefit.
According to current regulations, people participating in health insurance for 5 consecutive years or more will be entitled to payment for medical examination and treatment costs at a higher level if they simultaneously meet the conditions.
First of all, participants must have continuous health insurance participation time of 5 years or more. Continuous participation time is determined when the participation process is not interrupted beyond the prescribed time limit.
In addition, the amount of co-payment for medical examination and treatment costs in the year must be 6 times greater than the reference level. From July 1, 2026, the reference level is 2.53 million VND/month, corresponding to the co-payment threshold that must exceed 15.18 million VND in the year.
In addition to the two conditions above, patients must have medical examination and treatment at the right tuyến or in accordance with regulations on transferring to health insurance medical examination and treatment facilities. Some cases are still considered in accordance with regulations to enjoy benefits, such as emergency medical examination and treatment at any medical facility, examination at the initial medical examination and treatment registration facility, inpatient treatment at basic medical examination and treatment facilities or other special cases as prescribed by law.
100% of medical examination and treatment costs are paid
When fully meeting the conditions on participation time, co-payment level and medical examination and treatment regulations, health insurance participants from 5 consecutive years will be paid 100% of medical examination and treatment costs within the scope of benefits enjoyed by the health insurance fund.
This means that after the co-payment amount in the year exceeds 15.18 million VND (calculated from July 1, 2026), patients will not have to continue to co-pay medical examination and treatment costs within the scope of payment of health insurance for the remainder of the year, if they still fully meet the conditions according to regulations.
This regulation significantly reduces the financial burden on people with chronic diseases or long-term treatment, with high medical examination and treatment costs.
5-year continuous health insurance is therefore not only a milestone in participation time but also brings practical benefits, helping people reduce medical costs when unfortunately sick. However, to enjoy a 100% payment level, participants need to pay attention to fully meeting the conditions on participation time, co-payment level as well as performing medical examination and treatment in accordance with regulations.
