Sending a question to the Social Insurance agency, reader C.T.B.T said: "In September 2025, I was issued a certificate by the Social Insurance agency not to co-pay in the year (I paid hospital fees with an amount exceeding 6 months of basic salary).
In previous years, I was still repaid for overpaid money, but this year I was answered, there are no instructions yet. I would like to ask, how can I repay the overpaid hospital fees?".
Regarding this issue, Hanoi City Social Insurance answers as follows:
At the time before July 1, 2025, based on point b, clause 3, Article 27 of Decree No. 146/2018/ND-CP, patients with accumulated co-payments in the fiscal year greater than 6 months of base salary are directly paid this excess amount at the Social Insurance agency:
In case the patient has a cumulative co-payment amount in the fiscal year at different medical examination and treatment facilities or at the same medical examination and treatment facility greater than 6 months of basic salary, the patient shall bring documents to the social insurance agency where the health insurance card is issued to pay the co-payment amount greater than 6 months of basic salary and receive a confirmation that they are not co-paying in that year.
However, this regulation expires from July 1, 2025 according to Clause 4, Article 70 of Decree No. 188/2025/ND-CP, when the new Decree officially takes effect and replaces Decree No. 146/2018/ND-CP.
Based on Official Dispatch No. 6872/BYT-BH dated October 7, 2025 of the Ministry of Health guiding the organization of the implementation of Decree No. 188/2025/ND-CP dated July 1, 2025 of the Government, Article 54 of Decree No. 188/2025/ND-CP stipulates that cases of direct payment of health insurance medical examination and treatment costs do not stipulate direct payment of medical examination and treatment costs for patients who have participated in health insurance for 5 consecutive years or more and have a co-payment of medical examination and treatment costs in the year greater than 6 months of base salary.
Social insurance agencies and medical examination and treatment facilities ensure the rights and payments for patients according to regulations, patients do not have to carry out direct payment procedures.
The Social Insurance Agency is responsible for summarizing and regularly updating information on the amount of money and expenditures accumulated in the patient's financial year, the time when the patient participated in health insurance for 05 consecutive years or more, and notifying it on the Vietnam Social Insurance Data Reception Portal.
The medical examination and treatment facility shall base on the accumulated co-payment amount and the time when the patient participated in health insurance for 5 consecutive years or more to determine the time when the patient is eligible to enjoy co-payment exemption during the patient's medical examination and treatment.
Thus, according to the above guidance, the health insurance medical examination and treatment costs of Ms. C.T.B.T if incurred in the period from December 1, 2018 to the end of June 30, 2025 are applied according to point b, clause 3, Article 27 of Decree No. 146/2018/ND-CP as follows: The patient brings documents to the social insurance agency where the health insurance card is issued to pay the amount of co-payment greater than 6 months of base salary.
If the health insurance medical examination and treatment costs of Ms. T arise from July 1, 2025 onwards, the social insurance agency and medical examination and treatment facility will ensure the rights and pay the patient according to regulations, and the patient does not have to carry out direct payment procedures.
Because Ms. T's question did not provide complete information about the social insurance code, and the amount of money paid exceeding 6 months of base salary, Hanoi City Social Insurance could not accurately look up information about her case.
