Decree 188/2025/ND-CP detailing and guiding the implementation of a number of articles of the Law on Health Insurance takes effect from today - August 15, 2025.
Accordingly, the new health insurance benefit level for participants who have been paid for 100% of medical examination and treatment costs for 5 consecutive years is within the scope of benefits, if the amount of money paid in the year exceeds 6 months of basic salary.
According to regulations, the interruption period of health insurance participation of no more than 90 days is still counted as continuous. Some specific cases are also recognized as continuous participation, including: Workers going to work or study abroad; people accompanying their families for a term of service; children under 18 years old accompanying their parents; people waiting to receive unemployment benefits.
In case the electronic data is not enough to determine the participation period, the insurance agency will base on legal documents such as social insurance books, discharge decisions, work process confirmation papers, etc. to ensure benefits. In addition, people who have served in the army, police, key organizations or regular militia, when changing careers, retiring or quitting their jobs, will still have more time to participate in health insurance according to the new regulations.
When eligible, patients will be exempted from all medical examination and treatment costs within the scope of health insurance benefits until December 31 of the fiscal year. If the treatment process lasts from the previous year to the next year, the cost will be separated for each year.
In case the basic salary changes during the year, the cost and payment will also be adjusted to the new level. However, if the patient has paid more than 6 months of basic salary before the adjustment time, the benefits will remain the same and will not have to pay more.
According to Article 15 of Decree 188/2025/ND-CP, the health insurance benefits for some groups of subjects are stipulated as follows:
100% of medical examination and treatment costs: applied to subjects in Clause 2 and Clause 6, Article 5 of this Decree.
80% of medical examination and treatment costs: applied to subjects in Clauses 1, 3, 4, 5 and 7, Article 5.
People specified in Points a, b, c, d, d, Clause 3, Article 12 of the Law on Health Insurance, when examining and treating at facilities not under the management of the Ministry of National Defense or the Ministry of Public Security, will be covered by the Health Insurance Fund according to the benefit level in Article 11 of Decree 70/2015/ND-CP, amended and supplemented by Decree 74/2025/ND-CP.
These changes are considered to help better ensure the rights of health insurance participants, especially long-term and continuous participants.
