Health insurance participants will have more convenience when receiving medical examination and treatment costs directly from the social insurance agency (SI) according to the new regulations of Article 56 of Decree 188/2025/ND-CP. The process is concise, transparent and digital technology is applied to save time for both patients and management agencies.
According to regulations, patients or relatives must fill in all information in the payment request document directly according to Form No. 10 attached to Decree 188/2025/ND-CP. Here, patients choose to receive money at the one-stop department of the Social Insurance agency or transfer money to a registered personal account number. The dossier includes documents according to Article 55 of Decree 188/2025/ND-CP, submitted on the National Public Service Portal, application of Social Insurance, directly at the one-stop department or sent by post to the Social Insurance agency where the card is issued or where the contract with the medical examination and treatment facility is signed.
Immediately upon receipt, the Public Service Portal or the Social Insurance application will automatically issue an appointment letter to return the results. If submitted directly, the one-stop officer will check and issue an appointment letter. In case the application is valid, within 25 days from the date of receipt of the complete application, the Social Insurance agency must assess and pay the cost to the patient, in cash or by bank transfer.
If the dossier needs to be amended or supplemented, within 5 working days, the Social Insurance agency must clearly announce the content that needs to be adjusted. Patients or relatives have 20 days to complete and send back. From the date of receiving the complete supplemented documents, the Social Insurance agency will settle the payment within 20 days.
The new process both ensures publicity and transparency, and helps health insurance participants save time and travel costs. This is an important step in digital transformation of the social insurance sector, encouraging people to proactively participate and protect their rights when examining and treating diseases.
