Article 54 of Decree No. 188/2025/ND-CP of the Government detailing and guiding the implementation of a number of articles of the Law on Health Insurance clearly states: in some special cases, the Social Insurance Agency (SI) will directly pay the cost of health insurance examination and treatment (HI) to participants, instead of paying through medical facilities. Cases that are directly paid by social insurance in the following cases:
Patients are given emergency care, lose consciousness or die but have not yet presented their health insurance cards before being discharged from the hospital.
Health insurance participants under the management authority of the Ministry of National Defense and the Ministry of Public Security have lost their cards, incorrect card information or have not been reissued in time.
People eligible for state health insurance contributions but have not been granted a card, except for some cases specified in Article 50 of the Decree. At that time, the cost of medical examination and treatment within the scope of benefits will be fully paid from the date of determination in this group of subjects.
Patients receiving emergency care at medical examination and treatment facilities have not signed a health insurance examination and treatment contract, and the arising costs are still paid directly within the scope of benefits.
People who have changed the group of subjects have a higher health insurance benefit level but have not been issued a new card. Social Insurance will pay the difference in benefits for patients.
Patients must buy medicine and medical equipment themselves according to regulations. For the army, police, and cryptography, payment must comply with Decree 70/2015/ND-CP and Decree 74/2025/ND-CP, amended and supplemented.
Patients who go to the doctor for medical treatment during the period when the health insurance card is revoked, temporarily detained or temporarily locked without their fault will still be fully paid according to the correct beneficiaries.
Documents needed for payment
Article 55 of this Decree stipulates that to receive direct payment, health insurance participants need to prepare documents including:
The document requests direct payment (according to the form).
Photocopy of health insurance card or health insurance code, identification documents; discharge papers, medical examination forms or medical examination books; prescriptions (if any).
Invoices and statement of medical examination and treatment costs.
In particular, in cases of self-purchasing drugs and medical equipment, additional prescription forms and confirmation of shortage of drugs and equipment from medical facilities are required.
Thus, people need to pay attention to understanding the above cases to ensure their rights. When eligible for direct payment, patients need to prepare complete documents according to regulations to be resolved by the Social Insurance agency.
