Pay for health insurance if you have a valid card
The Ministry of Health has just issued new guidelines on health insurance (HI) payment in case patients present their cards late. Accordingly, people with a health insurance card who come to the clinic for examination and treatment but have not yet presented their card will still be covered by the health insurance fund within the scope of benefits, from the time of presentation of card information, except in emergency cases.
The Government's Decree 188/2025 clearly states: If the patient has a valid health insurance card but presents it late, the cost of medical examination and treatment arising before the time of presentation of the card will be paid directly by the health insurance fund to the patient.
The maximum payment level is 0.15 times the basic salary for outpatient examination and 0.5 times the basic salary for inpatient treatment. The cost after presenting the card will be paid as usual within the scope of health insurance benefits.
How to receive payment back
To receive a refund for the cost before presenting the card, the patient or family member needs to submit a written request for direct payment according to the form. You can choose to receive cash at the one-stop department of the Social Insurance agency or transfer it to your personal account.
The application can be submitted online on the National Public Service Portal, via the application of Vietnam Social Insurance, sent by post, or submitted directly to the social insurance agency where the card is located or issued.
After receiving all valid documents, within 25 days, the Social Insurance agency must complete the assessment and pay the patient. If the application needs to be supplemented, the Social Insurance agency will notify within 5 working days, and the patient will have a maximum of 20 days to supplement.
The Ministry of Health notes that people need to keep all invoices and documents before presenting their cards as a basis for payment. Although the benefits are still guaranteed, carrying a card or saving an electronic card when going to the doctor will help you pay quickly, avoiding having to do additional procedures.
Another notable new point in the Ministry of Health's guidelines is that health insurance participants who have participated in health insurance for 5 consecutive years will not need to submit the application for direct payment as before. The determination and exemption of payment will be automatically implemented through the data system connecting the social insurance agency and medical examination and treatment facilities.
For costs arising before July 1, 2025, the Social Insurance agency will still settle them according to the old regulations of Decree 146/2018/ND-CP, ensuring the rights of health insurance participants in the transition period.
