Cases receiving 100% of health insurance treatment costs from July 2025

The Lao Dong Newspaper Legal Consulting Office replied:

Clause 17, Article 1, Law amending and supplementing a number of articles of the Law on Health Insurance 2024 (effective from July 1, 2025) stipulates that health insurance participants when examining and treating diseases as prescribed in Articles 26 and 27 of this Law will be covered by the health insurance fund for medical examination and treatment costs within the scope of benefits with the following benefits:

a) 100% of medical examination and treatment costs for subjects specified in Points a, b, c, d, dd, e, h, i, o, r and s, Clause 3, Article 12 of this Law. Expenditures for medical examination and treatment outside the scope of health insurance benefits of subjects specified in Points a, b, c, d and d, Clause 3, Article 12 of this Law shall be paid from the health insurance fund for medical examination and treatment of this group of subjects; in case this funding source is not sufficient, it shall be guaranteed by the state budget;

b) 100% of medical examination and treatment costs in cases where the cost for one medical examination and treatment is lower than the level prescribed by the Government;

c) 100% of medical examination and treatment costs at medical examination and treatment facilities under the initial medical examination and treatment level, including: health stations; family medical examination and treatment facilities; military-civilian health stations, military-civilian health clinics; district-level health centers with medical examination and treatment activities licensed to operate under the form of clinics; health agencies, units, and organizations prescribed by the Minister of Health; medical examination and treatment facilities under the initial medical examination and treatment level in the army and police prescribed by the Minister of National Defense and the Minister of Public Security. 100% of outpatient medical examination and treatment costs at regional general clinics;

d) 100% of medical examination and treatment costs when the patient has participated in health insurance for 5 consecutive years or more and has the same amount of money to pay for medical examination and treatment costs during the year for medical examination and treatment visits as prescribed in Clause 3, Points a, b, c, dd and e, Clause 4, Clause 5, this Article, Article 26 and Article 27 of this Law, which is 6 times higher than the reference level;

Thus, from July 1, 2025, the above subjects will receive 100% of the cost of medical examination and treatment under health insurance.