Sending a question to Vietnam Social Security, reader N.H. C said: "I was diagnosed with chronic Hemophilia (hereditary blood clotting disorder) requiring long-term treatment, the treatment cost is very high, exceeding my ability to pay if there is no support from health insurance.
I would like to ask, can people with diseases like me be paid 100% health insurance? I already have a health insurance card but have not received 100% health insurance benefits, so what should I do to be considered for adjustment and supplementation of benefits?
What documents are included in the dossier? Which agency to submit? Are people with Hemophilia entitled to health insurance according to social protection groups or rare diseases, chronic diseases?
Regarding this issue, Vietnam Social Security answers as follows:
No regulations on health insurance benefits based on disease names
Regarding the health insurance benefit level for people with Hemophilia, the Health Insurance Law stipulates the health insurance benefit level according to health insurance participants, not stipulating the health insurance benefit level according to the disease name. Accordingly, Article 12 and Article 22 of the Health Insurance Law do not stipulate that people with Hemophilia have a benefit level of 100% of medical examination and treatment costs.
According to the provisions of point d, clause 1, Article 22 of the Health Insurance Law and Article 18 of Decree No. 188/2025/ND-CP dated July 1, 2025 of the Government detailing and guiding the implementation of a number of articles of the Health Insurance Law, the health insurance fund pays 100% of medical examination and treatment costs within the scope of benefits of health insurance participants from the time the patient simultaneously meets the conditions to participate in health insurance for 5 consecutive years or more and has a co-payment amount for medical examination and treatment costs in the financial year greater than 6 months of basic salary until the end of December 31 of that year, patients are entitled to non-co-payment regimes directly at the medical examination and treatment facility.
Identifying health insurance participants
Regarding health insurance participation according to social protection groups, because the information provided by Mr. C is incomplete, Vietnam Social Security provides some information to identify health insurance participants who are social protection beneficiaries in Article 5 of Decree No. 20/2021/ND-CP dated March 15, 2021 of the Government stipulating social assistance policies for social protection beneficiaries as follows:
- People who are classified as poor households, near-poor households who are not married or have no wife, have a husband or wife but have died or disappeared according to the provisions of law and are raising children under 16 years old or are raising children from 16 to 22 years old and that child is studying culture, vocational training, vocational secondary school, college, first degree university;
- Elderly people who are poor households, do not have people with obligations and rights to support or have people with obligations and rights to support but these people are receiving monthly social allowances;
- Elderly people who are poor households, do not have people with obligations and rights to support them, do not have conditions to live in the community, are eligible to be admitted to social assistance facilities but have people to nurture and care for them in the community;
- People with severe disabilities, people with particularly severe disabilities according to the provisions of law on people with disabilities.
In addition, Mr. Chien can contact the Commune People's Committee to know if he is eligible to participate in health insurance according to the social protection group.
Regarding health insurance participation according to groups of rare diseases and chronic diseases, according to the provisions of Appendix 01 of the List of diseases requiring long-term treatment issued together with Circular No. 25/2025/TT-BYT dated June 30, 2025 of the Minister of Health detailing the implementation of the Law on Social Insurance, the Law on Occupational Safety and Health in the field of health and the Law on Medical Examination and Treatment, diseases lacking element VIII genetic (Hemophilia A) and element IX genetic (Hemophilia B) belong to the list of diseases requiring long-term treatment.
In case you are a person who quit their job to receive sickness allowance for employees suffering from diseases on the list of diseases requiring long-term treatment, you will be paid health insurance by the Social Insurance agency according to the provisions of point b, clause 2, Article 12 of the Health Insurance Law.
To be determined whether he is subject to health insurance contributions by the social insurance agency or not, Mr. Chien is requested to contact the social insurance agency that is paying compulsory social insurance and provide information for verification and explanation.
