Medical examination and treatment at contracted medical facilities

In case MET is carried out in accordance with regulations at the registered primary health facility on HI card, or registered primary health facility or referred higher-level facility under regulation, the participant is entitled to 80%–100% MET expenditures, specifically:

100% MET expenditures is applied in the following situations:

Firstly, MET at primary facilities including health stations; family medicine clinics; military–civilian medical stations; military–civilian clinics; district health centers licensed to organize as clinics; clinic of agencies, units, or organizations as stipulated by the Minister of Health; and primary MET facilities in the army or police stipulated by the Minister of National Defense or the Minister of Public Security.

Secondly, outpatient examination and treatment at regional polyclinics.

Thirdly, the MET expense is lower than 15% of the statutory base salary at the time of MET.

Illustrative image 

Fourthly, HI participation duration from five consecutive years or more and the total annual co-payment for MET exceeds six months’ statutory base salary.

80% MET expenditure is applied for other cases.

MET is not carried out following HI regulations, e.g. self-referral to a facility without being registered as primary health facility, or transferring inter-facility without following regulation, the scope of benefits is as follows:

80% MET expenditure is applied under the following situations

Firstly, MET at basic or specialized health facilities for certain rare diseases, serious illnesses, surgical cases, or those requiring high-tech.

Secondly, MET at primary health facilities.

Thirdly, inpatient treatment at basic or specialized health facilities that were classified as provincial-level facilities by competent authorities before January 1, 2025.

Fourthly, MET at basic or specialized health facilities that were classified as district level before January 1, 2025.

40% MET expenditure is applied to inpatient treatment at specialized facilities.

HI MET without HI card or late presentation

If the participants cannot present their HI card information or present after discharge, VSS shall directly pay as follows:

- Outpatient examination and treatment: up to 0.15 times the statutory base salary at the time of MET (VND 2,340,000 × 0.15 = VND 351,000).

- Inpatient examination and treatment: up to 0.5 times the staturoty base salary at the time of discharge (2,340,000 VND × 0.5 = 1,170,000 VND).

MET at non-contracted health facilities

VSS directly pays for MET expense in the following cases:

- Primary MET facilities (under 50 points as prescribed) or those classified as district level before January 1, 2025, or temporarily recognized as basic level: Outpatient MET: up to 0.15 times the statutory base salary at the time of MET (2.340.000đ x 0,15 = 351,000 VND); Inpatient MET: up to 0.5 times the statutory base salary at the time of discharge (2.340.000đ x 0,5 = 1,170,000 VND).

Secondly, basic level MET facilities (50 to under 70 points as prescribed) or those classified as provincial level before January 1, 2025: Inpatient MET: up to 1 time of the statutory base salary at the time of discharge (2,340,000 VND).

Thirdly, specialized facilities: Inpatient MET patient enjoys up to 2.5 times the statutory base salary at the time of discharge (2,340,000 VND × 2.5 = 5,850,000 VND).

VSS directly pays to special cases within the participant’s benefit scope as follows:

Firstly, HI card data is not provided or inaccurate.

Secondly, the participant cannot present the HI card before ended treatment, immediate hospital referral for emergency, unconsciousness, death, or lost card without being reissued.

The participant should contact VSS offices for detailed guidance on direct payment procedures.

Emergency Case: The participant receives MET at any health facility but must present HI card information and ID with image before the treatment is discharged to receive full HI benefits.