Accordingly, certain cases are recognized as consecutive HI participation periods for the purpose of determining benefit for beneficiaries who have participated in HI for five consecutive years or more, as stipulated in Point d, Clause 1, Article 22 of the Law on Health Insurance. The specific cases are as follows:

(1) A break in HI participation of no more than 90 days is counted as a consecutive participation period.

(2) Individuals assigned by competent authorities to work, study, or perform duties abroad, as well as spouses or biological or legally adopted children under 18 accompanying their father or mother on a term of duty at a Vietnamese agency abroad, shall have their time abroad counted as a period HI participation.

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(3) Employees working abroad under the Law on Vietnamese Workers Working Abroad under Contracts, as well as individuals assigned by state agencies to work abroad, shall have their HI participation period before departure recognized, provided that they continue to participate in HI within 30 days of their return toVietnam.

Workers applying for unemployment benefits under the Law on Employment shall have their previous HI participation period recognized, excluding the period from the date of termination of their employment contract or labor contract to the date of submission of their application for unemployment benefits, the previous participation period is regulated as HI period participation.

Individuals specified in Points a, b, and d, Clause 3, Article 12 of the Law on Health Insurance, upon retirement, discharge from military service, transfer to another sector, or termination of employment, shall have their periods of study and service in the People's Army, People's Public Security, or cryptographic organizations counted as periods of HI participation. In case information is insufficient to determine the participation period, the social security office may rely on one of the documents issued by the relevant military, public security, or cryptographic unit that records the individual's service history. Documents may include a social insurance book; a decision on demobilization, discharge, or termination of employment; a personnel record for military personnel, defense workers and public employees, People's Public Security personnel, or cryptographic personnel; or a certificate of service history issued by a regiment-level unit or an equivalent or higher-level unit.

Individuals specified in Point đ, Clause 3, Article 12 of the Law on Health Insurance, completion of their service as permanent militia members, shall have their period of service counted as a period of HI participation.

Therefore, the above cases are recognized as consecutive HI participation periods to apply the relevant benefit to individuals who have participated in HI for five or more.

Health Insurance Benefits for Individuals with Five or More More of Participation

Individuals who have participated in health insurance for five consecutive years or more may be entitled to special benefits covering medical examination and treatment expenses, provided that they meet several conditions prescribed by law.

The first, the individual must have participated in HI continuously for at least five years. In addition, the total amount of medical examination and treatment expenses that the individual has paid out of pocket under the co-payment mechanism during the year must exceed six times the reference amount.

In addition to the participation time and co-payment amount requirements, the patient must also receive medical examination and treatment at the appropriate level, follow the or fall within other cases permitted by law.

Certain cases may also qualify for these benefits, including emergency medical examination and treatment at any medical facility; medical examination and treatment at a primary-level medical facility; inpatient treatment at a primary health facility; and other special cases prescribed by law.

Under the regulations, HI participant who have participated in HI for five years or more and meet all consecutive years and satisfy all the above conditions will be entitled to have 100% of eligible medical examination and treatment expenses covered by the Health Insurance Fund within the scope of their benefits.

Effective from July 1, 2026, the reference amount is calculated based on the basic salary of 2.53 million VND per month. Accordingly, the annual co-payment threshold to receive this benefit is greater than VND 15.18 million in one year.

The threshold of VND 15.18 million is equivalent to six times the reference amount corresponding to the new basic salary. Once this threshold is exceeded and all other conditions are met, HI participant will be entitled to 100% coverage of eligible medical examination and treatment expenses as regulated.