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Specific cases are mentioned as follows:

1. The individuals specified in Clauses 3, 4, 5, 8, 9, 11, 17, and 20 of Article 3 in this Decree are entitled to 100 per cent coverage of medical examination and treatment costs as prescribed in Point a, Clause 1, Article 22 of the Law on Health Insurance.

2. These groups are fully entitled to medical examination and treatment costs as stipulated in Point a, Clause 1, Article 22 of the Law on Health Insurance, and are exempt from the payment rate specified in Point c, Clause 2, Article 21 of the Law on Health Insurance. They include:

a) Revolutionary participants pre-1945

b) Revolutionary participants from January 1, 1945 to August 1945 uprising

c) Heroic Vietnamese mothers

d) War invalids, people enjoying preferential policies like war invalids, war invalids of type B, and sick soldiers with a working capacity reduction of 81 per cent or more  

e) War invalids, people enjoying preferential policies policies like war invalids, war invalids of type B, sick soldiers when treating wounds or recurring illnesses

f) Resistance fighters infected with toxic chemicals with a labour capacity reduction rate of 81 per cent or more

g) Children under 6 years old.

3.100 per cent coverage for medical expenses, provided treatment costs do not exceed 15 per cent of the basic salary.

4. 95 per cent of medical examination and treatment costs for subjects specified in Clause 1, Article 2, Clauses 12, 18 and 19, Article 3 and Clauses 1, 2 and 5, Article 4 of this decree.  

5. Implementation roadmap and benefit rates for outpatient medical examination and treatment at basic medical examination and treatment facilities as prescribed in Point e and Point h, Clause 4, Article 22 of the Law on Health Insurance are listed as follows: 

a) Beginning January 1, 2025, health insurance participants will receive full coverage for outpatient treatments scoring below 50 points.

From July 1, 2026, funding rates will vary based on medical facility performance scores, offering benefits from 50 per cent to 100 per cent according to their classification prior to 2025.

b) From July 1, 2026, health insurance participants will receive 50 per cent coverage for outpatient treatments scoring from 50 to below 70 points.

c) From July 1, 2026, health insurance participants will receive 50 per cent coverage at outpatient facilities that have been determined by a competent authority to be a provincial or central level or equivalent to a provincial or central level prior to January 1, 2025.

d) From July 01, 2026, health insurance participants will receive 50 per cent coverage at specialised medical examination and treatment facilities that have been determined by competent authorities to be provincial level or equivalent to provincial level prior to January 1, 2025, according to regulations in Point h, Clause 01, Article 2025 of the Law on Health Insurance.

6. The case specified in Point a, Clause 5 of this article shall be calculated to determine the amount of co-payment for medical examination and treatment costs in the year specified in Point d, Clause 1, Article 22 of the Law on Health Insurance.

7. Participants using out-of-network services will have some costs covered by the Health Insurance Fund, with any excess expenses falling on the patient.

8. Changes in health insurance classification due to State policies will facilitate recalculating benefits with the new health insurance card, activating updates immediately upon card validity.

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Regarding the regulation on the coverage for outpatient treatments based on medical facility performance scores, Tran Thi Trang, director of the Department of Health Insurance under the Ministry of Health, said the regulation not only helps ensure fairness in the allocation of health insurance resources but also improves patients’ access to health care services, especially those participating in health insurance in suburban or remote areas.

Decree 02/2025/ND-CP requires the use of level 2 electronic identity accounts or citizen identification cards instead of paper records at medical examination and treatment facilities. This aims to streamline administrative processes and improve patient experience.

By guaranteeing accuracy and speed in processing medical records, these electronic methods significantly reduce the time required for medical examinations and treatment registration.

In order for the Decree 02/2025/ND-CP to be effectively implemented, Deputy Minister of Health Tran Van Thuan said the ministry requested the Vietnam Social Security and local health departments nationwide to disseminate these provisions to medical examination and treatment facilities.

Medical facilities need to apply the new regulations from January 1, 2025 to ensure that patients will fully enjoy health insurance benefits in a quick and convenient manner, he said./.