Decree 188/2025/NĐ-CP: guidance on the Health Insurance Law

Article 1. Scope of adjustment

This decree provides detailed regulations and guidance for the implementation of certain provisions of the Law on Health Insurance No. 25/2008/QH12 dated November 14, 2008, as amended and supplemented by certain provisions according to Law No. 32/2013/QH13, Law No. 46/2014/QH13, Law No. 97/2015/QH13, Law No. 35/2018/QH14, Law No. 68/2020/QH14, Law No. 30/2023/QH15, and Law No. 51/2024/QH15 (hereinafter referred to as the Law on Health Insurance), including:

1. Detailed regulations on the following contents:

a) Health insurance medical examination and treatment contracts as stipulated in Article 25 of the Law on Health Insurance;

b) Procedures for health insurance medical examination and treatment as stipulated in Clause 1, Article 28 of the Law on Health Insurance;

c) Methods of payment and the application of payment methods for health insurance medical examination and treatment costs as stipulated in Article 30 of the Law on Health Insurance;

d) Payment of medical examination and treatment costs under health insurance in accordance with the provisions in points a and b of Clause 2 and Clause 3, Article 31 of the Health Insurance Law;

đ) Allocation and use of the fund in accordance with the provisions of Clause 5, Article 35 of the Health Insurance Law;

e) Handling violations of health insurance law in accordance with the provisions in point a, Clause 2, point a, Clause 3, and Clause 4, Article 49 of the Health Insurance Law.

2. It stipulates contents regarding:

a) Subjects participating in health insurance as prescribed in point a, clause 7, Article 12 of the Law on Health Insurance;

b) Contribution levels, contribution support levels, responsibilities, and methods of paying health insurance as prescribed in points đ and e, clause 1 and clause 7, Article 13 of the Law on Health Insurance;

c) Issuing paper and electronic health insurance cards in accordance with the provisions of Clause 3, Article 17 of the Health Insurance Law;

d) The scope of benefits for health insurance participants as prescribed in points a and c, Clause 3, Article 21 of the Health Insurance Law;

d) The level of health insurance benefits for health insurance participants as prescribed in point b, Clause 1, points e and h, Clause 4, Article 22 of the Health Insurance Law; in case health insurance participants use medical examination and treatment services on demand as provided in Clause 6, Article 22 of the Health Insurance Law and other cases not specified in Clause 1, Article 22 of the Health Insurance Law;

e) Signing contracts for health insurance medical examination and treatment as prescribed in Article 24 of the Health Insurance Law;

g) Payment of costs for health insurance medical examination and treatment as prescribed in point c, Clause 2 and point a, Clause 4, Article 31 of the Health Insurance Law;

h) Managing the health insurance fund, deciding on financial sources to ensure medical examination and treatment under health insurance in case of an imbalance between revenue and expenditure of the health insurance fund as prescribed in Clause 2, Article 34 of the Health Insurance Law;

i) Organize and operate health insurance in accordance with the provisions of Clause 5, Article 35 of the Health Insurance Law;

k) Cases specified in Clause 1, Article 48b of the Health Insurance Law but with justified reasons shall not be considered as evasion of health insurance contributions;

l) Transition regarding the implementation of health examination and treatment insurance contracts signed before July 1, 2025, that remain effective after July 1, 2025.

3. Guidance on the implementation of the following contents:

a) Payment for medicine and medical equipment costs in accordance with Clause 3, Article 55 of the 2023 Law on Bidding as amended and supplemented by Law No. 90/2025/QH15;

b) Application of information technology and digital transformation in the implementation of health insurance;

c) Duties and powers of ministries, localities, agencies, and competent persons regarding health insurance after the organizational apparatus has been arranged;

d) Responsibilities of relevant parties in the organization of implementation.

Article 2. Subjects of application

1. This decree applies to participants in health insurance, health examination and treatment facilities under health insurance, social insurance agencies, and other organizations and individuals related to health insurance, including subjects specified in clause 2 of this Article.

2. Health insurance participants and health examination and treatment facilities under health insurance in the following cases:

a) Health insurance participants under the management authority of the Ministry of National Defense and the Ministry of Public Security who receive examination and treatment at health examination and treatment facilities under health insurance not managed by the Ministry of National Defense or the Ministry of Public Security;

b) Health insurance participants not under the management authority of the Ministry of National Defense or the Ministry of Public Security who receive examination and treatment at health examination and treatment facilities under health insurance managed by the Ministry of National Defense or the Ministry of Public Security.

3. Participants in health insurance who belong to the People's Army, the People's Police, and those working in cipher operations who receive medical examination and treatment at health insurance medical facilities under the management authority of the Ministry of National Defense and the Ministry of Public Security shall be applied according to the separate regulations of the Government for these subjects.

Article 3. Cases not considered as evading health insurance contributions

Cases under the provisions in point a and point c, clause 1, Article 48b of the Health Insurance Law are not considered as evasion of health insurance payment if there is one of the following reasons as announced by the competent authorities on disaster prevention, emergency situations, civil defense, and epidemic prevention and control, including:

1. Storms, floods, inundation, earthquakes, large fires, prolonged droughts, and other types of natural disasters that directly and seriously affect production and business activities.

2. Dangerous epidemics announced by competent state authorities, causing serious impacts on the production, business activities, and financial capacity of agencies, organizations, and employers.

3. Emergency situations as prescribed by law causing sudden, unexpected impacts on the activities of agencies, organizations, and employers.

4. Other force majeure events as prescribed by civil law.

Article 4. Determination of the amount payable and reimbursement of expenses for the patient in case of late payment or evasion of health insurance contributions

1. Agencies, organizations, and employers who are late in paying or evade paying health insurance must pay the amount for the late payment or evasion to the social insurance agency. The amount to be paid for late payment or evasion of health insurance is determined as follows:

Cđt = Pst x n x 0.03%

Where:

- Cđt: Amount to be paid for the number of days of late payment or evasion for month t (t=1,2,3,...12)

- Pst: Amount required to be paid for month t

- n: Number of days of late payment or evasion.

2. Agencies, organizations, and employers that are late in paying or evade payment of health insurance must reimburse medical examination and treatment costs for employees in the 6 cases where agencies, organizations, or employers are late in paying or evade health insurance payments, as follows:

a) Employees or their relatives or lawful representatives according to the provisions of the law of the employees directly submit the application according to the components specified in Clauses 2, 3, and 4 of Article 55 of this Decree to the agency, organization, or employer that is late in paying or evading health insurance contributions;

b) Agencies, organizations, or employers are responsible for paying medical examination and treatment costs for the employees or their relatives or lawful representatives according to the provisions of the law of the employees within 40 days from the date of receiving a complete application for reimbursement;

c) Medical examination and treatment facilities provide a cost statement to determine the amount the patient has paid to the medical facility, accompanied by a legal invoice at the request of the patient, as a basis for the patient to request reimbursement of medical examination and treatment costs under health insurance.

SUBJECTS, CONTRIBUTION LEVEL, SUPPORT LEVEL FOR CONTRIBUTION, AND

RESPONSIBILITY FOR PAYING HEALTH INSURANCE

Article 5. Subjects participating in health insurance

In addition to the subjects participating in health insurance as prescribed in Clauses 1, 2, 3, 4, 5, and 6 of Article 12 of the Health Insurance Law, the subjects participating in health insurance also include the following subjects:

1. Rubber workers who are receiving monthly allowances according to the Government's regulations participate in group health insurance paid by the social insurance agency as stipulated in Clause 2, Article 12 of the Health Insurance Law.

2. People residing in communes that were revolutionary safe zones during the resistance against the French or against the Americans, who are currently permanently residing in communes that were revolutionary safe zones during the resistance against the French or against the Americans, have had their information updated in the National Database on Population, the Database on Residence, and participate in group health insurance paid by the state budget as prescribed in Clause 3, Article 12 of the Law on Health Insurance.

3. Individuals awarded the title of People's Artisan or Meritorious Artisan who belong to households with a monthly average income per capita lower than the basic salary level as prescribed by the Government, and who are not subjects specified in Clauses 1, 2, and 3, Article 12 of the Law on Health Insurance, participate in group health insurance paid by the state budget as prescribed in Clause 3, Article 12 of the Law on Health Insurance.

4. Victims of post-war mines and explosives as prescribed in Clause 8, Article 3 of Decree No. 18/2019/NĐ-CP dated February 1, 2019, of the Government on management and implementation of post-war mine and explosive remediation activities, who do not fall under the subjects specified in Clauses 1, 2, and 3, Article 12 of the Law on Health Insurance, shall participate in health insurance according to the group whose contribution is supported by the state budget as prescribed in Clause 4, Article 12 of the Law on Health Insurance.

5. Family members of persons performing other tasks in cryptologic agencies as prescribed by the law on cryptology, who are not subjects participating in health insurance as specified in points a, b, c, d, đ, e, g, h, and i of Clause 1, Clause 2, and Clause 3, Article 12 of the Law on Health Insurance, shall participate in health insurance according to the group whose premium is paid by the employer or the employee, or co-paid as stipulated in Clause 1, Article 12 of the Law on Health Insurance.

6. Participants in the resistance, national defense, international duty, and other subjects who have had their health insurance paid by the state budget according to the regulations in legal documents issued before January 1, 2025, shall participate in health insurance under the group funded by the state budget as stipulated in Clause 3, Article 12 of the Law on Health Insurance.

7. Students undergoing military training at the commune-level Military Command with college or university degrees in basic military studies under full-time programs, according to the decision of the Prime Minister and legal regulations before January 1, 2025, who are receiving living allowances from the state budget and have not yet participated in health insurance, shall participate in health insurance under the group funded by the state budget as stipulated in Clause 3, Article 12 of the Law on Health Insurance.

8. Subjects specified in clauses 1, 2, 3, 4, 5, 6, and 7 of this Article who simultaneously belong to multiple health insurance participant groups according to the groups specified in Article 12 of the Health Insurance Law shall participate in health insurance according to the principle prescribed in point a, clause 5, Article 13 of the Health Insurance Law.

9. Persons belonging to the subjects specified in clause 4 of this Article who simultaneously fall under the subjects specified in clause 4, Article 12 of the Health Insurance Law may choose to participate according to the category with the highest support level.

Article 6. Contribution rates, contribution support levels, and responsibility for paying health insurance

1. The premium paid by the employer or paid by the employee or jointly paid is prescribed as follows:

a) The monthly contribution of subjects specified in points a, c, d, and e, clause 1, Article 12 of the Health Insurance Law is 4.5% of the monthly salary used as the basis for mandatory social insurance contributions, of which the employer contributes two-thirds and the employee contributes one-third;

b) The monthly contribution rate for subjects specified in points b and đ, Clause 1, Article 12 of the Health Insurance Law is 4.5% of the monthly salary used as the basis for compulsory social insurance payment and is paid by the subjects themselves;

c) The monthly contribution rate for subjects specified in point g, Clause 1, Article 12 of the Health Insurance Law is 4.5% of the basic salary, of which the employer pays two-thirds and the employee pays one-third;

d) The monthly contribution rate for subjects specified in point h, Clause 1, Article 12 of the Health Insurance Law is 4.5% of the monthly salary used as the basis for compulsory social insurance payment, of which the employer pays two-thirds and the employee pays one-third;

d) The monthly contribution for subjects specified in point i, clause 1, Article 12 of the Law on Health Insurance is 4.5% of the base salary and is paid by the employer of defense workers and officials serving in the military, and by the employer of police workers serving in the people's police;

e) The monthly contribution for subjects specified in clause 5, Article 5 of this Decree is 4.5% of the base salary and is paid by the employer of other personnel working in cryptographic organizations in accordance with the law on cryptography.

g) Employees who are officials, public servants, or civil servants and are under temporary detention, temporary custody, temporary suspension from work, or temporary suspension from position without having been disciplined, the monthly contribution is 4.5% of 50% of the monthly salary used as the basis for compulsory social insurance payment of the employee for the month immediately preceding the temporary detention, custody, or suspension according to legal regulations, in which the employer pays two-thirds and the employee pays one-third. In case the competent authority concludes that there is no violation of the law, the employer and the employee must retroactively pay health insurance on the salary amount that is retroactively received.

2. The premium paid by the social insurance agency is prescribed as follows:

a) The monthly contribution of individuals specified in point a, clause 2, Article 12 of the Health Insurance Law is 4.5% of the pension or labor incapacity allowance;

b) The monthly contribution of individuals specified in points b and c, clause 2, Article 12 of the Health Insurance Law and clause 1, Article 5 of this Decree is 4.5% of the base salary;

c) The monthly contribution of individuals specified in point d, clause 2, Article 12 of the Health Insurance Law is 4.5% of the unemployment allowance.

3. The contribution rate for groups paid by the state budget is regulated as follows:

a) The monthly contribution of individuals specified in points e, g, h, i, k, l, m, o, p, q, r, s, t, and u, clause 3, Article 12 of the Health Insurance Law and clauses 2, 3, 6, and 7, Article 5 of this Decree is 4.5% of the base salary;

b) The monthly contribution of the subjects specified in point n, clause 3, Article 12 of the Law on Health Insurance is 4.5% of the basic salary and is paid through the agency, organization, or unit that grants the scholarship.

4. The contribution rate of the group supported by the state budget is stipulated as follows:

The monthly contribution of the subjects specified in clause 4, Article 12 of the Law on Health Insurance and clause 4, Article 5 of this Decree is 4.5% of the basic salary, self-paid by the subjects, and partially supported by the state budget according to the provisions of clause 6, Article this.

5. The monthly contribution of the subjects specified in clause 5, Article 12 of the Law on Health Insurance is stipulated as follows:

a) The monthly contribution is 4.5% of the basic salary and is paid by the subjects through the family household or self-paid individually.

b) Family members specified in point a, clause 5, Article 12 of the Law on Health Insurance who participate in health insurance under the household form in the fiscal year shall be entitled to the following contribution reductions: the first person contributes 4.5% of 10 times the basic salary; the second, third, and fourth persons contribute 70%, 60%, and 50%, respectively, of the first person's contribution; from the fifth person onwards, the contribution is 40% of the first person's contribution.

6. The level of support from the state budget is prescribed as follows:

a) 100% support of the health insurance contribution for individuals from near-poor households residing in poor communes according to the Prime Minister’s Decision and other documents of the competent authority;

b) At least 70% support of the health insurance contribution for subjects specified in point a, clause 4, Article 12 of the Law on Health Insurance;

c) Provide at least 70% support for health insurance contributions for subjects specified in point g, clause 4, Article 12 of the Health Insurance Law. The support period is 36 (thirty-six) months from the time the commune where the subject lives is no longer classified as an area with difficult or particularly difficult socio-economic conditions;

d) Provide at least 50% support for health insurance contributions for subjects specified in point i, clause 4, Article 12 of the Health Insurance Law. The support period is 01 year from the time the subject is recognized by the competent authority as a victim according to the provisions of the Law on Prevention and Combat of Human Trafficking;

d) Provide at least 50% support for health insurance contributions for subjects specified in points b, c, đ, e, and h, clause 4, Article 12 of the Health Insurance Law;

e) Provide at least 30% support for health insurance contributions for subjects specified in point d, clause 4, Article 12 of the Health Insurance Law and clause 4, Article 5 of this Decree.

Article 7. Methods and responsibilities for paying health insurance for certain subjects

1. For individuals receiving pensions, monthly disability allowances, or social insurance allowances guaranteed by the state budget as prescribed in Clause 2, Point q, Clause 3, Article 12 of the Health Insurance Law and Clause 1, Article 5 of this Decree, the social insurance agency shall monthly transfer the health insurance contribution for these individuals from the source of pension and social insurance allowance funds guaranteed by the state budget.

2. For the subjects specified in Points e, i, and k, Clause 3, Article 12 of the Health Insurance Law and Clause 6, Article 5 of this Decree, quarterly, the Department of Home Affairs shall transfer the health insurance contribution from the fund for implementing policies to favor individuals with meritorious services to the revolution into the health insurance fund. No later than December 15 each year, the home affairs agency must complete the transfer of the year's funds into the health insurance fund.

3. For the subjects specified in point r, clause 3, Article 12 of the Law on Health Insurance and clause 2, Article 5 of this Decree, quarterly, the Department of Health shall transfer health insurance contributions from the funds for implementing social protection policies into the health insurance fund. No later than December 15 each year, the Department of Health must complete the transfer of funds to the health insurance fund for that year.

4. For the subjects specified in points c, d, e, h, and i, clause 4, Article 12 of the Law on Health Insurance and clause 4, Article 5 of this Decree, quarterly, the social insurance agency shall compile the number of health insurance cards issued and the amount of contribution, supported contribution according to Form No. 1 of the Appendix issued together with this Decree, and send it to the Department of Finance to transfer health insurance contributions from the local budget according to the provisions of clause 10 of this Article.

5. For the subjects specified in points g, h, l (except for relatives of subjects managed by the Ministry of National Defense), m, o, p, s, t, and u of clause 3, points a and g of clause 4, Article 12 of the Law on Health Insurance, and clause 3, Article 5 of this Decree:

a) Quarterly, the social insurance agency shall compile the number of health insurance cards that have been issued and the amount of contributions, support for contributions according to Form No. 1 of the Appendix issued together with this Decree, and send it to the Department of Finance to transfer the funds into the health insurance fund as prescribed in clause 10 of this Article;

b) The time for calculating the amount payable for the subjects listed annually is from January 1; for the subjects added during the year, the payment is calculated according to clauses 3 and 4, Article 6 of this Decree, and benefits are enjoyed from the date specified in the approval decision.

6. For student subjects specified in point b, clause 4, Article 12 of the Law on Health Insurance:

a) Periodically every 03 months, 06 months, or 12 months, students or their parents or guardians are responsible for paying the portion of health insurance premiums required to be paid according to the provisions of Clause 2, Article 8 of this Decree to the social insurance agency;

b) Students studying at educational institutions or vocational education institutions under ministries or central agencies are supported by the central budget. Periodically every 03 months, 06 months, or 12 months, provincial or centrally-run city social insurance agencies aggregate the number of health insurance cards issued, the amount collected from students, and the amount of state budget support paid according to Form No. 1 in the Appendix issued with this Decree, and send it to Vietnam Social Insurance for aggregation and then to the Ministry of Finance to transfer the funds into the health insurance fund;

c) Students currently studying at other educational institutions or vocational education institutions shall be supported by the local budget, including any portion of central budget support (if any) where the educational institution is located, regardless of the students' place of residence. Periodically, every 3 months, 6 months, or 12 months, the social insurance agency shall compile the number of health insurance cards issued, the amount of money collected from students, and the amount of state budget support for contributions according to Form No. 1 of the Appendix issued together with this Decree, and send it to the Department of Finance to transfer funds into the health insurance fund as prescribed in Clause 10 of this Article.

7. For the subjects whose health insurance contribution level is partially supported by the state budget as stipulated in Point d, Clause 4, Article 12 of the Health Insurance Law:

a) Every 3 months, 6 months, or 12 months, the representative of the household directly pays the health insurance premium portion under the responsibility according to the provisions in Clause 2, Article 8 of this Decree to the social insurance agency;

b) Every 3 months, 6 months, or 12 months, the social insurance agency consolidates the number of health insurance cards issued, the amount collected from participants, and the amount of state budget support for payment according to Form No. 1 in the Appendix issued together with this Decree, and sends it to the Department of Finance to transfer the funds into the health insurance fund as prescribed in Clause 10 of this Article.

8. For subjects participating in health insurance under the household regimen specified in Clause 5, Article 12 of the Health Insurance Law: every 3 months, 6 months, or 12 months, the household representative or household member participating in health insurance pays the health insurance premium according to the provisions in Clause 3, Article 8 of this Decree to the social insurance agency.

9. For subjects participating in health insurance as prescribed in points h and i, Clause 1, Article 12 of the Health Insurance Law and Clause 5, Article 5 of this Decree, the employer pays health insurance for these subjects monthly together with health insurance for employees according to regulations, from the following sources:

a) For units using the state budget, it is ensured by the state budget;

b) For public service providers, it is financed by the unit's funds according to the law on the autonomy mechanism of public service providers;

c) For enterprises, it is financed by the enterprise's funds.

10. The Department of Finance, based on regulations on the decentralization of budget management by the competent authority and the summary table of subjects and state budget funds to be paid or supported to be paid as transferred by the social insurance agency, is responsible for transferring funds to the health insurance fund quarterly. No later than December 15 each year, the transfer of funds to the health insurance fund for that year must be completed.

11. For the subjects specified in point n, clause 3, Article 12 of the Health Insurance Law, every quarter, agencies, units, and organizations granting scholarships shall pay health insurance into the health insurance fund according to regulations.

12. For the subjects specified in point l, clause 3, Article 12 of the Health Insurance Law, who are relatives of subjects managed by the Ministry of National Defense, and the subjects specified in clause 7, Article 5 of this Decree, the financial agencies of units under the Ministry of National Defense shall pay health insurance to the Military Social Insurance quarterly.

13. In the case of a health insurance participant dying, going missing, or no longer residing in Vietnam, the health insurance premiums paid from the time of payment to the time of cessation of payment shall be calculated according to the reduction report list prepared by the competent authority.

Article 8. Determination of contribution amounts and contribution support for certain subjects when the State adjusts the health insurance contribution level or adjusts the basic salary level

1. For the group of subjects specified in Clause 3, Article 12 of the Health Insurance Law and the subjects entitled to 100% health insurance premium support as prescribed in Point a, Clause 6, Article 6 of this Decree who are fully supported by the state budget for health insurance contributions:

a) The amount of state budget contribution, support for monthly contributions is determined according to the health insurance contribution rate multiplied by the basic salary. When the state adjusts the health insurance contribution rate or adjusts the basic salary, the amount of state budget contribution is adjusted from the date of application of the new health insurance contribution rate and the new basic salary;

b) The health insurance contribution amount for the subjects specified in Point h, Clause 3, Article 12 of the Health Insurance Law is calculated from the date of birth until the child reaches 72 months of age. In the case of Vietnamese children born abroad, the health insurance contribution amount is calculated from the date the child returns to reside in Vietnam according to the provisions of law.

2. For the group of subjects whose health insurance premiums are partially supported by the state budget as prescribed in points b and d, Clause 4, Article 12 of the Health Insurance Law:

a) The monthly contribution of the participant and the support from the state budget are determined according to the health insurance contribution rate multiplied (x) by the base salary at the time the participant pays the health insurance;

b) When the State adjusts the health insurance contribution rate or adjusts the base salary, the participant and the state budget are not required to pay additional amounts nor are they entitled to a refund of the difference due to the adjustment of the health insurance contribution rate or base salary for the remaining period for which the participant has already paid health insurance.

3. For the group of subjects participating in health insurance as prescribed in Clause 5, Article 12 of the Health Insurance Law:

a) The monthly contribution amount of participants is determined according to the health insurance contribution rate multiplied by the base salary at the time of paying health insurance;

b) When the State adjusts the health insurance contribution rate or adjusts the base salary, participants are not required to pay additional amounts or are not entitled to a refund of the difference due to the adjustment of the health insurance contribution rate or the base salary for the remaining period for which they have already paid health insurance.

4. For participants joining on any day of the month, the health insurance contribution amount is determined on a monthly basis starting from the day they pay health insurance.

HEALTH INSURANCE CARD

Article 9. Compiling the list for issuing health insurance cards for certain subjects

1. The responsibility for creating the list for issuing health insurance cards is carried out according to the provisions in Clause 3, Article 8, and Clause 1, Article 17 of the Health Insurance Law.

2. The social insurance agency shall prepare a list for issuing health insurance cards to individuals who have donated body parts in accordance with the law, based on the discharge paper issued by the medical examination and treatment facility where the donor's body part was taken. The medical examination and treatment facility shall guide the donor to fully complete the information according to Form No. 2 in the Appendix attached to this Decree on the National Public Service Portal or through the application of the social insurance agency and shall guide the donor to carry out the procedures for issuing a health insurance card as prescribed in Article 11 of this Decree.

3. The commune-level People's Committee shall prepare a list for issuing health insurance cards for subjects prescribed in Clauses 1, 2, 3, 4, and 6 of Article 5 of this Decree, as well as for subjects specified in points e, h, i, k, o, r, s, and t of Clause 3 and points a, d, and g of Clause 4 of Article 12 of the Law on Health Insurance who are living in the community.

4. The employer shall prepare a list of subjects eligible for health insurance cards as prescribed in Clause 5, Article 5 of this Decree.

5. Facilities for nurturing and nursing war invalids and people with meritorious services to the revolution, social assistance facilities (hereinafter referred to as nurturing facilities) shall make a list for issuing health insurance cards to the subjects specified in points e, h, i, k, r, and s of Clause 3, Article 12 of the Health Insurance Law who are being regularly nurtured in the nurturing facilities.

6. The list of subjects participating in health insurance is made according to Form No. 3 and Form No. 4 of the Appendix issued together with this Decree.

Article 10. Health insurance card information

1. The electronic or paper health insurance card issued by the social insurance agency includes the health insurance number and the following basic information:

a) Personal information of the person participating in health insurance, including: full name, gender, date of birth;

b) Information on the level of health insurance benefits according to the subject participating in health insurance;

c) The effective date of the health insurance card;

d) The registered place for initial health insurance medical examination and treatment;

d) The time of participation in health insurance for 05 consecutive years or more for subjects who must co-pay for medical examination and treatment costs.

2. The electronic version of the health insurance card is presented in electronic data form created by the Vietnam Social Security using electronic means, containing information according to the provisions in clause 1 of this Article.

3. The health insurance card information specified in clause 1 of this Article is integrated and synchronized according to the health insurance number and the participant's identification number.

Article 11. Procedures for issuing health insurance cards

1. The social insurance agency issues an electronic health insurance card to each health insurance participant. In case the participant requests, the social insurance agency issues a paper version of the health insurance card.

2. The issuance of the health insurance card (including first-time issuance and reissuance) and the adjustment of health insurance card information are carried out as follows:

a) Health insurance participants shall fully declare information according to Form No. 2 of the Appendix issued together with this Decree, or the agency or organization managing the subjects shall fully declare information according to Form No. 3 of the Appendix issued together with this Decree on the National Public Service Portal or through the application of the social insurance agency, or submit directly at the one-stop counter of the social insurance agency assigned to receive, or send via public postal services to the social insurance agency assigned to receive;

b) Health insurance participants or agencies, organizations managing the objects shall select to issue an electronic health insurance card or a paper health insurance card on the Participation Declaration form or the list of participants. In case of changes in dependent information or changes in entitled benefits, the health insurance participant must provide scanned copies of relevant documents to submit together with the Declaration on the National Public Service Portal or via the application of the Social Insurance Agency, or submit directly at the one-stop counter of the Social Insurance Agency assigned with the task of receiving, or send through postal services to the Social Insurance Agency assigned with the task of receiving;

c) The national public service portal or the application of the social insurance agency automatically issues the Receipt of Application and the appointment for returning the results of issuing health insurance cards to the health insurance participants or to the agency or organization managing the subjects. In case the application is submitted directly at the one-stop counter of the social insurance agency, the officer receiving the application at the one-stop counter directly checks the application, issues the Receipt of Application, and sets the appointment for returning the results of issuing health insurance cards to the health insurance participants or to the agency or organization managing the subjects;

d) In the case of issuing an electronic health insurance card, within 5 working days from the date of receiving a complete application as prescribed in points a, b, and c of this clause, the social insurance agency shall deliver the electronic health insurance card result via the digital social insurance application (VssID), personal email, linked with a level 2 electronic identification account (VNeID). Health insurance participants use electronic devices with the VNeID or VssID application installed and logged in, connected to the internet to receive the electronic health insurance card.

In the case of issuing a paper health insurance card, within 5 working days from the date of receiving a complete application as prescribed in points a, b, and c of this clause, the social insurance agency shall send the paper health insurance card to the health insurance participant or the managing organization of the subject to hand over to the health insurance participant.

3. For children under 6 years old, the issuance of health insurance cards is carried out in connection with the procedures for birth registration and permanent residence registration as prescribed in Decree No. 63/2024/NĐ-CP dated June 10, 2024, of the Government, which stipulates the electronic interconnection of two groups of administrative procedures: birth registration, permanent residence registration, issuance of health insurance cards for children under 6 years old; death registration, deletion of permanent residence registration, handling funeral expenses, and survivor benefits.

4. The Military Social Insurance is responsible for issuing health insurance cards to the subjects specified in Clause 7, Article 5 of this Decree.

Article 12. Recalling, temporarily holding, or temporarily blocking the usage value of health insurance cards

1. Health insurance cards shall be revoked in the cases specified in Clause 1, Article 20 of the Law on Health Insurance.

2. Cases of fraud in the issuance of health insurance cards include:

a) Fraudulent acts regarding information on subjects and benefit levels in the issuance of health insurance cards;

b) Other fraudulent acts.

3. Health insurance cards shall be temporarily held or temporarily blocked in cases specified in Clause 2, Article 20 of the Law on Health Insurance.

4. When detecting acts of violation as prescribed in Clauses 1, 2, and 3 of this Article, medical examination and treatment facilities shall notify the social insurance agency.

5. The social insurance agency shall reclaim, temporarily hold, or temporarily block the usage value of health insurance cards when detecting or receiving notification from medical examination and treatment facilities about acts of violation as prescribed in Clauses 1, 2, and 3 of this Article.

6. When reclaiming, temporarily holding, or temporarily blocking the usage value of health insurance cards, the social insurance agency must notify the health insurance participant.

7. Health insurance cards that have been temporarily blocked for use will be unlocked, and those that have been temporarily detained will be returned when the person lending the card to someone else and the person using another person's health insurance card have fulfilled the obligation to pay fines and remedial measures (if any) according to the administrative penalty decision in the case specified in Clause 3 of this Article.

Article 13. The effective time of health insurance cards

1. For subjects specified in Point d, Clause 2, Article 12 of the Health Insurance Law: from the date of receiving unemployment benefits as stated in the decision to receive unemployment benefits from the competent state agency.

2. For subjects specified in Point h, Clause 3, Article 12 of the Health Insurance Law:

a) In the case of children born on or before September 30: from the date of birth until the end of September 30 of the year the child reaches 72 months old;

b) In the case of children born after September 30: from the date of birth until the end of the month the child reaches 72 months old.

3. For the subjects specified in point r, clause 3, Article 12 of the Law on Health Insurance: from the date of receiving social assistance under the decision of the People's Committee according to the delegated authority.

4. For subjects stipulated in point o, clause 3, and point a, clause 4, Article 12 of the Health Insurance Law who are 100% supported by the state budget for health insurance contributions: from the date determined in the Approval Decision of the list by the competent state agency.

5. For subjects stipulated in point m, clause 3, Article 12 of the Health Insurance Law: immediately after the body part is donated.

6. For subjects stipulated in point h, clause 4, Article 12 of the Health Insurance Law: from the date determined in the Approval Decision of the list by the competent state agency.

7. Subjects stipulated in point b, clause 4, Article 12 of the Health Insurance Law are students of general education institutions who pay annual health insurance as follows:

a) Grade 1 students: from October 1 of the first year of primary school; from the end of the month when the child reaches 72 months of age for cases stipulated in point b, clause 2 of this Article;

b) Grade 12 students: from January 1 to the end of September of that year. Grade 12 students are encouraged to pay health insurance and are entitled to health insurance payment support until December 31 of the final school year to ensure continuous health insurance benefits, without having to return the portion of state budget support for health insurance payment in case of a change of the target subject.

8. The subjects specified in point b, clause 4, Article 12 of the Health Insurance Law are students of higher education institutions and vocational education institutions who pay annual health insurance, in which:

a) First-year students of the course: from the enrollment date; in case the Grade 12 student’s card is still valid after the enrollment date, payment starts from the expiration date of the health insurance card;

b) Final-year students of the course: from January 1 to the last day of the month in which the course ends. It is encouraged that final-year students of the course participate in health insurance and receive health insurance premium support until December 31 of the final academic year to ensure continuous health insurance benefits, without having to return the state budget support for health insurance premiums in case of a change of eligibility.

9. For other subjects, the health insurance card is valid from the day the participant pays the health insurance premium, except as prescribed at point c, clause 3, Article 16 of the Health Insurance Law.

10. The use value of the health insurance card specified in this Article corresponds to the amount of health insurance contributions as prescribed, except for children under 6 years old.

SCOPE OF ENTITLEMENT, BENEFIT LEVEL OF THE PARTICIPANT

HEALTH INSURANCE

Article 14. Scope of coverage for patient transportation costs

1. Health insurance participants who fall under the subjects specified in points a, b, c, d, đ, e, h, i, o, and r of Clause 3, Article 12 of the Law on Health Insurance, in the case of being hospitalized or needing emergency care, must have their transportation costs to the medical examination and treatment facility covered.

2. The health insurance fund pays the patient transportation costs to the medical examination and treatment facility transferring the patient based on the specific patient transportation service price as follows:

a) For state-owned medical examination and treatment facilities, payment is made according to the patient transportation service price approved by competent authorities or set by regulations;

b) For private medical examination and treatment facilities, the applicable patient transport service prices are those of state medical examination and treatment facilities, which serve as the basis for requesting health insurance fund reimbursement, implemented according to principles similar to the payment of technical service costs in medical examination and treatment under health insurance for private medical examination and treatment facilities as prescribed in Article 47 of this Decree.

3. In cases where there is no established price for patient transportation services, the transportation cost reimbursed by the health insurance fund shall be determined based on the following grounds:

a) Based on the actual distance between the two medical examination and treatment facilities;

b) The payment rate for fuel costs is calculated according to the norm of 0.2 liters of gasoline commonly consumed per 1 km and does not apply the ratios or benefit levels specified in Article 22 of the Law on Health Insurance. The gasoline unit price is based on the common gasoline price in the area of the medical facility transporting the patient at the time of transportation, as recorded on the referral form.

4. For medical examination and treatment facilities providing patient transportation services in cases where there is no price for patient transportation services approved by the competent authority or stipulated as a regulated price, the health insurance fund shall reimburse as follows:

a) Pay the transportation costs for both the outbound and return trips to the medical facility, where the patient is transferred, according to the unit price on the gasoline or diesel purchase invoice based on the actual type of gasoline or diesel consumed by the vehicle transporting the patient, but not exceeding the fuel cost payment level specified in point b, clause 3 of this Article;

b) In cases where the vehicle transporting the patient does not use gasoline or diesel, the fuel cost payment level specified in point b, clause 3 of this Article shall apply;

c) In cases where more than one patient is transported on the same vehicle, the payment level is calculated according to the level specified for transporting one patient.

d) The medical examination and treatment facility that is responsible for transferring the patient is responsible for compiling all transportation costs and settling payment with the social insurance agency. Medical staff at the receiving medical examination and treatment facility must sign the transfer vehicle form of the transferring medical facility.

5. For patients using their own means of transportation, the health insurance fund will pay as follows:

a) Payment for one-way transportation costs (outbound) based on the patient transportation invoice to the receiving medical examination and treatment facility, up to the payment level not exceeding the stipulated limit in points a and b, clause 3 of this Article;

b) The medical examination and treatment facility that is responsible for transferring the patient must record on the referral form that the patient is using their own means of transportation.

c) The medical examination and treatment facility receiving the patient shall reimburse the patient based on the transportation invoice provided by the patient according to the provisions in point a of this clause and shall aggregate the transportation costs to settle with the social insurance agency.

Article 15. Health insurance benefits for certain subjects and cases

1. Health insurance participants who belong to the subjects specified in clauses 1, 2, 3, 4, 5, 6, and 7 of Article 5 of this Decree, when undergoing medical examination and treatment under the provisions of Articles 26 and 27 of the Law on Health Insurance, shall have their medical examination and treatment costs paid by the health insurance fund within the scope of entitlement at the following rates:

a) 100% of medical examination and treatment costs for the subjects specified in clauses 2 and 6 of Article 5 of this Decree;

b) 80% of medical examination and treatment costs for the subjects specified in clauses 1, 3, 4, 5, and 7 of Article 5 of this Decree.

2. Health insurance participants who fall under the subjects specified in points a, b, c, d, and đ of clause 3, Article 12 of the Health Insurance Law, when seeking medical examination and treatment at health insurance medical facilities not under the management authority of the Ministry of National Defense or the Ministry of Public Security, shall have their medical examination and treatment costs paid by the health insurance fund according to the benefit levels specified in Article 11 of Decree No. 70/2015/NĐ-CP dated September 1, 2015, of the Government detailing and guiding the implementation of certain articles of the Health Insurance Law for the people’s army, the people’s police, and cryptographic staff, as amended and supplemented by Decree No. 74/2025/NĐ-CP dated March 31, 2025, of the Government.

Article 16. Subjects not subject to the payment rate specified in point c, clause 2, Article 21 of the Health Insurance Law

Subjects to which the payment rate specified in point c, clause 2, Article 21 of the Health Insurance Law does not apply include:

1. Persons who participated in revolutionary activities before January 1, 1945.

2. Revolutionary activists from January 1, 1945 to the August Revolution in August 1945.

3. Heroic Vietnamese mothers.

4. War invalids, people entitled to policies like war invalids, type B war invalids, sick soldiers with labor capacity reduction of 81% or more.

5. War invalids, people entitled to policies like war invalids, type B war invalids, sick soldiers when treating wounds, recurring illnesses.

6. Resistance participants affected by toxic chemicals with labor capacity reduction of 81% or more.

7. Children under 6 years old.

Article 17. Application of health insurance benefits for certain cases

1. The cost for a single medical examination and treatment to determine that a person participating in health insurance is entitled to 100% of the medical examination and treatment costs as prescribed in Point b, Clause 1, Article 22 of the Health Insurance Law is less than 15% of the basic salary.

2. The provision at point b, clause 1, Article 22 of the Health Insurance Law and clause 1 of this Article applies to cases where health insurance participants go for medical examination and treatment according to the provisions in clauses 1, 3, 4, and 5 of Article 22 of the Health Insurance Law.

3. The provisions at points đ and e, clause 1, Article 22 of the Health Insurance Law apply to cases where health insurance participants go for medical examination and treatment according to the provisions in clauses 3, 4, and 5 of Article 22 of the Health Insurance Law, except for the cases specified in clause 2 of this Article and except for subjects entitled to 100% coverage of medical examination and treatment costs.

4. Participants in health insurance who fall under multiple cases with different benefit levels as stipulated in Clause 1, Article 22 of the Health Insurance Law shall apply the case with the highest benefit level. In cases where the benefit level specified in points a, b, c, and d of Clause 1, Article 22 of the Health Insurance Law is applied, the benefit level according to the subjects specified in points đ and e of Clause 1, Article 22 of the Health Insurance Law shall not be applied.

Article 18. Application of benefits for cases with continuous health insurance participation of 5 years or more

1. Some cases are considered as continuous health insurance participation periods to apply the benefit level when having 5 or more consecutive years of health insurance participation as stipulated in point d, Clause 1, Article 22 of the Health Insurance Law, detailed as follows:

a) Cases of interruption in health insurance participation for a period of 90 days are counted as continuous health insurance participation.

b) A person sent by a competent authority on a business trip, to study, work, or under the regime of spouse or legitimate biological or adopted children under 18 years old accompanying their parent serving a term at a Vietnamese agency abroad shall have the time spent abroad counted as the time participating in health insurance;

c) Employees who go to work abroad under the Law on Vietnamese Employees Working Abroad under Contracts and cases where they are sent by state agencies to work abroad, the time of participation in health insurance before going to work abroad is counted as the time of participation in health insurance if, upon returning to the country, they continue to participate in health insurance within 30 days from the date of entry;

d) Employees, during the procedure of applying for unemployment benefits under the Employment Law, except for the period from the date of termination of the labor contract or work contract to the date of submission of the application for unemployment benefits, the time of previous participation in health insurance is counted as the time of participation in health insurance;

d) Subjects specified in points a, b, and d of Clause 3, Article 12 of the Health Insurance Law, when retiring, being discharged from the military, transferring sectors, or leaving their job, the time spent studying and working in the People's Army, People's Police, and cryptographic organizations is counted as the period of participation in health insurance. In cases where there is insufficient basis to determine the period of participation in health insurance, the social insurance agency shall rely on one of the documents issued by the military, police, or cryptographic unit that shows the working process, such as: Social insurance book, decision on discharge or resignation; military, worker, and defense, police, or cryptographic personnel records; certificate of working process issued by a regiment-level unit or higher to determine the period of participation in health insurance for the subjects; 24

e) Subjects specified in point đ, clause 3, Article 12 of the Law on Health Insurance, when they cease to perform the duties of the regular militia, the time of performing the duty is counted as the time participating in health insurance.

2. Payment of medical examination and treatment costs for patients who have participated in health insurance for 5 consecutive years or more and have co-payment amounts for medical examination and treatment costs in a year greater than 6 months of the basic salary as prescribed in point d, clause 1, Article 22 of the Health Insurance Law is as follows:

a) The health insurance fund pays 100% of the medical examination and treatment costs within the scope entitled to by the health insurance participant from the time the patient simultaneously meets the conditions of participating 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 exceeding 6 months of the basic salary until December 31 of that year; in cases where the health insurance participant undergoes medical examination and treatment before January 1 and completes the medical examination, treatment, and hospital discharge from January 1 of the following year, the treatment costs are determined annually to calculate the co-payment amount.

b) The social insurance agency aggregates information on the cumulative co-payment amount within the financial year of the patient, the time when the patient has participated in health insurance for 5 consecutive years or more, and announces it on the Data Reception Portal of Vietnam Social Insurance. Healthcare facilities base on the cumulative co-payment amount and the time when the patient has participated in health insurance for 5 consecutive years or more to determine the time when the patient is eligible for co-payment exemption during the patient’s examination and treatment;

c) In the case that the base salary level changes during the year, the method for determining the remaining amount to be co-paid from the time the base salary changes until December 31 of that year is as follows

Total amount co-paid since January 01

before the date of the base salary change

(6 - ) x New base salary

Old base salary

For cases with co-payment amounts from January 1 to before the change of the basic salary level in the year that have reached or exceeded 6 months of basic salary, the benefits are granted according to regulations and this formula does not apply.

Article 19. Implementation roadmap and benefit rates for outpatient examination and treatment at primary healthcare facilities as prescribed in points e and h, clause 4, Article 22 of the Health Insurance Law

1. From January 1, 2025, when receiving outpatient medical examination and treatment at a primary-level medical facility with a score below 50 points or temporarily classified as basic level, health insurance participants will be paid 100% of the entitled amount by the health insurance fund, except for primary-level medical facilities that, before January 1, 2025, were determined by a competent authority to be at the provincial or central level.

2. From July 1, 2026, when receiving outpatient medical examination and treatment at a primary-level medical facility scoring from 50 to under 70 points, health insurance participants will be paid 50% of the entitled amount by the health insurance fund.

3. From July 1, 2026, when receiving outpatient examination and treatment at a basic-level medical examination and treatment facility that before January 1, 2025, was determined by the competent authority to be at the provincial level or central level, or equivalent to provincial or central level, health insurance participants will be reimbursed 50% of the entitled amount by the health insurance fund.

4. From July 1, 2026, when receiving outpatient examination and treatment at a specialized-level medical examination and treatment facility that before January 1, 2025, was determined by the competent authority to be at the provincial level under Point h, Clause 4, Article 22 of the Health Insurance Law, health insurance participants will be reimbursed 50% of the entitled amount by the health insurance fund.

Article 20. Benefit level for cases where health insurance participants undergo medical examination and treatment upon request

1. Persons with health insurance cards who undergo medical examination and treatment on request will have the part of the medical examination and treatment costs covered by the health insurance fund according to the scope and rate prescribed by the health insurance law. The difference between the costs of requested medical examination and treatment services and the costs covered by the health insurance fund shall be paid by the patient to the medical examination and treatment facility.

2. Medical examination and treatment facilities are responsible for ensuring human resources, professional conditions, publicly disclosing the costs that patients must pay beyond the covered scope and rate of health insurance, including the difference in costs, and must notify patients in advance.

Article 21. Provisions on the timing of applying health insurance benefit levels in cases of multiple benefit levels or changes in benefit levels

1. In cases where a health insurance participant is entitled to multiple levels of benefits as prescribed in Article 22 of the Health Insurance Law, they shall receive the highest level of benefit.

2. In cases of changing the health insurance benefit level, the new health insurance benefit level is calculated from the time the new health insurance card becomes valid. Patients with a health insurance card who are undergoing inpatient treatment and experience a change in the health insurance benefit level are responsible for providing information about the card related to the change in benefit level. Medical examination and treatment facilities are responsible for checking the rights and benefit levels of health insurance participants before the end of the examination, treatment session, or discharge from the hospital.

HEALTH INSURANCE EXAMINATION AND TREATMENT CONTRACT

Article 22. Conditions for signing a health insurance medical examination and treatment contract

1. Ensure the operational conditions of medical examination and treatment facilities in accordance with the provisions of Article 49 of the Law on Medical Examination and Treatment, suitable for the scope of health insurance medical examination and treatment services provided.

2. Ensure the standard for connection and interoperability of medical examination and treatment data for health insurance with the information system and health insurance adjudication of the social insurance agency as prescribed by the Minister of Health and verify the data for payment of medical examination and treatment expenses in accordance with the law.

Article 23. Health insurance medical examination and treatment contract

1. Health insurance medical examination and treatment contracts shall be signed between medical examination and treatment facilities that meet the conditions prescribed in Article 22 of this Decree and the social insurance agency authorized to be assigned to sign the contract:

a) Each operating license may be used to sign 01 health insurance medical examination and treatment contract, except in the cases provided for in points b and đ of this clause;

b) In the case that a medical examination and treatment facility has additional facilities within the same province or centrally-run city, it may sign 01 health insurance medical examination and treatment contract with the social insurance agency or separate health insurance medical examination and treatment contracts for each facility with the social insurance agency;

c) In the case where a medical examination and treatment facility has additional medical examination and treatment facilities in other provinces or centrally-run cities, each medical examination and treatment facility shall sign a health insurance medical examination and treatment contract with the social insurance agency at the location of the facility;

d) A medical examination and treatment facility with subordinate medical examination and treatment facilities that meet the conditions specified in Article 22 of this Decree but are not at the same professional and technical level shall sign separate medical examination and treatment contracts for the subordinate facilities;

đ) In the case of a health insurance medical examination and treatment facility under the management of the Ministry of National Defense or the Ministry of Public Security, the facility may sign one health insurance medical examination and treatment contract with the military or police social insurance agency and one contract with the social insurance agency under the Vietnam Social Security.

2. The medical examination and treatment contract for health insurance is implemented according to Form No. 5 of the Appendix issued together with this Decree and includes the basic contents prescribed in Article 25 of this Decree. The contract appendix as prescribed in Clause 2, Article 24 of this Decree and the notification documents as prescribed in Clause 3, Article 24 of this Decree are inseparable components of the contract and are valid for the duration of the contract's validity period.

3. In the event of changes as prescribed in Clause 2, Article 24 of this Decree, the medical examination and treatment establishment and the social insurance agency must sign a contract appendix as prescribed in Article 29 of this Decree.

4. The medical examination and treatment contract for health insurance takes effect from the date of signing the contract or as specifically stipulated in the contract.

5. The health insurance medical examination and treatment contract is a contract with an indefinite term or a term agreed upon by both parties, except in cases of contract termination as prescribed in points b, c, d, and đ of clause 1, Article 32 of this Decree. Annually, at the end of the fiscal year, the social insurance agency and the health insurance medical examination and treatment facility shall jointly agree to determine the contents and amounts of medical examination and treatment expenses proposed for payment, advance payment, verified, paid, unpaid, settled, refused for payment, and recovered during the year, as well as the methods and deadlines for resolving each item that has not been agreed upon, and the obligations to be performed by each party in order to provide a basis for the medical examination and treatment facility to exercise financial rights and obligations, settle accounts, and pay taxes (if any) on time, and for the social insurance agency to perform summary, reporting, and settlement.

6. Upon termination of the contract, the parties must carry out the contract liquidation procedures according to Form No. 6 of the Appendix issued with this Decree and the contents prescribed in Article 33 of this Decree.

7. Medical examination and treatment facilities are only allowed to provide medical examination and treatment covered by health insurance and to settle the costs of health insurance-covered medical examination and treatment from the time the health insurance medical examination and treatment contract comes into effect. The contracting parties must ensure the conditions of the contract throughout the duration of its implementation.

8. The person signing the health insurance medical examination and treatment contract on behalf of the medical examination and treatment facility is the head of the facility as stipulated in Clause 7, Article 2 of Decree 96/2023/NĐ-CP dated December 30, 2023, of the Government detailing certain provisions of the Law on Medical Examination and Treatment; the person listed on the registration of a private medical examination and treatment facility as an individual business owner; the person assigned as the head of the medical examination and treatment facility in the cooperative’s charter; or a deputy authorized or assigned by the entities specified in this clause.

9. For units and schools that are not state agencies or public service providers, the medical examination and treatment facilities of these units and schools shall apply the regulations on contracts for medical examination and treatment applicable to private medical examination and treatment facilities.

Article 24. Cases of signing contract appendices and notifying changes in information in the implementation of health insurance medical examination and treatment contracts

1. During the implementation of the contract, if there are arising issues or changes in the contents related to the execution of the contract, the parties shall carry out the procedure of signing a contract appendix according to the provisions in Clause 2 of this Article; notify according to the provisions in Clause 3 of this Article; and terminate the contract according to the provisions of Article 32 of this Decree.

2. In the case of changing the name, seal, account, account holder of the medical examination and treatment facility or social insurance agency, changing the professional and technical level, changing the number of hospital beds that requires adjusting the operation license, or changing the payment method, a contract appendix shall be signed.

3. In other cases where there are developments or changes to matters related to the implementation of the contract that do not fall under the provisions of Clause 2 of this Article and Article 32 of this Decree, the parties are not required to re-sign the contract or contract appendices. The medical examination and treatment facilities and the social insurance agency that have signed the contract will carry out notification procedures as a basis for implementation as follows:

a) The medical examination and treatment facility sends a document containing information and materials related to the changes to the social insurance agency where the contract was signed. The document issued by the medical examination and treatment facility is the original, and the document issued by the competent authority is a copy with the official seal of the medical examination and treatment facility for confirmation;

b) In the case where the social insurance agency has opinions on the changes or arising issues of the medical examination and treatment facility, within a maximum of 5 working days from the date of receiving the notification document from the medical examination and treatment facility, the social insurance agency is responsible for sending a response document to the medical examination and treatment facility specifying the content and reasons in the response document. If the social insurance agency does not provide opinions within 5 working days from the date of receiving the notification document, it is considered as agreement;

c) Within a maximum of 15 days from the date of receiving the response document with opinions from the social insurance agency, the medical examination and treatment facility is responsible for sending a document responding to the opinions of the social insurance agency.

4. During the waiting period for signing the contract appendix, the health insurance fund continues to pay for medical examination and treatment costs covered by health insurance for medical examination and treatment facilities, ensuring continuity.

Article 25. Content of the health insurance medical examination and treatment contract

1. The basic content of the health insurance medical examination and treatment contract stipulated in Clause 2, Article 25 of the Health Insurance Law is prepared according to Form No. 5 of the Appendix issued together with this Decree. In the case that a medical examination and treatment facility has multiple affiliated facilities operating under licenses at different locations and signs a joint contract, the content for each affiliated facility must be clearly specified.

2. The content regarding the target service population and the requirements for the scope of service provision of the medical examination and treatment facility must comply with the scope of professional activities approved by the competent authority. The expected number of health insurance cards and the structure of groups participating in health insurance for the initial health insurance medical examination and treatment facility must comply with the regulations of the Minister of Health.

3. Depending on the conditions of the medical examination and treatment facility, the social insurance agency and the medical examination and treatment facility may add other contents to the contract, which must be agreed upon and consensual by both parties, and must not violate the provisions of the law. In cases where consensus and agreement on the additional content cannot be reached by both parties, it shall not be included in the contract.

4. The method of payment for medical examination and treatment costs shall be carried out in accordance with the provisions in Chapter VII of this Decree.

5. The provisions on payment and settlement of health insurance medical examination and treatment costs in the contract shall be agreed upon by both parties according to the provisions of this Decree and the laws on health insurance.

6. The term of the health insurance medical examination and treatment contract shall be implemented in accordance with the provisions of Article 23 of this Decree.

7. Methods of resolving contract disputes are agreed upon by both parties. In the case that the parties choose to file a lawsuit with the court to resolve the contract dispute, it shall be carried out in accordance with civil law provisions. In case of issues arising related to policies, laws, regulations, or professional guidance, the parties shall report and submit recommendations to the competent state authorities for resolution.

8. Regulations on notifications and responses between the parties when there are changes or developments related to contract implementation; the mechanism for receiving and responding to information related to transferring, sending inspection data, and paying medical examination and treatment costs under health insurance.

Article 26. Dossier for signing a health insurance medical examination and treatment contract

1. Contract signing documents include:

a) The proposal document for signing a health insurance medical examination and treatment contract from the medical examination and treatment facility according to Form No. 7 in the Appendix issued together with this Decree;

b) A photocopy of the medical examination and treatment activity license issued by a competent state authority for the medical examination and treatment facility, with the official seal of the facility for verification;

c) A photocopy of the decision on grading or temporary grading of technical expertise for the medical examination and treatment facility by the competent authority; in the case specified in points đ and h, Clause 4, Article 22 of the Law on Health Insurance and Clauses 3 and 4, Article 19 of this Decree, a photocopy of the document from the competent authority determining that the medical examination and treatment facility has been assigned a technical expertise level before January 1, 2025, is also required. These documents must bear the official seal of the medical examination and treatment facility for verification;

d) A photocopy with the official seal of the medical examination and treatment facility for verification of the decision approving the list of medical technical services approved by the competent authority;

d) List of drugs and medical equipment used at medical examination and treatment facilities;

e) A list of personnel, total number of hospital beds of the medical examination and treatment facility by each department, room, and specialized unit approved by the competent authority;

g) A copy with the official stamp of the medical examination and treatment facility to confirm the decision approving the prices of medical examination and treatment services listed for payment by the health insurance fund, approved by the competent authority. In the case specified in Article 47 of this Decree, the medical examination and treatment facility shall submit a written proposal for the health insurance service prices to be applied to determine the payment level at the facility;

h) A list of software and hardware equipment ensuring interconnection for transferring electronic data in health insurance payment according to Form No. 8 of the Appendix issued together with this Decree;

i) For the documents specified in points b, c, d, and g of this clause, medical examination and treatment facilities are not required to submit copies in cases where the competent authority has sent the documents to the social insurance agency when issuing them, or in cases where they can be accessed on the competent authority’s online system; however, medical examination and treatment facilities must reference the web address where the information can be accessed in the request for signing the health insurance medical examination and treatment contract as specified in point a of this clause.

2. In the case of signing a consecutive contract when the previous contract has expired or both parties agree to terminate the contract early without any changes in the documents, the medical examination and treatment facility does not have to resubmit and can use the previously submitted dossier when signing the adjacent contract. In the case that the documents in the dossier stipulated in Clause 1 of this Article of the medical examination and treatment facility have changes, the medical examination and treatment facility only needs to submit the documents proving the changes.

3. Number of dossiers: 01 set.

4. The application is submitted electronically on the National Public Service Portal or through the application of the social insurance agency. In the period when the online public service system has not been completed, and at administrative units in areas with difficult or particularly difficult socio-economic conditions, the application shall be submitted directly at the one-stop counter of the social insurance agency assigned to receive it or sent via public postal service to the social insurance agency assigned to receive it.

Article 27. Dossier for signing a contract appendix

1. The file for signing the contract appendix includes:

a) The written request for signing the health insurance service contract appendix from the medical examination and treatment facility, social insurance agency, according to Form No. 7 Appendix issued together with this Decree;

b) A photocopy of the document proving the change for the case stipulated in Clause 2, Article 24 of this Decree, with the seal of the medical examination and treatment facility or social insurance agency to confirm.

2. Number of application sets: 01 set.

3. Applications are submitted electronically on the National Public Service Portal or via the Social Insurance Agency's application. In cases where the online public service system has not been completed and in administrative units in areas with difficult or particularly difficult socio-economic conditions, applications are submitted directly at the one-stop counter of the Social Insurance Agency assigned to receive them or sent via public postal services to the Social Insurance Agency assigned to receive them.

Article 28. Procedures for signing a health insurance medical examination and treatment contract

1. Medical examination and treatment facilities send applications according to the provisions in Article 26 of this Decree to the Social Insurance Agency authorized to assign contract signing tasks.

2. In cases where there is no request to amend or supplement the dossier, within 10 days from the date of receiving a complete and valid dossier eligible for contract signing (in the case of submitting a paper dossier, based on the date on the official dispatch stamp), the social insurance agency must complete the contract signing.

3. In cases where there is a request to amend or supplement the dossier, it shall be carried out as follows:

a) Within 5 working days from the date of receipt of the dossier (in the case of submitting a paper dossier, based on the date on the received official dispatch stamp), the social insurance agency is responsible for responding in writing, specifying the contents that need to be corrected or supplemented, and sending it to the medical examination and treatment facility;

b) Within 30 days from the date of receiving the written request for correction or supplementation (in the case of submitting a paper dossier, based on the date on the received official dispatch stamp), the medical examination and treatment facility is responsible for correcting, supplementing the dossier, and sending it to the social insurance agency. If more than 30 days pass and the medical examination and treatment facility does not supplement and send the dossier, the procedures specified in Clauses 1 and 2 of this Article must be repeated;

c) Within 10 days from the date of receipt of the amended or supplemented dossier (in case of submitting a paper dossier, based on the date stamped on the official dispatch), the social insurance agency shall execute the contract if the conditions are met or issue a written notice refusing to sign the contract if the conditions are not met, clearly stating the reasons and legal grounds for determining that the conditions for signing the contract have not been met.

4. The appraisal for signing the health insurance medical examination and treatment contract is carried out based on the dossier submitted by the medical examination and treatment facility in accordance with the provisions of Article 26 of this Decree. The medical examination and treatment facility shall be fully responsible before the law for the accuracy of the dossier and for ensuring compliance with the conditions for conducting medical examination and treatment as prescribed by law.

5. In the case of signing a consecutive contract when the previous contract has expired or both parties agree to terminate the contract early, the parties shall carry out the procedures according to the following regulations:

a) Medical examination and treatment facilities shall send the dossier as prescribed in Clause 2, Article 26 of this Decree to the social insurance agency authorized to be assigned the task of signing the contract;

b) In case there is no request to amend or supplement the dossier, within 03 working days from the date of receiving a complete and valid dossier that meets the conditions for signing the contract (for submission of a paper dossier, based on the date on the official dispatch stamp), the social insurance agency must complete the contract signing;

c) In case there is a request to amend or supplement the dossier, within 02 working days from the date of receiving the dossier (for submission of a paper dossier, based on the date on the official dispatch stamp), the social insurance agency is responsible for responding in writing specifying the content that needs to be amended or supplemented and sending it to the medical examination and treatment facility;

d) Within 10 days from the date of receipt of the document requesting amendments and supplements (in the case of submitting paper dossiers, based on the date stamped on the official dispatch), the medical examination and treatment facility is responsible for amending, supplementing the dossier, and sending it to the social insurance agency. In case the medical examination and treatment facility does not supplement and send the dossier within 10 days, the procedure must be redone according to the provisions of this Article;

d) Within 03 working days from the date of receipt of the amended and supplemented dossier (in the case of submitting paper dossiers, based on the date stamped on the official dispatch), the social insurance agency shall sign the contract if the conditions are met or provide a written notice of refusal to sign the contract if the conditions are not yet met, clearly stating the reasons and legal basis for determining the conditions are not sufficient for contract signing;

e) In the case where the medical examination and treatment facility and the social insurance agency agree to continue signing a new contract when the validity period of the health insurance medical examination and treatment contract expires, the signing of the new contract must ensure that the effective date of the contract follows immediately after the validity period of the old contract.

Article 29. Procedures for signing an appendix to the health insurance medical examination and treatment contract

1. Within 03 working days from the date of the document of the competent authority regarding changes to the case specified in Clause 2, Article 24 of this Decree, the social insurance agency shall send or the medical examination and treatment facility shall send the file to sign the contract appendix to the other party.

2. Within 05 working days from the date of receiving the file, the medical examination and treatment facility and the social insurance agency shall complete the signing of the contract appendix.

Article 30. Signing a health insurance medical examination and treatment contract at commune, ward, special zone health stations, maternity homes, regional general clinics, medical examination and treatment facilities of agencies, units, and schools

1. For communal, ward, special zone health stations, maternity houses, and regional general clinics, the signing of the health insurance medical examination and treatment contract shall be carried out in one of the following two forms:

a) The provincial People's Committee decides on 01 representative unit to sign the contract with the social insurance agency for the communal, ward, special zone health stations, maternity houses, and regional general clinics under its management area;

b) Commune, ward, special zone health stations, maternity homes, regional general clinics directly sign contracts with the social insurance agency.

2. For medical examination and treatment facilities of agencies, units, and schools (except agencies, units, and schools that are allocated budgets for medical examination and treatment in the primary healthcare work according to the provisions in Article 63 of this Decree), the social insurance agency directly signs health insurance medical examination and treatment contracts with the agencies, units, and schools.

3. Units signing contracts as prescribed in Clauses 1 and 2 of this Article are responsible for ensuring the operational conditions of medical examination and treatment facilities according to the signed contract.

Article 31. Suspension of health insurance medical examination and treatment contracts

1. The health insurance medical examination and treatment contract is temporarily suspended in whole or in part in the case that the medical examination and treatment facility is suspended in whole or in part according to the decision of the competent authority.

2. When making a decision to suspend all or part of the activities of a medical examination and treatment facility, the competent authority is responsible for sending a notification to the social insurance agency where the contract was signed. The temporary suspension of the medical examination and treatment contract is calculated from the effective date of the decision to suspend all or part of the activities of the medical examination and treatment facility. When making a decision to allow the medical examination and treatment facility to resume operations, the competent authority is responsible for sending a notification to the social insurance agency where the contract was signed.

3. In case a medical examination and treatment facility whose operations have been suspended is allowed to resume operations by the competent authority, the facility must send a written notice to the social insurance agency about continuing to implement the contract and submit documents as evidence if there are any changes compared to the contract documents before the contract suspension.

4. When suspending the contract, both parties must agree on measures to ensure the rights of patients during the suspension period. When resuming the contract, the medical examination and treatment facility is responsible for ensuring operational conditions in accordance with the signed health insurance medical examination and treatment contract.

Article 32. Cases of termination of contracts and procedures for termination of health insurance medical examination and treatment contracts

1. Cases of termination of the health insurance medical examination and treatment contract include:

a) Expiration of the contract term;

b) Mutual agreement between the parties to terminate the contract before the expiration date;

c) The medical examination and treatment facility ceases operations, is dissolved, or goes bankrupt;

d) The medical examination and treatment facility has its operating license revoked;

e) The suspension period exceeds 03 months and the medical examination and treatment facility has not remedied the violations in order to resume operations.

2. When the contract term expires as prescribed in points a and b of clause 1 of this Article, the parties shall carry out the contract liquidation procedure in accordance with the provisions of Article 33 of this Decree. 36

3. In the case of contract termination as prescribed in points c and d of clause 1 of this Article, within 03 working days from the date of cessation of operations according to the decision of the competent state authority, the medical examination and treatment facility is responsible for notifying the social insurance agency where the contract was signed about the contract termination. The parties shall carry out the contract liquidation procedures in accordance with the provisions of Article 33 of this Decree. The contract termination time is counted from the date the decision to cease operations or revoke the operating license of the medical examination and treatment facility takes effect.

4. In the case where the period specified in Point d, Clause 1 of this Article has expired and the medical examination and treatment facility has not been permitted by the competent authority as prescribed by the law on medical examination and treatment to resume operations, the social insurance agency that signed the contract and the medical examination and treatment facility shall terminate the contract and liquidate the contract in accordance with the provisions of Article 33 of this Decree.

Article 33. Settlement of health insurance medical examination and treatment contracts

1. The health insurance medical examination and treatment contract between the social insurance agency and the medical examination and treatment facility shall be liquidated after contract termination in accordance with the provisions of Article 32 of this Decree. The form for liquidating the health insurance medical examination and treatment contract shall be carried out according to Form No. 6 of the Appendix issued together with this Decree.

2. The liquidation of the contract shall be carried out in accordance with the provisions of civil law.

3. Both parties shall cross-check, identify, and agree on the contents and amounts of medical examination and treatment costs proposed for payment, advance payment, verified, paid, unpaid, settled, refused for payment, reclaimed within the year, as well as the methods and time limits for resolving each unresolved item, and the obligations to be fulfilled by each party; any amounts to be recovered or refunded (if any) will serve as the basis for contract termination. After reaching an agreement and confirmation, the social insurance agency shall carry out the payment or recovery of related amounts in accordance with regulations.

4. Rights and obligations of the social insurance agency:

a) Inspect and confirm debts and settlement reconciliation documents of medical examination and treatment facilities; request the return of payments made in violation of regulations (if any); refuse settlement if the medical examination and treatment facilities have not completed financial obligations or have not provided sufficient documents for the settlement.

b) Responsible for making payment of unpaid expenses on time; not to request the handover of original medical records, except in cases where otherwise provided by law.

5. Rights and obligations of medical examination and treatment facilities:

a) Request the social insurance agency to fully pay the settled expenses; retain medical records in accordance with regulations and only hand over documents for settlement purposes; may request to continue signing the contract if there is a need and conditions are met according to regulations;

b) Responsible for completing financial settlement and reimbursing amounts payable (if any); providing documents for reconciliation and inspection while ensuring regulations on medical record storage and being liable before the law for the documents and records that have been reimbursed with the social insurance agency; ensuring the transfer of patients to other medical examination and treatment facilities without affecting the benefits of health insurance participants.

Article 34. Rights and responsibilities of social insurance agencies in contract implementation

1. Rights of the social insurance agency

a) Rights as stipulated in Article 40 of the Law on Health Insurance;

b) Request medical examination and treatment facilities to transfer authenticated electronic data to settle health insurance medical examination and treatment costs as prescribed by the Minister of Health;

c) Require medical examination and treatment facilities to provide explanations in cases where the social insurance agency's statistics show that health insurance medical examination and treatment costs have increased more than the average increase of medical examination and treatment facilities with the same technical level, the same type of general or specialized medical facility in that year within the province, centrally-run city, or nationwide, or the average increase of that medical examination and treatment facility in the same period of the previous year;

d) Refuse to pay health insurance medical examination and treatment costs that are not in accordance with the law on health insurance and medical examination and treatment.

2. Responsibilities of the social insurance agency

a) Comply with the provisions of Article 41 of the Law on Health Insurance;

b) Provide medical examination and treatment facilities with information about the medical examination and treatment history of health insurance participants;

c) Ensure the confidentiality of information collected during the process of medical examination and treatment cost assessment under health insurance, and the exploitation and use of medical records in accordance with the provisions of law;

d) Coordinate with medical examination and treatment facilities in verifying and clarifying information of health insurance participants upon request, and resolving difficulties and obstacles in receiving and checking procedures for medical examination and treatment under health insurance; consider the recovery, temporary retention, or temporary suspension of health insurance cards and handle according to authority in cases of violations when receiving information about such violations; provide guidance and technical support in transferring electronic data to serve the appraisal and payment of medical examination and treatment expenses under health insurance for medical examination and treatment facilities;

d) Maintain receiving and timely responding to the reception of data on payment requests, return error documents specifying the errors, the portion of the payment request rejected due to errors, the results of medical examination and treatment cost assessment for health insurance, incidents, and obstacles related to data reception for medical examination and treatment facilities as prescribed;

e) Advance payment, settlement, and finalization of health insurance medical examination and treatment costs on time and with the correct amount, as well as the advance payment ratio in accordance with health insurance laws;

g) Agree on the number of files sent for assessment and the next period’s advance medical examination and treatment costs in case of incidents or obstacles in data reception;

h) Inspect contract implementation and check the maintenance of conditions after signing the contract by the medical examination and treatment facility.

3. Exercise other rights and responsibilities as stipulated by the law on health insurance and medical examination and treatment.

4. Accountability to state health management agencies in case of recommendations or complaints that the social insurance agency has violated contracts for medical examination and treatment under health insurance, payment, refusal of payment, or recovery of medical examination and treatment costs in violation of the law.

Article 35. Rights and responsibilities of medical examination and treatment facilities in contract implementation

1. Rights of medical examination and treatment facilities

a) Rights as prescribed in Article 42 of the Law on Health Insurance and provisions of the law on medical examination and treatment;

b) Be provided with timely information when the health insurance claims information system detects an increase in health insurance examination and treatment costs that is higher than the average cost of medical examination and treatment at facilities of the same technical level, the same type of general or specialized medical facility within the province, centrally-run city, or nationwide, or higher than the average increase of the same facility during the same period last year, in order to promptly review, check, verify, and implement appropriate adjustment measures;

c) Have the right to request the social insurance agency to clarify the reasons for delays in payment or settlement of health insurance examination and treatment costs;

d) Be promptly notified by the social insurance agency of any incidents in the data reception system, errors in dossiers, or errors in health insurance examination and treatment cost data when submitting payment requests;

d) Be entitled to propose to state management agencies in the fields of health and finance to provide guidance and resolve obstacles arising during the implementation of the contract;

e) Be entitled to have competent authorities consult on procedures, appraisal processes, regulations, and health insurance policies related to the rights and obligations of health insurance medical examination and treatment facilities.

2. Responsibilities of medical examination and treatment facilities

a) Comply with the provisions of Article 43 of the Law on Health Insurance and the responsibilities prescribed by law regarding medical examination and treatment;

b) Review and promptly issue procedures and professional guidelines in health insurance medical examination and treatment; comply with legal regulations on medical examination and treatment, professional guidance from the Ministry of Health, and relevant legal regulations on procurement and bidding to ensure the supply of drugs, chemicals, medical equipment, and medical technical services that are quality, effective, and economical;

c) Send electronic data on health examination and treatment costs covered by health insurance after the patient’s treatment session is completed, digitally sign the summary table of health examination and treatment costs of health insurance participants monthly or quarterly according to the regulations set by the Minister of Health; verify electronic data in accordance with legal regulations; be responsible before the law for the accuracy of the cost summary proposed for payment with the patient’s health insurance treatment cost list;

d) Establish information technology infrastructure systems, upgrade and complete hospital management software systems to properly comply with legal regulations on input data standards, output data standards, electronic data extraction, digital transformation, and electronic transactions in the health sector;

d) Comply with regulations on the payment of medical examination and treatment costs under health insurance; proactively review and check rising medical examination and treatment costs under health insurance at the facility according to recommendations and alerts from the social insurance agency; identify subjective and objective causes, develop and implement solutions to address subjective causes and inadequacies, and send them to the social insurance agency where the contract is signed;

e) Publicize the results of technical professional ranking approved by the competent authority along with the scores on the facility's electronic information page and at the patient reception area. The competent authority that ranks technical professional levels is responsible for publicizing the list of medical examination and treatment facilities that have been ranked along with the scores on the agency's electronic information portal and on the information system for managing medical examination and treatment activities;

g) In cases of providing medical examination and treatment on rest days or public holidays, medical examination and treatment facilities must arrange sufficient professional personnel, administrative, financial, and accounting departments to meet the requirements of medical examination and treatment, promptly resolve the rights of patients, and be appropriate to the scope of medical examination and treatment on rest days or public holidays;

h) Comply with regulations on the management and use of medicines and medical equipment to ensure quality and safety in providing health insurance medical examination and treatment services;

i) Fully prescribe and ensure the coverage scope of the health insurance fund for health insurance participants according to professional requirements and the disease condition; it is prohibited to charge additional fees from health insurance patients and to claim from the social insurance agency for costs that have already been included in the price structure of medical examination and treatment services regulated or approved by the competent authority for medical examination and treatment facilities.

3. Accountability to state health management authorities in case of recommendations or reports that a medical examination and treatment facility has violated the contract for medical examination and treatment under health insurance.

4. Exercising other rights and responsibilities as prescribed by the law on health insurance and medical examination and treatment.

Article 36. Inspection of the implementation of health insurance medical examination and treatment contracts

1. Cases of inspection include:

a) Regular inspections according to the annual plan;

b) Unscheduled inspections when legal violations are detected or there are signs of violations related to the implementation of the medical examination and treatment contract under health insurance.

2. Principles of inspection:

a) Inspections must be based on the inspection plan approved by the competent authority;

b) Regular inspections ensure the principle that medical examination and treatment facilities are not inspected more than once regarding the same content within one year, including inspections, audits, and examinations by competent authorities, except in cases where legal violations or signs of violations are detected;

c) The inspection content is based on the articles, clauses, content, and responsibilities stipulated in the signed health insurance medical examination and treatment contract. It does not include content outside the scope of the signed health insurance medical examination and treatment contract or content that is not within the functions and duties of the social insurance agency;

d) The inspection plan must be sent to the entity being inspected immediately after approval. The inspection schedule must be notified to the entity being inspected at least 07 days in advance; for sudden inspections, a written notice must be sent to the entity being inspected at least 01 day in advance;

d) The inspection conclusion must be sent to the entity being inspected. Within 03 months from the date of receiving the inspection conclusion, the inspected entity must report on the implementation of the inspection conclusion to the inspecting agency.

3. The Minister of Finance shall regulate the authority to inspect the implementation of contracts for medical examination and treatment covered by health insurance.

PROCEDURES FOR MEDICAL EXAMINATION AND TREATMENT UNDER HEALTH INSURANCE

Article 37. Procedures for health insurance medical examination and treatment as prescribed in Clause 1, Article 28 of the Health Insurance Law

1. Health insurance participants must present information about their health insurance card and personal identification documents in one of the following forms when undergoing medical examination and treatment:

a) Identity card or citizen identity card or level 2 electronic identification account (VNeID) integrated with information about the health insurance card;

b) Electronic or paper version of the health insurance card. For individuals participating in health insurance as specified in points a, b, c, and d of Clause 3, Article 12 of the Health Insurance Law, if there is no information about the health insurance card available on the information technology system, they must present the paper version of the health insurance card. In cases where the health insurance card does not have a photo or a health insurance number, one of the following identity documents must also be presented: identity card, citizen identification card, identification certificate, passport, linked with a Level 2 electronic identification account (VNeID) or the VssID application, or other identity documents issued by competent authorities or organizations, or a confirmation issued by the local police.

2. For children under 6 years old, they only need to present a paper or electronic health insurance card or the health insurance number; in cases where the health insurance card has not yet been issued, they must present the original or a copy of the birth certificate. For newborns, the father, mother, or a relative of the child must sign to confirm on the medical records, or the representative of the medical examination and treatment facility confirms on the medical records in cases where the child has no father, mother, or relatives.

3. Health insurance participants during the waiting period for issuance or for changes in health insurance card information, when visiting for medical examination and treatment, must present the receipt for the application and the appointment for issuing, reissuing, or replacing the health insurance card, information about the health insurance card provided by the social insurance agency or an organization or individual authorized by the social insurance agency to receive applications for reissuing or replacing the card, along with a type of personal identification of the person as prescribed in Point b, Clause 1 of this Article.

4. A person who has donated a human body part must present information about their health insurance card as prescribed in Clause 1 or Clause 3 of this Article. In case they do not yet have a health insurance card, they must present a discharge certificate issued by the medical examination and treatment facility where the body part was taken from the donor, along with one of the following identity documents of that person: citizen identification, national ID card, identity certificate, passport, linked to a Level 2 digital identification account (VNeID) or the VssID application, or other identity documents issued by a competent authority or organization. In the case of not having a health insurance card but requiring immediate treatment after donation, the medical examination and treatment facility and the patient or the patient’s relatives must confirm this in the medical record.

5. In emergency cases, health insurance participants must present the documents prescribed in Clause 1, Clause 2, or Clause 3 of this Article before the end of the treatment period.

Article 38. Procedures for health insurance medical examination and treatment in certain cases

1. In cases where the patient has a health insurance card when going for medical examination or treatment but presents the card information late, the health insurance fund will pay for medical examination and treatment costs within the scope of benefits and coverage from the time of presenting the health insurance information, except in emergency cases. The medical examination and treatment costs incurred before the patient presents the health insurance information will be paid directly by the health insurance fund in accordance with the provisions of Articles 55, 56, and 57 of this Decree.

2. In the case where a patient has an electronic health insurance card when going for health insurance examination and treatment but cannot present the electronic health insurance card due to connection with a level 2 electronic identification account (VNeID) or the VssID application being faulty or due to Internet connection errors, it is carried out as follows:

a) The patient provides the health insurance card number information for the medical examination and treatment facility to perform an information lookup on the Vietnam Social Security Data Reception Portal. In case the Vietnam Social Security Data Reception Portal cannot retrieve the information, the medical examination and treatment facility records the health insurance card number information and receives the patient for medical examination and treatment. The medical examination and treatment facility coordinates with the social insurance agency to re-check the patient's health insurance card information to determine the scope, benefits, and entitlements of health insurance.

b) In the case when, at the time the patient finishes the medical examination and treatment session and leaves the hospital, the electronic health insurance card management system is still malfunctioning and unable to extract information, and the social insurance agency has not yet verified or clarified the information, the medical examination and treatment facility is responsible for sending all medical examination and treatment records, the patient's contact information along with a screenshot of the lookup to the social insurance agency to continue verifying the information when the system is restored and to assess and pay medical examination and treatment costs according to regulations. The patient is responsible for providing information about the health insurance participant, health insurance card information to the medical examination and treatment facility, and ensuring the accuracy of the provided information.

3. Medical examination and treatment facilities and social insurance agencies are not allowed to stipulate additional medical examination and treatment procedures for health insurance beyond the procedures prescribed in this Article. In cases where medical examination and treatment facilities or social insurance agencies need to photocopy health insurance cards or documents related to the patient's medical examination and treatment for management purposes, they must photocopy them themselves after obtaining consent from the patient or the patient's guardian, and are not allowed to require the patient to make photocopies or pay for this cost.

METHOD OF PAYING MEDICAL EXAMINATION COSTS,

TREATING ILLNESSES WITH HEALTH INSURANCE

Article 39. Payment method based on service prices

1. The payment method based on service prices is the method of payment based on the prices of medical examination and treatment services and the costs included in the price structure of medical examination and treatment services according to the regulations of the law on medical examination and treatment but not yet included in the price used as a basis to determine the payment level of medical examination and treatment costs by the health insurance fund.

2. The payment level of medical examination and treatment costs by the health insurance fund is determined as follows:

a) For state medical examination and treatment facilities, the health insurance fund pays for medical examination and treatment costs under health insurance by the prices of medical examination and treatment services included in the list approved or prescribed by the competent authority for payment by the health insurance fund;

b) For private medical examination and treatment facilities, the health insurance fund pays for medical examination and treatment costs based on the service prices of medical examination and treatment listed in the catalog reimbursable by the health insurance fund, which are issued by the competent authority according to the law on medical examination and treatment or approved for public medical examination and treatment facilities in the area, following the principles stipulated in points a, b, c, and d, Clause 2, Article 47 of this Decree. The difference between the service prices of medical examination and treatment at private medical facilities and the service prices listed in the catalog reimbursed by the health insurance fund shall be paid by the patient.

3. For medical examination and treatment costs within the coverage, the benefit level of health insurance participants in the service price structure for medical examination and treatment according to the roadmap and regulations of the law on medical examination and treatment but not yet included in the price, the health insurance fund shall pay according to the actual quantity used, the purchase price as prescribed by the law on bidding, or according to the level of payment for medical examination and treatment costs of the health insurance fund for private medical facilities; blood and blood products costs are paid according to the regulations of the Minister of Health.

Article 40. Payment method based on capitation

1. Payment by capitation applies to outpatient medical examination and treatment under health insurance.

2. The scope of payment by capitation includes outpatient medical examination and treatment costs within the coverage and the benefit level of the holder of the health insurance card.

3. Vietnam Social Security determines the allocated fund for the year based on the total actual outpatient medical examination and treatment expenses covered by health insurance and the estimated outpatient medical examination and treatment expenses for the year according to the provisions in Clause 6 of this Article, for the social insurance agency to notify the health insurance medical facility.

4. In case there is a surplus of the allocated fund within the year, the medical facility may retain a portion of the funds and account it as the unit's service revenue; the remaining portion of the funds shall be transferred to the health insurance fund for adjustment.

5. In case the allocated fund is overdrawn during the year, the medical facility shall balance it within the facility's own revenue according to regulations; in case the medical facility overdraws the allocated fund for two consecutive years, consideration shall be given to adjustment for the following year. 46

6. The Minister of Health determines the diseases, disease groups, medical services, and costs that are not covered by case-based payment, guides the technical determination, and organizes the implementation of case-based payment.

7. The Ministry of Health shall preside over and coordinate with the Ministry of Finance to regulate the allocation of case-based funding, adjust any remaining funds, determine the portion of remaining funds that medical examination and treatment facilities can retain, and set the roadmap for case-based payment.

Article 41. Payment method based on diagnostic groups

1. Payment by Diagnosis-Related Group (DRG) is payment at a predetermined cost level for each group of diagnoses that share similar clinical characteristics and required resources, regardless of the actual costs incurred in medical examination and treatment under health insurance.

2. The scope of payment by diagnosis-related group includes the costs of medical examination and treatment within the entitlement and coverage level of the health insurance cardholder for inpatient and day treatment under health insurance.

3. The Minister of Health stipulates the scope of data used in developing the payment method according to DRG, the DRG list; the principles, methods, and techniques for building and adjusting DRG classification algorithms and cost accounting to calculate DRG payment parameters, determine cost levels, and total DRG funds; and provides guidance on organizational implementation and the roadmap for payment according to diagnosis groups.

4. Vietnam Social Security determines the DRG list, estimates total DRG costs, relative weights, base payment rates, and adjustment coefficients in accordance with the provisions of Clause 3 of this Article and sends them to the Ministry of Health for promulgation, while also sending the medical examination and treatment cost data used in constructing DRGs for storage and to support appraisal and issuance.

Article 42. Application of payment methods

1. The cost of medical examination and treatment covered by health insurance for medical services that have been paid according to one payment method shall not be paid again using another method.

2. The payment method applied at the medical examination and treatment facility is specified in the medical examination and treatment contract with the social insurance agency in accordance with the provisions of Article 25 of this Decree.

PAYMENT OF MEDICAL EXAMINATION AND TREATMENT COSTS BETWEEN AGENCIES

SOCIAL INSURANCE AND MEDICAL EXAMINATION AND TREATMENT FACILITIES

Article 43. Payment of costs for drugs and medical equipment transferred between health care facilities covered by health insurance

The health insurance fund covers the costs of medicines and medical equipment transferred between health insurance medical examination and treatment facilities in cases where, at the time the patient is prescribed or directed to use the medicine or medical equipment, it is not available and cannot be substituted with other medicines or medical equipment, specifically as follows:

1. The determination of medical examination and treatment facilities that do not have available medicines and medical equipment at the time of prescription and ordering, and cannot be substituted with other medicines or medical equipment, is regulated as follows:

a) Medical examination and treatment facilities do not have any commercial drugs containing the active ingredient prescribed to the patient, or have drugs with the same active ingredient but different concentration or dosage or dosage form or route of administration that cannot be substituted to prescribe to the patient;

b) Medical examination and treatment facilities do not have the medical equipment prescribed for the patient to use and do not have alternative medical equipment, except for in vitro diagnostic medical devices, personal specific medical devices, and medical devices listed in the medical device list issued by the Minister of Health that are purchased and sold like ordinary goods according to the provisions of Decree No. 98/2021/NĐ-CP dated November 8, 2021, of the Government on the management of medical equipment, amended and supplemented by Decree No. 07/2023/NĐ-CP dated March 3, 2023, and Decree No. 04/2025/NĐ-CP dated January 1, 2025, of the Government.

2. At the time the patient is prescribed or indicated, the medical examination and treatment facility does not have the medicine or medical equipment available due to one of the following reasons:

a) During the epidemic phase of group A, for medical examination and treatment facilities that are quarantined, under medical isolation, or located in areas implementing social distancing or performing epidemic prevention and control tasks;

b) Medical examination and treatment facilities are in the process of selecting a contractor according to the contractor selection plan that has been approved in one of the following forms: open bidding, restricted bidding, competitive quotation, direct procurement, or contractor selection in special cases but have not been able to select a contractor, or online quotation, or online procurement, and have conducted shortened contractor appointment as prescribed by the law on bidding but have not been able to select a contractor;

c) Medical examination and treatment facilities that have signed contracts with the contractor supplying drugs and medical equipment, but at the time of prescribing drugs or medical equipment for the patient, there is written evidence confirming that the contractor cannot supply the drugs (such as supply documents from the supplier, contract appendix, minutes confirming that the contractor does not supply the drugs).

3. The authority to decide cases eligible to receive drugs and medical equipment transferred from other health insurance medical facilities is regulated as follows:

a) The director of the medical examination and treatment facility where the patient is being treated, based on the actual situation and the conditions prescribed in Clauses 1 and 2 of this Article, shall select a health insurance medical facility that has the available drugs and medical equipment and approve the transfer;

b) The decision on choosing medical examination and treatment facilities for transferring drugs and medical equipment must ensure suitability, efficiency, and savings; it is encouraged to carry out the transfer of drugs and medical equipment for medical examination and treatment facilities within the same province or centrally-run city.

4. The transfer and payment for medicines and medical equipment are carried out as follows:

a) Medical examination and treatment facilities are responsible for informing about the transfer of medicines, medical equipment, and the costs that health insurance patients must pay in case patients have to pay additional costs outside the co-payment costs as prescribed;

b) The facility transferring medicines and medical equipment and the facility receiving medicines and medical equipment must have a written handover document;

c) The health insurance fund pays for medicines and medical equipment within the benefits and entitlement levels of the health insurance participant as prescribed to the medical examination and treatment facility receiving them, according to the health insurance payment price of the medical facility transferring the medicines and medical equipment. Other costs are paid by the patient to the medical examination and treatment facility providing treatment;

d) Medical examination and treatment facilities that receive drugs and medical equipment are responsible for paying the costs of drugs and medical equipment to the medical examination and treatment facilities from which they are transferred. Medical examination and treatment facilities that treat patients aggregate the portion of drug and medical equipment costs covered by the health insurance fund into the patient's medical examination and treatment expenses to pay to the social insurance agency;

d) The social insurance agency is responsible for publishing the quantity of unused drugs and medical equipment according to the bidding results of the health insurance medical examination and treatment facilities on the Data Reception Portal of Vietnam Social Insurance for medical examination and treatment facilities to reference when proposing the transfer of drugs and medical equipment.

5. In cases where a health insurance patient does not agree to pay for costs outside the scope of benefits and the level of benefits of the health insurance participant when transferring medications or medical equipment, the medical examination and treatment facility shall transfer the patient to another medical examination and treatment facility that can ensure the provision of medications and medical equipment for the patient's treatment.

Article 44. Regulations on transferring patients or specimen samples to another facility qualified to perform paraclinical services

1. Medical examination and treatment facilities shall only transfer patients or biological samples to receiving facilities that have been approved by the competent authority as meeting the conditions to perform laboratory services. The facility receiving the patient or biological sample to perform laboratory services shall not further transfer the patient or biological sample to a third (other) facility.

2. The transfer of performing ancillary clinical services is carried out according to the principle of complying with the requirements for technical expertise in medical examination and treatment, ensuring the rights of participants in health insurance, and falls under the following cases:

a) Clinical sub-services approved by a competent state agency for medical examination and treatment facilities and being implemented at the medical examination and treatment facility, but at the time of indication for use for the patient, that medical examination and treatment facility cannot perform or is insufficient to meet the full demand for the clinical sub-service. The medical examination and treatment facility transferring the patient or specimen fills in the information in Form No. 9 of the Appendix issued together with this Decree to be sent along during the transfer of the patient or specimen to the facility performing the clinical sub-service. The medical examination and treatment facility transferring the patient or specimen sends a list of the clinical sub-services already performed to the facility performing the clinical sub-service to the social insurance agency where the health insurance medical examination and treatment contract is signed, as a basis for payment; 50

b) Paraclinical services that have not been approved by the competent state authority for medical examination and treatment facilities but are actually necessary for professional activities and are included in the list issued by the Minister of Health. The head of the health insurance medical examination and treatment facility where the patient or specimen is referred, based on their functions, duties, and the scope of professional activities approved by the competent authority, shall prepare a list of paraclinical services that need to be referred and sign a framework contract with the facility performing the paraclinical services. The framework contract shall include content agreeing that the social insurance agency that signs the health insurance medical examination and treatment contract with the referring medical examination and treatment facility will inspect the paraclinical services received and performed at the facility providing the paraclinical services. The medical examination and treatment facility covered by health insurance where the patient or specimen is referred must send the list of ancillary services to be transferred and the principle contract to the social insurance agency where the health insurance medical examination and treatment contract was signed before implementation.

3. Medical examination and treatment facilities that transfer patients or biological samples are responsible for paying the costs to the medical examination and treatment facility or service-performing unit, and at the same time, they must aggregate the costs of ancillary clinical services into the patient's medical examination and treatment costs for reimbursement with the social insurance agency. Facilities receiving ancillary clinical services are not allowed to charge additional medical examination fees from the patient. In cases where the patient must pay extra costs for performing ancillary clinical services beyond the co-payment costs as prescribed, the medical examination and treatment facility transferring the patient or biological sample must inform and obtain the patient's consent before transferring the patient or biological sample.

4. The health insurance fund reimburses the costs of ancillary clinical services according to the scope and benefits of the insured person, specifically as follows:

a) In the case specified in point a, clause 2 of this Article: the health insurance fund shall pay according to the price of ancillary medical services approved by the competent authority for the facility where the ancillary service is performed, but not exceeding the price of medical examination and treatment services of the referring facility. In case the facility where the ancillary service is performed has not been approved by the competent authority or does not have a health insurance medical examination and treatment service price, the health insurance fund shall pay according to the price of technical services approved by the competent authority for the medical examination and treatment facility referring the patient or specimen;

b) In the case specified in point b, clause 2 of this Article: the health insurance fund shall pay according to the prices of subclinical services that have been approved by the competent authority for the facility where the subclinical services are performed. In cases where the facility performing the subclinical services has not yet had the prices of medical examination and treatment services approved by the competent authority, the health insurance fund shall pay according to the prices of technical services approved by the competent authority for state medical examination and treatment facilities, applied according to the payment principles specified in points a, b, c, and d, clause 2, Article 47 of this Decree.

Article 45. Payment of medical examination and treatment costs during the process of technology transfer

1. Payment for medical examination and treatment costs during the process of technical transfer performed by the personnel of the medical examination and treatment facility transferring the technique shall be implemented according to the technical transfer plan and technical transfer contract in accordance with the provisions of the law on medical examination and treatment.

2. Medical examination and treatment facilities receiving technical transfer are responsible for notifying in writing the social insurance agency that signs the medical examination and treatment insurance contract about the medical examination and treatment services carried out according to the project, transfer contract in order to serve as the basis for payment, and the written approval of competent authorities for special types of techniques. The health insurance fund shall pay according to the number of medical examination and treatment services in the project, transfer contract, or the written approval of competent authorities for special types of techniques.

3. The payment level based on the price of medical examination and treatment services listed in the reimbursement list approved by competent authorities for the medical examination and treatment facility receiving the technical transfer. In case the medical examination and treatment facility receiving the technical transfer is a private medical examination and treatment facility, it shall implement according to the provisions at point b, Clause 2, Article 39 of this Decree.

4. For medical examination and treatment costs that fall within the scope of health insurance coverage but have not been included in the structure of medical service prices, the health insurance fund shall pay according to the provisions of Clause 3, Article 39 of this Decree.

5. After completing the implementation of the contract for transferring the medical examination and treatment facility, it is necessary to submit to the competent authority for approval of the technical list and approval of prices according to the law on medical service pricing, to serve as the basis for payment for that technical service.

Article 46. Payment of medical examination and treatment costs for health care facilities providing health insurance medical services outside office hours or on holidays and weekends

1. Persons with health insurance cards who go for medical examination and treatment are eligible for payment by the health insurance fund within the scope and level of health insurance benefits.

2. Medical examination and treatment facilities are responsible for ensuring adequate personnel and professional conditions, disclosing any costs that patients must pay beyond the coverage and benefits of health insurance, and must notify patients in advance; they must also notify in writing the local state health management authority and the social insurance agency where the health insurance service contract is signed at least 03 working days before conducting medical examination and treatment activities outside of regular working hours or on weekends and holidays, to serve as a basis for implementation and payment of medical examination and treatment costs.

Article 47. Payment of medical examination and treatment service costs in health insurance medical services for private health care facilities

1. The payment level for medical examination and treatment services from the health insurance fund shall be implemented in accordance with the provisions of Article 39 of this Decree.

2. In the case where a private medical examination and treatment facility applies the payment rates for medical examination and treatment costs from the health insurance fund as prescribed in point b, clause 2, Article 39 of this Decree, it shall be implemented as follows:

a) Specialized medical examination and treatment facilities are reimbursed based on actual costs but not higher than the highest price of the medical examination and treatment service at the same level specialized medical facilities of the State in the province, or at the basic-level medical facilities of the State in the province in case there is no price from the specialized medical facilities of the State in the province;

b) Basic-level medical examination and treatment facilities are reimbursed according to the actual cost but not higher than the highest price of that medical examination and treatment service of basic-level state medical examination and treatment facilities in the province. In case the basic-level state medical examination and treatment facilities in the province do not have a price for that medical examination and treatment service, the reimbursement shall be made up to the lowest price of that technical service at specialized-level state medical examination and treatment facilities in the province;

c) Primary-level medical examination and treatment facilities are reimbursed based on the actual cost but not higher than the highest price of that medical examination and treatment service of state primary-level medical facilities in the province. In the case that state primary-level medical facilities in the province do not have a price for that medical examination and treatment service, the reimbursement is capped at the lowest price of that service at basic-level state medical facilities in the province;

d) In cases where the price of the medical examination and treatment service has not been regulated or approved by the competent authority for public medical examination and treatment facilities in the province, private medical examination and treatment facilities shall be reimbursed according to the principles specified in points a, b, and c of this clause based on the price of that medical examination and treatment service approved by the competent authority for public medical examination and treatment facilities in one of the neighboring provinces. If public medical examination and treatment facilities in neighboring provinces do not have a price for that medical examination and treatment service, reimbursement shall be made according to the price of that medical examination and treatment service approved by the competent authority for public medical examination and treatment facilities in another province nationwide.

Article 48. Payment level in cases where technical services have been prescribed and performed by a health care facility but cannot continue due to the progression of the illness or the patient’s physical condition

1. The health insurance fund pays according to the actual quantity of drugs, medical equipment, medical gas, materials, instruments, tools, chemicals used to perform that technical service, which is being paid to medical examination and treatment facilities by the health insurance fund, and the purchase price as prescribed by the law on bidding; for the cost of blood and blood products, payment is made according to the regulations of the Minister of Health.

2. The health insurance fund pays the portion of wages, salaries, allowances, contributions, and surgical or procedural allowances (if any) actually according to the rates prescribed by the Minister of Health based on the price structure of the technical service for which the facility is receiving payment from the health insurance fund.

Article 49. Payment of costs for purchasing medicines, chemicals, testing materials, and medical equipment for medical examination and treatment facilities that are public service providers self-financing regular and investment expenses, public service providers self-financing regular expenses, and private medical examination and treatment facilities in cases prescribed in Clause 3, Article 55 of the 2023 Law on Bidding, as amended and supplemented by Law No. 90/2025/QH15.

In the case where a medical examination and treatment facility is a public non-business unit that earns its own operating and investment funds, a public non-business unit that earns its own operating funds, and private medical examination and treatment facilities that do not choose to apply the provisions of the Law on Bidding for the purchase of medicines, chemicals, testing supplies, and medical equipment, and fall under the cases of payment according to the provisions of Clause 3, Article 39 of this Decree, the health insurance fund shall pay within the scope and level of benefits of the insured person based on the purchase price, but not higher than the unit price according to the results of the contractor selection that are still valid at the time of payment for medicines of the same trade name, manufacturer, origin, concentration, dosage, route of administration, the same technical criteria group, dosage form, unit of measure, or the same chemicals, testing supplies, and medical equipment with the same manufacturer, origin, and technical criteria according to the following principles and order of priority:

1. Results of national centralized procurement, results of price negotiations.

2. Results of centralized procurement in the province.

3. The purchasing results of the medical examination and treatment facilities of the State with the same level of professional and technical expertise in the same province as that medical examination and treatment facility.

4. In cases where there is no unit price prescribed in Clause 3 of this Article, the health insurance fund shall pay according to the following principles:

a) Primary-level medical examination and treatment facilities are reimbursed according to the lowest winning bid price of state basic-level medical examination and treatment facilities in the province. In case there is no winning bid price of state basic-level medical examination and treatment facilities, the medical examination and treatment facility is reimbursed according to the lowest winning bid price of state specialized-level medical examination and treatment facilities in the province;

b) Basic-level medical examination and treatment facilities are reimbursed according to the lowest winning bid price of state primary-level medical examination and treatment facilities in the province. In case there is no winning bid price of state primary-level medical examination and treatment facilities, the medical examination and treatment facility is reimbursed according to the lowest price of state specialized-level medical examination and treatment facilities in the province;

c) Specialized medical examination and treatment facilities are reimbursed according to the lowest winning bid price of State medical examination and treatment facilities at the primary or basic level in the province.

5. In cases where there is no price specified in Clause 4 of this Article, the health insurance fund shall reimburse according to the winning bid price of State medical examination and treatment facilities, based on the results of centralized procurement in neighboring provinces in the following order of priority:

a) According to the results of centralized procurement in the area;

b) The procurement results of State medical examination and treatment facilities with the same level of professional and technical expertise as that medical examination and treatment facility;

c) According to the principles stipulated in points a, b, and c of Clause 4 of this Article.

6. In cases where there is no unit price stipulated in Clause 5 of this Article, the health insurance fund shall pay according to the winning bid unit price of the state medical examination and treatment facility, and the result of centralized procurement in other provinces nationwide, following the principles specified in points a, b, and c of Clause 5 of this Article.

Article 50. Payment of medical examination and treatment costs for certain cases.

1. Payment of medical examination and treatment costs for children under 6 years old, and persons who have donated body parts but do not yet have a health insurance card:

a) Medical examination and treatment facilities use the function of looking up temporary health insurance card information on the Data Reception Portal of Vietnam Social Security to obtain temporary health insurance card information, aggregate medical examination and treatment costs covered by health insurance according to the entitled scope and rate, and send to the social insurance agency for payment according to regulations. In case the patient has not been issued a temporary card code, the medical examination and treatment facility enters full information on the Data Reception Portal of Vietnam Social Security for the Portal to automatically issue a temporary card code;

b) The social insurance agency is responsible for checking temporary health insurance card information and carrying out the payment of medical examination and treatment costs according to regulations.

2. In cases where a patient needs to be transferred to another medical examination and treatment facility and requires a medical staff to accompany them and the use of drugs and medical equipment according to professional requirements during transportation, the cost of drugs and medical equipment is included in the treatment costs of the medical examination and treatment facility that orders the patient transfer.

3. In cases where a patient has been stabilized after inpatient treatment but needs to continue using drugs after discharge as prescribed by the medical examination and treatment facility, the health insurance fund will cover the cost of drugs within the entitlement and benefit level prescribed by the Minister of Health. The medical examination and treatment facility will include this drug cost in the patient's treatment costs before discharge.

4. In cases where, upon visiting for medical examination and treatment, the patient's health insurance card is still valid, but during inpatient treatment, day treatment, or outpatient treatment at a medical facility the health insurance card expires, the health insurance fund shall pay the medical examination and treatment costs within the entitled scope and level until discharge, for a maximum of 15 days from the day the health insurance card expires. Upon discharge, at the end of the medical examination and treatment session, the patient is responsible for continuing the health insurance according to the expiration period of the expired health insurance card.

5. Expenses for medical examination and treatment for cases where participants in health insurance visit for medical examination and treatment before January 1 and complete the medical examination and treatment session, being discharged from January 1 of the following year, shall be handled as follows:

a) In case a medical examination and treatment facility continues to sign a contract for health insurance medical examination and treatment, it will be counted in the medical examination and treatment costs of the following year;

b) In case a medical examination and treatment facility does not continue to sign a contract for health insurance medical examination and treatment, it will be counted in the medical examination and treatment costs of the previous year.

6. In case a patient has a health insurance card when going for medical examination and treatment but presents the card information late, the health insurance fund will pay for the medical examination and treatment costs within the scope of benefits and the entitlement level from the time the insurance card information is presented. The medical examination and treatment costs during the period when the patient has not yet presented the insurance card information will be paid directly by the health insurance fund according to the procedures prescribed in Article 56 and the payment rates prescribed in Article 57 of this Decree.

Article 51. Refusal to pay health insurance medical examination and treatment costs.

1. Refusal to pay for health insurance medical examination and treatment costs is when the social insurance agency refuses to pay for health insurance medical examination and treatment costs that are determined to be not in accordance with the law on health insurance and medical examination and treatment during the appraisal process and before payment to the medical examination and treatment facility.

2. The refusal to pay must clearly state the basis, reason for refusal, and the amount refused in the appraisal record, including the health insurance medical examination and treatment costs proposed by the social insurance agency for payment through the electronic environment, which are automatically returned when the medical examination and treatment facility submits the data. Representatives of the social insurance agency and representatives of the medical examination and treatment facility shall agree to sign the medical examination and treatment cost appraisal record as the basis for settlement within the timeframe specified in point b, clause 2, Article 32 of the Health Insurance Law.

3. Medical examination and treatment facilities have the right to propose that the social insurance agency reconsider the refusal to pay for health insurance medical examination and treatment costs or to propose that the competent authorities review and resolve according to the provisions of the law.

Article 52. Recovery of health insurance medical examination and treatment costs.

1. The recovery of health insurance medical examination and treatment costs is carried out for health insurance medical examination and treatment costs that have been paid but are found to be inconsistent with legal regulations through inspection, examination, audit, resolution of difficulties, handling of legal violations by competent authorities, and discoveries during the implementation process.

2. Based on the conclusions and the handling results of the competent authority in accordance with Clause 1 of this Article, the director of the social insurance agency shall issue a document to recover medical examination and treatment costs under the health insurance coverage within its authority. The recovery document must clearly state the legal basis for the recovery, the content of the violation, the amount to be recovered, the deadline for recovery, and the responsibilities of organizations and individuals related to the recovered costs. Medical examination and treatment facilities are responsible for returning the recovered portion of funds to the Health Insurance Fund.

3. The recovered funds are to be accounted for in the year the recovery is carried out.

4. Medical examination and treatment facilities have the right to petition the social insurance agency to reconsider the recovery of health insurance medical examination and treatment costs or to petition the competent authority to review and resolve according to the provisions of the law. 58

5. In cases where the recovery of health insurance medical examination and treatment costs in inspection, examination, audit, and handling of legal violations by competent state agencies is governed by regulations different from this Article, those regulations shall apply.

Article 53. Responsibilities of the relevant parties in refusing payment and recovering health insurance medical examination and treatment costs.

1. Agencies, organizations, or individuals who are denied payment or are required to repay health insurance medical examination and treatment costs are responsible for complying with the decision of the social insurance agency or the final settlement results of the competent authority according to legal regulations.

2. When resolving the denial of payment or recovery of health insurance medical examination and treatment costs, the resolving agency must clearly determine the responsibility and the handling or recommendation for handling the responsibility of the relevant agencies, organizations, or individuals in accordance with the law.

3. In cases where the refusal of payment or recovery is not in accordance with the law, the social insurance agency that refuses payment or recovery shall be responsible for making additional payments and refunding the medical examination and treatment facility.

DIRECT PAYMENT OF MEDICAL EXAMINATION AND TREATMENT COSTS BETWEEN

SOCIAL INSURANCE AGENCY AND PARTICIPANTS

HEALTH INSURANCE

Article 54. Cases in which the social insurance agency directly pays medical examination and treatment expenses covered by health insurance directly to the person holding a health insurance card in accordance with point c, clause 2, Article 31 of the Law on Health Insurance

The social insurance agency shall directly pay the costs to health insurance participants according to the scope and level of benefits as prescribed by law on health insurance in the following cases:

1. Patients in an emergency condition, unconscious, or deceased who have not presented health insurance card information before being discharged.

2. Health insurance participants under the management authority of the Ministry of National Defense and the Ministry of Public Security who have lost their health insurance card but have not yet been reissued, or whose health insurance card information is erroneous or incorrect and has not been corrected or amended by the social insurance agency at the time of completing the medical examination and treatment visit, or discharge.

3. Health insurance participants who belong to the category whose health insurance premiums are paid by the state budget but have not been issued a health insurance card, except for cases stipulated in Clause 1, Article 50 of this Decree. The patient shall be reimbursed for the entire cost of medical examination and treatment within the scope of entitlement and the level of entitlement from the date they were determined to belong to the category whose health insurance is paid by the state budget but has not yet been reimbursed due to not having been issued a health insurance card.

4. Patients admitted to the emergency department at medical facilities that do not have a contract for medical examination and treatment with health insurance. Patients are reimbursed for the entire portion of medical examination and treatment costs within the entitled scope and the benefit level not yet paid according to the provisions of the law on health insurance.

5. In cases where medical examination and treatment under health insurance involve individuals who have changed to a group entitled to a higher level of health insurance benefits but have not yet been issued a new health insurance card, the social insurance agency shall pay the difference in costs between the two levels of benefits directly to the health insurance participant.

6. In cases where patients purchase drugs or medical equipment by themselves under the provisions of Articles 58 and 59 of this Decree. For subjects as stipulated in points a, b, c, and d of Clause 3, Article 12 of the Law on Health Insurance, the payment for drugs and medical equipment shall comply with the provisions of Decree No. 70/2015/NĐ-CP dated September 1, 2015, of the Government detailing and guiding the implementation of certain articles of the Law on Health Insurance for the People's Army, People's Police, and cryptography workers, as amended and supplemented by Decree No. 74/2025/NĐ-CP dated March 31, 2025, of the Government.

7. In cases where health insurance participants undergo medical examination and treatment during the period in which their card is confiscated, temporarily held, or temporarily blocked as regulated in Clauses 1, 2, and 3 of Article 12 of this Decree, and it is not the fault of the health insurance participant, the patient shall be reimbursed for the full cost of medical examination and treatment within the scope and level of benefits applicable to their category.

Article 55. Documents for requesting direct payment

1. A written request for direct payment according to Form No. 10 in the Appendix issued together with this Decree.

2. Documents that are copies including:

a) Health insurance card or health insurance number in cases where there is information on an electronic health insurance card, personal identification as regulated in Point b, Clause 1, Article 37 of this Decree. In cases regulated in Clause 5, Articles 54–60 of this Decree, the health insurance card includes both the old benefit level card and the new higher benefit level card;

b) Discharge papers or medical examination slips or medical records of the examination and treatment session for which reimbursement is requested (a photocopy with the official seal of the medical examination and treatment facility);

c) Prescription (if any).

3. Invoices and detailed cost statements.

4. In cases specified in Clause 6, Article 54 of this Decree, the documents for requesting direct reimbursement, in addition to the provisions in Clauses 2 and 3 of this Article, also include the following documents:

a) Medical equipment prescription sheet for the patient in case medical equipment is prescribed;

b) Confirmation slip of drug and medical equipment shortage according to Form No. 11 of the Appendix issued together with this Decree, provided by the medical examination and treatment facility to the patient.

Article 56. Procedure and process of direct payment

1. The patient or the patient's relative, as prescribed by the law on medical examination and treatment, shall fully declare information according to the direct payment request document in Form No. 10 of the Appendix issued together with this Decree (including selecting to receive direct payment at the one-stop counter of the social insurance agency or via the personal account declared according to Form No. 10), and at the same time submit the dossier as stipulated in Clauses 2, 3, and 4 of Article 55 of this Decree on the National Public Service Portal or via the application of the social insurance agency, or submit directly at the one-stop counter, or send through postal services to the social insurance agency in the area where the patient resides, or the social insurance agency that issued the card, or the social insurance agency that signed the medical examination and treatment insurance contract with the medical examination and treatment facility where the patient is treated.

2. National public service portal or via the application of the social insurance agency will automatically return the Receipt of Application and appointment for payment results directly to the patient or the patient's relative, or the officer receiving the application at the one-stop counter of the social insurance agency will directly check the application and issue the Receipt of Application and appointment for payment results directly to the patient or the patient's relative.

3. In case there is no request to amend or supplement the application, within 25 days from the date of receiving a complete valid application (for paper submissions based on the date indicated on the official dispatch stamp or the receipt of application), the social insurance agency must complete the health insurance assessment and pay the costs to the patient. Direct payment costs will be paid in cash or transferred to the patient's bank account provided in the payment request document.

4. In cases where there is a request to amend or supplement the documents, it shall be carried out as follows:

a) Within 5 working days from the date of receipt of the application (in the case of submitting a paper application, based on the date indicated on the official dispatch stamp or the application receipt), the social insurance agency must issue a document specifying the content that needs to be amended or supplemented and send it to the patient or the patient's relatives;

b) Within 20 days from the date of receiving the request document for amendment or supplementation (in the case of submitting a paper-based application, based on the date on the incoming official stamp or the receipt of the application), the patient or the patient's relatives are responsible for amending or supplementing the application and sending it to the social insurance agency for consideration;

c) Within 20 days from the date of receiving the amended and supplemented dossier that meets the prescribed conditions (in the case of submitting a paper dossier, based on the date indicated on the official dispatch stamp or the receipt of dossier), the social insurance agency must make the payment of costs to the patient. The payment can be made directly in cash or by transfer to the patient's bank account provided in the request for direct payment.

Article 57. Direct payment rates for cases specified in points a and b, clause 2, Article 31 of the Law on Health Insurance

1. In the case of patients coming for medical examination and treatment at primary-level medical examination and treatment facilities, which before January 1, 2025, were determined by competent authorities as district-level or primary-level medical examination and treatment facilities with a score of less than 50 or provisionally classified as primary-level (except for primary-level medical examination and treatment facilities that, before January 1, 2025, were determined by competent authorities as provincial-level and do not have a health insurance contract, except in emergencies), the payment rate is as follows:

a) In the case of outpatient medical examination and treatment, the health insurance fund pays according to the actual costs within the scope of entitlement and the health insurance benefit level as prescribed, but not exceeding 0.15 times the base salary at the time of medical examination and treatment; 62

b) In the case of inpatient medical examination and treatment, the health insurance fund shall pay according to the actual costs within the entitled scope and health insurance benefit level as prescribed, but no more than 0.5 times the basic salary at the time of discharge.

2. In cases where patients come for outpatient or inpatient treatment at primary-level medical examination and treatment facilities, which before January 1, 2025, have been determined by competent authorities as provincial-level or primary-level medical examination and treatment facilities scoring from 50 points to under 70 points and do not have a contract for health insurance medical examination and treatment (except in emergency cases), the health insurance fund shall pay according to the actual costs within the scope of entitlement and the health insurance benefit level as prescribed, but not exceeding 1.0 times the basic salary at the time of discharge.

3. In the case where a patient comes for inpatient examination and treatment at a specialized medical facility that does not have a health insurance agreement (except in emergency cases), the health insurance fund will pay according to the actual costs within the entitled scope and the health insurance benefit level as prescribed, but not exceeding 2.5 times the basic salary at the time of discharge.

4. In cases where the patient seeks medical examination and treatment not in accordance with the provisions of Clause 1, Article 28 of the Health Insurance Law, fails to present health insurance card information, or presents the card information late before the end of the medical examination, treatment session, or hospital discharge, except for the cases specified in Clause 1, Article 54 of this Decree and Clause 5 of this Article, the health insurance fund shall pay according to the actual costs within the scope of entitlement and the health insurance benefit level during the period the patient has not presented the health insurance card information, but not exceeding the specific maximum as follows:

a) In the case of outpatient medical examination and treatment, the maximum level shall not exceed 0.15 times the basic salary at the time of medical examination and treatment;

b) In the case of inpatient medical examination and treatment, the maximum level shall not exceed 0.5 times the basic salary at the time of discharge.

5. During the time the patient has not presented the health insurance card information as stipulated in Clause 1, Article 38 of this Decree, the subjects specified in points a, b, c, d, and đ of Clause 3, Article 12 of the Health Insurance Law are entitled to have the health insurance fund pay for medical examination and treatment costs within the scope of benefits and the rate of entitlement.

Article 58. Medicines and medical equipment eligible for direct payment to patients when purchased by the patients themselves

1. Drugs listed in the Rare Drug List as prescribed by the Minister of Health.

2. Medical devices of type C or D, except in vitro diagnostic medical devices, personal-specific medical devices, and medical devices listed in the List of Medical Devices promulgated by the Minister of Health, which are bought and sold as ordinary goods in accordance with the provisions of Decree No. 98/2021/NĐ-CP dated November 08, 2021 of the Government on the management of medical equipment, as amended and supplemented by Decree No. 07/2023/NĐ-CP dated March 03, 2023, and Decree No. 04/2025/NĐ-CP dated January 01, 2025 of the Government.

Article 59. Conditions for direct payment of costs to patients in cases where patients purchase medicines and medical equipment themselves

At the time of prescribing, medication orders, or medical device indications, all conditions must meet the following regulations:

1. At the time the patient is prescribed or directed, the medical examination and treatment facility does not have available medications or medical devices as prescribed in point b, clause 2, Article 43 of this Decree and falls under the following cases:

a) For medications: there is no commercial drug containing the active ingredient prescribed to the patient, or containing the same active ingredient but with different concentration or dosage or formulation or route of administration, and it cannot be substituted for prescribing to the patient;

b) For medical devices: there is no medical device that the patient is indicated to use and no medical device available for substitution.

2. It is not possible to transfer the patient to another medical examination and treatment facility in one of the following cases:

a) The health condition or disease of the patient is determined to be not sufficient to allow transfer;

b) Medical examination and treatment facilities where the patient is being examined and treated are under medical quarantine according to the law on prevention and control of infectious diseases;

c) Medical examination and treatment facilities where the patient is being examined and treated are facilities of specialized or highest-level technical expertise in the province or centrally-run city.

3. It is not possible to transfer medicine or medical equipment between medical examination and treatment facilities.

4. Medicines and medical equipment prescribed or indicated for use must be appropriate to the professional scope of the medical examination and treatment facility.

5. Medicines and medical equipment prescribed or indicated for use must fall within the benefits of the health insurance participant and have been reimbursed for medical examination and treatment costs under health insurance at one of the medical examination and treatment facilities nationwide.

6. Medical examination and treatment facilities are responsible for providing a certificate of drug and medical equipment shortage according to Form No. 11 in the Appendix issued together with this Decree to the patient as a basis for payment.

Article 60. Direct payment rates for patients in cases where patients purchase medicines and medical equipment themselves

1. The social insurance agency directly reimburses the patient according to the following regulations:

a) For drugs: the basis for calculating the reimbursement amount is the quantity and unit price recorded on the invoice purchased by the patient at the pharmaceutical business facility. In the case of drugs with prescribed payment rates or conditions, the payment is carried out according to the prescribed rates and conditions;

b) For medical equipment: the basis for calculating the reimbursement amount is the quantity and unit price recorded on the invoice purchased by the patient at the medical equipment sales facility. In the case of medical equipment with prescribed reimbursement rates, the reimbursement does not exceed the prescribed amount for that medical equipment.

2. The unit price of drugs and medical equipment used as a basis to determine the payment level must not exceed the payment unit price at the most recent time when payment is made for drugs and medical equipment that have been successfully bid at the medical examination and treatment facility where the patient has received medical services.

In cases where drugs and medical equipment have not been successfully bid at the medical examination and treatment facility where the patient has received medical services, the unit price used as a basis to determine the health insurance payment level is the valid contractor selection result at the time of payment in the following priority order:

a) Results of centralized national procurement or price negotiation results;

b) Results of centralized local procurement in the area;

c) The lowest contractor selection results of state medical examination and treatment facilities with the same level of technical expertise in the area. In case there are no contractor selection results from state medical examination and treatment facilities with the same level of technical expertise in the area, it shall be based on the lowest contractor selection results of other state medical examination and treatment facilities in the area;

d) The lowest contractor selection results at the time of payment of state medical examination and treatment facilities with the same level of technical expertise nationwide. In case there are no contractor selection results from state medical examination and treatment facilities with the same level of technical expertise nationwide, it shall be based on the lowest contractor selection results of other state medical examination and treatment facilities nationwide.

3. The social insurance agency shall deduct the medical insurance costs payable from the medical examination and treatment facility where the patient is treated as follows:

a) In cases where the cost of drugs and medical equipment is included in the price of medical examination and treatment services: it is deducted from the health insurance medical examination and treatment service costs of the medical facility at the payment rate prescribed in Clauses 1 and 2 of this Article;

b) In cases where the cost of drugs and medical equipment is not included in the price structure of medical examination and treatment services: no deduction is made from the health insurance medical examination and treatment service costs of the medical facility;

c) The cost of drugs and medical equipment paid directly by the social insurance agency to the patient is included in the projected expenses of the medical facility.

Article 61. Allocation and use of health insurance contributions

1. Allocation of 92% of the health insurance contributions for medical examination and treatment (hereinafter referred to as the medical treatment fund) is used for the following contents:

a) Pay expenses within the scope entitled to by participants of health insurance according to the provisions of the law on health insurance;

b) Set aside for educational institutions or vocational education institutions, agencies, organizations, enterprises that meet the conditions prescribed in Article 63 of this Decree.

2. Allocation of 8% of health insurance contributions to the reserve fund and for the organization and operation of health insurance is regulated as follows:

a) The level of reserve fund contribution is the remaining amount after deducting the costs for the organization and operation of health insurance as stipulated in point b of this clause, at least 4% of the health insurance contributions;

b) Expenditure for organization and operation of health insurance is a maximum of 4% of the health insurance contribution amount. After the Social Insurance Management Board approves the annual settlement of expenditures for the organization and operation of social insurance, unemployment insurance, and health insurance, Vietnam Social Insurance is responsible for supplementing any unused funds into the reserve fund for general adjustment. The Prime Minister decides the specific expenditure level for the organization and operation of health insurance for each year.

Article 62. Expenditure levels for medical examination and treatment in primary health care

1. The amount set aside for educational institutions or vocational education institutions includes:

a) Deducting 5% of health insurance revenue calculated on the total number of children under 6 years old or students currently attending the educational institution, calculated as follows:

Amount deducted = 5% x (Number of people x Health insurance amount x Institution factor x Time factor)

Where:

- Number of people: Total number of children under 6 years old; students currently attending the educational institution or vocational education institution who are participating in health insurance.

- Health insurance: The health insurance contribution rate applies to children under 6 years old or students, according to the provisions in Clause 3 and Clause 4, Article 6 of this Decree.

- Base: The base salary at the time of paying health insurance.

- Period: The number of months paying health insurance.

On a 3-month, 6-month, or 12-month basis, the social insurance agency is responsible for transferring the amount specified in this point to the educational institution or vocational education institution and consolidating it in the settlement of the health insurance medical examination and treatment fund;

b) Deduct 1% calculated on the monthly health insurance contribution for employees at the educational institution or vocational education institution, and the social insurance agency is responsible for paying this expense immediately after receiving the health insurance payment from the educational institution or vocational education institution.

2. The amount retained for agencies, organizations, or enterprises that meet the conditions specified in Clause 1, Article 63 of this Decree is 1% calculated on the monthly health insurance contributions for employees at the agency, organization, or enterprise. The social insurance agency is responsible for paying this expense immediately after receiving the health insurance contributions from the agency, organization, or enterprise.

3. The amount retained for workers on offshore fishing vessels:

a) The expenditure rate is 10% of the health insurance revenue calculated based on the number of workers on the vessel participating in health insurance to purchase medicine cabinets, medicines, medical equipment, and tools for first aid and initial treatment. The formula is as follows:

Retained amount = 10% x (Number of people x Health insurance amount x Facility coefficient x Time)

Where:

- Number of people: The number of people participating in health insurance working on offshore fishing vessels.

- Health insurance: The health insurance contribution for the first person in the household according to the provisions of Article 6 of this Decree.

- Basis: The base salary at the time of contribution.

- Period: Number of months of health insurance contributions;

b) The Chairman of the provincial People's Committee organizes the purchase and distribution of medicine cabinets, medicines, medical equipment, and tools to offshore fishing boat owners. The social insurance agency transfers the amount stipulated in point a of this clause to the agency or organization assigned by the Chairman of the provincial People's Committee to purchase medicine cabinets, medicines, medical equipment, and tools; and compiles the transferred amount into the medical examination and treatment fund's final accounts.

4. Based on actual needs and the ability to balance the health insurance fund, the Minister of Health submits to the Government to adjust the amount allocated for medical examination and treatment expenses in the initial healthcare activities.

Article 63. Conditions, content of expenditure, and settlement of costs for medical examination and treatment in primary health care

1. Educational institutions or vocational education institutions, agencies, organizations, enterprises (except for educational institutions or vocational education institutions, agencies, organizations, enterprises that have signed a contract for examination and treatment under health insurance as prescribed in Article 30 of this Decree) are allocated funds from the health insurance fund to carry out medical examination and treatment in primary healthcare when the following conditions are met:

a) There is at least one person qualified to work full-time or concurrently in primary health care according to the provisions of Article 19 of the Law on Medical Examination and Treatment; 68

b) There is a medical room or a private office to carry out first aid and initial treatment for individuals under the management of an educational institution or vocational education institution, agency, organization, or enterprise in case of accidents, injuries, or common illnesses during the time of studying or working at the educational institution or vocational education institution, agency, organization, or enterprise.

2. Specific content:

a) Expenses for purchasing medicine, medical equipment, materials, tools, instruments, and chemicals used for first aid and initial treatment for children, students, and individuals under the management of agencies, organizations, or enterprises in case of accidents, injuries, or common illnesses during the time of studying or working at the educational institution or vocational education institution, agency, organization, or enterprise;

b) Expenses for purchasing and repairing common medical equipment serving primary healthcare, document cabinets for managing health records at educational institutions or vocational education institutions, agencies, organizations, and enterprises;

c) Expenses for purchasing materials serving epidemic prevention activities, disease prevention hygiene, and medical examination and treatment activities in primary healthcare work.

3. Payment and finalization of funds:

a) For public educational institutions or public vocational education institutions, account for expenses for medical examination and treatment in primary health care into the costs of carrying out medical work at the institution and settle accounts with the higher-level management unit according to current regulations;

b) For non-public educational institutions or non-public vocational education institutions, account for expenses for medical examination and treatment in primary health care into the costs of the institution and settle accounts with the higher-level unit (if any);

c) For enterprises and economic organizations, open a separate accounting book to reflect the receipt and use of funds, without including them in the settlement of the enterprise's or economic organization's costs.

d) For other agencies and units, carry out the accounting of expenses for medical examination and treatment in primary healthcare into the costs of performing medical work of the agency or unit and settle accounts with the higher-level managing agency or unit (if any) or the financial authority at the same level according to current regulations.

4. Educational institutions or vocational education institutions, agencies, organizations, and enterprises that are allocated funding for medical examination and treatment in primary healthcare according to the provisions of this Decree are responsible for using it for primary healthcare activities, ensuring medicines and medical equipment for primary healthcare, and must not use it for other purposes. Any allocated funds not used by the end of the year can be carried over to the following year for continued use, summarized, and reported on the management and utilization of the funds in the annual activity report, and do not need to be settled with the social insurance agency.

5. The Minister of Health shall regulate the list of medical examination and treatment services covered by health insurance and the list of basic medicines and medical equipment in primary healthcare within the scope of payment by the Health Insurance Fund.

Article 64. Management and use of the reserve fund

1. Sources forming the reserve fund

a) The amount allocated annually according to the provisions in point a, Clause 2, Article 61 of this Decree;

b) Amounts of late payment or evasion of health insurance contributions;

c) Interest on late payment or evasion of health insurance contributions;

d) Earnings from investment activities from health insurance;

đ) Expenses not in accordance with regulations that must be recovered.

2. The reserve fund is used as follows:

a) To supplement funding for health insurance medical examination and treatment in cases where health insurance revenue for medical examination and treatment according to Clause 1, Article 61 of this Decree is less than medical examination and treatment expenditure in the year. After finalizing the settlement appraisal, Vietnam Social Security is responsible for providing the entire difference in funding from the reserve fund;

b) To advance or additionally pay for health insurance medical examination and treatment costs incurred in the previous year as stipulated in point b, Clause 4, Article 65 of this Decree;

c) Reimburse the state budget for the funds spent on duplicate health insurance cards.

3. In case the reserve fund is insufficient to supplement the medical examination and treatment funds as prescribed in Clause 2 of this Article, Vietnam Social Security shall report to the Social Security Management Board the resolution plan before reporting to the Ministry of Health and the Ministry of Finance.

The Ministry of Health shall take the lead, in coordination with the Ministry of Finance, to submit to the Government measures to ensure sufficient and timely funding for health insurance medical examination and treatment as prescribed.

Article 65. Preparation of budget estimates of revenue and expenditure, notification of expected expenditure and settlement of revenue and expenditure of the health insurance fund

1. Every year, Vietnam Social Security coordinates with Military Social Security and Public Security Social Security to prepare the estimated revenue and expenditure of the health insurance fund, including: expenditures for medical examination and treatment under health insurance, expenses for organizing and operating health insurance, allocations to the reserve fund from the year's revenue, and allocations to the reserve fund to pay for medical examination and treatment expenses of the previous year at medical facilities that were incurred for patients but have not yet been agreed upon for payment due to difficulties (if any), and investments from temporarily idle funds of the health insurance fund. These estimates are submitted to the Social Insurance Management Board for approval and sent to the Ministry of Finance before July 20 every year. The Ministry of Finance, in coordination with the Ministry of Health, compiles and submits the estimates to the Prime Minister before November 30 each year to allocate the revenue and expenditure estimates of the health insurance fund to Vietnam Social Security, Military Social Security, and Public Security Social Security.

2. Assign the budget estimate for medical examination and treatment under health insurance and notify the estimated amount for medical examination and treatment under health insurance:

a) Within 15 days from the date of receiving the decision on the allocation of the health insurance fund revenue and expenditure estimates from the Prime Minister, Vietnam Social Security shall allocate the health insurance medical examination and treatment expenditure estimates to the Social Insurance of provinces and centrally-run cities at a maximum of 92% of the nationwide health insurance contribution revenue estimate, after deducting the estimates that the Prime Minister has allocated to the Social Insurance of the Military and the Social Insurance of the Public Security.

b) Based on the provisions at point c of this clause, medical examination and treatment facilities shall prepare an estimated expenditure and send it to the Social Insurance agency where the medical examination and treatment contract for health insurance is signed. Based on the proposal of the medical examination and treatment facility and the allocated budget estimate, the provincial or centrally-run municipal Social Insurance shall notify the estimated health insurance medical examination and treatment expenditure to the medical examination and treatment facility. In case the medical examination and treatment facility has an estimated expenditure for the year that increases or decreases compared to the announced amount, the facility shall submit a written notice to the provincial or centrally-run municipal Social Insurance before October 15 each year to be compiled and adjusted within the allocated budget of the provincial or centrally-run municipal Social Insurance;

c) The projected expenditure is determined based on the health insurance medical examination and treatment expenditure estimates assigned by the Prime Minister and the actual health insurance medical examination and treatment expenditures of the previous year, projected increases or decreases in the number of medical examinations and treatments, average health insurance medical examination and treatment costs at medical examination and treatment facilities, medical service prices, the scope of health insurance benefits, and changes in policies and laws related to health insurance;

d) In the case where the total projected health insurance medical examination and treatment expenses of medical examination and treatment facilities during the year increase or decrease compared to the estimate assigned by Vietnam Social Security, the provincial or centrally-run city Social Security shall aggregate and submit to Vietnam Social Security before October 30 each year for consideration of adjustments among provinces and centrally-run cities. Vietnam Social Security shall aggregate and consider adjusting the health insurance medical examination and treatment expense estimates among provincial or centrally-run city Social Security within the scope of the assigned medical examination and treatment expense estimates and the assigned reserve fund estimates before November 15 each year as a basis for adjusting the projected health insurance medical examination and treatment expenses of the medical examination and treatment facilities.

3. In cases where the actual number of medical examination and treatment expenses of a medical examination and treatment facility in the year, as verified by the social insurance agency, exceeds the planned expenditure (including the amount announced at the beginning of the year and the adjusted amount during the year), the medical examination and treatment facility shall review and provide a written explanation of the causes affecting the excess of medical examination and treatment expenses compared to the planned expenditure, and submit it to the Social Insurance and the Department of Health of the centrally-affiliated province or city. The Social Insurance of the centrally-affiliated province or city shall take the lead, in coordination with the Department of Health, and be responsible for:

a) Coordinate with medical examination and treatment facilities to review the causes affecting the exceeding of the estimated health insurance medical examination and treatment expenses according to the explanation of the medical examination and treatment facility; review costs that have increased higher than the average increase of medical examination and treatment facilities of the same technical specialization level, the same type of general or specialized medical examination and treatment facilities in the province, centrally-run city, or nationwide;

b) Review and agree on determining the health insurance medical examination and treatment costs exceeding the estimated amount to be implemented in accordance with the provisions of the law on medical examination, treatment, and health insurance for reimbursement and supplement funding for the medical examination and treatment facility; refuse payment for medical examination and treatment costs that, upon review, are determined not to comply with the provisions of the law on medical examination, treatment, and health insurance. 72

In cases of disagreement with the refusal to pay medical examination and treatment costs, medical examination and treatment facilities have the right to petition the provincial or centrally-run city Social Insurance, or the Department of Health for consideration, or compile and send it to the Ministry of Health for resolution in accordance with the provisions of the law;

c) In cases where the estimate assigned by Vietnam Social Insurance is insufficient to supplement the funding for medical examination and treatment facilities, the provincial or centrally-run city Social Insurance shall send a request to Vietnam Social Insurance to supplement the funding for medical examination and treatment under health insurance within the scope of the medical examination and treatment estimate assigned by the Prime Minister.

4. In cases where the total actual health insurance medical examination and treatment costs in a year exceed the medical examination and treatment estimate assigned by the Prime Minister, Vietnam Social Insurance shall proceed as follows:

a) In cases where the amount allocated to the reserve fund from annual revenue according to the estimate assigned by the Prime Minister is sufficient to pay for additional expenses of health insurance medical examination and treatment exceeding the estimate, Vietnam Social Security shall supplement the funds for health insurance medical examination and treatment from the reserve fund to make the payment and report to the Board of Directors of Social Insurance, the Ministry of Health, and the Ministry of Finance on the results of implementation;

b) In cases where the amount allocated to the reserve fund from annual revenue according to the estimate assigned by the Prime Minister is insufficient to pay for additional expenses of health insurance medical examination and treatment exceeding the estimate, Vietnam Social Security shall report to the Board of Directors of Social Insurance, through the Ministry of Finance as the primary agency in coordination with the Ministry of Health, to submit to the Prime Minister for consideration the supplementation of funds for health insurance medical examination and treatment exceeding the estimate from the reserve fund (if any) and to be settled in the financial year in which the payment is made.

While waiting for the Prime Minister's approval, the social insurance agency shall advance the costs of medical examination and treatment covered by health insurance as approved by the Social Insurance Management Board.

After being approved by the Prime Minister, the social insurance agency supplements the remaining funds for the medical examination and treatment facility;

c) In the case that the reserve fund is insufficient to supplement the expenses for medical examination and treatment under health insurance, Vietnam Social Security shall consolidate and report to the Management Board for approval of a financial source assurance plan for medical examination and treatment under health insurance before submitting it to the Ministry of Health to take the lead in coordinating with the Ministry of Finance to report to the competent authority for a decision in accordance with the provisions of Clause 3, Article 64 of this Decree.

5. Advance payments, disbursements, and settlement of medical examination and treatment costs under health insurance for medical examination and treatment facilities are carried out quarterly in accordance with the provisions of Clauses 1 and 2, Article 32 of the Health Insurance Law.

In cases where the requested payments for medical examination and treatment costs under the provisions encounter difficulties, the time for resolving such difficulties and making payments shall not exceed 12 months from the date the medical examination and treatment facility submits a payment request.

6. Every year, before October 1, Vietnam Social Insurance is responsible for aggregating and preparing the financial settlement report of the previous year's health insurance fund in accordance with the provisions of Article 32 of the Health Insurance Law.

7. Matters regarding the financial mechanism of the health insurance fund not stipulated in this Decree shall be implemented in accordance with the Government's regulations on the financial mechanism of social insurance, health insurance, and unemployment insurance.

APPLICATION OF INFORMATION TECHNOLOGY, DIGITAL TRANSFORMATION

IN THE IMPLEMENTATION OF HEALTH INSURANCE

Article 66. Principles of applying information technology and digital transformation in the implementation of health insurance

1. Comply with the provisions of the law on the application of information technology; the provisions of the law on medical examination and treatment under health insurance; the law on protection of state secrets and related confidential information; the provisions of the law on electronic transactions, storage, and information security.

2. Comply with standards and technical regulations, ensuring compatibility, smoothness, and safety, facilitating electronic transactions between medical examination and treatment facilities and social insurance agencies.

3. Ensure the confidentiality and privacy of medical examination and treatment data and information of health insurance participants.

4. Ensure technical infrastructure, transmission lines, software, and human resources meet the requirements for applying information technology and digital transformation in implementing health insurance.

5. Ensure the ability to connect, interoperate, and share health insurance data with other information technology systems.

Article 67. Content of applying information technology and digital transformation in the implementation of health insurance

1. Apply information technology to serve state management work on health insurance at the central and local levels.

2. Apply information technology to digitize information of health insurance participants.

3. Apply information technology to develop and establish methods for paying medical examination and treatment costs covered by health insurance.

4. Apply information technology to serve the work of medical examination and treatment under health insurance at medical examination and treatment facilities.

5. Apply information technology to serve the work of advance payments, assessment, payment, and settlement of medical examination and treatment costs covered by health insurance between social insurance agencies and medical examination and treatment facilities.

6. Apply information technology to serve the management, allocation of health insurance funds, and collection and expenditure of health insurance.

7. Apply information technology in implementing health insurance to serve other tasks directed by the Government.

Article 68. Responsibilities of agencies and units regarding the application of information technology and digital transformation in the implementation of health insurance

1. Responsibilities of the Ministry of Health:

Develop, regulate, and promulgate common code catalogs applied in medical examination and treatment under health insurance; standards, data formats, connection, interoperability, and electronic data transfer in medical examination and treatment under health insurance, appraisal, and payment of health insurance medical examination and treatment costs.

2. Responsibilities of the Ministry of Finance:

Direct, organize the implementation of information technology applications and digital transformation in the management and implementation of regimes, policies, and legal regulations on health insurance, as well as in the management and use of the Health Insurance Fund.

3. The Ministry of Public Security is responsible for ensuring the connection and interconnection of the National Insurance Database with the National Population Database, and for developing utilities on the National Electronic Identification Application (VNeID) to serve citizens, relevant agencies, and units in resolving regimes, policies, and legal regulations on health insurance.

4. Responsibilities of Vietnam Social Security under the Ministry of Finance:

a) Apply information technology and digital transformation to facilitate and serve citizens, agencies, and organizations in implementing regimes, policies, and legal regulations on health insurance;

b) Develop and deploy a monitoring and warning system in the implementation of regimes, policies, and legal regulations on health insurance;

c) Organize the collection and online payment of health insurance, integrating automatic notifications to health insurance participants about the payment deadline and the amount due for the next payment at least 10 days before the health insurance card expires, automatically extend the participation period in health insurance when the participant has paid the health insurance fee, and notify the result of the payment;

d) Implement appraisal and contract signing for health insurance medical examination and treatment with medical facilities in an electronic environment;

d) Ensure the Data Reception Portal operates effectively;

e) Share complete, accurate, and timely data from the national insurance database with the Ministry of Health to perform state management functions on health insurance.

5. Responsibilities of medical examination and treatment facilities:

a) Apply information technology and digital transformation in health insurance medical examination and treatment in accordance with legal regulations;

b) Ensure the maintenance of connectivity standards and the interoperability of medical examination and treatment data for health insurance that has been verified with the information and health insurance assessment system of the social insurance agency as prescribed during the implementation of the health insurance medical examination and treatment contract;

c) Be legally responsible for the accuracy and legality of the data; ensure information security and confidentiality in accordance with legal regulations.

Article 69. Transitional provisions

1. In the case where a patient enters a medical examination and treatment facility before the effective date of this Decree and completes their medical examination and treatment from the effective date of this Decree, the provisions of this Decree or the regulations prior to the effective date of this Decree shall be applied in a manner favorable to the patient regarding procedures and health insurance benefits. 76

2. In the case where a health insurance participant is determined by a competent authority to belong to the category of health insurance participants whose premiums are paid or supported by the state budget before the effective date of this Decree, but the category changes due to the merger of administrative units during the organization and apparatus arrangement of the political system, the health insurance participant will continue to have their premiums paid or supported by the state budget and enjoy benefits according to the category specified in the document of the competent authority until the expiration of the document's validity or until the participant's category is re-determined according to a new document.

3. In the case where a health insurance medical examination and treatment contract is signed before July 1, 2025, and remains effective after July 1, 2025, it shall be carried out for the full term of the signed contract, except as provided in Clause 8 of this Article.

4. In the case of private medical examination and treatment facilities that have signed contracts for the supply of medicines, chemicals, testing supplies, and medical equipment before July 1, 2025, in accordance with the provisions of the law on bidding, they are allowed to use and pay for the full quantity of medicines, chemicals, testing supplies, and medical equipment as stipulated in the signed contracts.

5. Subjects participating in health insurance as regulated in points e, h, i, k, o, r, s, and t of Clause 3, and points a, b, d, and g of Clause 4, Article 12 of the Health Insurance Law, and the related dossiers for compiling the list of subjects participating in health insurance that are currently being processed by district-level agencies shall be transferred to the commune-level People’s Committee to continue implementation according to the legal documents issued before the effective date of this Decree until new documents are issued.

6. District, county, town, provincial city, centrally-controlled city medical centers, when reorganized under a new name, shall continue to apply the provisions at point c, Clause 1, Article 22 of the Law on Health Insurance in health examination and treatment covered by health insurance.

7. Replace the phrase “island district” at point b, Clause 4, Article 22 of the Law on Health Insurance with the phrase “special zone.”

8. In cases where medical examination and treatment facilities carry out reorganization, restructuring, merger, or change of name when implementing the reorganization of the local government apparatus at two levels:

a) Medical examination and treatment facilities continue to use the prices for medical examination and treatment services under health insurance that have been stipulated and approved by the competent authorities, and settle the costs of medical examination and treatment under health insurance before the facilities are arranged, reorganized, merged, or renamed, in order to settle the costs of medical examination and treatment under health insurance until the competent authorities stipulate and approve the prices for the new facilities;

b) In cases where a medical examination and treatment facility has to obtain a new, renewed, or adjusted operation license, during the process of obtaining the new, renewed, or adjusted operation license as prescribed, the operation licenses that have been issued to medical examination and treatment facilities before the date of arrangement, reorganization, merger, or name change shall continue to be used by both the old and new facilities for conducting medical examinations and treatments and maintaining the validity of the signed health insurance medical examination and treatment contracts until a health insurance medical examination and treatment contract is signed for the new facility under the new operation license. Medical examination and treatment facilities are responsible for ensuring the quality of medical examination and treatment services;

c) Registration for initial medical examination and treatment under health insurance for health insurance participants and the number of health insurance cards allocated to facilities for initial medical examination and treatment under health insurance before the date of being arranged, reorganized, merged, or renamed shall continue to be used for the new facility until guidance from the Department of Health is issued;

d) Medical examination and treatment facility code, the seal of the medical examination and treatment facility, the seal of the facility that holds the contract for medical examination and treatment under health insurance before the date of being arranged, reorganized, merged, or renamed shall continue to be used until the new facility is issued a new code and a new seal; in cases where the medical examination and treatment facility has its old seal revoked but has not yet been issued a new seal, procedures may be completed after the new seal is obtained;

d) Health insurance cards and health insurance card information with content changes due to reorganization, restructuring, merger, or name change shall continue to be used until adjusted by the competent authority;

e) Based on practical requirements in the locality, the People's Committee of the province or centrally-run city shall decide on solutions to handle arising situations to ensure the stable operation of medical examination and treatment facilities during the transitional period when arranging, reorganizing, merging, or changing the name of medical examination and treatment facilities; assign a focal unit responsible for representing and handling arising issues related to contract implementation, payment, settlement of health insurance medical examination and treatment costs, transferring patients between health insurance medical examination and treatment facilities, procurement, ensuring the supply of medicines and medical equipment, and resolving related difficulties that arise during the transfer process until the medical examination and treatment facilities are issued new operating licenses and sign new health insurance medical examination and treatment contracts.

9. The implementation of electronic verification of health insurance medical examination and treatment costs will be carried out no later than January 1, 2026.

Article 70. Effective date

1. This decree takes effect from August 15, 2025, except for the provisions in clauses 2 and 3 of this Article.

2. Articles from Article 1 to Article 11, Articles 14, 15, 17, 18, 19, from Article 22 to Article 36, from Article 39 to Article 44, Articles 49 and 50, from Article 54 to Article 61, Articles 69, 70, 71, and 72 of this Decree take effect from July 1, 2025.

3. Clause 8 of Article 69 of this Decree takes effect from July 1, 2025 to the end of December 31, 2025.

4. Abolish the articles and clauses of the following documents from July 1, 2025:

a) The provisions from Article 1 to Article 12, Clauses 1, 2, 3, 4, 5, and 6 of Article 14, from Article 16 to Article 26, Clauses 1, 2, 3, 4, 5, 6, 8, 9, and 11 of Article 27, from Article 28 to Article 36, and all templates in the Appendix issued together with Decree No. 146/2018/NĐ-CP dated October 17, 2018, of the Government detailing and guiding the implementation of certain articles of the Law on Health Insurance, as amended and supplemented by Decree No. 75/2023/NĐ-CP dated October 19, 2023, of the Government and Decree No. 02/2025/NĐ-CP dated January 1, 2025, of the Government;

b) Clauses 3 and 4 of Article 95 of Decree No. 24/2024/NĐ-CP dated February 27, 2024, of the Government detailing certain articles and measures for the implementation of the Law on Bidding regarding contractor selection;

c) Clause 5, Article 4 of Decree No. 74/2025/NĐ-CP dated March 31, 2025, of the Government, amending and supplementing certain articles of Decree No. 70/2015/NĐ-CP dated September 1, 2015, of the Government, detailing and guiding the implementation of certain articles of the Health Insurance Law for the people’s army, people’s police, and those working in cryptographic work.

5. Abolish the following documents from August 15, 2025:

a) Decree No. 146/2018/NĐ-CP dated October 17, 2018, of the Government detailing and guiding measures to implement certain articles of the Health Insurance Law;

b) Decree No. 75/2023/NĐ-CP dated October 19, 2023, of the Government amending and supplementing certain articles of Decree No. 146/2018/NĐ-CP dated October 17, 2018, of the Government detailing and guiding measures to implement certain articles of the Health Insurance Law;

c) Decree No. 02/2025/NĐ-CP dated January 1, 2025, of the Government amending and supplementing a number of articles of Decree No. 146/2018/NĐ-CP dated October 17, 2018, of the Government detailing and guiding the implementation of certain provisions of the Health Insurance Law, which has been amended and supplemented by a number of articles in Decree No. 75/2023/NĐ-CP dated October 19, 2023, of the Government.

6. In cases where the documents referenced in this Decree are replaced or amended, they shall be implemented according to the replacing document or the amended document.

Article 71. Responsibility for organization of implementation

1. The Ministry of Health is responsible for:

a) Guiding the organization of the implementation of policies and laws on health insurance;

b) Guiding the establishment of lists of subjects under management authority; determining and establishing lists of subjects stipulated in points h, r, s, and t of Clause 3, Article 12 of the Health Insurance Law;

c) Guide medical examination and treatment facilities to enhance the application of information technology in medical examination and treatment covered by health insurance; digitally sign, authenticate, and transfer data on requests for payment of medical examination and treatment costs covered by health insurance to the health insurance medical examination and treatment data reception system of the Ministry of Health and the appraisal information system of the Vietnam Social Security to serve health insurance management and the appraisal and payment of medical examination and treatment costs covered by health insurance;

d) Direct medical examination and treatment facilities and centralized procurement units to strictly comply with regulations related to procurement and bidding to ensure timely supply of medicines, chemicals, and medical equipment within the scope entitled to health insurance participants, practice thrift, and prevent waste;

d) Direct medical examination and treatment facilities to comply with the legal regulations on medical examination and treatment, the professional guidelines of the Ministry of Health; legal regulations related to the provision of medical technical services ensuring quality, efficiency, and cost-effectiveness;

e) Take the lead, in coordination with the Ministry of Finance, in preparing a report for the Government to submit to the National Assembly on the implementation of health insurance regimes and policies, including the management and use of the health insurance fund, either unexpectedly, periodically, or annually;

g) Take the lead, in coordination with relevant agencies, to inspect the implementation of health insurance policies and laws;

h) Issue guidelines for preparing estimated medical examination and treatment expenditures under health insurance, adjusting estimated expenditures, and determining the amount of health insurance expenditures exceeding the estimated expenditure that the health insurance fund will cover.

2. The Ministry of Finance is responsible for:

a) Balance and allocate the central budget to support localities that are not yet able to balance their own budgets to ensure the funding for implementing health insurance policies in accordance with the law on the state budget;

b) Direct and guide the organization of implementing health insurance policies and laws, managing and using the Health Insurance Fund under its authority;

c) Regulate the authority to sign health insurance medical examination and treatment contracts of the social insurance agency in accordance with the functions, tasks, powers, and organizational structure of Vietnam Social Security;

d) Issue forms for compiling payments and finalizing medical examination and treatment costs under health insurance, specifically regulating the procedures and processes for appraising medical examination and treatment costs under health insurance;

đ) Report annually on the management and use of the health insurance fund and submit it to the Ministry of Health for compilation in accordance with regulations.

3. The Ministry of National Defense, the Ministry of Public Security, and the Government Cipher Committee are responsible for guiding the implementation of health insurance for subjects under the management scope of the Ministry of National Defense and the Ministry of Public Security in examination and treatment as prescribed in this Decree; guiding the identification of relatives of personnel engaged in other work within the cipher organization as specified in Clause 5, Article 5 of this Decree.

4. The Ministry of Home Affairs is responsible for:

a) Guiding the identification and compilation of the list of subjects managed by the Ministry of Home Affairs as prescribed in points e, i, k, and persons living in island communes and special zones as stated in point o, Clause 3, Article 12 of the Law on Health Insurance;

b) Inspect the implementation of the legal provisions on the responsibility to participate in health insurance of employers and employees as stipulated in Clause 1, Article 12 of the Health Insurance Law and the subjects specified in point a of this Clause, except for subjects managed by the Ministry of National Defense and the Ministry of Public Security.

5. The Ministry of Education and Training is responsible for guiding the identification and listing of subjects specified in point b, Clause 4, Article 12 of the Health Insurance Law.

6. The Ministry of Culture, Sports and Tourism is responsible for identifying and guiding the preparation of the list of subjects specified in point h, Clause 4, Article 12 of the Health Insurance Law and Clause 3, Article 5 of this Decree.

7. The Ministry of Agriculture and Environment is responsible for:

a) Research and develop criteria for identifying poor households; near-poor households; households engaged in agriculture, forestry, fisheries, and salt production with average living standards suitable for the socio-economic conditions of each period, and submit to the Prime Minister for issuance;

b) Guide the identification and compilation of the list of subjects managed by the Ministry of Agriculture and Environment for people belonging to poor households; ethnic minorities belonging to near-poor households residing in communes and villages in ethnic minority and mountainous areas; people residing in areas with particularly difficult socio-economic conditions as specified in point o, clause 3, and points a and d, clause 4, Article 12 of the Health Insurance Law.

8. The Ministry of Ethnic Affairs and Religion is responsible for guiding the identification and listing of ethnic minority individuals residing in areas with difficult socio-economic conditions as stipulated in point o, clause 3 and point g, clause 4, Article 12 of the Law on Health Insurance.

9. Vietnam Social Security under the Ministry of Finance is responsible for:

a) Directing social security agencies at all levels to sign contracts with medical examination and treatment facilities that meet the conditions prescribed in this Decree; providing forms and guidance to the commune-level People's Committees in listing and managing the list of health insurance participants for subjects under their management in the locality;

b) Direct provincial and centrally-run city social insurance agencies to proactively coordinate with the Department of Health, the Department of Finance, and health insurance medical examination and treatment establishments in their area, neighboring areas, and relevant agencies to resolve issues within their authority or to propose to competent authorities for consideration and timely handling of problems arising in the implementation of health insurance policies and laws;

c) Improve the information technology system to ensure timely, smooth, and complete reception, assessment, and feedback to medical examination and treatment establishments on data regarding requests for payment of health insurance medical examination and treatment costs; ensuring accuracy, safety, information confidentiality, and the rights and benefits of the involved parties; 82

d) Ensure the effectiveness of inspection activities and the capacity of the team performing health insurance inspections; proactively review, detect, and send timely warning information to health insurance medical facilities about medical expenses that are higher than the average costs of medical facilities of the same technical level and type of general or specialized medical facilities, so that medical facilities can check and review them according to legal regulations in order to use the health insurance fund reasonably and effectively;

d) Timely aggregate information on the cumulative co-payment amount within the fiscal year of the patient, the time when the patient has participated in health insurance for at least 5 consecutive years, and notify on the Data Reception Portal for medical examination and treatment facilities to look up and determine the time when the patient is eligible to receive co-payment exemption during their medical examination and treatment; ensuring that it does not affect the patient's benefits;

e) Periodically report, annually or in sudden reports as requested by the state management agency on the implementation of health insurance policies and regimes; the situation of revenue, expenditure, management, and use of the health insurance fund, and send it to the Ministry of Health and Ministry of Finance for consolidation according to regulations;

g) Share and transfer data on health examination and treatment costs covered by health insurance to the Ministry of Health fully and promptly in order to develop and implement payment methods and establish policies in accordance with the law;

h) Provide the Department of Health of provinces and centrally-run cities with the number and structure of participants by group registered for primary health examination and treatment covered by health insurance, as well as updated information within the first 15 days of each quarter (if there are changes) according to Form No. 12 in the Appendix issued together with this Decree;

i) Publicly disclose and promptly update requirements and guidance on receiving, reporting incidents and issues related to the reception of data, refusal to receive health examination and treatment cost data on the Data Receiving Portal before applying it in health insurance appraisal.

10. The People's Committees of provinces and centrally-run cities are responsible for:

a) Direct and organize the implementation of policies and laws on health insurance at the local level;

b) Submit to the People's Council at the same level to ensure funding for paying health insurance for subjects whose premiums are covered or supported by the state budget according to current regulations;

c) Direct, urge, and ensure the conditions for implementing information technology applications, digital transformation, and data interconnection in medical examination and treatment for health insurance at medical facilities under management according to regulations;

d) Direct and preside over resolving any difficulties during the implementation of policies and laws on health insurance between medical facilities and social insurance agencies in the managed area;

d) Organize the implementation in accordance with the planning of the system of medical examination and treatment facilities; direct the inspection of compliance with the operational conditions of health insurance medical examination and treatment facilities; assess the demand for health insurance medical examination and treatment of the people and the capacity of the system of medical examination and treatment facilities in the area, and implement measures to ensure a balance and suitability between the number of health insurance medical examination and treatment facilities and the medical examination and treatment needs of the people in the area;

e) Based on the local budget capacity and other lawful sources of funding, submit to the People's Council of the province or centrally-run city to decide the level of health insurance support for subjects higher than the minimum support level stipulated in points b, c, d, đ, and e, clause 6, Article 6 of this Decree; the level of health insurance support for subjects who are not entitled to the support level prescribed in points b, c, d, đ, and e, clause 6, Article 6 of this Decree; the subjects to be supported and the level of support along with the co-payment of medical examination and treatment costs for health insurance participants when undergoing medical examination and treatment.

Article 72. Responsibility for enforcement

Ministers, heads of ministerial-level agencies, heads of government-affiliated agencies, chairpersons of the provincial and centrally-run city People's Committees, and relevant organizations and individuals are responsible for implementing this Decree./. ON BEHALF OF THE GOVERNMENT DEPUTY PRIME MINISTER Lê Thành Long 84

Appendix

(Attached to Decree No. 188/2025/NĐ-CP dated July 1, 2025 of the Government)

No. Serial number of form Form name

1 Form No. 1 Summary table of subjects and funding from the budget

The state pays, supports paying health insurance

2 Form No. 2 Declaration for participation and adjustment of health insurance information.

3 Form No. 3 List of subjects participating in health insurance

Form No. 4 List of household members participating in insurance

healthcare

Form No. 5 Contract for medical examination and treatment under health insurance

Form No. 6 Minutes of liquidation of medical examination and treatment contract

health insurance

Form No. 7 Document requesting contract signing, contract appendix

medical examination, medical treatment health insurance

List of hardware and software equipment

Form No. 8 ensures the connection for data transfer

Electronic transfer in health insurance payment

Form No. 9 Clinical service transfer slip

10 Form No. 10 Direct Payment Request Form

11 Form No. 11 Confirmation Slip of Drug and Medical Device Shortage

List of participants in health insurance registered for examination

12 Form No. 12 initial disease and treatment at the medical examination and treatment facility

disease

SOCIAL INSURANCE........ Form number 1

SOCIALIST REPUBLIC OF VIETNAM

Independence - Freedom - Happiness

SUMMARY TABLE OF SUBJECTS AND FUNDING FROM THE BUDGET

STATE CONTRIBUTION, SUPPORT FOR HEALTH INSURANCE PAYMENT LEVEL

Year… (Unit: Card; VND)

Amount, Amount Number of cards Amount of insurance contribution Amount Amount of bank Ministry of Finance, Ministry of Finance, Department

Number of participants in health insurance due to government regulations, Ministry of Health insurance premium according to family members, Ministry of Finance, self-paid insurance, state support, level of participation, Ministry of Home Affairs,

support contribution paid contribution household contribution, Interior, Health

administrative contribution support Health has not been transferred yet

A B 1 2 3 4=2-3 5 6=4-5

Total 1 Children under 6 years old 2 People belonging to the household

poor 3 People belonging to the household

near poor

- The subject eligible for the bank

state-supported books

100% contribution rate

- The subject eligible for the bank

state-supported books

...% contribution rate 4 Students, university students 5 People belonging to households

agriculture, forestry

industry, fisheries and

matches have a level

live on average 6 …….. PERSON IN CHARGE OF ACCOUNTING TABLE ... day.... month.... year ... (Sign, full name) (Sign, full name) DIRECTOR

(Sign, clearly write full name and stamp)

86

INSTRUCTIONS FOR PREPARING FORM NO. 1

Summary table of subjects and expenses paid by the state budget,

supporting the health insurance contribution rate

1. Purpose: to summarize the number of participating subjects and the amount of state budget contribution, support for health insurance payment.

2. Responsible for preparation: Social Insurance agency.

3. Time of preparation: quarterly.

4. Preparation method:

a) Indicators by column:

- Column A: record the serial numbers from smallest to largest for each group of health insurance participants whose premiums are paid or subsidized by the state budget.

- Column B: record the name of the group of health insurance participants whose premiums are paid or subsidized by the state budget.

- Column 1: record the number of health insurance cards issued.

- Column 2: record the amount of health insurance premiums calculated according to the prescribed rates.

- Column 3: record the amount paid by health insurance participants.

- Column 4: record the amount paid or subsidized by the state budget (= Column 2 - Column 3).

- Column 5: record the amount transferred by the Ministry of Finance, Department of Finance, Ministry of Home Affairs, and Ministry of Health.

- Column 6: record the amount that has not been transferred by the Ministry of Finance, Department of Finance, Ministry of Home Affairs, and Ministry of Health (= Column 4 - Column 5).

b) Indicators by row: record in order according to each group of health insurance participants whose premiums are paid or subsidized by the state budget.

Form No. 2

SOCIALIST REPUBLIC OF VIETNAM

Independence - Freedom - Happiness

DECLARATION

PARTICIPATION AND INFORMATION ADJUSTMENT FOR HEALTH INSURANCE

Health insurance code: ............................

I. Registering for health insurance for the first time [01]. Full name (in capital letters):............................... [02]. Gender:......................... [03]. Date of birth (day/month/year):............/.........../…….. [04]. Ethnicity:.............................. [05]. Nationality:..................... [06]. Citizen ID/Personal ID/Passport number:................................. [07]. Phone number:................................ [08]. Email (if any):......................................... [09]. Initial medical examination and treatment registration place:………………………………………... [10]. Register to receive administrative procedure results: [10.1]. Receive electronic health insurance card: - VssID - Email [10.2]. Receive paper health insurance card, address: [10.2a]. House number, street/village:……................................................................ [10.2b]. Commune, ward, special zone:…..……. [10.2c]. Province, city:.............................. II. Adjust the information recorded on the health insurance card [11]. Requested content for adjustment:……....................................................................... ………………………………………………………………………………………... [12]. Attached documents (if any)………………..……………………………………… ................................................................................................ ........................................ ………………………………………………………………………………………… CONFIRMATION OF THE UNIT ……, day…… month…… year……… ………………………………… DECLARANT .……………………………….. …………………………………………… .………………………………. …………………………………………… ………………………………… ……………………………………………

……………………………………………

88

Notes:

- Participants can look up their health insurance code at: https://baohiemxahoi.gov.vn

- In case of electronic declaration implementation:

+ Information fields that have been connected with the National Database on Population, National Residence Database, National Insurance Database, and other databases on the National Public Service Portal will be automatically filled in the electronic declaration. Individuals only need to fill in information that is not yet in the database.

+ In case the declarant uses a Level 2 electronic identification account (VneID) to log in to the National Public Service Portal to handle procedures electronically, signing the declaration is not required.

INSTRUCTIONS FOR COMPLETING FORM NO. 2: Declaration of Participation and Adjustment of Health Insurance Information

1. Purpose: For participants enrolling in health insurance for the first time to fully fill out information when they cannot find their health insurance number during a search, or for participants requesting adjustments to the information already recorded on their health insurance card (information about personal details, registered place for initial medical examination and treatment, etc.).

2. Responsible party: Participant.

3. Time of preparation: When the participant registers for health insurance for the first time or requests adjustments to the information already recorded on the health insurance card.

4. Preparation method:

Participants can look up their social insurance number at: https://baohiemxahoi.gov.vn

4.1. In the case of participants registering for health insurance for the first time: fill out Section I:

a) For participants filling out a paper form:

[01]. Full name: write the full surname, middle name, and given name in capital letters with the correct diacritical marks of the participant.

[02]. Gender: write the gender of the participant (if male, write “male”; if female, write “female”).

[03]. Date of birth: enter the full date, month, and year of birth as stated in the birth certificate or citizen identification/personal identification card or passport (for foreign nationals).

[04]. Ethnicity: enter the participant's ethnicity as stated in the birth certificate; leave blank for foreign nationals.

[05]. Nationality: indicate the nationality of the participant as stated in the birth certificate or citizen identification card/personal identification or passport (for foreign nationals).

[06]. Citizen identification/personal identification/Passport number: indicate the citizen identification/personal identification number or passport of the participant issued by the competent authority (including children under 6 years old who are issued a personal identification number).

[07]. Phone: indicate the participant's phone number or a contact number to reach the participant.

[08]. Email: indicate the participant's email address or a contact email address to reach the participant (if any).

[09]. Place of initial medical examination and treatment registration (applicable to first-time health insurance participants): indicate the place of initial medical examination and health insurance treatment registration chosen by the participant according to the guidance of the social insurance agency.

[10]. Register to receive the results of administrative procedure resolution.

In case of registering to receive administrative procedure results electronically: choose to receive the results via VssID or Email.

In case of registering to receive administrative procedure results in paper form: specify the full and detailed address where you currently live (house number, street/road, village; commune/ward/special district; province/centrally-governed city) so that the social insurance agency can deliver the health insurance card or other administrative procedure results.

b) For cases declared on the National Public Service Portal, the participant only fills in from item [06] to item [10]; for items [01] to [05], the system automatically fills in information that has been connected to the National Database on Population, the National Database on Residence, the National Database on Insurance, ...

4.2. In the case where the participant requests an adjustment of the information recorded on the health insurance card; fill out section II (Adjustment of information recorded on the health insurance card) as follows:

[11]. Content of the adjustment request: the participant clearly states the content of the requested adjustment of information recorded on the health insurance card, such as adjusting personal information (full name, date of birth, citizen identification number/personal identification/passport, ...), reissuing the health insurance card, phone number, email, ...

[12]. Accompanying documents (if any): list the names of the supporting documents.

91

Form No. 3

UNIT .............................. SOCIALIST REPUBLIC OF VIETNAM

Unit code: …………………. Independence - Freedom - Happiness

Tax code: …………………

Address: ……………………..

LIST OF INDIVIDUALS PARTICIPATING IN HEALTH INSURANCE

ID number Place Contribution amount Rate Type of health

insurance card

Registration code

Allowance Banks

public numbers

accounts Month book

civil insurance/ examination Deep Deep allowance

Salary and participation record

No. Full name, personal identification, position, allowance, seniority, family allowance, electricity, note

healthcare, individual, illness, salary, duty, professional scale, income, support, death, certificate, personnel, issued, (%) additional (%), initial (%)

Note: For those participating in health insurance for the first time: attach Form No. 2.

A B 1 2 3 4 5 6 7 8 9 10 11 12 13 (1) (2)

REPRESENTATIVE OF THE AGENCY OR UNIT CREATING THE LIST (Sign, clearly write full name, seal)

REPRESENTATIVE OF THE AGENCY, UNIT PREPARING THE LIST (Sign, clearly write full name, stamp)

91

92

INSTRUCTIONS FOR COMPLETING FORM NO. 3

List of subjects participating in health insurance

1. Purpose: to declare the information of people registering for health insurance participation, adjust health insurance contribution levels, and issue health insurance cards.

2. Responsibility for preparation: agencies, organizations, enterprises, commune-level People's Committees, or service organizations collecting/contributing educational institutions or social insurance agencies managing health insurance participants.

3. Time of preparation: prepare when the unit starts participating in health insurance contributions and when there are changes (increase, decrease) in the number of participants or the health insurance contribution amount.

4. Basis for preparation: Health insurance participation and information adjustment declaration form (Form No. 2), changes in contribution levels, and related dossiers and documents.

5. Preparation method:

a) General information section:

- Unit name: write the full name of the agency, organization, enterprise, commune-level People's Committee, or service/educational institution.

- Unit code: write the unit code issued by the social insurance agency.

- Tax code: write the tax code issued by the tax agency.

- Address: write the address of the head office.

b) Indicators by column:

- Column A: write the serial number from smallest to largest.

- Column B: clearly write the full name of each participant.

- Column 1: write the health insurance number of each participant.

- Column 2: write the citizen ID/personal identification number of each participant.

- Column 3: write the primary medical examination and treatment registration place according to the instructions of the social insurance agency.

- Column 4: write the salary received:

+ For employees:

* Employees who follow the salary regime prescribed by the State shall record it using a coefficient (including any retained difference coefficient, if any).

Example: If the salary stated in the recruitment decision or employment contract is 2.34, then record 2.34.

* Employees who follow the salary regime decided by the employer shall record the salary according to the job or position, in Vietnamese dong.

93

Example: If the employee's salary is 52,000,000 VND, then record 52,000,000 VND.

+ For those receiving monthly pensions, labor incapacity allowances, or unemployment benefits: record the pension, labor incapacity allowance, or unemployment benefit.

+ For those whose salary contributions are made by the state budget, supported by the state budget, or covered by social insurance contributions based on the basic salary: record according to the basic salary level.

+ For individuals in a household participating in health insurance under the household form: record the amount contributed by the participant in descending order of contribution.

Example: Mr. Nguyễn Văn B, Mrs. C (Mr. B's wife), and Mr. D (Mr. B's son) participate in health insurance from January 1, 2025, for 12 months, with a basic salary of 2,340,000 VND, the amount recorded in column 6 is as follows:

Mr. B: 2,340,000 VND; Mrs. C: 1,638,000 VND; Mr. D: 1,404,000 VND.

- Columns 5, 6, 7: Record position allowance; seniority beyond the frame, professional seniority as a percentage (%) in the corresponding column; if not receiving any allowance, leave it blank.

- Column 8: Record salary allowance and additional income according to labor law regulations (if any).

- Column 9: record the month and year of starting participation.

- Column 10: for subjects supported by the state budget, participating in group health insurance where they pay themselves (if any), indicate the % of state budget support (including additional support from local state budgets); leave blank for other subjects.

- Columns 11, 12: participants registering to receive an electronic or paper health insurance card, mark x in the corresponding column.

- Column 13: notes.

+ For employees: record the number; day, month, year of the labor contract, employment contract (clearly state the term of the labor contract, employment contract from day, month, year to day, month, year) or decision (recruitment, acceptance); suspension of the labor contract, unpaid leave, ... Clearly state the period (from day, month, year to day, month, year) of sick leave, illness, maternity leave paid under social insurance; for employees who suffer from diseases listed in the long-term treatment category while hospitalized, include supporting documents.

+ For individuals entitled to higher health insurance benefits (if any): record supporting documents such as for persons with meritorious services, veterans, ... 94

+ For those who only participate in health insurance subsidized by the state budget, and those participating in group health insurance who pay by themselves: record the number of months the health insurance card is valid corresponding to the amount of contribution.

c) Indicators by row:

- (1) Increase:

+ Record the sequence of increase in health insurance participants.

+ Record the sequence of increase in salary.

- (2) Decrease:

+ Record the sequence of decrease in health insurance participants.

+ Record the order of salary reduction.

Note: In cases of changing the initial medical registration location, fill in column B, column 1, column 3 and write the change content in column 12, leaving other columns blank.

d) After completing the declaration, sign, clearly write full name, and stamp.

+ Record the sequence of increase in salary.

- (2) Decrease:

+ Record the sequence of decrease in health insurance participants.

+ Record the order of salary reduction.

Note: In cases of changing the initial medical registration location, fill in column B, column 1, column 3 and write the change content in column 12, leaving other columns blank.

d) After completing the declaration, sign, clearly write full name, and stamp.

95

SOCIALIST REPUBLIC OF VIETNAM

Independence - Freedom - Happiness Form No. 4

LIST OF HOUSEHOLD MEMBERS PARTICIPATING IN HEALTH INSURANCE

Full name of household head: ......................................... Phone number (if any) ..............

Address: House number, street/road, village/hamlet: ..................................................

Commune, ward, special zone:……………......... Province, city:….........................

Card protection place

health insurance registration

Code Date, signature Officer Rate

insurance Number of months, medical examination Money system of the State Budget Record No. Full name health insurance CCCD/ID year illness, treatment salary with employer support Copy electric Copy note

vital disease household (%) death certificate

friend

head

A B 1 2 3 4 5 6 7 8 9 10 1 2 3 ...

Total number of people requesting health insurance cards:....... (Including:..... paper health insurance cards)

I certify that the declared contents are correct and take responsibility before the law

Regarding the declared content ......, day.... month.... year....

DECLARANT (Sign, full name)

96

Notes:

- Person participating in checking the health insurance number at the address: https://baohiemxahoi.gov.vn.

- The list of household members participating in health insurance must be updated with accurate household information in the National Database on Population or the National Database on Residence, or residence information on the electronic identification account (VneID).

- In case of electronic declaration implementation:

+ Information fields that have been connected with the National Database on Population, National Residence Database, National Insurance Database, and other databases on the National Public Service Portal will be automatically filled in the electronic declaration. Individuals only need to fill in information that is not yet in the database.

+ In case the declarant uses a level 2 electronic identification account (VneID) to log in to the National Public Service Portal to handle procedures electronically, they do not need to sign the declaration form.

97

GUIDELINES FOR COMPLETING FORM NO. 4

List of household members participating in health insurance

1. Purpose: To fully and accurately declare information of household members when registering for household-based health insurance to reduce the contribution amount.

2. Responsibility for preparation: representative of the household members.

3. Time of preparation: when household members participate together in health insurance under the household form within the fiscal year to reduce the contribution amount.

4. Preparation method:

a) General information section: fully write the full name of the household head; contact phone number; household address according to permanent or temporary residence.

b) Household member information table (for first-time health insurance participation, attach Form No. 2):

- Column A: write the serial number from 1 to the last member in the participant's household.

- Column B: write the full name, middle name, and given name of each household member (including the household head).

- Column 1: write the health insurance number of each participant.

- Column 2: write the citizen identification number/personal identity number of each household member issued by the competent authority.

- Column 3: write the full date of birth as in the birth certificate or citizen identification/personal identity card of each household member.

- Column 4: write the registered place for initial medical examination and treatment according to the instructions of the social insurance agency.

- Column 5: write the basic salary level.

- Column 6: record the relationship with the head of the household (according to information in the National Residency Database or the National Population Database or the VneID application).

- Column 7: record the percentage of state budget support (if any).

- Columns 8, 9: participants registering to receive an electronic or paper health insurance card should mark an 'x' in the corresponding column.

- Column 10: enter the number of months the health insurance card is valid corresponding to the amount of payment.

c) After completing the declaration: The participant writes: volunteering to declare, providing relevant documents to ensure accurate information, and taking responsibility before the law for the declared content; sign and clearly write full name.

Note: In cases of mergers or divisions of administrative boundaries, record according to the name of the locality at the time of declaration.

(See continued Official Gazette No. 979 + 980)

GOVERNMENT OFFICE PUBLICATION Address: No. 1, Hoang Hoa Tham, Ba Dinh, Hanoi Contact phone: - Content: 080.44417 - Distribution: 080.44243 Website http://congbao.chinhphu.vn Signatory: GOVERNMENT ELECTRONIC INFORMATION PORTAL GOVERNMENT LEGISLATIVE DOCUMENT

Decree No. 188/2025/NĐ-CP dated July 1, 2025, stipulates detailed regulations and guidelines for the implementation of certain articles of the Health Insurance Law (Continuation of Official Gazette No. 977 + 978)

Form No. 5

SOCIALIST REPUBLIC OF VIETNAM

Independence - Freedom - Happiness HEALTH INSURANCE EXAMINATION AND TREATMENT CONTRACT YEAR …

(No: /HDEX-BHI)(1)

Pursuant to the Civil Code dated …. month …. year …;

Pursuant to the Health Insurance Law dated …. month …. year …;

Pursuant to Decree No …/20../ND-CP dated … month … stipulating detailed regulations and guidelines for the implementation of certain articles of the Health Insurance Law;

Pursuant to … (enter the name of the document stipulating the functions, tasks, powers, and organizational structure of the medical examination and treatment facility) ................................................................. ;

Pursuant to … (enter the name of the document stipulating the functions, tasks, powers, and organizational structure of the social insurance agency signing the contract) ....................................................

Today, the day... month... year... at..........................., We consist of:

Party A (Name of the social insurance agency signing the contract): ......................................

Address:...........................................................................................................

Email address: ...............................................................................................

Phone:................................. Fax: ...................................................................

Account number: .............. At the bank ...................................................................

Represented by Mr./Ms.: .............................................................................................

Position: Director or Deputy Director (according to Power of Attorney No.: ....................... dated … day … month … year …)(2)

Party B: Name of the medical examination and treatment facility or unit entering into the medical examination and treatment contract: .......................................................................................................

Address:...........................................................................................................

Email address: ...............................................................................................

Phone: .............................. Fax: ......................................................................

Account number: ................. At the State Treasury or Bank .......................

Represented by Mr./Ms.: .............................................................................................

Position: Clearly state the position of the person authorized to sign the contract(3)/Authorized person (according to Power of Attorney No.: ..................... dated ... day ... month ... year ...)(4)

Medical examination and treatment facility code: ........................................................................

Professional and technical level: ....................................................................................

Rank/Temporary rank (if any): ...................................................................

Operating license number: .......................................................................................

Scope of expertise: ...........................................................................................

Total number of hospital beds of the facility according to the medical examination and treatment operation license (for medical examination and treatment facilities with inpatient treatment): .................................

Person responsible for the professional and technical aspects of the medical examination and treatment facility: ............................................................................................................................

Name of the commune, ward, special zone health station, maternity house, regional general clinic (in case the authorized agency assigns a unit to represent signing the contract for these facilities): ......................................................................

Address:...........................................................................................................

Email address: .......................................... Phone: ..................................

Represented by Mr./Ms.: .............................................................................................

Position: Head or Deputy Head of the commune, ward health station, maternity house, regional general clinic (according to Authorization Letter No.: ...... dated ... ... ...)(5)

CONTRACT CONTENT

The parties mutually agree to sign a contract for medical examination and treatment under health insurance according to the following terms:

Article 1. Medical examination and treatment organization

1. Target subjects: People participating in health insurance who come for medical examination and treatment at Party B's medical facilities.

For primary health insurance facilities, the expected number of cards and the structure of groups of health insurance participants (according to the allocation of the Department of Health or the number of cards from the previous year) should be noted.

2. Scope of service provision:

Clearly state the agreed content regarding Party B providing medical examination and treatment services within the scope of professional activities approved by the competent authority and covered by the health insurance fund, including: service and technical lists; lists of drugs and medical equipment used at the facility; and other content, if any.

3. Payment method:

Specify in detail the agreed-upon contents according to the provisions of the law regarding the method of payment for medical examination and treatment costs covered by health insurance.

Article 2. Advance payment, payment, settlement

The two parties agree on specific contents to implement the advance payment, payment, and settlement of medical examination and treatment costs based on the provisions of Article 32 of the Health Insurance Law, this Decree, and relevant documents in accordance with the law.

Article 3. Rights and responsibilities of Party A

1. Rights of Party A:

a) Implement according to the provisions of Article 40 of the amended Health Insurance Law and the provisions of this Decree;

b) Request Party B to provide documents to serve the medical insurance appraisal and to inspect the implementation of the medical examination and treatment contract under health insurance in accordance with the law;

c) Refuse to pay for medical examination and treatment costs under health insurance that are not in accordance with legal regulations;

d) Other rights according to the provisions of the law on health insurance and medical examination and treatment, and other necessary contents agreed upon by both parties (if any) in accordance with the provisions of the current law.

2. Responsibilities of Party A:

a) Comply with the provisions of Article 41 of the amended Law on Health Insurance and the provisions of this Decree;

b) Advance, pay, and settle health insurance medical examination and treatment costs quarterly for Party B in accordance with the provisions of Article 32 of the Law on Health Insurance, this Decree, and relevant legal documents; in case the two parties have not agreed on the result of the assessment, Party A shall still make the advance payment for Party B according to the provisions of Article 32 of the Law on Health Insurance;

c) Not require Party B to re-check the information on the health insurance card of patients who have participated in health insurance and whose medical examination and treatment costs have been settled through the financial year;

d) Do not cancel or recover costs that Party B has actually used for medical examination and treatment and that the medical examination and treatment facility has completed the payment procedures for in cases where the information on the health insurance card is incorrect or in cases where the social insurance agency adjusts the information on the health insurance card after the medical examination and treatment facility has checked the health insurance card information, or in cases where the patient changes the benefit level during inpatient treatment but does not provide the information to the medical examination and treatment facility;

d) Comply with the legal regulations on medical examination and treatment in performing the appraisal work; be legally responsible for the appraisal results and the settlement of health insurance medical examination and treatment costs;

e) Receive, assess, and promptly provide feedback to medical examination and treatment facilities regarding verified medical examination and treatment data for health insurance and submit requests for assessment on the data reception portal of Vietnam Social Security; ensure accuracy, safety, information confidentiality, and the rights of the relevant parties;

g) Proactively review, detect, and send timely warning information to health insurance medical examination and treatment facilities about medical examination and treatment costs that increase compared to the average cost of facilities of the same technical specialty level, the same type of general or specialized medical examination and treatment facility in the province, centrally-run city, or nationwide;

h) Other provisions of the law related to the implementation of the contract.

Article 4. Rights and responsibilities of Party B

1. Rights of Party B:

a) Comply with the provisions of Article 42 of the amended and supplemented Law on Health Insurance and the provisions of this Decree;

b) Other rights in accordance with the provisions of the law on health insurance and medical examination and treatment, and other necessary contents agreed upon by both parties (if any) in accordance with the current law.

2. Responsibilities of Party B:

a) Comply with the provisions of Article 43 of the amended and supplemented Law on Health Insurance and the provisions of this Decree;

b) Designate the use of drugs, chemicals, medical equipment, and medical services that ensure safety and effectiveness; prevent waste and legal violations;

c) Provide Party A with the documents to serve the work of health insurance assessment and inspection of the implementation of the health insurance medical examination and treatment contract in accordance with the law.

d) Be responsible before the law for the violations committed by Party B in implementing policies and laws on health insurance.

Article 5. Contract Term

This contract is valid for … years from the date of signing the contract. (From …/…/… to …/…/…)

Article 6. Method of Resolving Contract Disputes

1. If there are any obstacles or disputes related to the implementation of the contract, both parties will discuss and resolve them on the principle of complying with the law, protecting the legitimate rights and interests of the parties and the patients participating in health insurance, and in the spirit of cooperation, self-agreement, and reconciliation.

2. If the dispute cannot be resolved, either party has the right to file a lawsuit at the Court in accordance with the provisions of Article 48 of the Health Insurance Law. The Court's decision is the final decision for the two parties to implement.

3. During the dispute, both parties must still ensure that the medical examination and treatment of health insurance participants are not interrupted.

4. In the case of changes, suspension, or termination of the contract, it shall be carried out in accordance with the provisions of this Decree.

Article 7. General Commitment

1. Both parties commit to properly implementing the terms of the agreement in the contract and the provisions of the law.

2. Notices and agreements shall be made in writing and sent by postal mail or email to the addresses stated in this Contract.

3. Both parties agree to comply with the regulations and cooperate in applying information technology to facilitate the appraisal and settlement of medical examination and treatment costs under health insurance.

4. The parties must not provide or release information that affects the reputation and rights of the parties, or that affects policies and laws on health insurance.

5. When carrying out contract performance inspections, Party A must notify Party B in advance of the time and content of the inspection in accordance with the provisions of this Decree.

6. Other agreements (if any) must be acknowledged by both parties as appendices to this Contract, but must not contravene the provisions of the law.

This contract is made in 04 (four) copies of equal value, each party keeps 02 (two) copies.

REPRESENTATIVE OF PARTY A REPRESENTATIVE OF PARTY B

(Sign, full name, stamp) (Sign, full name, stamp)

Notes:

(1): The contract number is numbered according to the order of contracts within a year, starting from number 01 on the first day of the year and ending on December 31 of the contract's end year.

(3): Person authorized to sign the contract according to the provisions of Clause 8, Article 23 of this Decree.

(2), (4), (5): Record in case the head of the facility authorizes another person to sign the medical examination and treatment insurance contract.

Form No. 6

SOCIALIST REPUBLIC OF VIETNAM

Independence - Freedom - Happiness

MINUTES OF LIQUIDATION OF THE MEDICAL EXAMINATION AND TREATMENT INSURANCE CONTRACT

(Number:......./BBTL-…)(1)

Pursuant to the Civil Code dated …. month …. year …;

Pursuant to the Health Insurance Law dated …. month …. year …;

Pursuant to Decree No. …/20…/ND-CP dated… month… providing details and guidance for the implementation of certain articles of the Health Insurance Law;

Pursuant to…. (state the name of the document regulating the functions, tasks, powers, and organizational structure of the medical examination and treatment facility) ..................................................................

Pursuant to…. (state the name of the document regulating the functions, tasks, powers, and organizational structure of the social insurance agency signing the contract) .....................................................

Pursuant to the Health Insurance medical examination and treatment contract No. ………./HĐKCB-BHYT signed on …. day …. month …. year 20….;

Pursuant to the capacity and needs of both parties; .............................................................

Today, the day... month... year... at..........................., We consist of:

Party A (Name of the social insurance agency signing the contract): ......................................

Address:...........................................................................................................

Email address: ...............................................................................................

Phone:................................. Fax: ...................................................................

Account number: .............. At the bank ...................................................................

Represented by Mr./Ms.: .............................................................................................

Position: Director or Deputy Director (according to Power of Attorney No.: ....................... dated … day … month … year …)(2)

Party B: Name of the medical examination and treatment facility or unit entering into the medical examination and treatment contract: .......................................................................................................

Address:...........................................................................................................

Email address: ...............................................................................................

Telephone:............................... Fax: .....................................................................

Account number:............... At the State Treasury or Bank .........................

Represented by Mr./Ms.: .............................................................................................

Position: Clearly state the position of the person authorized to sign the contract (3)/Authorized person (according to Authorization Letter No.:..................... date… month… year…)(4)

Medical examination and treatment facility code: .........................................................................

Professional and technical level: ....................................................................................

Rank/Temporary rank (if any): ...................................................................

Operating license number: .......................................................................................

Scope of expertise: ...........................................................................................

Total number of hospital beds of the facility according to the medical examination and treatment operation license (for medical examination and treatment facilities with inpatient treatment): .................................

Person responsible for the professional and technical aspects of the medical examination and treatment facility: ............................................................................................................................

Name of the commune, ward, special zone health station, maternity house, regional general clinic (in case the authorized agency assigns a unit to represent signing the contract for these facilities): ......................................................................

Address:...........................................................................................................

Email address: .......................................... Phone: ..................................

Represented by Mr./Mrs.: ........................................................................................

Position: Head or Deputy Head of the commune, ward health station, maternity house, regional general clinic (according to Authorization Letter No.: ...... dated ... ... ...)(5)

The parties mutually agree to terminate the Health Insurance medical examination and treatment contract No. ………./HĐKCB-BHYT signed on …. day …. month …. year 20…according to the following terms:

Article 1. Agreement on contract termination

1. Reason for contract termination

Clearly state the agreed-upon reason for contract termination according to the provisions in Clause 1, Article 33 of this Decree.

2. Based on the implementation status of the Health Insurance medical examination and treatment contract No. ………./HĐKCB-BHYT signed on …. day …. month …. year 20…

The parties agree to sign this Minutes to liquidate the Health Insurance medical examination and treatment contract No. …./HĐKCB-BHYT signed on …. day …. month …. year 20...

Article 2. Confirmation of contract performance

- Both parties agree on the contents of the contract that have been performed: specify the contents in detail.

- Party A has carried out appraisal, advance payment, and payment of health insurance medical examination and treatment costs in accordance with regulations.

- Other contents (if any).

Article 3. Debt and Payment Obligations

- The total amount requested for payment of health insurance medical examination and treatment costs that Party B has carried out under Health Insurance Medical Examination and Treatment Contract No. ………./HĐKCB-BHYT dated …. month …. year 20… up to the point when both parties agree to terminate the contract:……………….. VND.

- The total amount agreed for settlement:……………….. VND.

- The total amount already paid to Party B:… VND.

- The remaining amount (if any):… VND, will be paid before … (as agreed).

- The costs not yet agreed for settlement:… VND. Method and time limit for resolution:……

- Other contents (if any).

- After completing financial obligations, both parties have no further debts related to this contract.

Article 4. Termination of contract validity

- Health insurance medical examination and treatment contract number ………./HĐKCB-BHYT signed on…. day…. month…. year 20… officially expires from the date…

- Both parties commit not to have any complaints or disputes related to the contract after liquidation.

Article 5. Commitment of the parties

- Both parties commit that they have fully performed their rights and obligations under the contract.

- This Contract Liquidation Minutes is made in 04 (four) copies with equal value, each party keeping 02 (two) copies.

REPRESENTATIVE OF PARTY A REPRESENTATIVE OF PARTY B (Sign, full name, seal) (Sign, full name, seal)

Notes:

(1): The liquidation minutes number is numbered according to the sequence of minutes in a year, starting from number 01 on the first day of the year and ending on December 31 of the year of contract liquidation.

(3): Person authorized to sign the contract, liquidate the contract.

(2), (4), (5): Record in case the head of the facility authorizes another person to sign the medical examination and treatment insurance contract.

Form No. 7

NAME OF SUPERVISING AGENCY/ORGANIZATION SOCIALIST REPUBLIC OF VIETNAM NAME OF MEDICAL EXAMINATION AND TREATMENT FACILITY Independence - Freedom - Happiness / NAME OF AGENCY

1, date … month … year …

SOCIAL INSURANCE

Number: … /… Re: Request to sign a contract/appendix to the contract for medical examination and treatment

health insurance

To: Social Insurance …/Name of the medical examination and treatment facility or

the unit authorized to sign the medical examination and treatment contract

Name of the proposing facility: Social Insurance …/Name of the medical examination and treatment facility or the unit authorized to sign the medical examination and treatment contract

Address:2 ................................................................................................................

Phone: ................. Fax: ................ Email (if any): ........................................

Medical examination and treatment operation license number:3…... Date of issue: …........... Place of issue: .......................................................................................................................

Number of ongoing health insurance medical examination and treatment contracts and the number of contract appendices of the signed contract (if any): 4 .......................................................

Case of request: Sign contract/Sign contract appendix 5: ..................................

The dossiers sent together with this application include the following documents: 6

(1) ..........................................................................................................................

(2) ..........................................................................................................................

(3) ..........................................................................................................................

...............................................................................................................................

Online address for checking the documents in the dossier: ..............................................

We respectfully request your agency to review and sign the contract/sign the contract appendix of the health insurance medical examination and treatment contract No. ………./HĐKCB-BHYT signed on …. day…. month…. year 20…

REPRESENTATIVE OF THE FACILITY (Sign, clearly write full name and seal)

1 Location.

2 Specific address of the medical examination and treatment facility as stated in the business license/address of the social insurance agency.

3 This content is specifically for cases where the medical examination and treatment facility is the proposing unit.

4 This content is reserved specifically for cases where the medical examination and treatment facility requests to sign an additional contract appendix.

5. Specifically record cases of signing contracts and signing contract appendices for medical examination and treatment under health insurance in accordance with the provisions of Article 23 and Article 24 of this Decree.

6. List all documents and papers submitted with the application.

Form No. 8

NAME OF MANAGEMENT AGENCY/ORGANIZATION SOCIALIST REPUBLIC OF VIETNAM

NAME OF MEDICAL EXAMINATION AND TREATMENT FACILITY Independence - Freedom - Happiness

_____________, date… month… year…

FOR ELECTRONIC DATA EXTRACTION IN HEALTH INSURANCE PAYMENT

I. HARDWARE EQUIPMENT TT Device Name Model Manufacturer Year of Manufacture Country of Origin Information Configuration Usage Status

1 Server 2 Workstation 3 Storage device 4 Uninterruptible Power Supply (UPS) 5 LAN network device 6 Internet network device 7 Other devices

II. HOSPITAL INFORMATION SYSTEM (HIS) SOFTWARE TT Content Information

1 Software name SIGNATURE OF REPRESENTATIVE OF MEDICAL EXAMINATION AND TREATMENT FACILITY

(Signature, seal)

2 Time of first use 3 Supplier 4 Origin (Lease/Purchase/Self-developed) 5 Usage status

13

SUPERIOR AUTHORITY SOCIALIST REPUBLIC OF VIETNAM Form No. 9

Independence - Freedom - Happiness

(MOH/DOH..) Patient code(2)

Admission number

NAME OF CLINICAL SERVICE FACILITY: ...

disease, treatment

Unit code (1) Number: ...../20.../PCDVCLS

CLINICAL SERVICE REFERRAL FORM To:...................................................

Medical examination and treatment facility:........................................ respectfully introduces:

☐ Patient:

☐ Sample specimen:…………...……………. (Specify the name of the specimen)

Reason for referral:

☐ Machine/medical equipment malfunction

☐ Lack of chemicals, test supplies

☐ Lack of personnel to perform clinical services

☐ Other reason: Specify clearly

Specific patient information is as follows:

- Patient full name: ........................................................................................

- Male/Female:...........……Year of birth:...............

- Address: ...............................................................................................................

...............................................................................................................................

- Ethnicity:.................................................... Nationality: ........................................

- Occupation:.................................................. Workplace ..............................

- Health insurance card number: ..........................................................................................

- Expiration date of health insurance card: Day….. Month……. Year ............

Expired: Unknown expiration date:

- Place of initial medical examination/treatment registration:

- Date of medical examination / Date of hospital admission:

- Medical examination/treatment type code:

- Treatment department: - Confirmed diagnosis (must specify diagnosis) - Comorbidities (if any): - Referred clinical services:

Sample submission method

No. Service code SERVICE NAME Patient Specimen

CLINICAL TEST to collect samples taken 1 2 from facility 3 … DOCTOR REQUESTS …, day… month… year… (Sign and clearly print full name) APPROVE SERVICE TRANSFER

(Sign and write full name)

Note: (1) According to the correct unit code in the health insurance inspection system; (2) Is the patient code at the medical examination and treatment facility that requests the clinical service.

Form number 10

SOCIALIST REPUBLIC OF VIETNAM Independence - Freedom - Happiness

DIRECT PAYMENT REQUEST

To: Social Insurance …………..……

Patient full name: ………………… Gender ..........................................................

Date of birth: ……./…./…….

Address: …………………………………… Phone number.............................................

Health insurance card code valid from ……./…./….. to ……./…./…….

Place of initial medical examination and treatment registration: .................................................................

Place of medical examination and treatment: ......................................................................................................

Form of medical examination and treatment (inpatient, outpatient): .............................................................

Diagnosis: ......................................................................................................................

Amount requested for payment:..............................................................................................

In words: ........................................................................................................................

Payment method: Cash  Bank transfer 

Account number: ...................................................................................................................

Account holder: .................................................................................................................

Relationship with the person requesting direct payment.......................................................

At the bank:.................................................................................................................

Reason for not receiving benefits at the medical examination and treatment facility: .............................

Attached documents include:

1 ………………..…..………………...… 2...............................................................

3 …………………………………...…… 4...............................................................

5 ………………………...……………… 6...............................................................

RECORD RECEIVER …….., day…. month……year…….

(Signature, full name) REQUESTER (Signature, full name)

NAME OF SUPERVISING AGENCY OR ORGANIZATION Form No. 11 NAME OF MEDICAL EXAMINATION AND TREATMENT FACILITY, SOCIALIST REPUBLIC OF VIETNAM

Independence - Freedom - Happiness

______________

CERTIFICATE OF SHORTAGE OF MEDICINE AND MEDICAL EQUIPMENT

(Issued to the patient for direct payment)

Full name of the patient:................................................................................................

Age: ........................................ Male/Female: .............................................................

Address:...........................................................................................................

Phone:.............................................................................................................

Health insurance card number:.............................................................................................

Name of prescribing doctor: ..........................................................................................

Department/Room: .........................................................................................................

Name of active ingredient:........................................................................................................

Dosage: ...........................................................................................................

Route of administration, form of use: ......................................................................................

Group, type of medical device: .......................................................................................

Unit of measurement: ...........................................................................................................

Medical examination and treatment facility and treatment prescription confirming the shortage of medicines and medical devices in accordance with the provisions of Article 58 and Article 59 of Decree No. …/2025/ND-CP. Specify each medicine and medical device as follows:

1. Medicines listed in the Rare Medicines List issued together with Circular No. ..... dated ....... by the Minister of Health (specify whether it is included or not and the serial number in the Circular)

...............................................................................................................................

...............................................................................................................................

2. Medical devices of category C or D, except for in vitro diagnostic medical devices, personal specific medical devices, medical devices listed in the medical device list issued by the Minister of Health, may be bought and sold like ordinary goods according to the provisions of Decree No. 98/2021/NĐ-CP dated November 8, 2021, of the Government on the management of medical equipment, amended and supplemented by Decree No. 07/2023/NĐ-CP dated March 3, 2023, and Decree No. 04/2025/NĐ-CP dated January 1, 2025, of the Government (specify whether or not, and which type of medical device it belongs to).

...............................................................................................................................

...............................................................................................................................

3. At the time of prescribing medication and indicating the use of medical devices, medical examination and treatment facilities must ensure the following conditions:

3.1. There are no medicines or medical devices as they are in the process of selecting a contractor according to the contractor selection plan approved through one of the following methods: Open bidding, restricted bidding, competitive quotation, direct procurement, or contractor selection in special cases, but a contractor has not yet been selected, or online quotation or online procurement, and a simplified tender assignment has been conducted according to the provisions of the law on bidding but a contractor has not been selected (specify the case of no medicines or medical devices).

...............................................................................................................................

...............................................................................................................................

- For medicines: There is no commercial medicine containing the active ingredient prescribed to the patient, or containing the same active ingredient but with a different concentration, dosage, formulation, or route of administration, and cannot be substituted to prescribe for the patient (specify yes or no).

...............................................................................................................................

...............................................................................................................................

- For medical devices: There are no medical devices that the patient is prescribed to use and there are no medical devices to replace them (specify whether or not)

...............................................................................................................................

...............................................................................................................................

3.2. It is not possible to transfer the patient to another medical examination and treatment facility in any of the following cases:

- The patient's health condition or disease is determined to be unfit for transfer (describe the patient's condition)

...............................................................................................................................

...............................................................................................................................

- The medical examination and treatment facility where the patient is being treated is under medical quarantine according to the provisions of the law on the prevention and control of infectious diseases (specify whether correct or not)

...............................................................................................................................

...............................................................................................................................

- The medical examination and treatment facility where the patient is being treated is a specialized-level medical examination and treatment facility (specify whether correct or not)

...............................................................................................................................

...............................................................................................................................

3.3. It is not possible to transfer drugs and medical devices between medical examination and treatment facilities according to the provisions of the law (specify whether correct or not)

...............................................................................................................................

...............................................................................................................................

3.4. Medications and medical devices prescribed and indicated for use are appropriate to the professional scope of the medical examination and treatment facility (specify whether correct or not)

...............................................................................................................................

...............................................................................................................................

3.5. Medications and medical devices prescribed and indicated for use fall within the benefits of health insurance participants (specify “included” or “not included” and clearly state the provisions in which official document)

...............................................................................................................................

...............................................................................................................................

3.6 Medications and medical devices prescribed and indicated for use have been included in the price structure of technical services (provide detailed information for each medication and medical device):

 Outside the structure of technical service prices

 Within the structure of technical service prices.

In case they are within the structure of technical service prices, specify:

- Name of technical service:………………………. Technical service code:.............................

- Technical service price:..................................................................................................... DEPARTMENT LEADER DOCTOR EXAMINING PATIENT/ ..., day... month... year... PHARMACY/ TREATMENT MATERIALS REPRESENTATIVE OF THE MEDICAL FACILITY (Signature, full name)

(Signature, full name) DISEASE, TREATMENT (Signature, stamp)

VIETNAM SOCIAL INSURANCE Form No. 12

SOCIAL INSURANCE…… SOCIALIST REPUBLIC OF VIETNAM

Independence - Freedom - Happiness ______________

LIST OF PARTICIPANTS IN HEALTH INSURANCE REGISTERED FOR MEDICAL EXAMINATION,

INITIAL TREATMENT AT.... (Name of the medical examination and treatment facility)

No. Target group according to Article 12 Quantity Notes

Health Insurance Law

1

2

3

4

5

6

...

..., day............ month......... year........ REPRESENTATIVE OF THE SOCIAL INSURANCE AGENCY

(Signature, full name, seal)

Note: Lists in this form are sent to medical examination and treatment facilities via electronic file or a signed and sealed copy from the social insurance agency.