Significant Updates to the Law on Health Insurance 

The Law on amendments, supplements of Law on Health Insurance 2024 (“the Law”) was approved by the National Assembly and will come into effect on 01 July 2025, except for some regulations taking effect earlier on 01 January 2025.

Besides, effective from 01 January 2025, Circular 01/2025/TT-BYT (“Circular 01”) detailing and guiding the implementation of a number of articles of the Law on Health Insurance in order to resolve the difficulties, limitations, and obstacles encountered in the implementation of the previous Circular 40/2015/TT-BYT, and at the same time to synchronize with the new regulations of the Law on Examination and Treatment and the Law on amendments, supplements of Law on Health Insurance 2024.

The Law brings about significant changes to the current legal framework of Health Insurance (“HI”), generally:

• Alignment with other relevant laws: The Law amends, and supplements the participation subjects, HI contribution responsibilities, payment method and period, responsibility for creating HI payment lists, and card validity period aligning with the provisions of the Law on Social Insurance and other relevant laws;
• Enhancement of HI-covered medical examination: The Law introduces regulations on initial registration for HI-covered medical examination and treatment, the transfer of patients among medical examination and treatment facilities under HI, in accordance with the technical expertise level as outlined in the 2023 Law on Medical Examination and Treatment;
• Expansion of HI benefits: The Law regulates the HI benefits level applied when patients are transferred between healthcare facilities regardless of administrative boundaries by province, maintaining the stable rate of HI benefits as stipulated in the current laws and expanding those benefits to some certain cases;
• Adjustment of the payment ratios of HI contribution: The Law adjusts payment ratios for HI-covered health examination and treatment, for reserve funds and organizing activities of HI from the amount of HI contributions;
• Adjustment of payment mechanism: The Law supplements the payment mechanism for drugs, medical equipment transferred between medical examination and treatment facilities, and payment of paraclinical service costs transferred to other facilities due to shortage of drugs and medical equipment;
• Strengthened enforcement: The Law adds stricter penalties for late HI payments and payment evasion, ensuring timely and adequate funding for the system;
• Improvement of the medical examination and treatment and HI system: The Law emphasize the responsibilities of the Ministry of Health in improving the medical examination and treatment and the efficiency of HI system. This includes strengthening treatment protocols, evaluating the rationality of HI-covered services, promoting the use of information technology and data sharing, and establishing transparent, public criteria for the HI coverage list;
• Digitalization and transparency: The Law supplements the provisions on electronic HI issuance, as well as strengthens the state audits of social insurance agencies, ensuring greater synchronization with the provisions of the Law on Social Insurance.

Circular 01 details and guides the new law with the following updates:

• List of diseases and groups of diseases: The circular promulgates a list of rare diseases, critical illnesses, and diseases requiring surgery or advanced techniques that are fully covered by HI, the right of patients to directly access specialized medical facilities without needing a referral letter. The list includes 62 diseases and groups of diseases treatable at specialized medical facilities, 167 at primary medical facilities, and 141 that can be transferred within a one-year referral letter (previously limited to the calendar year);
• HI coverage for individuals with changing residence, summer breaks or working leaves: The circular outlines the procedures for HI examination and treatment for individuals changing their residence place or temporary residence, ensuring continuous coverage for students during summer breaks, and for workers during leave;
• Promotion of the HI examination and treatment at grassroots level and simplifying the facilities transferring process: The circular prioritizes the initial registration for HI examination and treatment at the primary level and partially at the basic level, limiting accesss at specialized level. This aims to strengthen healthcare at the grassroots level. It also simplifies the process for transferring the healthcare facilities, making it more convenient for patients;
• Digitalization of the appointment/referral letters: The circular allows using both paper and electronic appointment/referral letters. It formalizes the electronic appointment/referral letters piloted and integrated into the VNeID application of the Ministry of Public Security under the Government's Project 06/CP.
• Allocation of HI cards: The circular establishes specific, transparent, and public criteria for allocating HI cards, defining the responsibilities of the Department of Health and the Social Insurance Agency in distribution and publicization of the number of HI cards to primary HI facilities. This improves registration and examination, treatment quality at the primary level and facilitates coordination, inspection, and supervision of implementation.
• The responsiblities of medical facilities: The circular stipulates the responsibilities of medical facilities in organizing and providing examination and treatment services, counseling patients on their rights and direct access options at the basic or specialized level, and publicly disclosing their professional and technical classification and scores online for public awareness.

What changes should enterprises/organizations pay attention to?

1. The adding cases of delayed payment and evasion of HI contributions and corresponding penalties.

Pursuant to Clause 9, Article 1 of the new Law, the acts of delay in payments and evasion of HI contributions are added in the prohibited acts.

Accordingly, the new Law has added Article 48a and Article 48b after Article 48 of the 2008 Health Insurance Law, containing provisions related to delayed payments and evasion of HI contributions, of which details the respective acts:

Delayed payment of HI contributions refers to the act of an employer in the following situations:

• Failing to prepare a list, or preparing an incomplete list of individuals who are required to participate in HI, within 60 days from the regulated deadline;
• Cases not considered as evasion of HI contributions as stipulated by the Law.

Evasion of HI contributions refers to the act of an employer in the following situations:

• After 60 days from the deadline, the employer fails to prepare a list or prepares an incomplete list of individuals who are required to participate in HI;
• Registering the wage base for HI contributions that is lower than the wage specified by the Law;
• Failing to pay or paying insufficient HI contributions after 60 days from the latest HI payment deadline, and after being urged by the competent authority in accordance with government regulations;
• Other cases that are considered as evasion of HI contributions as prescribed by the Government.

2. Expanding the categories of mandatory HI participants and regulations on contribution methods for individuals such as business managers, controllers, representatives of state capital, representatives of enterprise capital in joint-stock companies and parent companies, managers of cooperatives, and cooperative union managers who do not receive salaries.

These objectors are required to pay the full amount of contributions directly to the social insurance agency or pay through business households, enterprises, cooperatives, or cooperative unions managing the contributions according to the monthly, quarterly (every 3 months), or semi-annual (every 6 months) payment methods.

3. Adding regulations on the latest deadlines for HI contributions for employers:

• The last day of the following month for the monthly contribution method;
• The last day of the following month after the contribution cycle for the quarterly (every 3 months) or semi-annual (every 6 months) contribution methods.

4. Specific regulations on measures to handle delayed payments and evasion of HI contributions:

    Measures for handling delayed HI payments include:

• Mandatory payment of the full delayed amount; an additional payment of 0.03% per day based on the delayed HI contributions and the number of days of delay into the HI fund;
• Imposition of administrative penalties in accordance with legal regulations;
• No consideration for emulation titles or awards.

    Measures for handling evasion of HI contributions include:

• Mandatory payment of the full evaded amount; an additional payment of 0.03% per day based on the evaded HI contributions and the number of days of evasion into the HI fund;
• Imposition of administrative penalties or criminal liability in accordance with legal regulations;
• No consideration for emulation titles or awards.

Furthermore, agencies, organizations, and employers who delay or evade HI contributions for employees are required to reimburse the full cost of medical examinations and treatments within the scope of HI benefits that the employee has paid during the period when they did not have a HI card due to delayed or evaded contributions.

Conclusion

Enterprises/organizations shall comply with obligations related to HI contributions for their employees, hence, will need to adapt to these changes. These obligations may include:

• Ensuring accurate and timely payment of HI contributions;
• Complying with the updated regulations regarding employee registration and participation in the HI program;
• Understanding and implementing the changes in benefit coverage and payment mechanisms;
• Staying informed about the Ministry of Health's guidelines and implementing any necessary adjustments to their internal procedures accordingly.

This new legislation will have a significant impact on the Vietnamese healthcare system, improving access to high-quality medical care and enhancing the overall well-being of the population. Enterprises/organizations play a crucial role in ensuring the successful implementation of these changes by fulfilling their obligations and actively supporting their employees in accessing healthcare services.

Disclaimer

This Newsletter contains only brief notes and includes legislation in force as of January 2025. The information herein is general and is not intended to address the circumstances of any particular individual or entity. Although we endeavor to provide accurate and timely information, there can be no guarantee that such information is accurate as of the date it is received or that it will continue to be accurate in the future. No one is entitled to rely on this information, and no one should act on such information without appropriate professional advice obtained after a thorough examination of the particular situation.