Vietnam Health Insurance Updates: New Regulations Effective August 15, 2025

Significant changes to Vietnam’s health insurance policies are set to take effect on August 15, 2025, impacting benefit levels, card usage, and coverage eligibility. These updates, detailed in Decree 188/2025/ND-CP, aim to streamline the healthcare process and expand access to insurance benefits for Vietnamese citizens.

Key Changes to Health Insurance Regulations

Refunds for High Out-of-Pocket Expenses

Subscribers who have continuously held health insurance for five years may be eligible for a full refund of examination and treatment costs if their annual out-of-pocket expenses exceed six months of the basic salary. This provision, outlined in Article 18 of Decree 188, offers substantial financial relief to individuals with significant healthcare needs.

Continuity of Coverage

The new rules recognize interruptions in health insurance coverage of up to 90 days as continuous coverage. This ensures that individuals who experience temporary lapses in coverage—due to employment changes or other circumstances—do not lose their accumulated benefits. Specific cases such as employees working or studying abroad, temporary family dispatch, children under 18 accompanying parents, and those awaiting unemployment benefits are too considered continuous subscription.

Coverage for Former Military and Police Personnel

Individuals who previously served in the military, police, or other security forces will maintain their health insurance eligibility even after changing jobs, retiring, or resigning. This ensures continued healthcare access for those who have served the nation.

Expanded Coverage Levels

Article 15 of Decree 188/2025/ND-CP specifies varying levels of coverage based on subscriber categories. Those in specific categories (Articles 5, Paragraphs 2 and 6) will receive 100% coverage for eligible medical examinations and treatments. Other categories (Articles 5, Paragraphs 1, 3, 4, 5, and 7) will receive 80% coverage.

Using Health Insurance Without a Card

Decree No. 188 of 2025 outlines five situations where patients can receive health insurance benefits even without presenting a physical health insurance card:

• Children under 6 years of age who have not yet been issued a card.
• Individuals awaiting card renewal, reissue, or information correction (with appointment confirmation and ID).
• Patients in emergency situations, unconscious, or deceased.
• Individuals who have lost or damaged their card or have incorrect information on it.
• Individuals whose premiums are paid by the state budget but have not yet received a card.

In these cases, patients or their families must provide identification, birth certificates, or appointment confirmations, and medical institutions will verify insurance eligibility.

Health Insurance Card Cancellations and Suspensions

Health insurance cards may be canceled or temporarily suspended under certain circumstances, as detailed in Article 20 of the Health Insurance Act:

• Misconduct in the issuance of health insurance cards.
• Utilize of another person’s health insurance card.

If a violation is detected, the medical institution must immediately notify the social insurance institution. Suspended cards will be reinstated once fines are paid and corrective measures are implemented.

Notification of Card Status Changes

Social insurance institutions are required to notify subscribers when their health insurance card is canceled, temporarily suspended, or suspended (Article 12 of Decree No. 188).

These changes represent a significant step towards improving the accessibility and efficiency of Vietnam’s health insurance system, providing greater financial protection and peace of mind for citizens.