Health Insurance (“HI”) is an important social security policy that ensures equitable and sustainable access to healthcare services for all citizens. Currently, this matter is governed under the Law on HI 2008, amended and supplemented under laws in 2013, 2014, 2015, 2018, 2020, and 2023 (hereinafter referred to as “the prevail HI Laws”).
However, along with the changes in socio-economic realities, many provisions of the prevail HI Laws have revealed limitations, required for amendments and supplements to be more suitable with practical needs and enhance management efficiency. Such amendments not only resolve existing issues but also establish the foundation for a modern, equitable, and humane HI system. Accordingly, on November 27, 2024, the National Assembly approved the Law on amendment and supplementation of certain provisions of the Law on HI, which will take effect from July 1, 2025 ("the Law on HI 2024").
In general, objectively assessing, ATA Legal Services believes that the contents of the Law on HI 2024 shall properly implement goals of ensuring rights of HI participants and improving the efficiency of management and compliance with laws on HI.
1. Expansion of scope of subjects participating in HI
One of the key reasons for amendments and supplementations of the Law on HI 2024 is the expansion of scope of subjects as participants, especially groups with labor relationships and/or income receivers being paid with salaries or remuneration by Vietnamese enterprises, who are:
- Employees working under fixed-term contracts with at least one month validity period, including cases where employees and employers agree with alternative titles with contents therein indicating works under payment term as wages, salaries and having management, direction and supervision of one party;
- Enterprise managers, controllers, representatives of State capital, and representatives of enterprise capital as prescribed by law;
- Members of Boards of Directors, General Directors, Directors, members of Board of Supervisors or controllers, and other elected management positions in cooperatives and cooperative alliances as stipulated by the Law on Cooperatives, regardless of whether they receive salaries or not.
- Workers as foreign citizens in Vietnam employed under fixed-term labor contracts with at least 12 months validity period by employers in Vietnam.
The Law on HI 2024 also regulates obligations on participating in HI of certain subjects paid by the State Budget, such as village health workers, midwives; workers, not eligible to have pensions, and not old enough to have social retirement allowances, are under monthly allowances period time, in accordance with regulations of laws on social insurance.
2. Adjustment of contribution rates and period for HI
The adjustment of HI contribution rates is a main point of the amendments of the Law on HI 2024, ensuring fairness, reasonableness, and sustainability for the HI system.
The Law on HI 2024 regulates contribution rates and responsibilities on HI contribution of participants in detail. HI contribution rates are determined as a percentage of wages used as the basis for mandatory social insurance contributions under the Law on Social Insurance, pensions, allowances, or reference levels. For cases where HI contribution rates are calculated as a percentage of the reference, levels, different calculation bases shall be applied to each subjects. Currently, the regulated reference levels are based on base salary; however, in the event of wage policy changes, the Government will determine the specific reference levels.
The HI contribution rates, applied for each subject groups, are regulated in Clause 11 of Article 1, which supplements Article 13 of the Law on HI 2008. The rates are categorized by each subjects in detail as follows:
- Contribution rates paid by employers, employees, or jointly by both.
- Contribution rates paid by social insurance agencies.
- Contribution rates paid or supported by the State Budget.
- Contribution rates for individuals or households participating willingly.
In a case where an individual falls under multiple subject categories, their contribution rate shall be determined based on a priority order, except for certain special circumstances. For household HI contributions, discounts shall be applied to HI contribution from the second member’s onwards, contribution rates shall be applied from 70% to 40%. The Government shall regulate the contribution rates, levels of support, and payment responsibilities applied to each participant categories in detail.
Besides, the Law on HI 2024 regulates deadlines for HI contributions paid by employers, in detail as follows:
- For monthly contributions, the payment must be completed by the last day of the following month.
- For contributions made every three or six months, the payment must be completed by the last day of the following month right after the payment cycle.
The above clear regulation shall help enterprises to comply easily and plan their obligations on HI contributions effectively before deadlines. This regulation of the Law on HI 2024 shall be considered as a big improvement, shall enhance consistency in legal application and transparency in HI management, compared to the prevail HI Laws.
3. Adjustment of HI benefit rates in cross-facility medical services
The regulations of the Law on HI 2024 adjust towards more flexible HI benefit rates, remove differences of administrative boundaries in cross-facility medical services. In a case where HI participants use medical services in medical facilities different from their registered medical facilities, the reimbursement rates shall be calculated under the prevail Laws on HI, in detail as follows:
- 40% of inpatient treatment costs at central-level hospitals.
- 60% of treatment costs at provincial-level hospitals.
- 70% of treatment costs at district hospitals.
To improve the limitations of out-of-level reimbursement rates, especially at major hospitals, the Law on HI 2024 stipulates HI benefit rates for cross-facility services. HI participants, using medical services in medical facilities different from their registered medical facilities, are reimbursed percentages accordingly, classified as follows:
- 100% of benefit rates for cases where using:
+ Medical treatments at basic or specialized facilities for rare diseases, severe illnesses, or in need of high-tech/surgical procedures as regulated by the Ministry of Health;
+ Inpatient treatments at specialized facilities by ethnic minorities, poor households in disadvantaged areas or island communes, .
+ Medical treatments at basic-level registered facilities;
+ Inpatient treatments at basic facilities; or
+ Medical treatments at basic-level/specialized facilities previously classified as district-level facilities before January 1, 2025.
- 50%-100% of benefit rates for outpatient treatments at basic-level facilities, depending on expertised, technical classifications and the Government's orientation.
- 40% of benefit rates for inpatient treatments at specialized facilities, except for cases qualifying for higher benefit rates. For specialized facilities previously classified as provincial-level facilities before January 1, 2025, patients are eligible to receive 50%-100% benefit rates for outpatient treatments and 100% benefit rates for inpatient treatments.
- 100% of benefit rates in emergency cases, regardless of facilities compared to the prevail Laws on HI where patients, classified as emergency cases by doctors, regardless facilities, are eligible to receive up to 80% benefit rates applied to workers.
4. Electronically issued HI cards
Starting from July 1, 2025, electronic HI cards shall be implemented, with the same legal validity as paper cards’ under the new provisions of the Law on HI 2024. The electronic cards shall integrate personal information and HI data, use QR code technology or other forms of digital identification, make it easier for participants to check their medical history and insurance benefits. Each HI participants shall only be issued with one unique HI number, ensuring consistency and effective management.
5. Supplementation of provisions on late payments, evasion of HI contributions and penalties
One of the main regulations, supplemented in the Law on HI 2024, is the detailed regulation on late payments and evasion of HI contributions, along with strict penalties for such violations. Late payments or evasion of HI contributions not only damages the HI fund but also affects rights of participants, leading to denial of coverage for medical treatment as a base for creating unfairness in public health protection.
In acordance with regulations on resolving violations, the prevail Laws on HI mentioned the fact that employers failing to pay or underpaying HI contributions to the HI fund but there is lack of clear, comprehensive regulation as a measure to resolve late payments and evasion of HI contributions.
To enhance the legal framework for resolving violations of HI regulations, the Law on HI 2024 regulates in detail as follows:
Late payment of HI contributions is understood as a case where organizations, individuals, participating in HI, fail to fulfill their payment obligations on time as required. In this case, in addition to paying the full amount of the overdue payment, the violating entity will be charged with an interest rate of 0.03% per day on the overdue HI contribution amount and the overdue number of days into the HI fund. Late payments of HI contributions shall be subject to administrative penalties in accoradance with regulations of laws. Simultaneously, organizations, having employees who delay payment of HI contributions, shall not be considered for commendations or awards.
Evasion of HI contributions is a fraudulent act, intentionally failing to fulfill the obligations on payment of HI contribution, including providing false labor declarations, not paying HI contribution for employees, or reducing HI contributions to cut costs. The penalties for evasion of HI payments are similar to those for late payments, as this is a serious legal violation that causes significant losses to the HI fund.
In addition to administrative and criminal penalties, if an employee needs to use medical treatment within the scope of their HI benefits but does not receive benefits as required, such agencies, organizations, or employers who delayed or evaded the HI contributions must reimburse the employee with the amount paid during the period when they did not have the HI card.
These regulations aim not only to protect the rights of HI participants but also to create a clear and fair legal environment, helping to prevent fraudulent activities and ensuring the sustainable development of the HI fund.
The Law on HI 2024 shall bring positive changes to enhance workers' benefits and the transparency of enterprises. However, to ensure compliance and take advantage of the new policies, enterprises need to timely update their management processes and strengthen coordination with relevant authorities to fully understand the amendments and supplementations to the Law on HI 2024.
The Law on Health Insurance 2024 will take effect from July 1, 2025./.
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