New points of the Amended Health Insurance Law 2024

On November 27, 2024, the National Assembly passed Law No. 51/2024/QH15 amending and supplementing several provisions of the Law on Health Insurance (“Amended Health Insurance Law 2024”), which will take effect on July 1, 2025. This law marks a significant step forward in improving the legal framework for health insurance, aiming to ensure the rights of participants, enhance management efficiency, and expand access to healthcare services. The new amendments and supplements are expected to address current shortcomings while meeting the growing healthcare needs of the population. Through this article, TNTP Lawyer will highlight some notable new points of the Amended Health Insurance Law 2024.

1.Expanding the categories of Health insurance participants

Clause 10, Article 1 of the Amended Health Insurance Law 2024 introduces several significant adjustments regarding the categories of health insurance participants. Specifically:

• The scope of application has been expanded by reducing the required duration of labor contracts for health insurance participation. Accordingly, employees with labor contracts of at least one month are now included in the categories of health insurance participants, instead of the current requirement of at least three months.
• Additionally, the law adds several categories of mandatory health insurance participants, whose contributions are funded by the state budget, including individuals aged 75 and older who are receiving monthly survivor benefits; individuals aged 70 to under 75 from near-poverty households who are receiving monthly survivor benefits; and other specified groups.
• Mandatory health insurance participants with state-subsidized contributions include village health workers and rural midwives; members of local security and public order protection forces.

This expansion not only ensures fairness and access to healthcare benefits for vulnerable groups but also reflects the state’s special attention to the elderly and individuals in difficult circumstances. Additionally, it encourages healthcare workers in remote and rural areas to remain committed to their roles, thereby contributing to improved healthcare services in disadvantaged regions.

2.Adjustment of health insurance benefits for outpatient treatment outside the designated network

According to Clause 17, Article 1 of the Amended Health Insurance Law 2024, which revises and supplements Article 22 of the current Health Insurance Law, the provisions are as follows:

• From July 1, 2025, individuals participating in health insurance who receive outpatient medical examination and treatment outside the designated network will receive 50% payouts (reimbursements) from the health insurance fund, instead of having to pay the entire cost themselves as previously required. This provision brings significant benefits to patients, especially those who face challenges in accessing in-network healthcare services.
• Furthermore, the Amended Health Insurance Law 2024 enhances the benefits for health insurance participants, ensuring 100% payouts with specific provisions as follows:
• Receive 100% reimbursements for medical examination and treatment at the initially registered health insurance facility nationwide.
• Receive 100% reimbursements for inpatient treatment at basic-level health insurance facilities nationwide.
• Receive 100% reimbursements for medical examination and treatment at any basic or advanced-level health insurance facility that was designated as a district-level facility before January 1, 2025.

These adjustments not only reduce the financial burden on patients but also create more favorable conditions for accessing healthcare services, contributing to the improvement of community health and the quality of medical care.

3.At-home medical care also covered by health insurance

According to Clause 2 and Clause 3 of Article 3 of the Amended Health Insurance Law 2024 stipulate that health insurance participants will have the following expenses covered by the health insurance fund: medical examination and treatment, including remote consultations, support for remote medical examination and treatment, family medicine services, at-home medical care, rehabilitation, routine prenatal check-ups, and childbirth.

This regulation not only facilitates health insurance participants’ access to healthcare services but also supports at-home healthcare, especially for individuals with special needs or those who face mobility difficulties. Additionally, this is a solution to enhance the quality of healthcare, particularly in the context of epidemics or emergency situations, when access to healthcare facilities is challenging. As a result, health insurance participants can be more at ease knowing they will receive quality healthcare services at home, ensuring timely and effective protection of their health.

4.Payment between healthcare facilities

• The Amended Health Insurance Law 2024 introduces new regulations regarding the payment mechanism for medicines and medical equipment transferred between healthcare facilities. Specifically, in certain special cases, the health insurance fund will cover the costs of medicines and medical equipment when transferred from one healthcare facility to another, provided the following conditions are met:
• When a patient requires medication or medical equipment, but the healthcare facility does not have it available and cannot substitute it with a similar product;
• If it is not possible to transfer the patient to another healthcare facility to receive the necessary medication or medical equipment;
• If the healthcare facility has conducted procurement through a bidding process as per regulations but is unable to purchase the required medication or medical equipment due to specific reasons.
• In these cases, the health insurance fund will pay for the medication and medical equipment based on the payment rates of the transferring healthcare facility. The receiving healthcare facility is responsible for paying the transferring facility, and then the cost will be incorporated into the patient’s medical expenses to be reimbursed by the social insurance agency.
• Additionally, the Law also stipulates the payment of costs for paraclinical services. When a healthcare facility does not have the necessary conditions to provide essential paraclinical services, the cost for these services will be transferred to a facility that is qualified to provide them, after approval by the competent authority.

5.Some notable other regulations

• Increase in spending on medical examination and treatment: The law stipulates an increase in the allocation from the health insurance fund to cover medical examination and treatment activities, raising it to 92%, while reducing the amount dedicated to the reserve fund and administrative activities of the health insurance fund to 8%. Of this, at least 4% of the health insurance contributions must be allocated to the reserve fund. The law also clearly defines the time limit for notifying the results of medical cost assessments.
• Expansion of benefits for health insurance participants: The law adds services such as treatment for strabismus and refractive errors for children under six years old, aiming to enhance healthcare for children.
• Simplification of administrative procedures: The law reduces paperwork, strengthens the application of information technology, decentralizes and delegates authority, making it easier for individuals, agencies, and organizations to participate in and use health insurance.
• Clear time limits for notifying medical cost assessments: The law ensures transparency and timeliness in notifying the results of medical assessments, helping health insurance participants accurately understand their entitlements.
• Strengthening the responsibilities of involved parties: The law specifies the responsibilities of agencies and organizations in compiling the list of health insurance contributors, ensuring the protection of participants’ rights.

The Amended Health Insurance Law 2024 represents a comprehensive reform, not only expanding coverage but also enhancing service quality and improving benefits for the people. This is a significant step toward ensuring social security policies and creating a sustainable foundation for Vietnam’s healthcare system.

The above is an article by TNTP Lawyers on the topic: “New points of the Amended Health Insurance Law 2024” We hope this article provides valuable insights for our readers.

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