Latest instructions on medical examination and treatment using health insurance

Going to the doctor with health insurance is a familiar thing, but not everyone clearly understands what documents they need to bring, what the process is, and what cases are handled flexibly. The Ministry of Health has just issued the latest guidelines, helping people grasp common situations and how to handle them legally.

The Ministry of Health has issued Decision No. 2555/QD-BYT promulgating newly amended and supplemented administrative procedures in the field of health insurance, and at the same time abolishing a number of procedures in the field of health finance according to the provisions of Decree No. 188/2025/ND-CP of the Government.

People who are waiting to be issued, reissued or change information about their health insurance card, when going for medical examination or treatment, need to bring the receipt of the application and appointment to return the results issued by the social insurance agency or authorized unit, along with valid identification documents.

According to the new regulations, health insurance participants need to take two steps when going for medical examination and treatment. The first step is to present full information related to the health insurance card, personal identification documents and other relevant documents as required. The second step is for the medical examination and treatment facility to receive the patient and conduct diagnosis and treatment according to their expertise.

Notably, the Ministry of Health has provided detailed instructions for common cases in the process of medical examination and treatment using health insurance. Accordingly, patients can use many forms to present health insurance information, including citizen identification, level 2 electronic identification account with integrated health insurance card information, paper or electronic health insurance card.

In case the health insurance participant does not have information that can be looked up on the information technology system, he/she must present a paper health insurance card along with one of the following identification documents: citizen identification card, passport, level 2 electronic identification account, VssID application or confirmation paper from the commune-level police.

For children under 6 years old, a paper health insurance card, an electronic version or a health insurance number can be used. In case a health insurance card has not been issued, an original or a copy of the birth certificate can be used. For newborns without parents or relatives accompanying them, the medical examination and treatment facility will confirm directly in the medical record.

People who are waiting to be issued, reissued or change information on their health insurance card, when going for medical examination or treatment, need to bring the receipt of the application and appointment to return the results issued by the social insurance agency or authorized unit, along with valid identification documents.

If the person who donated the organ does not have a health insurance card, he/she must use the hospital discharge papers issued by the medical facility where the organ was taken and valid identification documents. In case of immediate treatment after donation, the information will be confirmed directly in the medical record.

In case of emergency, the patient must provide additional relevant documents as prescribed before the end of the treatment period. In case the electronic health insurance card cannot be presented due to system or application errors such as VNeID or VssID, the patient can provide the card number for the medical facility to look up.

If the information cannot be found, the medical examination and treatment facility will still receive the patient and coordinate with the social insurance agency to verify the information to ensure the patient's rights.

When a patient is discharged from the hospital but the information has not yet been verified, the medical examination and treatment facility is responsible for sending the records and contact information to the social insurance agency to continue the assessment and payment of medical examination and treatment costs according to regulations.

In case of changing the place of residence for less than 30 days, health insurance participants who have declared their residence according to the law on residence, if they go to see a doctor or receive medical treatment at a place other than the original registration place, can still be examined and treated at an equivalent facility suitable for the new place of residence.

In this case, the patient needs to present the required documents along with one of the following documents proving temporary residence or stay: a business trip assignment document, student card, leave decision, mobile work assignment, or a document confirming family relationship with updated residence information on the level 2 electronic identification account.

In case the patient is scheduled for a follow-up examination by the medical facility, he/she will be given a follow-up appointment slip in paper or electronic form according to the prescribed form. The paper appointment slip must have the seal and signature of the treating physician; the electronic copy must have a digital signature. Each appointment slip can only be used once.

In case the patient is transferred, the medical facility where the transfer takes place will issue a Health Insurance Medical Examination and Treatment Facility Transfer Form according to the form, valid for 10 working days from the date of signing. In special medical cases as prescribed in Circular No. 01/2025/TT-BYT, the Transfer Form can be valid for up to 1 year.

Regarding the cost of medical examination and treatment under health insurance, the prices are applied according to the list approved by the competent authority. These are the prices of medical examination and treatment services paid by the health insurance fund, paid by the state budget, or services not included in the health insurance list but not on-demand services. The Ministry of Health requires medical examination and treatment facilities and social insurance agencies not to prescribe additional procedures outside the issued list.

In addition, if the medical examination and treatment facility or social insurance agency needs to photocopy the health insurance card or related documents for the purpose of managing the records, it must do so after obtaining the consent of the patient or guardian. Absolutely do not ask the patient to photocopy or pay for the photocopying costs.

The Ministry of Health emphasized that the correct and full implementation of the new regulations will contribute to ensuring the rights of health insurance participants, while improving the quality and efficiency of medical examination and treatment management nationwide.

Source: https://baodautu.vn/huong-dan-moi-nhat-ve-kham-chua-benh-bang-bao-hiem-y-te-d361283.html