People who have had health insurance for 5 years no longer have to pay the excess themselves, so who will do it?

According to the latest guidance from the Ministry of Health, people who have participated in health insurance for 5 consecutive years will no longer have to submit documents to pay for the excess of 6 months of basic salary as previously prescribed.

Patients receiving health insurance examination at University of Medicine and Pharmacy Hospital, Ho Chi Minh City - Photo: DUYEN PHAN

Regarding the rights of health insurance buyers, according to the new regulations, determination and payment will be made automatically between medical facilities and social insurance agencies.

The Ministry of Health has just issued a document guiding the implementation of Decree 188/2025 of the Government detailing and guiding the implementation of a number of articles of the Law on Health Insurance. Notably, the Ministry of Health guides the direct payment of health insurance costs for participants who have participated for 5 consecutive years.

According to the provisions of the Law on Health Insurance, if a health insurance participant has participated in health insurance for 5 consecutive years and the co-payment amount in the year exceeds 6 months of basic salary, the excess payment amount greater than 6 months of basic salary will be refunded.

Health insurance participants must bring invoices and documents to the social insurance agency to receive the excess amount. At the same time, the patient is also given a certificate confirming that he/she does not have to pay co-payments for the rest of the year.

However, this regulation officially expires from July 1, 2025, when Decree No. 188 of 2025 takes effect, replacing Decree 146.

According to the latest guidance from the Ministry of Health, people who have participated in health insurance for 5 consecutive years will no longer have to make direct payment procedures.

Instead, the social insurance agency will monitor, accumulate and update the amount the patient has paid during the year. When reaching 6 months of basic salary, the information will be announced on the Vietnam Social Insurance data system. The medical facility will look up this information to automatically apply the exemption of the remaining payment for the patient.

This means that when eligible for co-payment exemption, patients only need to go for medical examination and treatment as usual, without having to prepare documents or wait for payment later.

According to the guidance of the Ministry of Health, medical examination and treatment facilities and social insurance agencies are responsible for closely coordinating, accurately updating information, and ensuring people's rights.

If a medical facility miscalculates or sends incorrect data, affecting the patient's rights, the facility will be held responsible.

If the social insurance agency does not update and fully disclose information, the social insurance agency must also take responsibility.

Thus, when participating in health insurance for 5 consecutive years, people will be exempted from paying more than 6 months of basic salary without having to submit documents or make direct payment procedures.

All processes will be performed automatically on the data system, making medical examination and treatment with health insurance convenient, transparent and reducing inconvenience for patients.

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Source: https://tuoitre.vn/nguoi-mua-bao-hiem-y-te-du-5-nam-khong-con-phai-tu-thanh-toan-phan-vuot-tran-vay-ai-se-lam-20251010095112008.htm