List of groups of subjects and diseases eligible for 100% health insurance from July 1

The Law on Health Insurance 2024 (Law on Health Insurance No. 51/2024/QH15) officially took effect from July 1, 2025, bringing many positive changes to expand access to health services and enhance equity in health care for people.

Groups of subjects entitled to 100% of health examination and treatment costs under health insurance from July 1, 2025

According to Clause 3, Article 12 of the 2024 Law on Health Insurance, the Health Insurance Fund will pay all medical examination and treatment costs for many priority groups.

In which, the armed forces including officers, professional non-commissioned officers, professional soldiers on active duty and officers, technical non-commissioned officers of the people's public security are entitled to this regime.

Armed forces students are also on the priority list, including non-commissioned officers and soldiers of the People's Army on active duty, non-commissioned officers and soldiers on duty in the People's Public Security, and military, police, and cryptography students receiving living expenses.

People with revolutionary contributions and veterans, as well as children under 6 years old, relatives of martyrs and those who have raised martyrs are all entitled to 100% of health insurance examination and treatment costs.

The law pays special attention to vulnerable groups in society. People from poor households, ethnic minorities from near-poor households residing in communes and villages in ethnic minority and mountainous areas are entitled to full medical examination and treatment costs.

People who are receiving monthly social benefits, monthly child support benefits as prescribed by law, and people receiving monthly survivor benefits who are eligible for social benefits are also included in the group receiving 100% of the costs.

In particular, people aged 75 and over receiving monthly pensions and people aged 70 to under 75 from near-poor households receiving monthly pensions are subject to this preferential policy.

Special cases are covered by the Health Insurance Fund 100% of the cost.

In addition to the main target groups, the 2024 Health Insurance Law also stipulates a number of special cases where the Health Insurance Fund will cover 100% of the costs. These include one-time medical examination and treatment costs below the level prescribed by the Government and medical examination and treatment at primary health facilities.

People who have participated in health insurance continuously for 5 years or more and the amount of co-payment for medical examination and treatment in the year is greater than 6 times the basic salary will also enjoy 100% of the cost. At the same time, all cases of emergency medical examination and treatment at any medical facility will be fully paid.

Cases of self-examination and treatment outside the designated medical facility are entitled to 100% of the benefit level.

An important new point is that the 2024 Health Insurance Law expands benefits for patients who seek medical examination and treatment outside the health care system.

Ethnic minorities and poor households living in economically and socially disadvantaged areas, especially disadvantaged areas, and people living in island communes and island districts receiving inpatient treatment at specialized facilities are entitled to 100% of the benefit level.

Cases of medical examination and treatment at basic or specialized facilities that are diagnosed to treat serious diseases, rare diseases, requiring surgery or high technology according to regulations of the Ministry of Health are also subject to priority policies.

List of 62 critical illnesses covered by 100% health insurance without referral

Circular No. 01/2025/TT-BYT, effective from January 1, 2025, stipulates that people with serious illnesses in the list of 62 diseases are entitled to 100% health insurance without needing a referral when going to a specialized medical facility.

Tuberculous meningitis

Tuberculous meningitis

Other tuberculosis of the nervous system

Tuberculosis of nervous system, unspecified

Pulmonary mycobacterial infection

Acute pulmonary histoplasma capsulatum infection

Acute pulmonary blastomycosis

Paracoccidioidomycosis of the lungs

Pulmonary sporotrichosis

Invasive pulmonary aspergillosis

Cryptococcal infection of the lungs

Pulmonary mucormycosis

Disseminated mucormycosis

Pancreatic cancer

Thymic malignancy

Malignant tumors of the heart, mediastinum and pleura

Malignant neoplasm of bone and articular cartilage of other and unspecified sites

Malignant tumor of the meninges

Malignant brain tumor

Malignant tumors of the spinal cord, cranial nerves, and other parts of the central nervous system

Secondary malignant tumors of the brain and meninges

Malignant tumor group

Malignant neoplasms of the lymphoid system, hematopoietic system and related tissues

Myelodysplastic syndrome

Other forms of bone marrow failure

Other hypercoagulable diseases (Antiphospholipid syndrome)

Infection-associated hemophagocytic lymphohistiocytosis

Insulin-dependent diabetes mellitus (with multiple complications)

Non-insulin dependent diabetes mellitus

Aromatic amino acid metabolism disorders

Branched-chain amino acid metabolism disorders and fatty acid metabolism disorders

Other disorders of amino acid metabolism

Lysosomal storage disorders (Pompe disease, MPS disease, Gaucher disease, Fabry disease)

Disorders of copper metabolism (including Wilson's disease)

Amyloidosis

Recurrent depressive disorder

Obsessive-compulsive disorder

Encephalitis, myelitis and encephalomyelitis

Multiple sclerosis

Neuromyelitis optica [Devic]

Myasthenia gravis

Retinopathy of prematurity

Heart failure

Toxic epidermal necrolysis (Lyell/Steven Johnson)

Post-cardiac surgery syndrome

Other dysfunctions after cardiac surgery

Other interstitial lung diseases

Lung and mediastinal abscess

Empyema (severe infection of the lungs)

Crohn's disease (regional enteritis)

Pemphigus

Reticular vasculitis

Febrile neutrophilic dermatosis [Sweet's syndrome]

Systemic lupus erythematosus with visceral involvement

Neonatal diabetes

Other congenital malformations of the brain

Other congenital malformations of the spinal cord

Group of congenital malformations of the circulatory system

Congenital deformity of the hip joint

Resistance to anti-tuberculosis drugs

Sequelae of War Activities (Sequelae of War Wounds)

Status of organ and tissue grafts