List of groups and diseases eligible for 100% health insurance coverage from July 1st.
From July 1st, 2025, there will be some changes and expansions to the list of diseases and beneficiaries covered by health insurance. Below is the detailed information:
The Health Insurance Law of 2024 (Health Insurance Law No. 51/2024/QH15) officially came into effect on July 1, 2025, bringing many positive changes aimed at expanding access to healthcare services and enhancing equity in healthcare for the people.
The following groups will be entitled to 100% coverage of medical examination and treatment costs under health insurance from July 1, 2025.
According to Clause 3, Article 12 of the 2024 Health Insurance Law, the Health Insurance Fund will cover the full cost of medical examination and treatment for many priority groups.
This includes members of the armed forces, comprising officers, non-commissioned officers, professional soldiers currently serving, and officers and non-commissioned officers specializing in technical fields within the People's Public Security Force.
Military personnel are also on the priority list, including non-commissioned officers and soldiers of the People's Army currently serving, non-commissioned officers and conscripted soldiers in the People's Public Security, as well as military, police, and intelligence trainees receiving living allowances.
For those who have rendered meritorious service to the revolution and veterans, as well as children under 6 years old, relatives of martyrs, and those who have cared for martyrs, 100% of the medical examination and treatment costs are covered by health insurance.
The law places special emphasis on 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 coverage of medical examination and treatment costs.
Those receiving monthly social welfare benefits, monthly support allowances as stipulated by law, and those receiving monthly survivor's benefits who are eligible for social welfare benefits are also included in the group receiving 100% coverage of costs.
Specifically, this preferential policy applies to individuals aged 75 and above receiving monthly survivor's benefits, and individuals aged 70 to under 75 belonging to near-poor households who are receiving monthly survivor's benefits.
In special cases, the health insurance fund covers 100% of the costs.
In addition to the main target groups, the 2024 Health Insurance Law also stipulates several special cases where the health insurance fund covers 100% of the costs. These include one-time medical examination and treatment costs below the government-regulated level and medical examination and treatment at primary-level medical facilities.
Individuals who have participated in health insurance continuously for 5 years or more and whose co-payment for medical examinations and treatments in the year exceeds 6 times the basic salary are also entitled to 100% coverage. Furthermore, all emergency medical examinations and treatments at any medical facility are fully reimbursed.
Patients who seek medical treatment outside their designated healthcare network are entitled to 100% of their benefits.
One important new feature is that the 2024 Health Insurance Law expands benefits for patients seeking medical examination and treatment outside their designated healthcare network.
Ethnic minorities and people from poor households living in socio-economically disadvantaged or extremely disadvantaged areas, as well as those living in island communes and districts, are entitled to 100% of their inpatient treatment at specialized facilities.
Cases of examination and treatment at basic or specialized facilities where a definitive diagnosis is made for the treatment of serious illnesses, rare diseases, or diseases requiring surgery or advanced techniques as regulated by the Ministry of Health are also subject to priority policies.
List of 62 critical illnesses covered by health insurance at 100% without a referral letter.
Circular No. 01/2025/TT-BYT, effective from January 1, 2025, stipulates that people suffering from serious illnesses listed in the catalog of 62 diseases are entitled to 100% health insurance coverage without needing a referral letter when visiting specialized medical facilities.
Tuberculous meningitis
Tuberculous meningitis
Other forms of tuberculosis of the nervous system
Neurological tuberculosis, unspecified
Mycobacteria infection in the lungs
Acute pulmonary histoplasma capsulatum infection
Acute pulmonary blastomycosis
Paracoccidioides fungal infection of the lungs
Lung infection
Invasive pulmonary aspergillus infection
Cryptococcal infection of the lungs
Pulmonary mucor infection
Disseminated mucor infection
Malignant pancreatic tumors
Malignant thymic tumor
Malignant tumors of the heart, mediastinum, and pleura.
Malignant tumors of bone and articular cartilage in other and unspecified locations.
Malignant tumors 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 tumors of the lymphoid system, hematopoietic system, and related tissues.
Myelodysplastic syndrome
Other forms of bone marrow failure
Other hypercoagulable disorders (Antiphospholipid syndrome)
Hemophagocytic syndrome associated with infection
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
Lysosome storage disorders (Pompeosthesia, MPS, Gaucher disease, Fabry disease)
Copper metabolism disorders (including Wilson's disease)
Powdery degeneration
Recurrent depressive disorder
Ritualistic Obsessive-Compulsive Disorder
Encephalitis, myelitis, and encephalomyelitis
Multiple sclerosis
Optic neuromyelitis [Devic]
Muscle weakness
Retinopathy of prematurity
Heart failure
Toxic epidermal necrosis (Lyell/Steven Johnson)
Post-cardiac surgery syndrome
Other functional disorders following cardiac surgery
Other interstitial lung diseases
Lung and mediastinal abscess
Chest abscess (severe lung infection)
Crohn's disease (regional inflammatory bowel disease)
Pemphigus
Reticular vasculitis
Neutropenic skin disease with fever [Sweet's syndrome]
Systemic lupus erythematosus with visceral involvement
Neonatal diabetes
Other congenital brain abnormalities
Other congenital abnormalities of the spinal cord
A group of congenital abnormalities of the circulatory system.
Congenital deformity of the hip joint
Resistance to anti-tuberculosis drugs
The aftermath of war (Aftermath of war wounds)
Condition of organ and tissue grafts
