List of groups of subjects and diseases eligible for 100% health insurance from July 1
From 1/7/2025, there are some changes and expansions to the list of diseases and subjects covered by health insurance (HI). Below are the details:
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 and technical non-commissioned officers of the People's Public Security enjoy 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 people who have contributed to raising 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 and near-poor households residing in communes and villages in ethnic minority and mountainous areas are entitled to full medical examination and treatment costs.
People receiving monthly social benefits, monthly child support benefits as prescribed by law, and 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 costs.
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. This includes 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 for 5 consecutive years or more and whose 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 designated area.
Ethnic minorities and poor households living in economically and socially difficult areas, especially difficult areas, and people living in island communes and island districts when receiving inpatient treatment at specialized facilities are entitled to 100% of the benefits.
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 paper
Circular No. 01/2025/TT-BYT takes effect from January 1, 2025, stipulating 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 the nervous system, unspecified
Pulmonary mycobacterial infection
Acute pulmonary histoplasma capsulatum infection
Acute pulmonary blastomycosis
Paracoccidioidomycosis of the lungs
Pulmonary sporotrichosis
Invasive pulmonary aspergillosis
Pulmonary cryptococcosis
Pulmonary mucormycosis
Disseminated mucormycosis
Pancreatic malignancy
Thymic malignancy
Malignant tumors of the heart, mediastinum, and pleura
Malignant neoplasm of bone and articular cartilage of other and unspecified sites
Malignant tumors of the meninges
Malignant brain tumors
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, 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 abscesses
Empyema (severe lung infection)
Crohn's disease (regional enteritis)
Pemphigus
Reticular vasculitis
Febrile neutrophilic dermatosis [Sweet's syndrome]
Systemic lupus erythematosus with visceral damage
Neonatal diabetes
Other congenital malformations of the brain
Other congenital malformations of the spinal cord
Group of congenital malformations of the circulatory system
Congenital deformities of the hip joint
Resistance to anti-tuberculosis drugs
Sequelae of war activities (Sequelae of war wounds)
Status of organ and tissue grafts