On January 1, 2025, the Ministry of Health issued Circular No. 01/2025/TT-BYT, detailing and guiding the implementation of several articles of the Law on Health Insurance. This document updates many significant points regarding applicable subjects, initial medical examination and treatment registration procedures, referrals, and chronic disease management, aiming to maximize convenience for health insurance participants.
Scope and Applicable Subjects
The Circular applies broadly to health insurance participants, medical facilities, and related agencies. A notable point is the expansion of benefits regarding medical facilities under the Ministry of National Defense and the Ministry of Public Security. Specifically, these facilities are permitted to register initial medical care and accept referrals for civilian subjects not under their management. Conversely, personnel of the armed forces may also register for medical care at civilian facilities.
Medical Procedures When Changing Residence
For health insurance participants traveling for work, study, or mobile work in another province for less than 30 days, medical benefits are guaranteed if residence declaration has been completed. When seeking medical care, patients must present a dispatch letter or student ID, along with residence information updated to level 2 on the VNeID application. This regulation simplifies administrative procedures, bypassing the referral paper requirement for short-term travel cases.
Benefits for Rare Diseases, Critical Illnesses, and High-Tech Surgeries
The Circular issues a list of diseases eligible for 100% benefit coverage without requiring a referral paper. Patients diagnosed with diseases listed in Appendix I (specialized level) or Appendix II (basic level) will receive benefits immediately at that facility without undergoing facility transfer procedures.
Initial Registration and Health Insurance Card Allocation
Health insurance participants have the right to choose an initial medical facility near their residence or workplace. The allocation of health insurance cards is based on the principle of balancing the demand and the response capacity of the medical facility. Priority groups such as people with meritorious services, people over 75 years old, children, and island residents are prioritized for registration at basic or specialized level facilities depending on health conditions and specific regulations. Participants are allowed to change their initial registration place within the first 15 days of each quarter.
Regulations on Patient Transfer and Chronic Disease Management
Patient transfer is carried out according to the professional hierarchy: from the initial level to the basic level, and from the basic level to the specialized level when treatment capacity is exceeded. Specifically, for stable chronic diseases, specialized or basic level facilities may transfer patients back to commune health stations or initial level facilities for continued monitoring and medication dispensing. The initial level facility is responsible for managing, dispensing medication, and performing technical services according to the instructions of the upper level.
Transfer Records and Re-examination Appointments
The medical facility transfer form is valid for 10 working days from the date of signing. Specifically for chronic diseases or long-term treatments listed in the regulations, the transfer paper is valid for up to 01 calendar year. Regarding re-examination procedures, doctors will record the appointment schedule on the Re-examination Appointment Sheet or integrate it into the prescription/discharge paper; each sheet is valid for use only once for the next visit.
MSc. Le Viet Anh – Deputy Director of the Center for Support & Continuing Education