3 new regulations on health insurance examination and treatment take effect from January 1, 2025

From January 1, 2025, people participating in health insurance will enjoy a number of new regulations, facilitating medical examination and treatment, improving benefits and reducing administrative procedures.

3 new regulations on health insurance examination and treatment take effect from January 1, 2025

From January 1, 2025, people participating in health insurance will enjoy a number of new regulations, facilitating medical examination and treatment, improving benefits and reducing administrative procedures.

These important changes are stipulated in the Law amending and supplementing a number of articles of the Law on Health Insurance, with the aim of improving the quality of health services and helping people access health care services more quickly and effectively. Here are three new highlights:

From January 1, 2025, the classification of health insurance drugs according to hospital classes will be officially abolished.

From 2025, patients with rare or serious diseases can be treated directly at specialized medical facilities without having to request a referral as before.

Diseases such as cancer, lupus erythematosus, organ transplants, strokes, and other serious diseases will be covered 100% by health insurance when patients are treated at higher-level hospitals. This regulation helps shorten treatment time and minimize administrative procedures, while ensuring health insurance benefits for patients.

According to Circular 22/2024/TT-BYT, from January 1, 2025, if the hospital does not have the necessary medicine or medical equipment in the health insurance list, the patient will be reimbursed when purchasing medicine or equipment outside.

Refund conditions include: the hospital does not have the medicine because it has not selected a supplier or there is no alternative medicine. Patients only need to provide a receipt for the purchase of medicine or equipment at a pharmaceutical facility and social insurance will pay the cost according to the price listed on the receipt, not exceeding the hospital's prescribed payment level.

From January 1, 2025, the classification of health insurance drugs according to hospital classes will be officially abolished. Instead, medical examination and treatment facilities will be allowed to use the entire list of drugs within their scope of expertise regardless of hospital class.

This helps people access timely treatment drugs, especially in emergency situations or when lower-level hospitals do not have treatment drugs.

Circular 37/2024/TT-BYT also stipulates a flexible payment mechanism for drugs to treat rare or chronic diseases, while reducing the time to process documents so that health insurance participants can receive benefits more quickly.

These new regulations not only help reduce the burden of medical costs on people but also create fairness in access to health care services.

Removing the drug classification regulations will help lower-level hospitals provide better quality medical services, while reducing the burden on upper-level hospitals. Lower-level medical facilities will be encouraged to invest in equipment, improve the quality of treatment, and attract medical personnel.

Health insurance regulations will also facilitate people to seek medical examination and treatment at any medical facility in the country without having to worry about complicated referral procedures.

In addition, changes in payment for medicine and medical equipment costs help patients reduce costs and easily access quality medical services.

New regulations on health insurance from January 1, 2025 are expected to create an important shift in the health insurance system in Vietnam.

The Government and the Ministry of Health hope that these changes will not only help improve the quality of medical examination and treatment but also contribute to ensuring the rights of health insurance participants, helping to reduce the proportion of direct out-of-pocket costs for people, while improving the efficiency of using the health insurance fund.

Source: https://baodautu.vn/3-quy-dinh-moi-ve-kham-chua-benh-bao-hiem-y-te-co-hieu-luc-tu-ngay-112025-d236569.html