Health Insurance: Update Benefit Codes

by priyanka.patel tech editor

Vietnam Expands Healthcare Coverage: Low-Income & Elderly Residents Gain Full Reimbursement

Vietnam is bolstering access to healthcare for its most vulnerable citizens, wiht a new directive guaranteeing 100% reimbursement of medical costs for low-income households and residents aged 75 and over who receive a social pension. The Ministry of Health issued the order on Thursday, mandating urgent changes to benefit codes within the nation’s health insurance system to ensure full coverage for eligible individuals.

Expanding Access to Essential Care

The resolution, outlined in Article 2, paragraph 1, number 261/2025/QH15, aims to eliminate financial barriers to healthcare for those most in need. Currently, individuals from low-income households with the insured code “CN” receive 95% reimbursement under benefit code 3. similarly, those aged 75 and over receiving an old-age pension, identified by the insured person code “LH,” are currently covered at 80% under benefit code 4.

“Persons participating in health insurance and belonging to low-income households, as well as older people aged 75 and over who receive a social pension, are entitled to 100% reimbursement of the costs of medical examinations and treatments within the scope of health insurance benefits,” a senior official stated.

Did you know? – Vietnam’s health insurance system covers over 90% of the population, but reimbursement levels have historically varied based on income and age. This directive aims to address those disparities.

Urgent Code Updates Required

To enact this change, the Ministry of Health has directed the Vietnamese social Security governance to swiftly update the benefit codes. Specifically, insured individuals with code “CN” will transition from benefit code 3 to benefit code 2, reflecting the 100% reimbursement level. Likewise, those with code “LH” will move from benefit code 4 to benefit code 2.

This transition is critical to ensuring that eligible citizens receive the full extent of their entitled benefits. The ministry of Health is emphasizing the importance of accurate record-keeping and efficient processing of claims.

Pro tip – Healthcare facilities should verify patient insurance codes at the point of service to ensure the correct reimbursement rate is applied. Contacting claims officers is encouraged for assistance.

Nationwide Implementation & Oversight

All medical examination and treatment facilities across Vietnam are now required to verify health insurance card information and uphold the rights of insured individuals, adhering to all applicable regulations. Facilities are instructed to proactively contact relevant claims officers and social security representatives should any difficulties arise during implementation.

Provincial and city health authorities have been tasked with overseeing the implementation of these provisions within their respective jurisdictions, ensuring consistent application and equitable access to care.

This directive represents a notable step towards strengthening Vietnam’s social safety net and ensuring that all citizens have access to the healthcare they need, regardless of their financial circumstances. The Ministry of Health anticipates a smooth transition and ongoing monitoring to maximize the impact of this expanded coverage.

Why: The Vietnamese Ministry of Health issued a directive to expand healthcare coverage and eliminate financial barriers to care for low-income households and residents aged 75 and over receiving a social pension.

Who: the directive impacts low-income households (identified by insurance code “CN”) and residents aged 75 and over receiving a social pension (identified by insurance code “LH”). It also affects all medical examination and treatment facilities across Vietnam, and also provincial and city health authorities.

What: The directive guarantees 100% reimbursement of medical costs for eligible individuals, up from 95% and 80% respectively. This requires updating health insurance benefit codes from 3/4 to 2.

How did it end?: The directive was issued on thursday and requires immediate implementation. The Ministry of Health anticipates a smooth transition with ongoing monitoring to maximize the impact of the expanded coverage. Provincial and city health authorities are responsible for overseeing implementation and ensuring equitable access to care.

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