Khám chữa bệnh BHYT năm 2026: Thủ tục mới nhất người dân cần biết

From 2026 onwards, the health insurance examination and treatment process will undergo some important adjustments. Understanding these regulations will save time and minimize complications.

According to Article 37 of Decree 188/2025/ND-CP guiding the procedures for medical examination and treatment under health insurance as stipulated in Clause 1, Article 28 of the 2008 Health Insurance Law, No. 25/2008/QH12, amended and supplemented by the 2024 amended Health Insurance Law, No. 51/2024/QH15, the following documents are required for health insurance examination and treatment:

Documents required for health insurance examination and treatment:

Individuals participating in health insurance must present information about their health insurance card and identification documents in one of the following forms:

Citizen ID card or electronic identification account (VNeID) level 2 with integrated health insurance card information.

Individuals participating in health insurance must present information about their health insurance card and identification documents.

Electronic or paper health insurance card.

In cases where health insurance card information cannot be retrieved from the information technology system, A paper copy of the health insurance card must be presented.

If the health insurance card does not have a photo or health insurance number, one of the following identity documents must be presented: National ID card, citizen ID card, certificate of identity, passport, linked to a level 2 electronic identification account (VNeID) or the VssID application, or other identity documents issued by a competent agency or organization, or a confirmation letter from the commune police.

People can present the electronic health insurance card on VNeID or VssID instead of the paper copy when receiving medical treatment.

Procedures for children under 6 years old:
Only present: Paper or electronic health insurance card or health insurance number.

If a health insurance card has not yet been issued, present the original or a copy of the birth certificate.

For newborns: The father or mother or relative of the child must sign the medical record. In cases where the child has no parents or relatives: The representative of the medical facility must confirm this on the medical record.

In cases awaiting issuance, re-issuance, or replacement of health insurance cards:
Individuals participating in health insurance who are awaiting issuance or changes to their health insurance card information must present the following when seeking medical examination or treatment:

The receipt of application and appointment for issuance, re-issuance, or replacement of the health insurance card.

Information on the health insurance card issued by the Social Insurance agency or an organization/individual authorized by the Social Insurance agency to receive applications for re-issuance or replacement of the card.

One type of document proving the person's identity as stipulated in point b, clause 1 of this Article.

In cases of organ donation: Individuals who have donated organs must present information on their health insurance card as stipulated in clause 1 or clause 3 of this Article.

In cases where a health insurance card is not yet available, the following must be presented:

A discharge certificate issued by the medical facility where the organ was harvested.

One of the following documents proving the donor's identity: National ID card, citizen ID card, certificate of identity, passport, linked to a level 2 electronic identification account (VNeID) or the VssID application, or other identity documents issued by a competent authority or organization.

If, at the time the patient finishes their medical examination, treatment, or discharge, the electronic health insurance card management system is still malfunctioning and cannot extract information, and the Social Insurance agency has not yet verified the information:

In cases where a health insurance card is not yet available but immediate treatment is required after donation, the medical facility and the patient or their family member must confirm this in the medical record.

Emergency Cases
In emergency cases, health insurance participants must present the documents as prescribed in Clause 1, Clause 2, or Clause 3 of this Article before the end of the treatment period.

Health Insurance Examination and Treatment Procedures in Certain Cases
If a patient with a health insurance card presents their card information late when seeking medical examination or treatment, the health insurance fund will reimburse the medical examination and treatment costs within the scope of benefits and coverage levels from the time the health insurance card information is presented, except in emergency cases. Medical examination and treatment costs incurred during the period when the patient has not presented their health insurance card information will be reimbursed directly by the health insurance fund as prescribed in Articles 55, 56, and 57 of this Decree.

Patients provide their health insurance card number to the medical facility so that it can look up the information on the Vietnam Social Security Data Reception Portal.

In cases where a patient has an electronic health insurance card but cannot present it during a medical examination or treatment due to a link to a level 2 electronic identification account (VNeID), a VssID application error, or an internet connection error, the following procedure should be followed:

The patient provides their health insurance card number to the medical facility so that it can look up the information on the Vietnam Social Security Data Reception Portal. If the Vietnam Social Security Data Reception Portal cannot retrieve the information, the medical facility should record the health insurance card number and admit the patient for examination and treatment. The medical facility should coordinate with the Social Security agency to re-look up the patient's health insurance card information to determine the scope, benefits, and entitlements covered by health insurance.

In cases where, at the time a patient finishes their medical examination, treatment, or discharge, the electronic health insurance card management system is still malfunctioning and unable to extract information, and the Social Insurance agency has not yet verified or clarified the information, the medical facility is responsible for sending all medical records, patient contact information, and screenshots of the search to the Social Insurance agency for further verification once the system is restored and for assessment and payment of medical expenses according to regulations.

Patients are responsible for providing information about their health insurance participation status and health insurance card information to the medical facility and ensuring the accuracy of the information provided.

Medical facilities and the Social Insurance agency are not allowed to prescribe additional health insurance medical examination and treatment procedures beyond those stipulated in this article.

Medical facilities and the Social Insurance agency are not allowed to prescribe additional health insurance medical examination and treatment procedures beyond those stipulated. In cases where medical examination and treatment facilities or social insurance agencies need to photocopy health insurance cards and other documents related to patients' medical examinations and treatments for management purposes, they must make the photocopies themselves after obtaining the consent of the patient or their guardian. They are not allowed to request the patient to make the photocopies or pay for this cost.