5-year consecutive health insurance: Automatic co-payment exemption, no application required

According to current regulations, people participating in health insurance for 5 consecutive years or more when going for medical examination and treatment (MET) at the right tuyến and having the amount of joint payment for MET costs in the year greater than the prescribed level will be entitled to 100% of MET costs within the scope of benefits.

Previously, when meeting the above conditions, patients had to keep all invoices and documents of co-payment for medical examinations and treatments in the year, then directly bring the dossier to the social insurance agency to carry out procedures to request repayment of the overpaid co-payment amount or apply for a Certificate of Non-Co-payment in the Year. This takes a lot of time and effort to travel and creates pressure on document management for patients.

Ho Chi Minh City Social Insurance said that Decree No. 188/2025/ND-CP has made a strong breakthrough to simplify administrative procedures, shifting from the mechanism of people submitting applications themselves to functional agencies proactively serving.

Specifically, Point b, Clause 2, Article 18 of Decree No. 188/2025/ND-CP details the responsibilities of social insurance agencies and medical examination and treatment facilities in automating the confirmation of health insurance participants' rights. Accordingly, the social insurance agency is responsible for automatically summarizing the accumulated co-payment amount in the financial year of health insurance participants, accurately updating the time of 5 consecutive years of each individual, and at the same time publicly and continuously disclosing this data on the Data Reception Portal of the Health Insurance Assessment Information System. On that basis, the medical examination and treatment facility directly bases on the data disclosed on the Social Insurance Reception Portal to determine when patients are exempted from co-payment right at the time of incurring medical examination and treatment costs.

Thus, health insurance participants no longer have to prepare or submit payment requests directly at the social insurance agency as before, limiting multiple trips, reducing paperwork, not having to keep invoices and documents and waiting for procedures to be resolved. The benefits are automatically confirmed by the system, ensuring that patients are exempted from co-payment right at the medical examination and treatment facility when they meet the conditions, faster, more convenient and transparent.

When going for medical examination and treatment on the right route, people only need to present their health insurance card (or health insurance card information integrated on the VssID, VNeID applications). If the accumulated co-payment amount in the financial year reaches the prescribed milestone, the interconnected data system at the medical examination and treatment facility will automatically identify and exempt 100% of co-payment costs within the health insurance scope for subsequent medical examinations and treatments in that year.

Health insurance participants need to check their participation process, medical examination and treatment history, and accumulated co-payment amount, and can proactively look up directly on the VssID - Digital Social Insurance application or the Electronic Information Portal of Vietnam Social Insurance without having to go directly to the Social Insurance agency.

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