Ministry of Health clarifies the health insurance benefit level for retirees over 75 years old

Pensioners are paid 95% of medical examination and treatment costs by health insurance.

Voters in An Giang province proposed adjusting the health insurance payment policy for retired officials, especially those aged 75 and over who are seriously ill and require regular treatment. According to voters, having to self-pay 5% of medical examination and treatment costs may create a financial burden, significantly affecting the monthly income of pensioners.

Responding to the proposal, the Ministry of Health said that people who are receiving pensions belonging to groups covered by social insurance agencies, are paid 95% of medical examination and treatment costs within the scope of benefits by the health insurance fund. People who have participated in health insurance for 5 consecutive years or more, have co-payment amounts in the year exceeding 6 times the reference level and meet the conditions according to regulations will be paid 100% of costs within the scope of benefits by the health insurance fund.

From January 1, 2026, people from 75 years old who are receiving social pension benefits will be paid 100% of medical examination and treatment costs within the scope of benefits by health insurance. This policy applies to groups eligible for social pension benefits, not automatically applied to all people from 75 years old who are receiving pensions.

The Ministry of Health acknowledges the proposal to study raising the health insurance benefit level for retirees from 75 years old, especially those with low pensions, suffering from serious illnesses or chronic diseases requiring long-term treatment.

Research policies to encourage long-term health insurance participants

Voters also proposed to supplement preferential policies for people who participate in health insurance continuously for more than 5 years, 10 years or longer, in order to encourage people to maintain participation and contribute to the implementation of the goal of universal health insurance.

According to the Ministry of Health, the current health insurance benefit level ranges from 80% to 100% of medical examination and treatment costs within the scope of benefits, depending on each subject. Participants who have participated for 5 consecutive years or more can be paid 100% of the costs within the benefit scope if they meet the conditions on the amount of co-payment and related regulations.

The Ministry of Health acknowledges the proposal to supplement incentive policies for long-term health insurance participants for research in the process of perfecting the law on health insurance.

Procedures for enjoying social allowances are not mandatory health check-ups

Regarding the proposal to review regulations on health check-ups for consideration of social allowances, the Ministry of Health cited Decree No. 20/2021/ND-CP, amended and supplemented by Decree No. 76/2024/ND-CP.

According to current regulations, the monthly social assistance application file includes declarations and related documents for information comparison, depending on the case. The documents may include citizen identification cards, birth certificates, disability confirmation papers or health status confirmation papers under the prescribed conditions.

The Ministry of Health affirmed that the procedure for requesting monthly social allowances does not require people to have health check-ups to be considered for benefits.

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