What are the benefits of health insurance? Rights and obligations of participants in the US

What are the benefits of health insurance? Rights and obligations of participants in the US Vietnam's Health Insurance (HI) system, organized by the State to provide universal healthcare, is one of the most practical social welfare policies and has gained wide participation from the public and workforce. So what exactly is health insurance? What are the rights and obligations of participants? This article from eBH (Electronic Social Insurance) will help answer those questions.

1. What is Health Insurance?

According to Clause 1, Article 2 of the Law on Health Insurance 2008, amended by Clause 1, Article 1 of the 2014 Law on Health Insurance, the definition of Health Insurance (HI) is as follows:
What are the benefits of health insurance? Rights and obligations of participants in the US

“Health insurance is a form of compulsory insurance applied to subjects as prescribed by law to provide healthcare, operated by the State on a non-profit basis.”

The goal of the HI system is to reduce the financial burden of medical expenses for participants and provide better access to quality healthcare services, based on the principle of risk-sharing among contributors.

Medical expenses under the HI scheme are jointly covered by the Health Insurance Fund and the insured individual.

According to Clause 3, Article 2 of the 2008 Law, as amended by Clause 35, Article 1 of the 2024 HI Law, the Health Insurance Fund is:

“A financial fund formed from health insurance contributions and other lawful sources, used to pay for healthcare costs of insured individuals, administrative costs of the Social Insurance Agency, and other lawful HI-related expenses.”

This fund is centrally and transparently managed, ensuring balanced revenues and expenditures and is guaranteed by the State.

1.1 Responsible Authority

Previously, HI was managed by health insurance organizations (as per Article 9 of the 2008 Law). However, starting from July 1, 2025, under Clause 7, Article 1 of the 2024 Law, the Vietnam Social Security (VSS) will be the sole responsible agency for implementing HI policies and managing the HI fund.

1.2 Types of Health Insurance Participation

In 2025, based on the participant's category, there are two forms of participation:

1. Compulsory Health Insurance
   Applied to employees, employers, civil servants, and officials who are required by law to participate in the scheme.

2. Voluntary Health Insurance
   Designed for individuals not subject to compulsory coverage, offering everyone access to healthcare support. Participants can choose payment methods and contribution levels based on their financial conditions.

Household-based HI participation allows all household members to enroll. The more members join within the same fiscal year, the greater the premium discount offered.

2. Rights and Obligations of Health Insurance Participants

According to Chapter 8 of the 2008 Law, amended by the 2014 Law, participants have the following:

2.1 Rights

As outlined in Article 36 of the 2008 Law and Clause 24, Article 1 of the 2014 Law:

1. Health Insurance Card
   Upon payment, participants receive a HI card, required for receiving healthcare at authorized medical facilities.
   Starting in 2025, both a paper card and an electronic card (via VNeID/VssID) will be issued free of charge and are equally valid.

2. Household Registration Option
   Applicable to family members not subject to compulsory HI. Discounts are provided based on the number of household members participating.

3. Choice of Healthcare Provider
   Participants can choose their initial medical facility (noted on their HI card).
   From July 1, 2025, they can change their registered facility within the first 15 days of each quarter.

4. Access to HI Medical Services
   Participants can receive care at all HI-authorized facilities.

5. Reimbursement of Medical Costs
   Depending on treatment level, medical condition, and participant type, reimbursement rates range from 40% to 100%.

6. Right to Information
   Participants can request information on HI policies, procedures, and their entitlements.

7. Right to File Complaints
   Participants may file complaints or report violations of HI laws by involved entities or individuals.
   What are the benefits of health insurance? Rights and obligations of participants in the US

2.2 Obligations

According to Article 37 of the 2008 Law, to enjoy full benefits, participants must:

1. Pay HI premiums fully and on time.

2. Use the HI card properly — it must not be lent or transferred to others.

3. Follow regulations and procedures during medical visits.

4. Pay the non-covered portion of medical costs as per the regulations.

3. Health Insurance Contributions and Benefits

Outlined in Clauses 2 and 3, Article 3 of the 2008 Law and amended by subsequent laws in 2014 and 2024.

3.1 Contribution Rates

As per Clause 2, Article 1 of the 2024 Law:

• HI contributions are calculated as a percentage of monthly salary, pension, allowance, or reference income, depending on the participant’s group.

Who is responsible for paying HI contributions?

From July 1, 2025, based on Clause 11, Article 1 of the 2024 Law, responsibility lies with:

1. Employers and employees

2. Social insurance organizations

3. The State Budget (fully or partially)

4. Individuals or jointly with commune-level People’s Committees

3.2 Benefit Rates

According to Clause 3, Article 3 of the 2008 Law, amended in 2014 and 2024:

Benefit rates depend on:

• The severity of the medical condition

• The category of participant

• The duration of participation

Before July 1, 2025: Benefits are regulated by Clause 15, Article 1 of the 2014 Law (amending Article 22 of the 2008 Law).
From July 1, 2025: New rules in Clause 17, Article 7 of the 2024 Law apply.

For example:

• If the patient follows referral regulations, the Health Insurance Fund covers 40% to 100% of expenses depending on the case.

• In emergency situations, participants are eligible for 100% coverage at any medical facility.

• Those eligible under multiple participant categories will receive the highest applicable benefit rate.

4. Prohibited Acts in Health Insurance

Under Article 11 of the 2008 Law, participants must avoid the following violations to prevent legal penalties:

• Failing to pay or underpaying HI contributions

• Falsifying HI cards or lending them to others

• Providing false information or data related to HI
  What are the benefits of health insurance? Rights and obligations of participants in the US

Conclusion

The information above outlines the structure and benefits of Vietnam’s health insurance system, as updated by eBH (Electronic Social Insurance). We hope it provides clarity and helps individuals make informed decisions regarding their healthcare participation.

For assistance, please contact eBH or call the Vietnam Social Insurance Customer Support Hotline at 1900 9068 (charges: 1,000 VND/minute).