Who gets the highest health insurance benefits?

(Dan Tri) - There are groups whose health insurance covers 100% of medical examination and treatment costs, along with many other benefits.

From January 1, the level of health insurance benefits will be adjusted when the 2024 Law on Health Insurance and Decree No. 02/2025/ND-CP detailing and guiding measures to implement the Law on Health Insurance come into effect.

Accordingly, the level of health insurance benefits for participants is stipulated in Article 22 of the 2024 Law on Health Insurance. In particular, the group entitled to the highest health insurance benefits is stipulated in Point a, Clause 1, Article 22.

People in this group enjoy two major health insurance benefits. First, they enjoy 100% of the cost of medical examination and treatment covered by health insurance. Second, the cost of medical examination and treatment outside the scope of health insurance benefits is also paid from the health insurance fund for medical examination and treatment of this group; in case this fund is not enough, it will be guaranteed by the state budget.

Different health insurance participants enjoy different health insurance benefits (Illustration: Tung Nguyen).

On January 1, 2025, the Government issued Decree No. 02/2025/ND-CP amending and supplementing a number of articles of Decree No. 146/2018/ND-CP (detailing and guiding measures to implement the Law on Health Insurance, which has been amended and supplemented by a number of articles in Decree No. 75/2023/ND-CP).

Decree No. 02/2025/ND-CP amended Article 14 of Decree No. 146/2018/ND-CP, providing more detailed regulations on the group entitled to the highest health insurance benefits.

Clause 1, Article 14 of Decree 146/2018/ND-CP stipulates that 8 groups of subjects participating in health insurance are entitled to both health insurance benefits as prescribed in Point a, Clause 1, Article 22 of the Law on Health Insurance. These 8 groups include:

Firstly, people with revolutionary contributions as prescribed in the Ordinance on preferential treatment for people with revolutionary contributions.

Second, veterans join the resistance.

Third, people participating in the resistance and defending the Fatherland.

Fourth, people who are eligible for monthly social assistance and benefits according to the provisions of the law on the elderly, the disabled and social assistance.

Fifth, people from poor households; ethnic minorities living in areas with difficult socio-economic conditions; people living in areas with especially difficult socio-economic conditions; people living in island communes, island districts and some other subjects.

Sixth, relatives of martyrs include: biological father; biological mother; wife or husband, children of martyrs; people who have contributed to raising martyrs.

Seventh, people aged 80 or older who are receiving monthly pension benefits according to the provisions of the law on social insurance.

Eighth, people from safe zone communes and revolutionary safe zones during the resistance war against France and the US are currently residing in safe zone communes during the resistance war against France and the US.

Clause 2, Article 14 of Decree 146/2018/ND-CP also stipulates 7 more groups of subjects entitled to health insurance benefits that are higher than the 8 groups above.

In addition to the two health insurance benefits stipulated in Point a, Clause 1, Article 22 of the Law on Health Insurance, these 7 groups are entitled to a third benefit: "The payment rate for drugs, medical equipment, and medical technical services within the scope of benefits of health insurance participants is not applied". These 7 groups include:

First, revolutionary activists before January 1, 1945.

Second, revolutionary activists from January 1, 1945 to the August 1945 uprising.

Third, Vietnamese Heroic Mother.

Fourth, war invalids, people enjoying policies like war invalids, war invalids of type B, and sick soldiers with a reduced working capacity of 81% or more.

Fifth, war invalids, people enjoying policies like war invalids, war invalids of type B, sick soldiers when treating wounds, or having a relapse of illness.

Sixth, resistance fighters infected with toxic chemicals have a labor capacity reduction rate of 81% or more.

Saturday, children under 6 years old.

Source: https://dantri.com.vn/an-sinh/nhung-ai-duoc-huong-quyen-loi-bao-hiem-y-te-cao-nhat-20250218135549295.htm