Non-referred diseases will still enjoy 100% health insurance in 2025

(Dan Tri) - According to new regulations, people with one of 62 serious illnesses will not need a referral letter and will still enjoy 100% health insurance benefits.

People with serious illnesses can go to specialized medical facilities for treatment without needing to be referred (Illustration: Duc Trinh).

The Ministry of Health has just issued Circular No. 01/2025/TT-BYT detailing and guiding the implementation of a number of articles of the Law on Health Insurance (HI). The Circular takes effect from January 1.

According to regulations, patients participating in health insurance must go to the medical facility where they initially registered for health insurance. In case of necessity, the treating doctor will prescribe a referral but must ensure the correct procedure.

If a patient voluntarily goes to a specialized medical facility for examination and treatment, not at the medical facility initially registered, he/she will not be entitled to health insurance at the prescribed level (depending on the case and the participant, the health insurance benefit rate will be different).

However, in Article 5, Circular No. 01/2025/TT-BYT stipulates that patients diagnosed with 62 rare and serious diseases will be examined and treated at specialized medical examination and treatment facilities.

In case a patient is diagnosed by a medical facility with one of the 62 diseases above, they are still entitled to 100% of the health insurance benefits as prescribed when they go to a specialist for examination and treatment without having to comply with the referral regulations or need a referral letter.

The list of these diseases is issued in Appendix I of Circular No. 01/2025/TT-BYT. Specifically as follows:

List of some diseases that can be examined and treated at specialized medical examination and treatment facilities from 2025 (Graphic: Tung Nguyen).

Source: https://dantri.com.vn/an-sinh/nhung-benh-khong-chuyen-tuyen-van-duoc-huong-bhyt-100-trong-nam-2025-20250107125759644.htm