Law 51/2024/QH15 amending the Health Insurance Law, effective 01/7/2025, together with guiding Decree 188/2025/ND-CP, is the biggest health-insurance change in years: wider compulsory coverage, eased cross-level treatment access and new benefits. Employers — especially those with foreign staff — must update both contribution compliance and how they brief employees on entitlements.
Contributions and covered persons: what employers must get right
The employee health-insurance contribution remains 4.5% of the monthly salary used as the contribution base, split 3% employer and 1.5% employee, within the compulsory social-insurance package employers already administer. The real change is scope: more groups are clarified as compulsory participants or state-supported. Foreign employees working in Vietnam under labour contracts are compulsory health-insurance participants on the same footing as Vietnamese staff — an FDI employer cannot contract out by paying cash instead, and non-payment is both an administrative violation in social insurance and a ground for arrears collection.
Benefits: referral easing is the headline change
The amendment replaces the old administrative ‘correct referral line’ logic with management by technical specialty level, so participants can be treated at facilities matching the required specialty level without the former line barriers in many cases; reimbursement still tiers by participant group (commonly 80%, with 95-100% for priority groups). New treatment forms such as telemedicine and home visits within regulated scope were added, and the reimbursable drug and technical-service lists expand on a roadmap. In practice HR must still brief staff: initial registration remains important for routine care, and self-referring beyond the covered level outside the eased-referral cases reduces reimbursement — the point employees most often discover only at the payment desk.
Employer compliance duties
After 01/7/2025 employers should: register every compulsory participant including newly hired foreign staff; reconcile contribution salary bases with the rules to avoid arrears on inspection; and update internal processes for (now mainly electronic, via VssID) cards and for staff without social-insurance numbers. Employers should also present the upgraded public coverage in offer packages for foreign experts, since it genuinely substitutes part of basic private cover.
Recommendations
Run an internal briefing on the 2025 changes for both Vietnamese and foreign staff; audit for unregistered or under-contributing employees; and observe Decree 188/2025/ND-CP’s application milestones for cases arising around the law’s effective date. Foreign staff holding private international policies remain compulsory participants in parallel — there is no individual opt-out by agreement.
Frequently Asked Questions
What is the current health-insurance contribution rate?
For contracted employees it is 4.5% of the contribution-base monthly salary: 3% employer, 1.5% employee. Law 51/2024/QH15 effective 01/7/2025 keeps this rate structure while widening coverage and benefits; guidance sits in Decree 188/2025/ND-CP.
How were treatment benefits expanded?
The amendment eases cross-level access by technical specialty level instead of administrative lines in many cases, adds telemedicine and home treatment within regulated scope, and expands reimbursable lists on a roadmap. Reimbursement still tiers by group — commonly 80%, and 95-100% for priority groups.
How does provincial/central referral now work?
Management is by the facility’s technical specialty level rather than the former provincial/central administrative lines. Full-rate benefits apply when treatment is at a facility matching the specialty level and within an eased-referral case; see Decree 188/2025/ND-CP for case detail.
What happens if a patient self-refers to a higher level?
Treatment beyond the covered specialty level without an eased-referral case or proper transfer documentation reduces the reimbursement rate by law. Employees should be briefed before self-referring to top-tier hospitals.
This article has been quality-reviewed by the FLAW AI Legal Council