How to Use Health Insurance Cards Correctly: Which Hospitals Are Eligible for 100% Coverage?

Date: 2025.08.14

Already Have a Health Insurance Card — So Why Are You Still Paying Medical Fees?

Wrong-level medical examination: Losing your health insurance benefits entirely?

The reality: not everyone with health insurance gets 100% coverage. However, since 2024, numerous positive changes have created opportunities for many groups of patients to receive fully covered treatment — provided they know which category they belong to and visit the correct facility.

This article will clarify:

– Who is eligible for 100% health insurance coverage?

– Where should you go for proper-level medical examinations?

– How to avoid losing your benefits due to lack of information?

1. List of 62 diseases eligible for 100% health Insurance coverage without referral

According to Circular 01/2025/TT-BYT issued by the Ministry of Health, effective January 1, 2025, patients diagnosed with 62 types of critical illnesses, rare diseases, or requiring advanced medical interventions will be covered 100% by the health insurance fund for medical examination and treatment costs—without the need for a referral letter.

Notable conditions include:

– Tuberculous meningitis

– Tuberculous brain tumor

– Pulmonary mycobacterial infection

– Malignant thymoma

– Rare cancers

– Metabolic genetic diseases…

➡️ Patients can directly visit provincial or central hospitals for treatment without facing payment refusal or the need to request a referral.

2. Groups eligible for 100% health insurance coverage for medical treatment

Beyond the cases involving the 62 diseases listed above, the new regulations also expand the scope of individuals entitled to 100% health insurance coverage for medical treatment costs, including:

🧍‍♂️ Priority and Special Policy Groups:

– Active-duty armed forces personnel, armed forces trainees, and permanent militia members.

– War veterans, revolution contributors, and relatives of martyrs.

– Children under 6 years old.

🏠 Disadvantaged Groups:

– People living in poverty.

– Ethnic minorities in near-poor households living in difficult, especially difficult areas, island communes, and island districts.

– Residents of communes in revolutionary safe zones, remote areas, and economically disadvantaged regions.

💸 Recipients of allowances and pensions:

– People receiving social assistance, nursing allowances, or monthly survivor benefits.

– People aged 75+ receiving survivor benefits.

– People aged 70 to under 75 from near-poor households receiving survivor benefits.

– Pensioners or those with low-level labor incapacity allowances.

🏥 Special Cases:

– Patients with any of the 62 eligible diseases (see Section 1).

– Emergency patients treated at the nearest hospital with a valid card.

– Individuals insured for 5+ consecutive years whose treatment costs exceed the payment cap.

These changes simplify procedures and expand coverage, especially for critical illness and emergency cases — a step toward a fairer, more accessible healthcare system.

3. Proper-level treatment at Primary healthcare facilities = 100% coverage

According to regulations, health insurance participants receive full coverage when treated at their registered primary facility, including:

– Commune, ward, and town health stations
These are the closest grassroots health centers to the community, providing care and treatment for common illnesses.

– Family medicine clinics or health centers
Clinics or centers that offer primary healthcare services based on the family medicine model.

– Military-civilian clinics
Part of the military health system, serving military personnel and civilians in military areas.

– District health centers with licensed clinics
General clinics under the district health center, handling common diseases and referring patients to higher levels when necessary.

– Healthcare units of authorized agencies/organizations
Medical units operated by authorized agencies or organizations with valid licenses.

– Military and police sector medical facilities
Medical facilities under the Ministry of National Defense and the Ministry of Public Security, as regulated by their respective ministers.

Important Notes:

– Treatment must be at the registered level to qualify, meaning at the primary healthcare facilities listed above.

– Health insurance participants receiving treatment at these facilities will have 100% of their medical expenses covered by the health insurance fund, within their entitled benefits.

– This policy encourages grassroots healthcare use, reduces higher-level hospital overload, and saves costs.

4. Documents required?

– When using a health insurance card for medical examination and treatment, participants need to prepare the following documents to ensure full entitlement to benefits:

– Valid Health Insurance Card: The original, valid health insurance card issued by the social insurance agency.

– Identification Documents: National ID card (CMND/CCCD) or other photo ID for identity verification.

– Additional proof if applicable:

– Health insurance participation declaration form (for first-time participants or card replacement).

– List of health insurance participants prepared by the agency, unit, or local authority (for those under collective management).

Additionally, in cases of emergency treatment or visiting the nearest healthcare facility, patients should also bring documents proving eligibility for 100% coverage (e.g., certificate of poverty status, documents proving special policy beneficiary status, etc.).

5. Conclusion

A health insurance card is small but invaluable.. However, to receive 100% coverage of hospital fees, simply “carrying the card” is not enough. The key lies in having the right knowledge, going to the correct facility, and bringing complete documents.

With the positive changes from 2024 to 2025, many diseases and patient groups have had their benefits expanded, allowing full payment without the need for referrals. This is a great opportunity—but only useful if you know how to use it correctly.

⚠️ Important tips to maximize your health insurance benefits:

🔹 Always bring your original health insurance card along with your ID (CCCD/CMND) when seeking medical care.

🔹 Verify your registered primary healthcare facility carefully to ensure you receive proper-level treatment when needed.

🔹 Inpatient treatment at provincial hospitals: No referral is required, and you will still receive 100% coverage.

🔹 If diagnosed with one of the 62 critical illnesses: You can go directly to central hospitals and still get full coverage.

🔹 In emergencies: No referral required—just go to the nearest hospital and present your card afterward.

🔹 Regularly check your health insurance card’s validity to avoid payment denial due to expiration.

_{Source: Legal Library – Excerpt from Circular 01/2025/TT-BYT}