From July 1, 2026, when the base salary increases to 2.53 million VND/month according to Decree 161/2026/ND-CP, the co-payment cost threshold for health insurance (HI) participants for 5 consecutive years to enjoy 100% of medical examination and treatment costs also increases accordingly.
According to Clause 17 Article 1 of the Law amending and supplementing a number of articles of the Law on Health Insurance in 2024, health insurance participants will be paid 100% of medical examination and treatment costs within the scope of benefits by the health insurance fund if they simultaneously meet the following conditions:
Having participated in health insurance for 5 consecutive years or more;
Having the amount of co-payment for medical examination and treatment costs in the year greater than 6 times the reference level;
Medical examination and treatment in accordance with regulations, including the correct registered place, the correct referral process or in cases where benefits are allowed when medical examination and treatment are not in the original registered place as prescribed by law.
Cases that still enjoy benefits include emergency medical examination and treatment at any medical facility; medical examination and treatment according to the referral process; examination at the initial registration facility; inpatient examination at basic medical examination and treatment facilities; or medical examination and treatment for some rare diseases, dangerous diseases, diseases requiring surgery, high technology according to the regulations of the Ministry of Health.
For ethnic minorities, people from poor households living in areas with difficult socio-economic conditions, especially difficult conditions, or in island communes and island districts, health insurance benefits are also guaranteed when inpatient examination and treatment at specialized medical examination and treatment facilities as prescribed.
From July 1, 2026, the base salary increases from 2.34 million VND to 2.53 million VND/month. Accordingly, the "6 times the reference level" threshold is adjusted from 14.04 million VND to 15.18 million VND.
This means that people participating in health insurance for 5 consecutive years will only receive 100% of medical examination and treatment costs when the amount of co-payment in the year exceeds 15.18 million VND, instead of 14.04 million VND as before.
The adjustment of the co-payment threshold is to be consistent with the new basic salary level, while the remaining conditions to enjoy 5-year consecutive health insurance benefits are still maintained according to the provisions of the amended Law on Health Insurance in 2024.
