Many people have fallen into the situation of holding a health insurance card in their hand but still having to quietly pay almost all expenses just because... they went for examination not at the original registered place. Some people work far from home, the place of registration for medical examination and treatment is still in the old locality. Some people want to go to a hospital with a more suitable specialty. Some people simply choose medical facilities near their workplace to save travel time. These very ordinary choices often narrow health insurance benefits.
Before July 1, 2026, people with health insurance cards who go for outpatient examinations outside the prescribed line will only be paid 100% of the benefit level by the health insurance fund for some diseases on the list of the Ministry of Health; the remaining diseases will not be paid.
From July 1, 2026, benefits are expanded: diseases in the list are still entitled to 100% of the health insurance benefit level, while diseases outside the list will be paid 50% of the benefit level by the health insurance fund instead of not being supported as before. This regulation helps patients reduce costs when going for outpatient examinations outside the line. However, the 50% payment level does not apply to all hospitals but is only for some basic and specialized level medical examination and treatment facilities as prescribed.
According to new regulations, people with health insurance cards who go for outpatient examinations at some qualified medical facilities will be paid 50% of the benefit level by the health insurance fund for diseases and groups of diseases that have not been paid for before. This is not too big a change to completely eliminate the barrier of out-of-zone examinations, but it is enough to reduce the financial burden for many patients.
It is worth noting that this policy follows the direction of expanding benefits instead of just tightening regulations on proper tuyến, tuyến transfer. In the context that people are moving more and more to study, work and live, the need to be examined and treated in convenient places is very practical.
The new regulation does not mean that just going to any hospital for outpatient examination is reimbursed by health insurance. The support level only applies to some basic and specialized level medical examination and treatment facilities as prescribed, and also depends on the health insurance benefit level of each person and the scope of costs paid by the insurance fund.
In particular, many people easily misunderstand the concept of "50% benefit level". This is not health insurance paying half of the total medical examination bill. For example, people with a health insurance benefit level of 80% will be paid by the fund equivalent to 40% of the costs within the scope of benefit; people who receive 95% will be paid 47.5%, while the group receiving 100% will be paid 50%.
However, expanding from being unpaid to being partially supported is still a positive change. For patients with chronic diseases who have to be re-examined many times or workers with low incomes, each reduced expense is meaningful.
Health insurance is built on the spirit of risk sharing and ensuring social security. Therefore, every time the benefits of participants are expanded, it contributes to bringing this policy closer to the goal of serving the people.
Medical examination and treatment at the right registered place or completing full referral procedures is still a way to fully enjoy benefits. But adding an "accommodation" for outpatient cases outside the line shows that HI policy is gradually adapting to real life, instead of just requiring people to adapt to regulations.
An effective social security policy is not only measured by the amount of funds paid, but also by the people's perception that when they need support, they will not be left behind just because of a difference in procedures. Expanding health insurance payments for outpatient visits from July 1, 2026 is a step in that direction.
