No longer "losing everything" of health insurance benefits when undergoing out-of-zone examinations
From July 1, 2026, millions of health insurance (HI) participants will enjoy another notable benefit when going for outpatient treatment outside the prescribed line. For the first time, patients will no longer have to pay all costs themselves when choosing a medical facility outside the initial registration place, but will be paid 50% of the benefit level according to the health insurance card by the HI Fund.
For many years, Ms. Nguyen Thu Nga (Hong Ha ward, Hanoi) has regularly come to Thanh Nhan Hospital for examination and monitoring of high blood pressure and bone and joint diseases. Although fully participating in health insurance, due to outpatient examinations outside the tuyến, all medical examination, testing and medicine costs must be self-paid.
When I learned that from July, health insurance will pay a part of the out-of-zone examination costs, I am very happy. People will have more choices suitable for their accommodation and travel conditions without having to worry about losing all insurance benefits as before" - Ms. Nga shared.
Not only Ms. Nga, many people believe that the new regulations will help them be more proactive in choosing medical facilities with appropriate expertise or convenient transportation, especially for those who regularly have to monitor and treat chronic diseases.
According to new regulations, outpatients at basic-level facilities will be paid 50% of the benefit level according to the health insurance card by the Health Insurance Fund. This is considered an important step forward in the roadmap to expand benefits for insurance participants.
For people with a health insurance benefit level of 80%, if the total cost of medical examination and treatment is 1 million VND, the Health Insurance Fund will pay 400,000 VND; patients only have to pay the remaining 600,000 VND. Previously, the entire cost was paid by patients themselves.
Hospital forecasts sharp increase in patient number
While people are eagerly waiting for new policies, many hospitals are also urgently completing response plans to the possibility of increasing the number of people coming for examination.
Dr. Nguyen Van Thuong - Director of Thanh Nhan Hospital - said that currently the hospital receives about 1,500 outpatient visits and more than 1,100 inpatients each day. Of which, outpatient visits account for about 25%.
When the new policy takes effect, we expect the rate of out-of-line patients to increase to 30-35%, especially people from neighboring Hanoi localities" - Mr. Thuong assessed.
To avoid the risk of overload, the hospital has developed many response scenarios. The clinic system has been reviewed, ready to expand when necessary; medical personnel have been arranged to be strengthened; drug and consumption materials have also been prepared at a higher reserve level.
According to hospital leaders, the entire reception team, nurses, social workers and doctors have been trained on the new regulations of the Health Insurance Law to ensure that consulting and guidance for patients are agreed upon from the early days of implementation.
To avoid congestion when the number of examinees increases, hospitals are promoting the upgrade of information technology systems. At Thanh Nhan Hospital, the software has connected with the national HI database, automatically determining the benefit level and calculating costs paid by the HI fund, helping to shorten procedure time.
The hospital also prepares enough medicines and medical supplies and is ready to purchase additional supplies when necessary. Currently, the unit has the capacity to meet about 2,000 visits per day.
Not only Thanh Nhan Hospital, many medical facilities in Hanoi have also arranged more preventive clinics, strengthened human resources, classified patients and promoted communication to help people understand new benefits.
In addition to the policy of paying 50% of outpatient examination costs outside the tuyến, from July 1, the level of medical examination and treatment costs paid 100% by health insurance for cases with total costs below 15% of the base salary also increased from 351,000 VND to 37,950 VND. People can use health insurance cards, chip-based citizen identification cards or VNeID integrated with health insurance when going for medical examination and treatment.
