Many cases are paid 50%
Before July 1, 2026, if people with health insurance cards come for outpatient check-ups not at the original registered place or do not have a referral letter, the health insurance fund will only pay 100% of the benefit level for some diseases in the list prescribed by the Ministry of Health. The remaining diseases will not be paid.
From July 1, 2026, new regulations expand rights as follows:
Diseases on the list of the Ministry of Health are still entitled to 100% of the health insurance benefit level as before.
Diseases outside the list will be paid 50% of the benefit level by the health insurance fund, instead of not being supported.
This helps patients save significant costs when needing outpatient examinations outside the tuyến.
Not every hospital is applied
The 50% payment rate does not apply to all hospitals.
The policy is only applied at some basic and specialized level medical examination and treatment facilities according to the provisions of law. Therefore, before going for examination, people should find out if the medical facility they choose is eligible for the policy or not.
How is 50% of the benefit level calculated?
Many people easily misunderstand that health insurance will pay 50% of the total medical examination costs. In fact, it is not so.
The figure of 50% is calculated based on the health insurance benefit level of each person, not on the entire invoice.
For example:
People with a health insurance benefit level of 80% will be paid 40% of the costs within their benefit scope by the health insurance fund.
People with a benefit level of 95% will be paid 47.5% of the expenses.
People belonging to the 100% benefit group will be paid 50% of the costs.
Expenses outside the scope of health insurance such as on-demand services or costs that are not eligible for payment are still paid by patients themselves.
To enjoy benefits, conditions need to be met
The new regulation does not mean that from July 1, 2026, people with health insurance cards can go to any hospital and be paid 50%.
Being entitled to benefits also depends on many factors such as:
Professional level of medical examination and treatment facility.
Disease or group of diseases diagnosed.
Health insurance benefit level for patients.
To fully enjoy benefits, health insurance participants should still have medical examinations at the initial registration place or comply with regulations on referrals.
If you want to go for outpatient check-ups at another facility, people should contact the hospital or social insurance agency in advance to know if the facility is applying the new policy or not.
