From July 1, 2026, new regulations on health insurance policy officially take effect according to the Law on Health Insurance, Decree No. 188/2025/ND-CP and Decree No. 161/2026/ND-CP of the Government. This is the content stated in Official Dispatch No. 302/CSYT-CD dated June 1, 2026 of the Health Insurance Policy Implementation Board, Vietnam Social Security. The adjustments focus on expanding the benefits of participants, and at the same time updating the benefit level and contribution level according to the new basic salary level.
According to Vietnam Social Security, a noteworthy new point is to expand the benefit level for health insurance participants who self-go for outpatient medical examination and treatment (KCB) in some cases. Specifically, from July 1, 2026, outpatient KCB patients at some basic and specialized level medical facilities, depending on the type of facility identified by competent authorities, will be paid 50% of the benefit level within the scope of benefits for diseases and groups of diseases remaining outside the list specified in Circular No. 01/2025/TT-BYT, instead of not being paid as before. This regulation contributes to reducing the burden of costs, while creating more favorable conditions for people to access health services.
In addition, the base salary is adjusted to 2.53 million VND/month as a basis for calculating many health insurance benefits. Accordingly, participants are entitled to 100% of medical examination and treatment costs if the one-time cost is less than 15% of the base salary (equivalent to 379,500 VND). At the same time, people participating in health insurance for 5 consecutive years or more will be paid 100% of the costs within the scope of enjoyment when the amount paid together in the year exceeds 6 times the base salary level (equivalent to 15,188,000 VND).
The payment level for some technical services is also adjusted. Accordingly, in case health insurance participants are appointed to perform technical services, the health insurance fund will pay the total cost of medical equipment for one use of technical services not exceeding 45 months of base salary (equivalent to 113,850,000 VND).
In addition, the regulation also clarifies the level of direct payment for health insurance medical examination and treatment costs in some specific cases such as health insurance participants coming for inpatient medical examination and treatment at specialized medical examination and treatment facilities without health insurance medical examination and treatment contracts (except for emergency cases) or not presenting complete procedures as prescribed. Payment levels are determined according to the basic salary level ratio, ensuring harmony between patients' rights and the fund's ability to pay.
