From July 1, 2026, health insurance (HI) participants who go for outpatient examination and treatment in the wrong initially registered place will have their payment benefits expanded at some basic and specialized medical facilities.
According to new regulations, for diseases and groups of diseases that have been specified by the Ministry of Health in the list of outpatient care benefits, the health insurance fund continues to pay 100% of the benefit level according to current regulations.
A noteworthy point is that for diseases and groups of diseases outside this list, patients will be paid 50% of the benefit level within the scope of benefits. Previously, these cases were not paid by health insurance when undergoing outpatient examinations outside the line.
According to Ms. Nguyen Lan Huong - Deputy Head of the Health Insurance Policy Implementation Board (Vietnam Social Security), this is a step to expand benefits according to the roadmap, contributing to reducing the cost burden for people when they need medical examination and treatment outside the initial registration location.
However, the policy does not apply to all medical facilities. The 50% payment level is only implemented at some basic and specialized level medical examination and treatment facilities as prescribed by law.
Specifically, the subjects of application include basic level facilities previously identified as equivalent to provincial or central levels; basic level facilities with professional capacity from 50 to under 70 points according to technical regulations; and some specialized level medical examination and treatment facilities equivalent to provincial levels.
Representatives of Vietnam Social Security noted that many people are misunderstanding that health insurance will pay 50% of the total medical examination and treatment costs. In fact, this rate is calculated based on the health insurance benefit level of each person and only applies to costs within the scope of health insurance payment.
For example, people with a health insurance benefit level of 80% will be paid by the health insurance fund equivalent to 40% of the costs within the scope of benefit. People with a benefit level of 95% will be paid 47.5%, while the 100% benefit group will be paid 50%.
Expenses outside the scope of HI, on-demand services or expenses that are not eligible for payment are still self-paid by patients.
Although benefits are expanded, the social insurance agency recommends that people still seek medical examination and treatment at the initial registration place or properly implement referral regulations to fully enjoy health insurance benefits.
Expanding payment from 0% to 50% for many outpatient outpatient cases is expected to help people reduce medical costs, while improving access to quality medical examination and treatment services.
