From July 1, 2026, many new regulations on health insurance (HI) officially take effect, helping participants enjoy more benefits when seeking medical examination and treatment. Although functional agencies have widely propagated in the past, some contents still need to be explained specifically for people to easily grasp.
50% off-limits outpatient examination costs are paid
According to new regulations, health insurance participants when undergoing outpatient examinations outside the tuyến at basic level medical examination and treatment facilities from 50 points or more, temporarily ranked basic level facilities or specialized level facilities previously under the provincial tuyến will be paid 50% of the medical examination and treatment costs according to the beneficiary's benefit level by the Health Insurance Fund.
For example, patients with 100% health insurance benefits, out-of-line examinations with a total cost of 1 million VND at basic-level hospitals will be paid 500,000 VND by the fund. Patients only have to pay themselves the remaining 500,000 VND.
For people with a health insurance benefit level of 80%, if the total examination cost is 1 million VND, the fund will pay 400,000 VND, and the patient will pay 600,000 VND on their own.
Expanding benefits with examination costs below 379,500 VND
Another noteworthy new point is that health insurance participants with a total cost for one medical examination and treatment of less than 15% of the base salary (equivalent to less than 379,500 VND) will enjoy more incentives.
If medical examination and treatment are in accordance with the tuyến, the Health Insurance Fund will pay 100% of the costs at all medical examination and treatment facilities under the initial level, basic level and specialized level.
In case of out-of-zone examination, the benefit level is calculated according to the ratio specified in the Law on Health Insurance.
For example, with a total medical examination and treatment cost of 370,000 VND, patients belonging to the group entitled to 100% of the benefit level according to regulations on rare diseases, dangerous diseases or diseases requiring high technology will be paid the entire 370,000 VND by the fund and will not have to co-pay.
In case of inpatient treatment at specialized level medical examination and treatment facilities with a benefit level of 40%, the Health Insurance Fund will pay 148,000 VND, and the patient will pay 220,000 VND on their own.
These changes are expected to help reduce the financial burden on people when seeking medical treatment, while encouraging people to participate in and maintain long-term health insurance.
