Sharp reduction of expenditures from patients' own pockets
From July 1, new regulations on health insurance policies 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.
Thus, from July 1, 2026, health insurance participants will benefit in both directions: Expanding the scope of fund payment when outpatient examination is outside the line and increasing financial support by adjusting the benefit thresholds according to the new base salary level, especially beneficial for people with chronic diseases, long-term treatment and people who regularly use high-tech services.
The most notable change is that people who self-examine for outpatient visits outside the line are entitled to health insurance in more cases.
If outpatient examination is performed at some basic or specialized level medical examination and treatment facilities as prescribed, the health insurance fund will pay 50% of the health insurance benefit level for diseases outside the list of diseases allowed for over-level examination.
According to Lao Dong reporters' records, currently, in many cases, patients who come to upper-level hospitals for outpatient examinations not at the initial registered place are not reimbursed by health insurance according to regulations, and patients must pay for all examination, testing, and medicine costs themselves.
Mr. Phan Van Binh (Hanoi) registered for health insurance at the commune health station. Due to prolonged stomach pain, he went to a central hospital himself, underwent gastroenterology and outpatient examinations.
The total cost of the examination is 2 million VND, of which the medical examination cost is 200,000 VND, endoscopy is about 1,000,000 VND, and medicine costs are about 800,000 VND.
But if he falls into the case of applying the new regulations from July 1st, Mr. Binh believes that he may belong to the group enjoying 80% health insurance, then the health insurance fund will pay 50% of the 80% benefit level, which is 40% of the cost.
In this case, health insurance pays about 800,000 VND, I only have to pay about 1.2 million VND, instead of having to pay the entire 2 million VND myself as it is now. That is too beneficial for people. In cases like mine, going to a higher-level doctor and still being paid health insurance will save a lot of costs" - Mr. Binh shared.
Notable changes in health insurance policy
Expanding the benefit level for health insurance participants who self-go for outpatient medical examination and treatment in some cases is a noteworthy new point in this change.
Accordingly, from July 1, 2026, outpatient medical examination and treatment 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 cost burden and creating more favorable conditions for people to access medical services.
In addition, the base salary is adjusted to 2.53 million VND/month as a basis for calculating many health insurance benefits. 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 by the fund when the amount paid together in the year exceeds 6 times the base salary (equivalent to 15,180,000 VND).
The payment level for some technical services is also adjusted. 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 basic salary.
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 all 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.
