Vietnam Enhances Health Insurance: 50% Coverage for Out-of-Network Outpatient Care from July 1

Vietnam is set to implement new health insurance policies on July 1, significantly enhancing benefits for participants, particularly concerning outpatient care and treatments within designated networks.

A key change involves coverage for patients seeking outpatient treatment outside their assigned medical facility. Under the new regulations, the health insurance fund (BHYT) will cover 50% of the costs for such care, provided the facility meets certain service point criteria. This applies to basic, intermediate, or specialized facilities that were classified as provincial-level before January 1, 2025.

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Outpatient care outside the network: health insurance fund pays 50% according to the benefit level.

For instance, an individual eligible for 100% coverage would have 50% of their outpatient costs reimbursed if they seek care outside their network at an applicable facility. If the total bill is 1 million VND, the BHYT would pay 500,000 VND, leaving the patient to pay the remaining half. Similarly, someone eligible for 80% coverage would receive 40% of the bill from BHYT.

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Costs of examination under 379,500 VND: In-network treatment will be 100% covered by the health insurance fund.

Furthermore, for medical examinations costing less than 15% of the base salary (approximately 379,500 VND), individuals seeking treatment within their designated network will receive 100% coverage. This means patients will no longer need to co-pay for these specific treatments, a change from previous regulations.

The Ministry of Health has also outlined how patients can determine the service points and classification of medical facilities. Individuals can check this information through the website of the Department of Medical Examination and Treatment Management, local Departments of Health, or individual hospital websites. This transparency aims to help citizens understand their coverage and navigate the updated health insurance system effectively.

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According to the Ministry of Health, these are important new points because previously, many cases of outpatient care outside the network were not covered or had lower coverage.