Vietnam Expands Health Insurance Coverage for Out-of-Network Outpatient Visits

Vietnam is set to implement a significant change to its health insurance policy starting July 1, expanding coverage for outpatient medical visits made outside a patient's designated network. Under current regulations, individuals visiting out-of-network facilities only receive 100% coverage for a specific list of illnesses. For all other conditions, patients bear the full cost.

The revised policy will allow health insurance beneficiaries to receive 50% coverage for their benefit level on outpatient visits for conditions not on the pre-approved list. This applies to basic-level healthcare facilities that meet certain criteria, as well as specialized facilities previously classified as provincial-level. This adjustment aims to ease the financial burden on patients and enhance their access to medical services.

It is important to note that the 50% coverage refers to 50% of the benefit level, not 50% of the total cost. For example, a patient eligible for 100% coverage whose outpatient visit costs 1 million VND will have 500,000 VND covered by insurance (1,000,000 VND x 100% x 50%). If the patient is eligible for 80% coverage, the insurance will cover 400,000 VND (1,000,000 VND x 80% x 50%), leaving the patient to pay the remaining amount.

Healthcare facilities are required to publicly display information about their classification and service points. Patients can consult websites of the Ministry of Health's Department of Medical Examination and Treatment Management or local Departments of Health to determine facility eligibility for the new policy before seeking treatment.