Health insurance benefits expanded

Beginning July 1, 2026, several new regulations under the Law on Health Insurance and accompanying decrees went into force, signaling a substantial shift in social security policy.

A patient receives health insurance-covered medications following an outpatient consultation at Dong Nai General Hospital. Photo: Hanh Dung

In addition to expanding the scope of coverage by the health insurance fund, the new regulations also raise benefit levels in line with the new base salary, enabling people to access medical services more conveniently and easing the financial burden when they fall ill.

Reducing healthcare costs

Nguyen Thi Quy, Deputy Director of Dong Nai Social Security, said that after more than 16 years of implementing the Law on Health Insurance, the health insurance policy has continued to be refined with a patient-centered approach, ensuring that all citizens have access to healthcare services at reasonable costs.

The most notable change, effective July 1, 2026, is that health insurance participants who seek outpatient care at basic-level healthcare facilities with a score of over 50 points, provisionally classified basic-level facilities or specialized-level facilities that had been classified as provincial-level before January 1, 2025, will have 50% of their benefit level paid by the health insurance fund. This is considered a significant change because, under previous regulations, health insurance cardholders who sought out-of-network outpatient care for many common illnesses had to pay the full cost of medical examination and treatment themselves.

According to Nguyen Lan Huong, Deputy Head of the Health Insurance Policy Implementation Board under Vietnam Social Security, the new regulation is intended to provide additional financial support, reduce financial pressure, and increase access to quality medical services for health insurance participants. However, the public should clearly understand this regulation. Not all cases of out-of-network outpatient care are eligible for payment at 50% of the benefit level. The regulation applies only to certain basic-level and specialized healthcare facilities that meet legal requirements. In addition, payment depends on the type of disease, disease group, the participant's health insurance benefit level, and the scope of costs covered by the health insurance fund.

This means citizens should continue to seek medical examination and treatment at their originally registered healthcare facility or follow the established referral procedures to ensure full entitlement to their health insurance benefits.

Advancing sustainable social security

In addition to expanding the scope of coverage, many other benefits for health insurance participants have been adjusted as of July 1, 2026, in line with the new base salary of 2.53 million VND per month.

Accordingly, the health insurance fund will cover 100% of medical examination and treatment costs when the total cost of a single visit is less than 15% of the base salary, equivalent to 379,500 VND.

For participants with at least five consecutive years of health insurance coverage, if the annual co-payment exceeds six times the base salary (equivalent to 15.18 million VND), the health insurance fund will cover 100% of medical examination and treatment costs within the scope of coverage. In addition, payment levels for certain technical services have also been adjusted. Under the new regulations, the health insurance fund will cover the cost of medical devices used in a single technical procedure up to a maximum of 45 times the base salary, equivalent to 113.85 million VND. This policy is of practical significance for people with chronic illnesses, those requiring long-term treatment, and those facing high treatment costs, helping reduce the financial burden on patients' families.

Nguyen Thi Quy, Deputy Director of Dong Nai Social Security, emphasized that the synchronized adjustment of health insurance policies demonstrates the consistent direction of the Party and the State in improving the health insurance system toward universal coverage, increasing benefits for participants, and sharing healthcare-related financial risks. Recent experience shows that health insurance provides practical benefits for each citizen and reinforces its role as a vital pillar of the social security system, helping citizens feel more secure in the event of illness and moving closer to the goal of fair and sustainable universal healthcare.

Specialist II Doctor Le Thi Phuong Tram, Deputy Director of Dong Nai General Hospital, said that to ensure benefits for health insurance participants from July 1, 2026, the hospital has developed a plan to recruit more doctors, particularly internal medicine specialists, and add internal medicine clinics, which have traditionally received large numbers of patients. The hospital has also introduced biometric kiosks for medical examination registration. All patients, whether or not their health insurance cards were initially registered at the hospital, can use these kiosks to register for examinations. On their first visit, patients use their national ID cards and facial recognition to register in the system. For subsequent examination registrations, they do not need to bring any documents and can simply register with facial recognition to enter the clinic, without having to take queue numbers multiple times as they did in the past.

"Regarding the dispensing of health insurance-covered medicines, the hospital will continue implementing solutions to further reduce waiting times for patients," said Dr. Tram.

On the morning of July 1, Dong Nai Social Security, in coordination with the Dong Nai Post Office, held a launch ceremony in response to Vietnam Health Insurance Day under the theme “Universal Health Insurance – A Foundation for Sustainable Social Security.”

By Hanh Dung – Translated by Minh Hong, Minho