Calculation of the 50 Percent Rate for Out-of-Network Health Insurance Examinations
Starting July 1, 2026, the 50 percent health insurance support applied at certain central hospitals without a referral document is calculated according to the individuals' own insurance coverage level.
The practice allowing health insurance participants to receive treatment without a referral document at certain central hospitals outside their initial registration location is in effect, along with the calculation method for payment rates and drug coverage details.
New Era in Central Hospitals
Starting July 1, 2026, health insurance participants can benefit from healthcare services without the need for a referral document at certain central hospitals outside their initially registered healthcare facility.
This practice does not cover all hospitals nationwide and is valid only for specific healthcare facility groups designated by law.
Calculation Method of the 50 Percent Rate
The assistance amount being 50 percent does not mean that directly half of the total bill will be paid, but rather it is determined according to the individual's own insurance coverage rate.
For instance, when a patient with an 80 percent health insurance coverage receives a 50 percent rate benefit, the insurance covers 40 percent of the costs.
Example Cases of the Practice
75-year-old hypertension patient Ms. T. from Ninh Binh applied to Friendship Hospital without a referral and underwent examinations and various tests.
A 50 percent portion of the approximately 4.1 million VND expenses was covered by the Health Insurance Fund in accordance with out-of-network coverage rules.
Medicine and Treatment Expenses
Within the framework of current regulations regarding out-of-network health insurance coverage, patients' drug rights are also kept under protection.
Experts emphasize that these payments are valid only for expenses within the coverage scope that comply with the insurance's price and payment conditions.