Details of Out-of-Network Health Insurance Reimbursement Rates
The calculation method for the 50 percent health insurance discount applied to out-of-network treatments without a referral document at certain hospitals in Hanoi has been explained.
The details of out-of-network health insurance discounts applied without a referral document starting July 1, 2026, at Friendship Hospital and the Central Forensic Psychiatry Hospital in Hanoi, along with the principles for calculating actual reimbursement amounts, have been clarified.
Frequently Asked Questions Regarding Out-of-Network Treatments
Since the implementation of the new policy, individuals utilizing health insurance benefits independently have been concerned about how reimbursements are calculated.
Patients frequently question whether examination, testing, and medication expenses are covered within the scope.
Case Study Implementation at Friendship Hospital
A patient residing in Ninh Binh with 100 percent health insurance coverage visited Friendship Hospital for an examination without a referral document.
Half of the approximately 4.1 million VND expense was covered by the Health Insurance Fund.
What Does the 50 Percent Rate Actually Mean?
Experts emphasize that 50 percent of the provided assistance does not mean 50 percent of the total cost.
The actual reimbursement amount is determined based on the patient's insurance coverage level and the cost share covered by the policy.
New Regulations in Central Hospitals
Patients can receive treatment without a referral document at Friendship Hospital and the Central Forensic Psychiatry Hospital in Hanoi.
Reimbursement rates vary proportionally for patients with different levels of insurance coverage.