Health Insurance Coverage for Outpatient Treatments and New Rates in Vietnam

A new era is beginning in Vietnam for outpatient treatments voluntarily carried out by health insurance holders at certain medical facilities. Starting July 1, 2026, payments will be provided by the health insurance fund for various disease groups that were previously excluded from coverage.

Scope and Date of the New Regulation

New health insurance benefit levels have been announced for patients receiving treatment outside the designated health network or applying on their own in Vietnam. According to the announcement, these practices will be implemented starting July 1, 2026.

While these expenses were previously covered only for diseases included in the Ministry of Health regulations, no payments were made for other disease groups.

50% Payment Support from the Health Insurance Fund

With the new regulation, for diseases not listed in Circular No. 01/2025/TT-BYT, the health insurance fund will cover fifty percent of the applicable reimbursement amount.

Individuals who apply on their own at basic and specialized medical facilities will be able to benefit from this opportunity for diseases that were previously out of scope.

Calculation of the Reimbursement Rate

Mrs. Nguyen Lan Huong, Deputy Head of the Health Insurance Policy Implementation Board of Vietnam Social Security, stated that this change expands benefits according to a roadmap.

The reimbursement rate is not the same for all cases and varies depending on the medical facility, diagnosis, and insurance coverage.

Implementation Principles and Digital Solutions

To fully benefit from all rights, participants are required to be examined at their initially registered medical facility or follow the referral rule.

On the other hand, transactions are being expedited with digital solutions such as chipped ID cards and the VNeID application, aiming for a paperless healthcare system.