Ms. Tran Thi Trang, Director of the Health Insurance Department (Ministry of Health), announced that under the new regulation, the Health Insurance Fund (HIF) will cover 50% of a patient's eligible benefit level for out-of-network outpatient medical examination and treatment costs at basic-level medical facilities with 50 points or more. Previously, individuals seeking out-of-network care had to bear the entire cost themselves, with no reimbursement from health insurance.

Currently, health insurance participants are entitled to three main benefit levels: 80%, 95%, and 100% of eligible medical examination and treatment costs. With the implementation of this new policy, patients receiving out-of-network outpatient care will be reimbursed 50% of these respective benefit levels.

For example, an individual with a 100% health insurance benefit level, registered for medical examination and treatment at an initial-level hospital (equivalent to a former district-level hospital), seeks out-of-network outpatient care at a basic-level hospital (equivalent to a former provincial-level hospital). If the total cost is one million VND, health insurance will cover 500,000 VND, with the patient paying the remaining amount.

Similarly, an individual with an 80% benefit level, receiving out-of-network care at a specialized-level facility with a cost of one million VND, will have 400,000 VND covered by health insurance and will self-pay 600,000 VND.

The public can look up the professional levels and ranking points of medical facilities on the website of the Department of Medical Examination and Treatment Administration, local Departments of Health, or at the hospitals themselves. The Ministry of Health requires these units to fully publicize this information to facilitate public access and ensure their rights when using health insurance.

People receiving medical examinations at Tan Nhon Phu ward health station, TP HCM, 4/2026. Photo: Quynh Tran

According to Ms. Trang, this new regulation aims to minimize the amount people have to pay out-of-pocket when visiting hospitals, while also ensuring the safety of the reserve Health Insurance Fund.

The health insurance network currently covers about 94% of the population, with over 95,5 million participants. Among nearly 184 million medical examinations and treatments recorded last year, approximately 40 million people used their health insurance cards regularly, with an average frequency of 4,5 times per year. The total amount paid by the insurance agency to patients nationwide last year reached nearly 140 trillion VND.

Le Nga