From 1/7, health insurance (BHYT) participants who independently seek out-of-area outpatient medical examination and treatment at certain basic and specialized medical facilities will be reimbursed 50% of their benefit level by the Health Insurance Fund for specific diseases or groups of diseases.

Nguyen Lan Huong, Deputy Head of the BHYT Policy Implementation Department at Vietnam Social Security, clarified that "50% of the benefit level" does not mean the Fund will cover 50% of the total amount on the medical bill. This percentage is calculated based on each individual's health insurance benefit level and applies only to amounts within the covered scope, according to BHYT prices and payment conditions.

For instance, a person with an 80% health insurance benefit level, when eligible for 50% of that benefit, will have 40% of their costs paid by the Fund. A person with a 95% benefit level will receive 47,5% coverage within the eligible scope. Costs outside the covered scope, on-demand services, or items not meeting payment conditions remain the patient's responsibility.

Residents receive medical examinations at Tan Nhon Phu Ward Health Station, TP HCM, 4/2026. *Photo: Quynh Tran*

According to Huong, the new regulation does not imply that BHYT participants can visit any hospital for outpatient care and receive 50% coverage from the Health Insurance Fund. This payment level is determined by the technical professional classification assigned to the medical facility by a competent authority (initial, basic, or specialized level); the diagnosed disease or group of diseases; the patient's health insurance benefit level; and the scope of the Fund's coverage.

Specifically, this policy applies to three categories of facilities:

• Basic-level medical facilities that were classified as provincial, central, or equivalent before 2025.
• Basic-level facilities with a total professional capacity assessment score ranging from 50 to under 70 points.
• Specialized-level facilities that were classified as provincial or equivalent before 2025.

Vietnam Social Security advises individuals to seek medical care at their registered or in-network facilities. For out-of-area outpatient visits, patients should contact the medical facility or the Social Security agency in advance to obtain information regarding eligible facilities, coverage scope, and payment levels.

By the end of 2025, health insurance coverage is projected to exceed 95% of the population.

Hong Chieu