Starting July 1, major revisions to health insurance policies will officially take effect, expanding medical examination and treatment benefits while raising financial coverage limits.
At Saint Paul Hospital in Hanoi, lines of patients remain long even during the weekend. Le Thi Hoa, a 52-year-old independent trader from Yen Hoa Ward, Hanoi, shared her initial concerns about the policy shift.
"My family runs an independent trading business. When we first heard news that health insurance premiums would increase from July 1, we were worried about the extra financial burden," Hoa said. "However, after local officials explained that the increase corresponds to a base salary hike, which in turn significantly boosts our medical coverage, we felt reassured."
Amended Health Insurance Law expands access, eases costs for chronic patients
A primary highlight of the amended Law on Health Insurance is the expansion of healthcare access. Insured individuals can now access medical services conveniently near their permanent, temporary, or current place of residence instead of being constrained by rigid administrative boundaries.
Furthermore, patients diagnosed with rare, life-threatening conditions, or those requiring surgeries and high-tech interventions, can now bypass traditional referral tiers to access specialized and big hospitals directly. The Health Insurance Fund will still cover these treatments according to standard benefit rates, reducing treatment delays and eliminating the need for patients to secure multiple referral forms.
For households managing chronic illnesses, these policy adjustments serve as a critical financial cushion.
Nguyen Duy Luan, a 46-year-old resident of Tan My Ward, Ho Chi Minh City, whose mother has undergone long-term hemodialysis, welcomed the update. "My mother has held a health insurance card for over five consecutive years. Previously, the 20 percent co-payment requirement created a heavy financial burden for our family each year," Luan explained. "Under the new policy, individuals with over five consecutive years of insurance coverage will have 100 percent of their medical expenses covered once their cumulative annual co-payments exceed six months of the base salary, equivalent to VND15,180,000."
New Health Insurance Policy takes effect from July 1, 2026:
50 percent health insurance coverage for out-of-network outpatient medical examination and treatment costs,
Completely free for bills under VND379,500,
Participation in health insurance for 5 consecutive years entitles you to 100 percent coverage when the annual co-payment exceeds VND15.18 million,
The reimbursement limit for medical equipment has been increased to VND113.85 million.
The Ministry of Health
Health insurance premiums bring broader benefits and easier access to care
According to representatives from Vietnam Social Security, the core driver behind the July 1 policy update is the Government's decision to raise the base salary from VND2,340,000 per month to VND2,530,000 per month. Because health insurance premiums are calculated as a percentage of the base salary, contribution rates for households, students, and workers will rise accordingly.
Director Tran Thi Trang of the Health Insurance Department under the Ministry of Health, noted that while premium rates are increasing, patient benefits are expanding in tandem.
Specifically, insured individuals will receive 100 percent coverage for single-visit medical costs that fall below 15 percent of the monthly base salary, which currently equals VND379,500.
Additionally, the threshold for the consecutive five-year insurance benefit has shifted. The maximum annual co-payment limit, set at six months of the base salary, will rise to over VND15 million. Once a patient's out-of-pocket expenses exceed this threshold, they qualify for 100 percent coverage on all subsequent correct-tier medical visits for the remainder of the year.
Decree No. 161/2026/ND-CP significantly relaxes the restrictions on out-of-network healthcare services, addressing a long-standing grievance among insured patients.
Starting July 1, in addition to specific patient groups who already receive full coverage, individuals seeking out-of-network outpatient care will have 50 percent of their covered category expenses paid by the Health Insurance Fund. This administrative reform enables patients to access high-tech medical services at higher-tier hospitals without facing the full financial burden alone.
Hospital administrators in Ho Chi Minh City view the 50 percent out-of-network outpatient coverage as a major improvement for both medical staff and patients. Integrated electronic data networks allow hospitals to process these claims instantly through their software, sparing patients from returning to local clinics for physical referral documents.
Hospital leaders noted that more transparent, timely disbursements from the Health Insurance Fund will enable medical centers to confidently procure high-quality pharmaceuticals and standard medical supplies to optimize patient care.
