According to Article 22 of the Health Insurance Law 2008 amended and supplemented in 2014, from January 1, 2021, the benefit level of health insurance in Vietnam will change when receiving out-of-network medical examination and treatment. To be specific:
Article table of contents
Hanoi-Vietnam: From January 01, 2021, the benefit level of health insurance when receiving out-of-network medical examination and treatment will be increased (Illustration)
1. The benefit level of health insurance for health insurance card holders when receiving out-of-network medical examination and treatment covered by the health insurance fund as when receiving in-network medical examination and treatment
| Entity | Benefits | Notes |
| Central hospitals | 40% of inpatient treatment costs | |
| Provincial hospitals | 60% of inpatient treatment costs | Expires on December 31, 2020 |
| 100% of inpatient treatment costs | Applies from January 1, 2021, Nationwide | |
| District hospitals | 100% of medical costs |
Additionally, certain cases of out-of-network medical examination and treatment are entitled to the benefit level of health insurance as in-network as follows:
+ Ethnic minorities and people from poor households participating in health insurance living in socio-economically disadvantaged areas and extremely disadvantaged areas; people participating in health insurance living in island communes and districts are entitled to 100% payment of medical costs at district hospitals by the health insurance fund within the entitlement of the health insurance card (including outpatient and inpatient treatment costs).
+ Ethnic minorities and people from poor households participating in health insurance living in socio-economically disadvantaged areas and extremely disadvantaged areas; people participating in health insurance living in island communes and districts are entitled to 100% payment of inpatient treatment costs at provincial and central hospitals by the health insurance fund within the entitlement of the health insurance card.
+ Health insurance card holders initially registered for medical examination and treatment at commune-level health stations or polyclinics or district hospitals receiving medical examination and treatment at commune-level health stations or polyclinics or district hospitals within the same province are entitled to 100% of treatment costs covered by the health insurance fund within the entitlement of the health insurance card.
+ In cases where health insurance card holders request the out-of-network medical examination and treatment and are subsequently referred to another medical facility, the health insurance fund will cover the medical costs as stipulated by Clause 3, Article 22 of the Health Insurance Law, except for the following cases: emergency; inpatients being diagnosed with other diseases beyond the clinical scope of the treatment facility; condition progresses beyond the capacity of the professional scope.
2. The benefit level of health insurance for inpatient treatment costs of health insurance participants receiving out-of-network medical examination and treatment at provincial medical facilities nationwide
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Entity |
Benefit level |
Notes |
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Officers, professional soldiers, non-commissioned officers, army soldiers on active duty; professional officers and non-commissioned officers and professional and technical officers and non-commissioned officers working in the People's Public Security force, People's Public Security trainees, non-commissioned officers and soldiers serving for a definite term in the People's Public Security; cipher officers receiving the same salary as military personnel; cipher trainees entitled to benefits and policies according to the benefits and policies applicable to students in military and police schools |
100% of medical costs |
Medical costs outside the scope of entitlement to health insurance are paid from the health insurance fund for medical examination and treatment of this group of entities; in case this funding source is insufficient, the state budget shall cover them. |
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People with meritorious services to the revolution, veterans |
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Children under 6 years old |
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Persons eligible for monthly social protection allowances |
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Members of poor households; ethnic minorities living in disadvantaged areas; people living in extremely disadvantaged areas; people living in island communes, island districts |
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Relatives of people with meritorious services to the revolution are natural fathers, mothers, spouses, and children of martyrs; people with meritorious services to nurturing martyrs |
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The cost of a medical examination and treatment is lower than the level prescribed by the Government and medical examination and treatment at the commune level |
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Patients who have participated in health insurance for 5 consecutive years or more and have paid out-of-pocket costs for medical examination and treatment in the year exceeding 6 months' statutory pay rate, except cases of out-of-network medical examination and treatment |
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People receiving pensions and monthly allowances for loss of working capacity; |
95% of medical costs |
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Relatives of people with meritorious services to the revolution |
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People from near-poor households |
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People receiving pensions and monthly allowances for loss of working capacity; |
80% of medical costs |
Thus, from January 01, 2021, the benefit level of health insurance when receiving out-of-network medical examination and treatment will be increased.
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