The 50% off-site health insurance benefit applies at which medical facilities from July 1?

From July 1, health insurance participants who self-go for outpatient medical examination and treatment at a number of basic and specialized medical facilities will be paid 50% of the benefit level for diseases and groups of diseases by the Health Insurance Fund.

Ms. Nguyen Lan Huong, Deputy Head of Health Insurance Policy Implementation under Vietnam Social Insurance, said “50% benefit” should not be understood as the Fund will pay 50% of the entire amount stated on the medical examination and treatment bill. This rate is calculated based on each person’s health insurance benefit and only applies to the amount within the benefit range, according to the price and health insurance payment conditions.

For example, a person with a health insurance benefit of 80%, when in the case of being paid 50% of the benefit, the Fund pays 40% of the costs; People with a benefit level of 95% will be paid 47.5% by the Fund within the scope of their benefit. Expenses outside the scope of benefits, required services or amounts not eligible for payment are still paid by the patient.

According to Ms. Huong, the new regulations do not mean that health insurance participants can go for outpatient examination at any hospital and have 50% paid by the Health Insurance Fund. This payment level is based on the technical and professional level that the medical examination and treatment facility has been ranked by the competent authority (initial level, basic level or advanced level); diagnosed disease or group of diseases; The patient’s health insurance benefit level and the scope of payment by the Fund.

Specifically, the policy applies to three groups: basic-level medical examination and treatment facilities that, before 2025, have been determined by competent authorities to be provincial, central or equivalent to provincial or central level; The facility is classified as basic, with a total score of 50 to less than 70 points assessing professional capacity; specialized level facilities that before 2025 are determined to be provincial or equivalent to provincial level.

Vietnam Social Insurance recommends that people should go for examination at the place of initial registration for medical examination or treatment. If going for an outpatient examination, the patient should contact the medical facility or Social Insurance agency in advance to receive information about the facility, scope and payment level.

By the end of 2025, the health insurance coverage rate will reach over 95% of the population.