Vietnam health insurance reforms boost coverage and set 15 m₫ annual out‑of‑pocket cap

Effective 1 July 2026 Vietnam will apply new health‑insurance rules that expand benefits for insured patients. Out‑patient visits at facilities scoring over 50 points that are outside the usual referral network will be reimbursed by the health‑insurance fund at 50 % of the patient’s entitlement level (cost × entitlement × 50 %). For low‑cost visits below 379,500 VND, in‑network care will be covered 100 %.

In parallel, the annual maximum amount that patients must pay out‑of‑pocket for hospital care is being raised to 15,180,000 VND (about 15.2 million VND). Once a patient’s cumulative co‑payment reaches this threshold in a calendar year, any further treatment costs will be paid in full by the insurance fund, provided the patient has at least five years of continuous coverage, seeks care within the designated pathway, and has previously spent more than six times the basic salary on eligible services.