Vietnam Social Security clarifies health insurance coverage rules

Vietnam Social Security has issued guidance clarifying that health insurance coverage rates of 80%, 95%, or 100% do not represent the total payment percentage of a hospital bill. The health insurance fund only covers expenses that fall within the approved scope and meet specific regulatory conditions.

Patients may still be responsible for several types of costs, including: • Co-payments required by the participant's specific coverage level. • Costs for medicines, medical supplies, or technical services that fall outside the approved list. • Expenses that do not meet specific payment conditions. • Price differences for requested services.

Three main factors determine the final amount paid by the insurance fund: the participant's coverage group, whether the expenses fall within the approved scope, and whether the medical examination or treatment meets registration and referral requirements (such as inpatient vs. outpatient status and initial registration compliance).