Expanding benefits for out-of-network outpatient care

Having treated hypertension and hypothyroidism for many years, Hoàng Thị Hà from Điện Biên Phủ ward has to visit the hospital for re-examination and medicine pick-up almost every month. Previously, each time she wanted to undergo an examination at a medical facility with a higher specialization level than her initial registration place, she had to obtain a transfer form. Without this form, she had to pay for most of the outpatient examination costs by herself.

“When hearing the information that starting from July 1, health insurance participants would enjoy expanded benefits for out-of-network outpatient care, I felt very delighted,” Hoàng Thị Hà shared. “What elderly people like us desire most is to select a medical facility that fits our illness condition while still receiving support from the health insurance fund. The new policy will help reduce treatment costs and ease the hardships of each examination drive.”

Not only Hoàng Thị Hà but many residents across the province also expressed their concurrence when the health insurance policy continues to be adjusted with a patient-centered approach. For individuals with chronic diseases, the elderly, or those who frequently require follow-up examinations, the new regulations will create more favorable conditions in accessing medical services, alleviating financial pressure for each treatment.

According to the new regulations, starting from July 1, 2026, health insurance participants who spontaneously seek out-of-network outpatient examination and treatment at qualified facilities will be reimbursed by the health insurance fund at 50% of their benefit level within the scope of benefits. This stands as a vital new point because previously, the majority of out-of-network outpatient cases were not covered by the health insurance fund.

Every day, the provincial General Hospital receives nearly 500 outpatient examination turns, within which the group of out-of-network patients accounts for around 50%. Projecting that the number of out-of-network citizens seeking examinations will rise to about 60% to 70% after the new regulations take effect, the hospital has formulated plans to guarantee smooth examination and treatment operations, avoiding any impact on service quality.

Trần Đức Nghĩa, Deputy Director of the provincial General Hospital, stated that the unit has reviewed the entire reception workflow, arranged additional examination tables, reinforced human resources at departments with high patient volumes, and upgraded the information technology system to ensure quick and accurate health insurance reception and payment. Communication work to help the public correctly understand the policy is also prioritized. The expansion of benefits does not mean that all out-of-network outpatient cases enjoy the same payment level. The benefit level still depends on the professional tier of the medical facility, the illness condition, the scope covered by the health insurance fund, and the specific benefit level of each target group according to regulations.

Therefore, alongside elevating professional quality, the hospital will strengthen guidance and explanations so that residents clearly grasp the new regulations, limiting instances of incomplete understanding that lead to expectations exceeding the scope of the policy or missing out on their legitimate benefits.

A solid anchor for social security

Alongside expanding examination and treatment benefits, according to the new regulations, starting from July 1, 2026, health insurance participants will have 100% of costs within their entitled scope paid by the health insurance fund if the cost of a single medical examination and treatment visit is lower than VND 379,500. Previously, the threshold for full coverage was under VND 351,000.

Concurrently, the payout rates for multi-year continuous health insurance participants and the maximum payment level for high-tech medical equipment have also been adjusted in a more beneficial direction. Each new regulation enacted aims for the highest goal of helping the public receive better healthcare and reducing the burden of treatment costs, especially for the poor, the elderly, ethnic minorities in remote and isolated areas, and patients requiring long-term treatment.

In Điện Biên, the health insurance policy has served as a sanctuary for hundreds of thousands of residents during sickness and disease over many years. In 2025 alone, the provincial Social Insurance paid medical examination and treatment costs for over 785,000 turns of people, with a total amount exceeding VND 630 billion. Among these were 3,521 cases with high treatment costs, where the total amount paid by the health insurance fund exceeded VND 50 billion. In the first quarter of 2026, the Provincial Social Insurance finalized health insurance medical examination and treatment costs for 173,224 turns of people, totaling VND 146 billion.

These figures do not only reflect the scale of the policy but also demonstrate the practical significance of the health insurance card for each citizen. Each cost item paid by the health insurance fund, whether large or small, contributes to helping patients alleviate their financial burdens, especially for families in difficult circumstances and individuals with diseases requiring long-term treatment.

In the journey toward universal healthcare, every perfected policy is another step forward for the people. With the new features of the Law on Health Insurance taking effect from July 1, 2026, the people of Điện Biên will secure more opportunities to access medical services more conveniently. This also stands as a clear testament to the humane nature of the health insurance policy, a vital pillar of the social security system.