I. Legal basis

• Decree No. 188/2025/ND-CP
• Decree No. 161/2026/ND-CP

II. From July 1, 2026, health insurance-covered medical bills below VND 379,500 to be fully covered by health insurance

Pursuant to Clause 1, Article 17 of Decree No. 188/2025/ND-CP, the following is provided:

• For the purpose of determining entitlement to 100% coverage of health insurance-covered medical examination and treatment costs under Point b, Clause 1, Article 22 of the Law on Health Insurance, the cost of a single medical examination and treatment visit must be lower than 15% of the statutory base salary.

Pursuant to Article 3 of Decree No. 161/2026/ND-CP, the statutory base salary applicable from July 1, 2026, is prescribed as follows:

• From July 1, 2026, the statutory base salary shall be VND 2,530,000 per month.

Accordingly, when receiving medical examination and treatment services covered by health insurance, a patient shall be entitled to 100% reimbursement of the medical examination and treatment costs by the Health Insurance Fund where the cost of a single medical examination and treatment visit is less than 15% of the statutory base salary.

At the same time, 15% of the statutory base salary (effective from July 1, 2026) is calculated as follows: 15% × VND 2,530,000 = VND 379,500.

Accordingly, from July 1, 2026, where the cost of a single health insurance-covered medical examination and treatment visit is less than VND 379,500, the patient shall be entitled to 100% coverage of such costs by the Health Insurance Fund.

III. Maximum health insurance contribution rate

In addition, from July 1, 2026, the maximum monthly health insurance contribution for employees will increase to VND 759,000, compared to the previous maximum of VND 702,000 per month. Pursuant to Clause 5, Article 14 of the 2008 Law on Health Insurance (as amended by Clause 12, Article 1 of the 2024 Law Amending and Supplementing a Number of Articles of the Law on Health Insurance) and Article 6 of Decree No. 188/2025/ND-CP, an employee is required to contribute 1.5% of his or her salary, while the employer contributes 3%. The maximum contribution amount is calculated as 1.5% × (20 times the reference level of VND 2.53 million), equivalent to VND 759,000 per month.

IV. What percentage of medical examination and treatment costs is covered by health insurance?

Coverage depends on the insured person’s category and the level of care at which medical examination and treatment are received. For medical examination and treatment within the prescribed referral pathway, the Health Insurance Fund covers 100%, 95%, or 80% of eligible medical expenses, depending on the entitlement specified on the health insurance card, while the patient is required to make a co-payment of 5% or 20% of such expenses. For medical examination and treatment outside the prescribed referral pathway, the Health Insurance Fund covers 100%, 50%, or 40% of the entitlement applicable to treatment within the prescribed referral pathway, depending on the insured person’s category and the type of medical examination and treatment received.

Pursuant to Article 22 of the 2008 Law on Health Insurance, as amended by Clause 17, Article 1 of the 2024 Law Amending and Supplementing a Number of Articles of the Law on Health Insurance, health insurance benefit levels applicable to medical examination and treatment are as follows:

4.1. Medical examination and treatment in accordance with the prescribed referral pathway

• 100% of medical examination and treatment costs in the following cases:
  • The insured person belongs to a category entitled to full health insurance coverage, such as persons with meritorious services to the revolution, children under six years of age, members of poor households, and other beneficiaries as prescribed by law.
  • The cost of a single medical examination and treatment visit is lower than the threshold prescribed by the Government.
  • Medical examination and treatment at the primary registered healthcare facility (including commune health stations, family medicine clinics, district-level medical centers, and similar healthcare facilities).
  • The insured person has participated in health insurance continuously for at least five consecutive years and the cumulative co-payment amount incurred during the year exceeds six times the reference level.
  • Emergency medical examination and treatment received at any healthcare facility.

• 95% of medical examination and treatment costs: Pensioners, persons receiving incapacity benefits, and members of near-poor households (i.e., the categories of insured persons specified in Point a, Clause 2; Point k, Clause 3; and Points a and g, Clause 4, Article 12 of the 2008 Law on Health Insurance, as amended by Clause 10, Article 1 of the 2024 Law Amending and Supplementing a Number of Articles of the Law on Health Insurance).

• 80% of medical examination and treatment costs: All other insured persons not falling within the categories eligible for 100% or 95% coverage (i.e., the general category of health insurance participants).

4.2. Medical examination and treatment outside the prescribed referral pathway

• 100% of the benefit level applicable to medical examination and treatment within the prescribed referral pathway in the following cases:
  • Treatment of rare diseases, serious illnesses, diseases requiring surgery, or high-technology medical procedures included in the list promulgated by the Ministry of Health.
  • Medical examination and treatment at a primary healthcare facility.
  • Inpatient treatment at a basic-level healthcare facility.
  • Medical examination and treatment at basic-level or specialized-level healthcare facilities that, prior to January 1, 2025, were classified as district-level hospitals.
  • Ethnic minority persons and members of poor households residing in areas with difficult or extremely difficult socio-economic conditions, island communes, or island districts who receive inpatient treatment at specialized-level healthcare facilities.

• 50% to 100% of the benefit level applicable to medical examination and treatment within the prescribed referral pathway: Outpatient medical examination and treatment at basic-level healthcare facilities, subject to the results of professional and technical classification of healthcare facilities, in accordance with the implementation roadmap and specific benefit rates prescribed by the Government, except for the cases specified in Points a and đ, Clause 4, Article 22 of the 2008 Law on Health Insurance, as amended by Clause 17, Article 1 of the 2024 Law Amending and Supplementing a Number of Articles of the Law on Health Insurance.

• 50% of the benefit level applicable to medical examination and treatment within the prescribed referral pathway for outpatient medical examination and treatment, in accordance with the implementation roadmap prescribed by the Government; and 100% of the benefit level applicable to medical examination and treatment within the prescribed referral pathway for inpatient treatment at specialized-level healthcare facilities that, prior to January 1, 2025, had been classified by the competent authority as provincial-level hospitals.

• 40% of the benefit level applicable to medical examination and treatment within the prescribed referral pathway: Inpatient treatment at specialized-level healthcare facilities, except for the cases specified in Points a, b, đ, and h, Clause 4, Article 22 of the 2008 Law on Health Insurance, as amended by Clause 17, Article 1 of the 2024 Law Amending and Supplementing a Number of Articles of the Law on Health Insurance.

V. About Us, Hankuk Law Firm

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