Major Changes to Vietnam’s Health Insurance Policies Effective July 1, 2026

Starting July 1, 2026, Vietnam will implement significant reforms to its health insurance system, as outlined in the amended Health Insurance Law and Decrees 188/2025/ND-CP and 161/2026/ND-CP. These changes aim to adjust contribution rates, expand benefits, and redefine coverage limits, impacting millions of citizens. Here’s a breakdown of the key updates.

Revised Contribution Rates Based on New Minimum Wage

The government has raised the minimum wage to 2.53 million VND per month (approximately $105 USD), directly affecting health insurance contributions. The new structure for family-based insurance is as follows:

• First person: 4.5% of the minimum wage, amounting to 1,366,200 VND annually.
• Second person: 70% of the first person’s contribution (956,340 VND/year).
• Third person: 60% of the first person’s contribution (819,720 VND/year).
• Fourth person: 50% of the first person’s contribution (683,100 VND/year).
• Fifth and subsequent family members: 40% of the first person’s contribution (546,480 VND/year).

These adjustments mean families will pay between 50,000 to 100,000 VND more annually per member compared to current rates.

Expanded Benefits for Outpatient Care

A notable change is the expansion of coverage for outpatient treatments. Starting July 1, 2026, patients consulting approved medical facilities for non-listed conditions will receive 50% coverage from the health insurance fund. This shift aims to reduce financial burdens and improve access to care, particularly for those with chronic or less common illnesses.

Increased Coverage Limits

The reforms also raise the maximum reimbursement thresholds:

• Minor medical exams: 100% coverage for costs under 15% of the minimum wage (379,500 VND).
• 5-year coverage eligibility: Patients with continuous contributions for five years or more will get 100% coverage if annual out-of-pocket expenses exceed 6 times the minimum wage (15.18 million VND).
• High-tech services: Single-use medical equipment or services are capped at 45 times the minimum wage (113.85 million VND).

Eligible Cases for Premium Refunds

The policy also outlines four scenarios for refunding unused contributions:

1. Card expiration: Refunds are calculated based on unused periods for cards issued under the new category.
2. Government funding adjustments: Increased state support allows refunds for unused contributions during the new policy period.
3. Death before card validity: Refunds apply to contributions paid before the card’s activation date.
4. Duplicate coverage: Ref
   
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