On January 12th, the Ho Chi Minh City Social Insurance Agency announced that Article 2 of Resolution 261/2025/QH15 issued by the National Assembly (regarding special mechanisms and policies to create breakthroughs in the protection, care, and improvement of public health) has expanded healthcare benefits and reduced medical costs for citizens.
Accordingly, the implementation includes increasing the ratio and payment levels for health insurance examination and treatment costs. Coverage for screening, diagnosis, and early treatment of certain diseases and priority groups will be funded by health insurance, following a roadmap aligned with the country’s socioeconomic development and state budget balancing capabilities.
From 2026, benefits for health insurance participants will increase.
Health insurance participants from near-poor households and elderly individuals aged 75 and above receiving social pensions will receive 100% coverage for medical examination and treatment within the eligible scope.
The coverage ratio for health insurance within the eligible scope will increase for social policy beneficiaries, vulnerable populations, low-income individuals, and other priority groups.
Health insurance benefits for cases specified in Article 22 of the Health Insurance Law will also be adjusted.
Accordingly, 100% coverage for medical examination and treatment costs will apply in various scenarios, including for policy beneficiaries as defined by the Health Insurance Law. This also applies when the cost of a single medical examination is lower than the government-mandated threshold.
Coverage includes examinations at primary healthcare facilities (community health stations, family medical clinics, military-civilian health stations), outpatient visits at regional polyclinics, participants with five consecutive years of health insurance whose co-payment exceeds six times the reference level, and emergency care at any medical facility.
Benefit levels by group: 95% coverage for groups such as pensioners and near-poor individuals, and 80% for other beneficiaries.
Individuals seeking medical treatment outside their registered primary facility will still receive insurance benefits at varying rates. These include 100% coverage for primary care or basic-level inpatient treatment, and 100% coverage for severe, rare, or surgically complex conditions requiring advanced techniques.
Coverage for inpatient treatment at specialized facilities will be 40% (unless higher rates apply). Outpatient coverage at basic-level facilities will follow a government-defined roadmap.
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