Vietnam’s Ministry of Health began applying revised health insurance rules on July 1, 2026, extending partial reimbursement to some out-of-network outpatient care and lifting benefit ceilings tied to a higher base salary. The changes land in a market where statutory coverage already reaches almost the entire population and where commercial health cover is the fastest-expanding non-life line, sharpening the question of how public and private health provision will coexist.
The reach of Vietnam’s state scheme frames the commercial stakes. Vietnam Social Security reported that health insurance covered 95.2% of the population by the end of 2025, a level it called the highest recorded and one that met a national target set for 2030 five years early, according to Vietnam News. The system processed roughly 195.5 million insured medical visits in 2025, with claims proposed for payment of about VND 161,628 trillion.
That expansion has been paired with steadily richer statutory benefits. From Jan. 1, 2026, near-poor households and people aged 75 or older receiving social pension benefits moved to 100% reimbursement of covered costs, removing a co-payment that had left near-poor households paying 5%. The reimbursement rules follow Article 22 of the 2024 Law on Health Insurance, which lists 11 groups entitled to full coverage. The direction of travel is set out in Directive No. 52-CT/TW, issued Oct. 3, 2025, which targets coverage above 95% by 2026 and full national coverage by 2030, alongside a roadmap that envisages exemption from basic hospital fees within the benefit package, according to SGGP.
Against that backdrop, the July 1 measures adjust the edges of the statutory scheme rather than its core. Enrolees who seek outpatient care without following referral rules – described in the regulations as self-initiated examination and treatment not in accordance with regulations – now receive 50% of covered costs at facilities that previously paid nothing, including those ranked provincial or central level before Jan. 1, 2025, and basic facilities scoring from 50 to below 70 points, with conditions listed in Appendices 1 and 2 of Circular No. 01/2025/TT-BYT still covered in full. The ministry illustrated the mechanics: an enrolee entitled to 100% coverage with a VND 1,000,000 bill at a basic-level provincial hospital receives VND 500,000 from the Health Insurance Fund.
Benefit ceilings also rose because several are pegged to the base salary, which Decree No. 161/2026/ND-CP set at VND 2,530,000 a month from July 1, up from VND 2,340,000. Full coverage within fund limits now applies when a single visit costs below 15% of that base, or VND 379,500, and the fund covers medical equipment for a single technical service up to 45 months of base salary, or VND 113,850,000. Household contributions moved in step: the first member pays 4.5% of the base salary, or VND 1,366,200 a year, with later members paying declining shares of that figure.
For carriers, the relevant signal is where private premiums are growing as the state fills more of the population’s basic needs. Vietnam’s insurance sector generated about VND 237.2 trillion (US$9.1 billion) in premium income in 2025, a 4% rise from 2024, according to National Statistics Office estimates. Non-life premiums rose 10.3% to VND 88.4 trillion, while life premiums were roughly flat at VND 148.8 trillion, up 0.5%. Data from the Insurance Association of Vietnam show health insurance was the largest non-life segment by premium revenue in the first nine months of 2025, ahead of property, engineering, motor, and marine.
Penetration remains low, leaving room for both public and private growth. One industry analysis put the insurance penetration rate at 2.6% of GDP in 2022, rising to a projected 3.5% by 2025, according to IncorpAsia. At a regional level, a Prudential study of six ASEAN markets, including Vietnam, found insurance penetration across the bloc at around 3% of GDP against a global average near 7%. Speaking at the UK-Vietnam Business Summit in Ho Chi Minh City on Nov. 5, Steven Chan, group chief government relations and policy officer at Prudential plc, said: “In recent years in Southeast Asia the insurance industry has grown faster than GDP – 6.1% versus 4.9%.”
The overlap between an expanding statutory scheme and commercial health cover is where the July 1 changes matter for the industry. The combination of wider state coverage, faster non-life growth, and the scale of health business is expected to shape product design, pricing, distribution, and capital allocation as carriers reassess how public and private cover interact across income segments and regions. As statutory reimbursement reaches deeper into outpatient care and co-payments, the space for commercial products may shift toward gaps the public fund does not close – higher-tier facilities, faster access, and services outside the statutory package.
