How much does health insurance pay for “off-network” care — the most confusing question in Vietnamese health insurance, because rates differ by facility level and inpatient vs outpatient.
Off-network reimbursement rates
Under the Health Insurance Law (25/2008/QH12, amended 46/2014/QH13): since 1 January 2021, provincial-level pooling applies — insured inpatients at any provincial hospital nationwide are covered as in-network, no referral needed. Central-level bypass (self-referral to a central hospital without a referral letter): only 40% of inpatient costs are covered. Outpatient off-network visits: the fund does not pay (except specific prescribed cases).
Referral letters: when needed?
A referral letter is the condition for in-network benefits when moving up levels (provincial to central). The lower facility issues it when the case exceeds its specialty capacity. Self-bypassing to central level without one means only the 40% inpatient rate above.
Emergency cases
Emergency patients at any facility are covered as in-network, referral or not. This key exception turns on the receiving facility’s professional determination of emergency status — not the patient’s own claim.
Frequently Asked Questions
Are central-level off-network outpatient visits covered?
No — the fund does not cover self-referred central-level outpatient visits without a referral letter under current rules. Patients pay in full.
How long is a referral letter valid?
For the period stated on the letter (usually 10 working days) and one treatment episode. Expired letters must be reissued.
I fall ill while on business in another province?
Covered. Provincial-level inpatient care where you are temporarily staying is treated as in-network under provincial pooling; emergencies are in-network everywhere.
This article has been quality-reviewed by the FLAW AI Legal Council
