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If a change in benefit entitlement occurs during inpatient treatment, the patient is responsible for providing the updated HI card information. The medical facility must verify and apply the new benefit level before discharge.

These provisions ensure that HI payments are made fully and promptly, in line with patients’ entitlements in all circumstances. Healthcare facilities are responsible for verifying the entitlements and benefit levels of HI participants before completing treatment.

Compared to the previous regulations, patients who voluntarily sought outpatient treatment at provincial or central hospitals without a referral were not entitled for HI reimbursement of outpatient costs, except in certain cases such as emergencies or out-of-network inpatient treatment.For example, the HI Fund only covered 40% of inpatient costs at central-level hospitals under the 2014 Law on HI. As a result, out-of-network outpatients previously had to bear the full cost.

For the first time, the new regulation allows the HI Fund to reimburse the costs of out-of-network outpatient treatment at rates of 50% or 100%, depending on each case, according to a defined roadmap.

This is a major step forward, from previously 0% coverage, out-of-network outpatients are now entitled to 50–100% cost reimbursement within the insurancebenefit scope, thereby narrowing the benefits gap between in-network and out-of-network care and moving closer to the goal of equitable universal HI.

In addition, in the past, costs for on-demand medical services were not covered by HI at all. Patients opting for on-demand services such as consultation with a professor or a service room) had to pay the full amount by themselves, with HI only covering services within the standard benefit list. Under the new regulation, the HI Fund will reimburse the portion of costs within the benefit entitlement, even for on-demand services.

The new provisions under Decree No. 188 significantly expand the benefits for HI participants, particularly for out-of-network outpatient treatment and on-demand services, and clarify the principles of entitlement to better safeguard the legitimate rights and interests of participants.