BVCare (New) Coverage Limits: Life, Accident, Inpatient, Outpatient and Dental

When companies evaluate employee benefit packages, the first question is usually straightforward: what is the maximum payout for each benefit per year? The coverage limits under the new Bao Viet corporate health insurance (BVCare New) are systematically categorised by benefit group, making it easy for employers to evaluate the level of protection provided to each insured person. The figures below reflect Appendix I on insurance scope and benefits; exact limits in your enterprise policy may differ, so please consult your contract wording or insurance representative.

📊 BVCare (New) Coverage Limits by Benefit Group

BVCare New divides protection into core and optional benefit groups, each featuring its own maximum annual limit of liability per person. Businesses can choose a designated sum insured within policy bands, or benchmark limits against monthly salary for specific categories.

To understand the scope of each group and how benefits work together, see our detailed guide on What Does BVCare (New) Enterprise Health Insurance Cover?

🧬 Life Coverage: Dedicated Caps for Cancer, Cardiovascular Disease, and Stroke

For enterprise clients with revenue between 1 billion and 3 billion VND, alongside the overall maximum liability of 1 billion VND, policy rules specify a dedicated sub-limit of 300,000,000 VND/person/year for life claims when death or permanent total disability arises from cancer, cardiovascular diseases, stroke, or associated complications, sequelae, and related pathologies.

This special cap represents the total maximum payout for an insured individual if an event stems from one or more conditions in this medical group. Importantly, in the event of a non-accidental death occurring outside a medical facility where the medical cause cannot be confirmed, if the death occurs within 3 months of the last date the insured underwent medical care for one of these specified conditions, the life benefit remains eligible for payout up to this dedicated disease cap.

For individual claim events, death and permanent total disability are typically paid at 100% of the sum insured, whereas permanent partial disability from accidents is compensated according to the percentage schedule defined in the policy tables.

🏥 Inpatient Benefits: Sub-Limits Set at One-Third of the Sum Insured

Inpatient treatment for illness and maternity carries an annual maximum liability between 120 million and 1.8 billion VND per person, regulated by key operational sub-limits:

• Secondary Limit of Liability (MTN phụ): Calculated as the chosen sum insured divided by 3, serving as the benchmark cap for hospitalisation and surgical procedures.
• Hospitalisation (capped at 60 days/year): Room and board costs are capped at 5% of the secondary limit/day, up to the secondary limit/person/year. For companies with fewer than 100 employees, room and board at private hospitals, international medical facilities, or voluntary/on-demand/service wards of public hospitals is limited to 3% of the secondary limit/day.
• Surgical Treatment: Covers actual necessary expenses up to the secondary limit/person/year.
• Pre-hospitalisation Consultation (single visit within 30 days before admission), Post-hospitalisation Follow-up (within 30 days post-discharge), and Home Nursing Care (up to 30 days/year): Each capped at 5% of the secondary limit/person/year.
• Daily Hospital Cash Allowance (maximum 60 days/year; only 1 of 3 tiers applies): 0.1% of secondary limit/day at private/international facilities or voluntary wards; 0.2% of secondary limit/day at standard public hospitals; or 0.3% of secondary limit/day at public hospitals if compulsory state health insurance (BHYT) covers 60% or more of total medical expenses.
• Rehabilitation: 10% of secondary limit/person/year; Ambulance Service: Up to the secondary limit; Burial Allowance upon hospital death: 2,000,000 VND/case.
• Newborn Care (applicable to enterprise groups of 50 or more employees): 1% of secondary limit/person/year.

Regarding maternity benefits, maximum annual limits depend directly on the company's group size:

• Under 50 employees: 15,000,000 VND annual cap (normal delivery and non-surgical complications capped at 8,000,000 VND; caesarean section and surgical complications capped at 15,000,000 VND).
• 51 to 100 employees: 20,000,000 VND annual cap (sub-limits of 10,000,000 VND and 20,000,000 VND respectively).
• 101 to 200 employees: 30,000,000 VND annual cap (sub-limits of 25,000,000 VND and 30,000,000 VND respectively).

For more details on tier criteria and family enrolment, read our overview on Adding Family Members to BVCare: Spouse, Children and Parents by Group Size.

🦷 Outpatient and Dental Cover: Per-Visit, Daily, and Annual Caps

The optional outpatient rider offers annual coverage from 4 million to 30 million VND, subject to distinct operational limits:

• Outpatient Illness Treatment: Capped at 20% of the outpatient sum insured per visit or treatment course, with no restriction on the number of clinic visits per year. Outpatient pregnancy complications are capped at 500,000 VND/year.
• Physiotherapy and Prescribed Alternative Therapies: 2% of the outpatient sum insured/person/day, up to 60 days/year.
• Basic Dental Care (examinations, gingivitis treatment, fillings, root canal therapy, scaling capped at 500,000 VND/year, and pathological tooth extractions): 10% to 100% of the outpatient sum insured/person/year depending on selected plan terms.
• Routine Prenatal Care: Capped at 5% of the outpatient sum insured/person/year.

Comprehensive Dental Care is available as a distinct optional rider with limits ranging from 3 million to 20 million VND/year. It covers teeth scaling twice a year and oral surgical procedures. If an enterprise enrolls in Comprehensive Dental Care, basic dental coverage under the outpatient rider no longer applies. Dentures, aesthetic orthodontics, and accidental tooth damage are excluded from this benefit.

Income Loss Allowance / Wage Allowance pays a daily benefit calculated as the chosen sum insured divided by the total covered days, up to a maximum of 180 days per year for sick leave resulting from accidents or illness (maternity leave is excluded), up to 300,000,000 VND per category/year.

📌 Essential Considerations When Reviewing Limits

• Total indemnity paid for any insured person within a single policy year cannot exceed the maximum stated limits in the policy schedule.
• At traditional medicine, physiotherapy, or rehabilitation institutions: hospital cash allowance and income loss allowance (if included) are limited to a maximum of 5 days per hospitalisation episode, and no more than 3 admissions per year, unless specific amendments are stipulated in the contract.
• In Appendix I, co-payment is marked as not applicable; however, specific group-size underwriting terms or extensions may introduce co-payment requirements, so employers must review contract schedules carefully.
• Actual financial limits depend on the policy tier chosen and the total group headcount. Always verify against Appendix I of your formal quote before policy execution.

To verify qualification rules, age brackets, and expatriate conditions, refer to Who Can Join BVCare (New)? Age, Health and Expat Eligibility Rules alongside options for HEALTHCARE INSURANCE FOR EXPATS.

Clear awareness of coverage ceilings enables companies to balance employee welfare against premium budgets while avoiding unexpected out-of-pocket costs during claims. If your organisation requires tailored guidance to structure optimal coverage limits, reach out for reliable, professional support.