THE LAW
HEALTH INSURANCE
Pursuant to the 1992 Constitution of the Socialist Republic of Vietnam, which was amended and supplemented according to Resolution No. 51/2001/QH10;
The National Assembly promulgates the Health Insurance Law.
CHAPTER I
GENERAL PROVISIONS
Article 1. Scope of regulation and subjects of application
1. This Law regulates health insurance regimes and policies, including subjects, premium levels, responsibilities and health insurance payment methods; health insurance card; scope of health insurance coverage; organize medical examination and treatment for health insurance participants; pay for medical examination and treatment costs covered by health insurance; Health Insurance Fund; rights and responsibilities of parties related to health insurance.
2. This law applies to domestic organizations and individuals and foreign organizations and individuals in Vietnam related to health insurance.
3. This law does not apply to business health insurance.
Article 2. Explanation of terms
In this Law, the following terms are understood as follows:
1. Health insurance is a form of insurance applied in the field of health care, not for profit, organized and implemented by the State and subjects responsible for participating in accordance with the provisions of the Law. This.
2. Universal health insurance means that all subjects specified in this Law participate in health insurance.
3. Health insurance fund is a financial fund formed from health insurance contributions and other legal revenue sources, used to pay medical examination and treatment costs for health insurance participants. , costs of managing the health insurance organization's apparatus and other legal costs related to health insurance.
4. Employers include state agencies, public service units, people's armed forces units, political organizations, socio-political organizations, socio-political - professional organizations , social organizations, socio-professional organizations, enterprises, cooperatives, individual business households and other organizations; Foreign organizations and international organizations operating in Vietnamese territory are responsible for paying health insurance.
5. Initial medical examination and treatment facility covered by health insurance is the first medical examination and treatment facility registered by the health insurance participant and recorded in the health insurance card.
6. Health insurance appraisal is a professional activity conducted by a health insurance organization to evaluate the reasonableness of providing medical services to health insurance participants, as a basis for payment. Payment of medical examination and treatment costs covered by health insurance.
Article 3. Health insurance principles
1. Ensure risk sharing among health insurance participants.
2. Health insurance premiums are determined by the percentage of salary, wages, pensions, benefits or the minimum wage of the administrative area (hereinafter referred to as the minimum wage). ).
3. The level of health insurance benefits depends on the level of illness and target groups within the scope of benefits of health insurance participants.
4. Medical examination and treatment costs covered by health insurance are paid jointly by the health insurance fund and health insurance participants.
5. The health insurance fund is managed centrally, uniformly, publicly, transparently, ensuring balance of revenue and expenditure and protected by the State.
Article 4. State policy on health insurance
1. The State pays or supports health insurance premiums for people with meritorious services to the revolution and some social groups.
2. The State has preferential policies for investment activities from health insurance funds to preserve and grow the fund. The fund's revenue and profits from investment activities from the health insurance fund are exempt from tax.
3. The State creates conditions for organizations and individuals to participate in health insurance or pay health insurance for target groups.
4. The State encourages investment in developing advanced technology and technical means in health insurance management.
Article 5. State management agency on health insurance
1. The Government unifies state management of health insurance.
2. The Ministry of Health is responsible before the Government for implementing state management of health insurance.
3. Ministries and ministerial-level agencies, within the scope of their duties and powers, coordinate with the Ministry of Health to perform state management of health insurance.
4. People's Committees at all levels, within the scope of their duties and powers, perform state management of health insurance in their localities.
Article 6. Responsibilities of the Ministry of Health regarding health insurance
Preside over and coordinate with relevant ministries, ministerial-level agencies, agencies and organizations to perform the following tasks:
1. Develop policies and laws on health insurance, organize the health system, medical technical professional lines, and financial sources to serve the protection, care and improvement of people's health based on on universal health insurance;
2. Develop strategies, planning, and overall plans for health insurance development;
3. Issue a list of drugs, medical supplies, technical services within the scope of benefits of health insurance participants and professional and technical regulations related to medical examination and treatment covered by health insurance. ;
4. Develop and submit to the Government solutions to ensure balance of the health insurance fund;
5. Propagate and disseminate policies and laws on health insurance;
6. Direct and guide the organization and implementation of the health insurance regime;
7. Inspect, examine, handle violations and resolve complaints and denunciations about health insurance;
8. Monitor, evaluate and summarize activities in the field of health insurance;
9. Organize scientific research and international cooperation on health insurance.
Article 7. Responsibilities of the Ministry of Finance regarding health insurance
1. Coordinate with the Ministry of Health, relevant agencies and organizations to develop financial policies and laws related to health insurance.
2. Inspect and examine the implementation of legal regulations on financial regimes for health insurance and health insurance funds.
Article 8. Responsibilities of People's Committees at all levels regarding health insurance
1. Within the scope of their duties and powers, People's Committees at all levels have the following responsibilities:
a) Direct the organization and implementation of policies and laws on health insurance;
b) Ensure funding for health insurance premiums for subjects paid or supported by the state budget according to the provisions of this Law;
c) Propagate and disseminate health insurance policies and laws;
d) Inspect, examine, handle violations and resolve complaints and denunciations about health insurance.
2. In addition to performing the responsibilities specified in Clause 1 of this Article, the People's Committees of provinces and centrally run cities are also responsible for managing and using funding sources as prescribed in Clause 2, Article 35 of the Law. This.
Article 9. Health insurance organization
1. Health insurance organizations have the function of implementing health insurance regimes, policies and laws, managing and using health insurance funds.
2. The Government specifically regulates the organization, functions, tasks and powers of health insurance organizations.
Article 10. Audit of health insurance fund
Every 3 years, the State Audit audits the health insurance fund and reports the results to the National Assembly.
In case the National Assembly, the National Assembly Standing Committee or the Government request, the State Audit will conduct an unscheduled audit of the health insurance fund.
Article 11. Prohibited acts
1. Not paying or not paying enough health insurance according to the provisions of this Law.
2. Fraud and falsification of health insurance records and cards.
3. Using health insurance premiums and health insurance funds for the wrong purpose.
4. Obstruct, cause difficulties or damage the legitimate rights and interests of health insurance participants and parties related to health insurance.
5. Intentionally reporting false information and providing false information and data about health insurance.
6. Taking advantage of positions, powers, expertise, and operations to contravene the law on health insurance.
CHAPTER II
SUBJECTS, PAYMENT LEVELS, RESPONSIBILITIES
AND METHOD OF PAYING FOR HEALTH INSURANCE
Article 12. Health insurance participants
1. Employees working under labor contracts with indefinite term, labor contracts with a term of 3 months or more according to the provisions of labor law; Employees who are business managers receive salaries and wages in accordance with the law on wages and salaries; officials, civil servants and public employees according to the provisions of law (hereinafter referred to as employees).
2. Professional officers, non-commissioned officers and professional and technical officers and non-commissioned officers working in the People's Public Security force.
3. People receiving monthly pensions and disability benefits.
4. People who are receiving monthly social insurance benefits due to work accidents or occupational diseases.
5. People who have stopped receiving disability benefits are receiving monthly benefits from the state budget.
6. Commune, ward, and town officials who have quit their jobs are receiving monthly social insurance benefits.
7. Commune, ward, and town officials who have quit their jobs are receiving monthly benefits from the state budget.
8. People receiving unemployment benefits.
9. People who contributed to the revolution.
10. Veterans according to the provisions of the law on veterans.
11. People who directly participated in the resistance war against America to save the country according to Government regulations.
12. Current National Assembly deputies and People's Council deputies at all levels.
13. People eligible to receive monthly social protection benefits according to the provisions of law.
14. People from poor households; Ethnic minorities are living in areas with difficult and especially difficult socio-economic conditions.
15. Relatives of people who have contributed to the revolution according to the provisions of law on preferential treatment for people who have contributed to the revolution.
16. Relatives of the following subjects according to the provisions of law on People's Army officers, military service, People's Police and ciphers:
a) Officers and professional soldiers of the People's Army on active duty; non-commissioned officers and soldiers serving in the People's Army;
b) Professional officers, non-commissioned officers and professional and technical officers and non-commissioned officers working in the People's Public Security force; non-commissioned officers and soldiers of the People's Public Security serving for a limited period of time;
c) Officers and professional soldiers who are doing cipher work at the Government Cipher Committee and people who are doing cipher work are paid according to the salary table of People's Army officer ranks and the salary table of specialized soldiers. belongs to the People's Army but is not a soldier or people's police officer.
17. Children under 6 years old.
18. People who have donated human body parts according to the provisions of law on donation, retrieval, transplantation of tissues, human body parts and donation and retrieval of corpses.
19. Foreigners studying in Vietnam are granted scholarships from the Vietnamese State budget.
20. People from near-poor households.
21. Students.
22. People in households engaged in agriculture, forestry, fishery and salt production.
23. Relatives of the employee specified in Clause 1 of this Article that the employee is responsible for raising and living in the same household.
24. Members of cooperatives and individual business households.
25. Other subjects as prescribed by the Government.
Article 13. Health insurance premiums and responsibilities
1. Health insurance premiums and responsibilities are regulated as follows:
a) The maximum monthly payment rate of the subjects specified in Clauses 1 and 2, Article 12 of this Law is equal to 6% of the employee's monthly salary, of which the employer pays 2/3 and employees pay 1/3. During the time an employee takes leave to enjoy maternity benefits when giving birth or adopting a child under 4 months old according to the provisions of law on social insurance, the employee and the employer are not required to pay insurance. but still counted in the period of continuous health insurance participation to enjoy health insurance benefits;
b) The maximum monthly payment rate of the subjects specified in Clause 3, Article 12 of this Law is equal to 6% of the pension or disability allowance and is paid by the social insurance organization;
c) The monthly payment rate of the subjects specified in Clauses 4, 5 and 6, Article 12 of this Law is at most 6% of the minimum salary and is paid by the social insurance organization;
d) The maximum monthly payment rate of the subjects specified in Clause 8, Article 12 of this Law is equal to 6% of the unemployment benefit level and is paid by the social insurance organization;
d) The monthly payment rate of the subjects specified in Clauses 7, 9, 10, 11, 12, 13, 14, 15, 16, 17 and 18, Article 12 of this Law is at most 6% of the minimum wage and paid by the state budget;
e) The maximum monthly payment of the subjects specified in Clause 19, Article 12 of this Law is equal to 6% of the minimum salary and is paid by the agency, organization or unit granting the scholarship;
g) The monthly payment rate of the subjects specified in Clauses 20, 21 and 22, Article 12 of this Law is at most 6% of the minimum salary and is paid by the subjects;
The state budget partially supports health insurance premiums for the subjects specified in Clauses 20 and 21, Article 12 of this Law and the subjects specified in Clause 22, Article 12 of this Law with an average standard of living;
h) The maximum monthly payment rate of the subjects specified in Clause 23, Article 12 of this Law is equal to 6% of the minimum wage and is paid by the employee;
i) The monthly payment rate of the subjects specified in Clause 24, Article 12 of this Law is at most 6% of the minimum salary and is paid by the subjects;
k) The maximum monthly payment rate of the subjects specified in Clause 25, Article 12 of this Law is equal to 6% of the minimum salary.
2. In case a person simultaneously belongs to many different health insurance subjects as prescribed in Article 12 of this Law, the health insurance premium must be paid according to the first subject that that person is identified in the order of the conditions. subjects specified in Article 12 of this Law.
In case the subjects specified in Clause 1, Article 12 of this Law have one or more labor contracts of indefinite term or with a term of 3 months or more, health insurance must be paid according to the labor contract. highest salary and wages.
3. The Government specifies the contribution and support levels specified in Clause 1 of this Article.
Article 14. Salaries, wages, and allowances serve as the basis for paying health insurance
1. For employees subject to the salary regime prescribed by the State, the basis for paying health insurance is the monthly salary according to rank, military rank and position allowances and allowances. Over-seniority allowance, seniority allowance (if any).
2. For employees receiving salaries and wages according to the employer's regulations, the basis for paying health insurance is the monthly salary and wages stated in the labor contract.
3. For people receiving pensions, disability benefits, and monthly unemployment benefits, the basis for paying health insurance is the pension, disability benefits, and monthly unemployment benefits.
4. For other subjects, the basis for paying health insurance is the minimum salary.
5. The maximum wage and salary to calculate health insurance premiums is 20 times the minimum salary.
Article 15. Method of paying health insurance
1. Every month, the employer pays health insurance for the employee and deducts the health insurance premium from the employee's salary and wages to pay at the same time to the health insurance fund.
2. For agricultural, forestry, fishery, and salt enterprises that do not pay monthly salaries, every 3 months or 6 months, the employer pays health insurance for employees and deducts the contributions. Health insurance from employees' salaries and wages to be paid at the same time to the health insurance fund.
3. Every month, the social insurance organization pays health insurance for the subjects specified in Clauses 3, 4, 5, 6 and 8, Article 12 of this Law to the health insurance fund.
4. Every year, agencies and organizations managing the subjects specified in Clauses 7, 9, 10, 11, 12, 13, 14, 17 and 18, Article 12 of this Law pay health insurance for the subjects. This goes to the health insurance fund.
5. Every year, agencies and organizations managing people with meritorious services to the revolution and the subjects specified in Points a, b and c, Clause 16, Article 12 of this Law pay health insurance for their relatives to the fund. Health Insurance.
6. Every month, agencies, organizations, and units granting scholarships pay health insurance for the subjects specified in Clause 19, Article 12 of this Law to the health insurance fund.
7. The Government specifically regulates the method of paying health insurance for subjects specified in Clauses 20, 21, 22, 23, 24 and 25, Article 12 of this Law.
CHAPTER III
HEALTH INSURANCE CARD
Article 16. Health insurance card
1. Health insurance cards are issued to health insurance participants and serve as a basis for enjoying health insurance benefits according to the provisions of this Law.
2. Each person is only issued one health insurance card.
3. The time when the health insurance card is valid for use is specified as follows:
a) For health insurance participants as prescribed in Clause 3, Article 50 of this Law who pay health insurance continuously from the second time onwards or health insurance participants specified in Clause 2, Article 51 of this Law, the health insurance card is valid from the date of payment of health insurance;
b) For people participating in health insurance as prescribed in Clause 3, Article 50 of this Law paying health insurance for the first time or paying health insurance intermittently, the health insurance card is valid for use after 30 days. days from the date of payment of health insurance; Particularly for benefits of high-tech services, the health insurance card is valid for use after 180 days from the date of payment of health insurance;
c) For children under 6 years old, the health insurance card is valid until the child turns 72 months old.
4. Health insurance card is not valid in the following cases:
a) The card has expired;
b) The card is modified or erased;
c) The person whose name is on the card does not continue to participate in health insurance.
5. Health insurance organizations regulate health insurance card models, manage health insurance cards uniformly throughout the country and must organize the issuance of insurance cards no later than January 1, 2014. The medical certificate has a photo of the health insurance participant.
Article 17. Issuance of health insurance cards
1. Documents for issuance of health insurance card include:
a) Document of registration to participate in health insurance from the agency or organization responsible for paying health insurance specified in Clause 1, Article 13 of this Law;
b) List of health insurance participants prepared by the agency or organization responsible for paying health insurance specified in Clause 1, Article 13 of this Law or the representative of the person voluntarily participating in health insurance ;
c) Declaration of individuals and households participating in health insurance.
2. Documents for issuance of health insurance cards for children under 6 years old include:
a) Copy of birth certificate or copy of birth certificate. In case the child does not have a copy of the birth certificate or a copy of the birth certificate, there must be a confirmation from the People's Committee of the commune, ward or town where the father, mother or guardian resides;
b) List or application for health insurance card from the People's Committee of the commune, ward or town where the child resides.
3. Within 10 working days from the date of receipt of complete documents specified in Clauses 1 and 2 of this Article, the health insurance organization must issue a health insurance card to the health insurance participant.
Article 18. Re-issuance of health insurance card
1. Health insurance card is reissued in case of loss.
2. People who lose their health insurance card must submit an application to reissue the card.
3. Within 7 working days from the date of receiving the application to re-issue the card, the health insurance organization must re-issue the card to the health insurance participant. While waiting for the card to be reissued, the card holder can still enjoy the benefits of a health insurance participant.
4. The person whose health insurance card is reissued must pay the fee. The Minister of Finance regulates the fee for reissuing health insurance cards.
Article 19. Changing health insurance card
1. Health insurance cards can be exchanged in the following cases:
a) Torn, crushed or damaged;
b) Change the place of registration for initial medical examination and treatment;
c) The information recorded on the card is incorrect.
2. Documents to change health insurance card include:
a) Application to change card of health insurance participant;
b) Health insurance card.
3. Within 7 working days from the date of receipt of complete documents specified in Clause 2 of this Article, the health insurance organization must change the card for the health insurance participant. While waiting for the card to be replaced, the card holder can still enjoy the benefits of a health insurance participant.
4. People who have their health insurance card replaced because it is torn, damaged or damaged must pay a fee. The Minister of Finance regulates the fee for changing health insurance cards.
Article 20. Revocation and temporary seizure of health insurance cards
1. Health insurance card is revoked in the following cases:
a) Fraud in issuing health insurance cards;
b) The person whose name is on the health insurance card does not continue to participate in health insurance.
2. Health insurance cards are temporarily seized in cases where the person seeking medical examination or treatment uses another person's health insurance card. The person whose health insurance card is temporarily detained is responsible for returning the card and paying the fine according to the provisions of law.
CHAPTER IV
SCOPE OF HEALTH INSURANCE BENEFITS
Article 21. Scope of benefits of health insurance participants
1. Health insurance participants have the following costs covered by the health insurance fund:
a) Medical examination, treatment, rehabilitation, periodic prenatal examination, childbirth;
b) Medical examination for screening and early diagnosis of some diseases;
c) Transporting patients from district level to higher level for subjects specified in Clauses 9, 13, 14, 17 and 20, Article 12 of this Law in case of emergency or when undergoing inpatient treatment and requiring transfer. technical expertise.
2. The Minister of Health shall specifically stipulate point b, clause 1 of this Article; Preside over and coordinate with relevant agencies to promulgate a list of drugs, chemicals, supplies, medical equipment, and medical technical services within the scope of benefits of health insurance participants.
Article 22. Health insurance benefits
1. Health insurance participants who go for medical examination and treatment according to the provisions of Articles 26, 27 and 28 of this Law will have the health insurance fund pay the medical examination and treatment costs within the allowed scope. benefit as follows:
a) 100% of medical examination and treatment costs for subjects specified in Clauses 2, 9 and 17, Article 12 of this Law;
b) 100% of medical examination and treatment costs in cases where the cost for one medical examination and treatment is lower than the level prescribed by the Government and medical examination and treatment at the commune level;
c) 95% of medical examination and treatment costs for subjects specified in Clauses 3, 13 and 14, Article 12 of this Law;
d) 80% of medical examination and treatment costs for other subjects.
2. In case a person belongs to many subjects participating in health insurance, he/she will receive health insurance benefits according to the subject with the highest benefit.
3. The Government regulates the level of payment for medical examination and treatment costs in cases of exceeding technical and professional levels, medical examination and treatment on request, using high-cost high-tech services and medical schools. Other cases not specified in Clause 1 of this Article.
Article 23. Cases not eligible for health insurance
1. Expenses in the case specified in Clause 1, Article 21 have been paid by the state budget.
2. Nursing and convalescence at nursing and convalescence facilities.
3. Health examination.
4. Pregnancy testing and diagnosis are not for treatment purposes.
5. Use assisted reproductive technology, family planning services, abortion, except in cases where pregnancy must be terminated due to fetal or maternal pathology.
6. Use cosmetic services.
7. Treatment of strabismus, nearsightedness and refractive errors of the eye.
8. Use alternative medical supplies including artificial limbs, artificial eyes, artificial teeth, eyeglasses, hearing aids, and mobility aids in medical examination, treatment and rehabilitation.
9. Medical examination, treatment, and rehabilitation for occupational diseases, labor accidents, and disasters.
10. Medical examination and treatment in cases of suicide or self-injury.
11. Medical examination and treatment of drug addiction, alcohol addiction or other addictive substances.
12. Medical examination and treatment of physical and mental injuries caused by that person's illegal acts.
13. Medical examination, forensic examination, forensic psychiatric examination.
14. Participate in clinical trials and scientific research.
CHAPTER V
ORGANIZING MEDICAL EXAMINATION AND TREATMENT
FOR HEALTH INSURANCE PARTICIPANTS
Article 24. Medical examination and treatment facilities covered by health insurance
1. Health insurance covered medical examination and treatment facility is a medical facility that has signed a medical examination and treatment contract with a health insurance organization.
2. Medical examination and treatment facilities covered by health insurance include:
a) Commune health stations and equivalent, maternity homes;
b) General and specialized clinics;
c) General and specialized hospitals.
Article 25. Health insurance medical examination and treatment contract
1. Health insurance medical examination and treatment contract is a written agreement between a health insurance organization and a medical examination and treatment facility on the provision of services and payment of insured medical examination and treatment costs. medical insurance.
2. Health insurance medical examination and treatment contract includes the following main contents:
a) Subjects served and requirements for quality of service provision;
b) Payment method for medical examination and treatment costs;
c) Rights and responsibilities of the parties;
d) Contract term;
d) Liability due to breach of contract;
e) Conditions for change, liquidation, and contract termination.
3. The agreement on conditions for changing, liquidating, and terminating the contract specified in Point e, Clause 2 of this Article must ensure not to interrupt the medical examination and treatment of health insurance participants.
4. The Minister of Health regulates the form of health insurance medical examination and treatment contract.
Article 26. Registering for medical examination and treatment under health insurance
1. Health insurance participants have the right to register for initial health insurance medical examination and treatment at commune-level, district-level or equivalent medical examination and treatment facilities; except for cases registered at provincial or central medical examination and treatment facilities according to regulations of the Minister of Health.
In case the health insurance participant has to work mobile or temporarily reside in another locality, he/she will receive initial medical examination and treatment at a medical examination and treatment facility appropriate to his/her professional and technical level and where he/she is located. They are working mobile or temporarily residing according to regulations of the Minister of Health.
2. Health insurance participants are allowed to change the initial medical examination and treatment registration facility at the beginning of each quarter.
3. The name of the initial medical examination and treatment facility covered by health insurance is written on the health insurance card.
Article 27. Treatment referral
In cases where technical expertise is beyond the scope of the medical examination and treatment facility covered by health insurance, the health insurance medical examination and treatment facility is responsible for promptly transferring the patient to another health insurance medical examination and treatment facility according to regulations on specialized referral. technical subject.
Article 28. Procedures for medical examination and treatment covered by health insurance
1. Health insurance participants must present their health insurance card with photo when coming for medical examination and treatment; In case the health insurance card does not have a photo, the health insurance card must be presented along with documents proving the person's identity; For children under 6 years old, only health insurance card must be presented.
2. In case of emergency, health insurance participants can receive medical examination and treatment at any medical examination and treatment facility and must present their health insurance card along with the documents specified in Clause 1 of this Article. before leaving the hospital.
3. In case of referral for treatment, health insurance participants must have transfer records from the medical examination and treatment facility.
4. In case of re-examination as required for treatment, health insurance participants must have a re-examination appointment letter from the medical examination and treatment facility.
Article 29. Health insurance assessment
1. Health insurance appraisal content includes:
a) Check medical examination and treatment procedures covered by health insurance;
b) Check and evaluate the appointment of treatment, use of drugs, chemicals, supplies, medical equipment, and medical technical services for patients;
c) Check and determine medical examination and treatment costs covered by health insurance.
2. Health insurance appraisal must ensure accuracy, openness and transparency.
3. Health insurance organizations perform health insurance appraisals and are responsible before the law for the appraisal results.
CHAPTER VI
PAYMENT OF MEDICAL EXAMINATION AND TREATMENT COSTS HEALTH INSURANCE
Article 30. Method of payment for medical examination and treatment costs covered by health insurance
1. Payment of medical examination and treatment costs covered by health insurance is made according to the following methods:
a) Capitation payment is payment according to the norm of medical examination and treatment costs and the premium calculated on each health insurance card registered at a health insurance medical examination and treatment facility for a period of time. certain time;
b) Payment based on service price is payment based on the cost of drugs, chemicals, supplies, medical equipment, and medical technical services used for patients;
c) Case-based payment is payment based on predetermined medical examination and treatment costs for each case according to diagnosis.
2. The Government specifically regulates the application of the payment method for medical examination and treatment costs covered by health insurance specified in Clause 1 of this Article.
Article 31. Payment of medical examination and treatment costs covered by health insurance
1. Health insurance organizations pay medical examination and treatment costs covered by health insurance with medical examination and treatment facilities according to health insurance medical examination and treatment contracts.
2. Health insurance organizations pay health insurance medical examination and treatment costs directly for health insurance card holders who go for medical examination and treatment in the following cases:
a) At a medical examination and treatment facility without a medical examination and treatment contract with health insurance;
b) In case of medical examination and treatment not in accordance with the provisions of Articles 26, 27 and 28 of this Law;
c) Abroad;
d) Some other special cases prescribed by the Minister of Health.
3. The Ministry of Health shall preside over and coordinate with the Ministry of Finance to stipulate procedures and payment levels for the cases specified in Clause 2 of this Article.
4. Health insurance organizations pay medical examination and treatment costs on the basis of hospital fees according to Government regulations.
Article 32. Advance, payment, settlement of medical examination and treatment costs covered by health insurance
1. Health insurance organizations are responsible for making quarterly advances to health insurance medical examination and treatment facilities at least equal to 80% of the actual health insurance medical examination and treatment costs of the previous quarter. has been settled. For a medical examination and treatment facility that signs a medical examination and treatment contract with health insurance for the first time, the first advance is at least equal to 80% of the medical examination and treatment cost covered by health insurance for a quarter according to the regulations. signed contract.
2. Payment and settlement between medical examination and treatment facilities and health insurance organizations are made quarterly as follows:
a) In the first month of each quarter, medical examination and treatment facilities covered by health insurance are responsible for sending a final report on medical examination and treatment costs covered by health insurance for the previous quarter to the health insurance organization;
b) Within 30 days from the date of receiving the settlement report from the health insurance covered medical examination and treatment facility, the health insurance organization is responsible for reviewing and notifying the cost settlement results. . Within 15 days from the date of notification of settlement results, the health insurance organization must complete the payment with the medical examination and treatment facility.
3. Within 40 days from the date of receipt of complete dossier requesting payment from the health insurance participant for medical examination and treatment according to the provisions of Points a and b, Clause 2, Article 31 of this Law; Within 60 days from the date of receiving complete dossiers requesting payment from health insurance participants for medical examination and treatment according to the provisions of Points c and d, Clause 2, Article 31 of this Law, the insurance organization shall Health insurance must pay medical examination and treatment costs directly for these subjects.
CHAPTER VII
HEALTH INSURANCE FUND
Article 33. Sources of formation of health insurance fund
1. Health insurance premiums according to the provisions of this Law.
2. Profit from investment activities of the health insurance fund.
3. Sponsorship and aid from domestic and foreign organizations and individuals.
4. Other legal sources of income.
Article 34. Management of health insurance fund
1. The health insurance fund is managed centrally, uniformly, publicly, transparently and has decentralized management within the health insurance organization system.
2. The Government specifically regulates the management of health insurance funds; Decide on financial sources to ensure medical examination and treatment covered by health insurance in case of imbalance in health insurance fund revenues and expenditures.
Article 35. Use of health insurance fund
1. The health insurance fund is used for the following purposes:
a) Payment of medical examination and treatment costs covered by health insurance;
b) Expenses for managing the health insurance organization according to administrative expenditure norms of state agencies;
c) Invest to preserve and grow the health insurance fund according to the principles of safety and efficiency;
d) Establish a medical examination and treatment reserve fund for health insurance. The reserve fund must be at least equal to the total health insurance medical examination and treatment expenses of the two immediately preceding quarters and must not exceed the total health insurance medical examination and treatment expenses of the two immediately preceding years.
2. In cases where provinces and centrally run cities have health insurance revenues greater than health insurance medical examination and treatment expenses, they may use part of the surplus to serve insured medical examination and treatment. local health insurance.
3. The Government specifically regulates this Article.
CHAPTER VIII
RIGHTS AND RESPONSIBILITIES OF THE PARTIES
RELATED TO HEALTH INSURANCE
Article 36. Rights of health insurance participants
1. Get a health insurance card when paying health insurance.
2. Select the initial medical examination and treatment facility covered by health insurance according to the provisions of Clause 1, Article 26 of this Law.
3. Receive medical examination and treatment.
4. Health insurance organizations pay medical examination and treatment costs according to the health insurance regime.
5. Request health insurance organizations, health insurance medical examination and treatment facilities and relevant agencies to explain and provide information about health insurance regimes.
6. Complain and denounce violations of the law on health insurance.
Article 37. Obligations of health insurance participants
1. Pay health insurance in full and on time.
2. Use your health insurance card for the right purpose, do not lend your health insurance card to others.
3. Implement the regulations in Article 28 of this Law when coming for medical examination and treatment.
4. Comply with the regulations and instructions of health insurance organizations and medical examination and treatment facilities when coming for medical examination and treatment.
5. Pay medical examination and treatment costs to medical examination and treatment facilities in addition to the costs paid by the health insurance fund.
Article 38. Rights of organizations and individuals to pay health insurance
1. Request health insurance organizations and competent state agencies to explain and provide information about health insurance regimes.
2. Complain and denounce violations of the law on health insurance.
Article 39. Responsibilities of organizations and individuals paying health insurance
1. Prepare an application for a health insurance card.
2. Pay health insurance in full and on time.
3. Deliver the health insurance card to the health insurance participant.
4. Provide complete and accurate information and documents related to the health insurance responsibilities of the employer and the representative of the health insurance participant when requested by the organization. health insurance agency, employee or employee representative.
5. Comply with inspection and examination of the implementation of legal regulations on health insurance.
Article 40. Rights of health insurance organizations
1. Require employers, representatives of health insurance participants and health insurance participants to provide complete and accurate information and documents related to their responsibilities for carry health insurance.
2. Inspect and assess the implementation of medical examination and treatment covered by health insurance; revoke and temporarily hold health insurance cards for the cases specified in Article 20 of this Law.
3. Request medical examination and treatment facilities covered by health insurance to provide records, medical records, and documents on medical examination and treatment to serve health insurance assessment work.
4. Refuse to pay medical examination and treatment costs covered by health insurance not in accordance with the provisions of this Law or not in accordance with the content of the medical examination and treatment contract covered by health insurance.
5. Request the person responsible for compensating the health insurance participant to reimburse the medical examination and treatment costs paid by the health insurance organization.
6. Propose to competent state agencies to amend and supplement policies and laws on health insurance and handle organizations and individuals that violate the law on health insurance.
Article 41. Responsibilities of health insurance organizations
1. Propagate and disseminate policies and laws on health insurance.
2. Guide documents, procedures, and organize the implementation of health insurance regimes to ensure quick, simple and convenient for health insurance participants.
3. Collect health insurance premiums and issue health insurance cards.
4. Management and use of health insurance fund.
5. Sign a health insurance medical examination and treatment contract with the medical examination and treatment facility.
6.Pay medical examination and treatment costs covered by health insurance.
7. Provide information about medical examination and treatment facilities covered by health insurance and guide health insurance participants in choosing an initial medical examination and treatment facility.
8. Check the quality of medical examination and treatment; Health insurance appraisal.
9. Protect the rights of health insurance participants; Resolve according to authority recommendations, complaints and denunciations regarding health insurance regimes.
10. Store records and data on health insurance according to the provisions of law; Apply information technology in health insurance management, build a national database on health insurance.
11. Organize the implementation of statistics, reports, and professional guidance on health insurance; Report periodically or unexpectedly when required on the management and use of health insurance funds.
12. Organize training, professional development, scientific research and international cooperation on health insurance.
Article 42. Rights of medical examination and treatment facilities covered by health insurance
1. Request the health insurance organization to provide complete and accurate information related to health insurance participants, medical examination and treatment costs for health insurance participants at the facility medical examination and treatment.
2. Receive advance funding from the health insurance organization and pay medical examination and treatment costs according to the signed medical examination and treatment contract.
3. Recommend to competent state agencies to handle organizations and individuals violating the law on health insurance.
Article 43. Responsibilities of medical examination and treatment facilities covered by health insurance
1. Organize quality medical examination and treatment with simple and convenient procedures for health insurance participants.
2. Provide medical records and documents related to medical examination and treatment and payment of medical examination and treatment costs for health insurance participants at the request of health insurance organizations and government agencies. competent country.
3. Ensure necessary conditions for health insurance organizations to perform assessment work; Coordinate with health insurance organizations in propagating and explaining health insurance regimes to health insurance participants.
4. Check, detect and notify health insurance organizations of violations regarding the use of health insurance cards; Coordinate with health insurance organizations to revoke and temporarily hold health insurance cards for the cases specified in Article 20 of this Law.
5. Manage and use funds from the health insurance fund in accordance with the provisions of law.
6. Organize the implementation of statistics and reports on health insurance according to the provisions of law.
Article 44. Rights of employee representative organizations and employer representative organizations
1. Require health insurance organizations, medical examination and treatment facilities and employers to provide complete and accurate information related to employees' health insurance policies.
2. Propose to competent state agencies to handle violations of the law on health insurance that affect the legitimate rights and interests of employees and employers.
Article 45. Responsibilities of employee representative organizations and employer representative organizations
1. Propagate and disseminate health insurance policies and laws to employees and employers.
2. Participate in developing and recommending amendments and supplements to policies and laws on health insurance.3. Participate in monitoring the implementation of health insurance laws.
CHAPTER IX
INSPECTION, COMPLAINTS, ACCUSATION, DISPUTE RESOLUTION
AND HANDLING OF VIOLATIONS ON HEALTH INSURANCE
Article 46. Health insurance inspection
Health inspectors perform specialized inspection functions on health insurance.
Article 47. Complaints and denunciations about health insurance
Complaints and settlement of complaints about administrative decisions and administrative acts on health insurance, denunciations and settlement of denunciations of violations of the law on health insurance are carried out in accordance with the provisions of law. Law on complaints and denunciations.
Article 48. Disputes over health insurance
1. Dispute about health insurance is a dispute related to the rights, obligations and responsibilities of health insurance between the following subjects:
a) Health insurance participants as prescribed in Article 12 of this Law, representatives of health insurance participants;
b) Organizations and individuals pay health insurance according to the provisions of Clause 1, Article 13 of this Law;
c) Health insurance organization;
d) Medical examination and treatment facilities covered by health insurance.
2. Disputes over health insurance are resolved as follows:
a) The disputing parties are responsible for conciliating the content of the dispute themselves;
b) In case conciliation fails, the disputing parties have the right to sue in court according to the provisions of law.
Article 49. Handling of violations
1. Anyone who violates the provisions of this Law and other provisions of law related to health insurance shall, depending on the nature and severity of the violation, be disciplined and fined. administrative violations or criminal prosecution. If causing damage, compensation must be made according to the provisions of law.
2. Agencies, organizations, and employers who are responsible for paying health insurance but do not pay or pay insufficiently according to the provisions of law, along with having to pay the full unpaid amount, must also pay The amount of interest during the period of late payment according to the basic interest rate announced by the State Bank; If not, at the request of the person competent to handle administrative violations, banks, other credit institutions, and the state treasury will be responsible for deducting money from the deposit account of the person responsible for paying the guarantee. health insurance to pay the unpaid amount, late payment and interest on this amount to the health insurance fund account.
CHAPTER X
TERMS ENFORCEMENT
Article 50. Transitional provisions
1. Health insurance cards and free medical examination and treatment cards for children under 6 years old that were issued before the effective date of this Law have the following validity:
a) According to the expiry date stated on the card in case the card shows validity until December 31, 2009;
b) Until December 31, 2009 in case the card has a validity after December 31, 2009.
2. The scope of benefits of people who are issued health insurance cards before this Law takes effect will comply with current regulations of the law on health insurance until December 31, 2009.
3. Subjects specified in Clauses 21, 22, 23, 24 and 25, Article 12 of this Law who have not yet implemented the provisions of Points b, c, d and dd, Clause 2, Article 51 of this Law, have the right to Voluntary participation in health insurance according to Government regulations.
Article 51. Effectiveness of implementation
1. This Law takes effect from July 1, 2009.
2. The roadmap for implementing universal health insurance is prescribed as follows:
a) Subjects specified in Clauses 1 to 20, Article 12 of this Law shall have health insurance from the effective date of this Law;
b) Subjects specified in Clause 21, Article 12 of this Law shall have health insurance from January 1, 2010;
c) Subjects specified in Clause 22, Article 12 of this Law shall have health insurance from January 1, 2012;
d) Subjects specified in Clause 23 and Clause 24, Article 12 of this Law shall have health insurance from January 1, 2014;
d) Subjects specified in Clause 25, Article 12 of this Law shall have health insurance according to the Government's regulations no later than January 1, 2014.
Article 52. Detailed regulations and implementation instructions
The Government details and guides the implementation of assigned articles and clauses in the Law; guide other necessary contents of this Law to meet the requirements of state management.
This Law was passed by the 12th National Assembly of the Socialist Republic of Vietnam, 4th session, on November 14, 2008 .
PRESIDENT OF CONGRESS
Nguyen Phu Trong