Luật Bảo hiểm y tế - văn bản Tiếng Anh - The Law on Health Insurance of Vietnam.
THE NATIONAL ASSEMBLY
--------- |
SOCIALIST REPUBLIC OF
VIET NAM
Independence - Freedom - Happiness |
No. 25/2008/QH12
|
Hanoi, November 14, 2008
|
LAW
ON HEALTH INSURANCE
Pursuant to the 1992 Constitution of
the Socialist Republic of Vietnam, which was amended and supplemented under
Resolution No. 51/2001/QH10;
The National Assembly promulgates the
Law on Health Insurance.
Chapter I
GENERAL PROVISIONS
Article 1. Governing scope and subjects of
application
1. This Law provides the health insurance
regime and policies, including participants, premium rates, responsibilities
and methods of payment of health insurance premiums; health insurance cards;
eligible health insurance beneficiaries; medical care for the insured; payment
of costs of medical care covered by health insurance; health insurance fund;
and rights and responsibilities of parties involved in health insurance.
2. This Law applies to domestic and
foreign organizations and individuals in Vietnam that are involved in health insurance.
3. This Law does not apply to
commercial health insurance.
Article 2. Interpretation of terms
In this Law, the terms below are
construed as follows:
1. Health insurance is
a form of insurance applied in the health care sector for non-profit purposes,
organized by the State and joined by responsible persons under this Law.
2. All-people health insurance means
health insurance joined by all persons prescribed in this Law.
3. Health insurance fund means
a financial facility set up from health insurance premium payments and other
lawful collections, which is used to cover costs of medical care for the
insured, managerial costs of health insurance institutions and other lawful
costs related to health insurance.
4. Employers include
state agencies, public non-business 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 the Vietnamese territory, which are
responsible for making health insurance contributions.
5. Health insurance-covered
primary care provider means the first medical examination and
treatment establishment registered by an insured and indicated in the health
insurance card.
6. Health insurance assessment means
professional activities conducted by a health insurance institution to evaluate
the reasonableness of medical care services provided to an insured serving as a
basis for the payment of costs of health insurance-covered medical care.
Article 3. Health insurance principles
1. Ensuring the sharing of risks among
the insured.
2. Health insurance premiums shall be
determined in percentage of wage, remuneration, pension, allowance or minimum
salary in the administrative sector (below referred to as the minimum salary).
3. Health insurance benefits shall be
based on the seriousness of sickness and category of beneficiaries within the
scope of the insured’s benefits.
4. Costs of health insurance-covered
medical care shall be jointly paid by the health insurance fund and the
insured.
5. The health insurance fund shall be
managed in a centralized, unified, public and transparent manner, ensuring the
balance between revenue and expenditure, and be protected by the State.
Article 4. State policies on health
insurance
1. The State pays, or assists payment
of, health insurance premiums for people with meritorious services to the
revolution and a number of social beneficiary groups.
2. The State adopts preferential
policies for the health insurance fund’s investments in order to preserve and
increase the fund. The fund’s revenues and profits from its investments are
tax-free.
3. The State creates favorable
conditions for organizations and individuals to join health insurance or pays
health insurance premiums for several beneficiary groups.
4. The State encourages investment in
technological development and advanced technical facilities for health
insurance management.
Article 5. State management agencies in
charge of health insurance
1. The Government performs the unified
state management of health insurance.
2. The Ministry of Health shall take
responsibility before the Government for performing the state management of
health insurance.
3. Ministries and ministerial-level
agencies shall, within the ambit of their tasks and powers, coordinate with the
Ministry of Health in performing the state management of health insurance.
4. People’s Committees at all levels
shall, within the ambit of their tasks and powers, perform the state management
of health insurance in localities.
Article 6. The Ministry of Health’s
responsibilities for health insurance
To assume the prime responsibility for,
and coordinate with other ministries, ministerial-level agencies and relevant
agencies and organizations in. performing the following tasks:
1. Formulating health insurance
policies and law, organizing the health care system, professional and technical
lines and financial sources for the protection, care and improvement of
people’s health, based on all-people health insurance;
2. Formulating strategies, planning and
master plans on development of health insurance;
3. Promulgating lists of drugs, medical
supplies and technical services which the insured is entitled to, and
professional and technical regulations on health insurance-covered medical
care;
4. Working out and submitting to the
Government solutions to ensure the balance of the health insurance fund;
5. Popularizing and disseminating
health insurance policies and law;
6. Directing and guiding the
implementation of the health insurance regime;
7. Inspecting, examining and handling
violations in, and settling complaints and denunciations about, health
insurance;
8. Monitoring, assessing and reviewing
activities in the health insurance domain;
9. Organizing scientific research and
international cooperation on health insurance.
Article 7. The Finance Ministry’s
responsibilities for health insurance
1. To coordinate with the Ministry of
Health, concerned agencies and organizations in formulating health
insurance-related Financial policies and regulations.
2. To inspect and examine the
implementation of legal provisions on financial mechanisms applicable to health
insurance and the health insurance fund.
Article 8. Responsibilities of People’s
Committees at all levels for health insurance
1. Within the ambit of their tasks and
powers, People’s Committees at all levels shall:
a/ Direct and organize the
implementation of policies and law on health insurance;
b/ Ensure funding to pay health
insurance premiums for persons eligible for premium payment or support from the
state budget under this Law;
c/ Popularize and disseminate health
insurance policies and law;
d/ Inspect, examine and handle
violations of, and settle complaints and denunciations about, health insurance.
2. Apart from the responsibilities
defined in Clause 1 of this Article, People’s Committees of provinces and
centrally run cities shall also manage and use funding sources under Clause 2,
Article 35 of this Law.
Article 9. Health insurance institutions
1. Health insurance institutions
function to implement health insurance regimes, policies and law, and manage
and use the health insurance fund.
2. The Government shall specify the
organization, functions, tasks and powers of health insurance institutions.
Article 10. Audit of the health insurance
fund
Once every three years, the State Audit
shall audit the health insurance fund and report the results to the National
Assembly.
If requested by the National Assembly,
the National Assembly Standing Committee or the Government, the State Audit
shall conduct extraordinary audit of the health insurance fund.
Article 11. Prohibited acts
1. Failing to pay or fully pay health
insurance premiums under this Law.
2. Committing fraud related to or
forging health insurance files or cards.
3. Using collected health insurance
premiums or the health insurance fund for improper purposes.
4. Obstructing, troubling or causing
harms to the insured and parties involved in health insurance in the exercise
of their lawful rights and enjoyment of their benefits.
5. Deliberately making false reports or
providing false information and data on health insurance.
6. Abusing one’s position, power or
professional operations to act in contravention of the health insurance law.
Chapter II
THE INSURED, RATES, LIABILITIES AND
METHODS OF PAYMENT OF HEALTH INSURANCE PREMIUMS
Article 12. The insured
1. Laborers working under
indefinite-term labor contracts or labor contracts of full three-month or
longer term according to the labor law; business managers who enjoy salaries or
remunerations under the salary and remuneration law; cadres, civil servants and
employees prescribed by law (below collectively referred to as employees).
2. Professional officers and
non-commissioned officers and officers and non-commissioned officers
specialized in technical areas who are serving in the people’s security force.
3. Persons on pension or monthly
working capacity loss allowance.
4. People on monthly social insurance
allowance for labor accident or occupational disease.
5. People who have stopped enjoying
working capacity loss allowances and are enjoying monthly allowances from the
state budget.
6. Commune, ward or township cadres who
have stopped working and are enjoying monthly social insurance allowances.
7. Commune, ward or township cadres who
have stopped working and are enjoying monthly allowances from the state budget.
8. People on unemployment allowance.
9. People with meritorious services to
the revolution.
10. War veterans as defined by the war
veteran law.
11. People who personally participated
in the anti-US resistance war for national salvation under the Government’s
regulations.
12. Incumbent National Assembly
deputies and People’s Council deputies at all levels.
13. People on monthly social welfare
allowance as prescribed by law.
14. Poor household members; ethnic
minority people living in areas with difficult or exceptionally difficult
socio-economic conditions.
15. Relatives of people with
meritorious services to the revolution as prescribed by the law on preferential
treatment toward people with meritorious services to the revolution.
16. Relatives of the following people
as prescribed in the laws on People’s Army officers, military service, people’s
public security and cipher officers:
a/ On-service officers, career army men
of the People’s Army; non-commissioned officers and soldiers who are serving in
the People’s Army;
b/ Professional officers and
non-commissioned officers and specialized technical officers and
non-commissioned officers who are working in the people’s security force;
non-commissioned officers and soldiers who are serving in the people’s security
force for a given period;
c/ Career officers and army men doing
cipher work in the Government Cipher Committee and those doing cipher work and
salaried according to the stafe payroll of People’s Army officers or the state
payroll of People’s Army career men who are neither army men nor policemen.
17. Children aged under 6 years.
18. People who have donated parts of
their bodies under the law on donation, taking and transplantation of tissues
and human organs and donation and taking of cadavers.
19. Foreigners studying in Vietnam who
are granted scholarships from the Vietnamese State’s budget.
20. Members of households living just
above the poverty line.
21. Pupils and students.
22. Members of agricultural, forestry,
fishery and salt-making households.
23. Relatives of employees defined in
Clause 1 of this Article whom the employees have to rear and who live together
with them in the same families.
24. Members of cooperatives or
individual business households.
25. Other persons according to the
Government’s regulations.
Article 13. Health insurance premium rates
and responsibilities to pay health insurance premiums
1. Health insurance premium rates and
responsibilities to pay health insurance premiums are prescribed as follows:
a/ The monthly premium rate applicable
to persons defined in Clauses 1 and 2, Article 12 of this Law is equal up to 6%
of the employee’s monthly salary or remuneration, with the employer paying two
thirds of the amount and the employee one-third. In the period when the
employee takes maternity leave or rears an adopted child of under 4 months
according to the social insurance law, the employee and employer are not
required to pay health insurance premium and this period is still counted in
their consecutive health insurance participation time for entitlement to health
insurance benefits;
b/ The monthly premium rate applicable
to persons defined in Clause 3, Article 12 of this Law is equal up to 6% of
their pension or working capacity loss allowance, and such premiums shall be
paid by the social insurance institution;
c/ The monthly premium rate applicable
to persons defined in Clauses 4,5 and 6, Article 12 of this Law is equal up to
6% of the minimum salary and such premiums shall be paid by the social
insurance institution;
d/ The monthly premium rate applicable
to persons defined in Clause 8, Article 12 of this Law is equal up to 6% of
their unemployment allowance and such premiums shall be paid by the social
insurance institution;
e/ The monthly premium rate applicable
to persons defined in Clauses 7, 9, 10, 11, 12, 13, 14, 15, 16, 17 and 18,
Article 12 of this Law is equal up to 6% of the minimum salary and such
premiums shall be paid by the state budget;
f/ The monthly premium rate applicable
to persons defined in Clause 19, Article 12 of this Law is equal up to 6% of
the minimum salary and such premiums shall be paid by the scholarship-awarding
agencies, organizations or units;
g/ The monthly premium rate applicable
to persons defined in Clauses 20, 21 and 22, Article 12 of this Law is equal up
to 6% of the minimum salary and such premiums shall be paid by these persons;
The state budget shall pay part of
health insurance premiums for persons defined in Clauses 20 and 21, Article 12
of this Law and those defined in Clause 22, Article 12 of this Law who have
average living standards;
h/ The monthly premium rate applicable
to persons defined in Clause 23, Article 12 of this Law is up to 6% of the
minimum salary and paid by the employees;
i/ The monthly premium rate applicable
to persons defined in Clause 24, Article 12 of this
Law is equal up to 6% of the minimum
salary and such premiums shall be paid by these persons;
j/ The monthly premium rate applicable
to persons defined in Clause 25, Article 12 of this Law is equal up to 6% of
the minimum salary.
2. In case an insured concurrently
belongs to different categories specified in Article 12 of this Law, he/she
shall pay health insurance premiums like those in the first category which
he/she belongs to in the order of priority defined in Article 12 of this Law.
In case a person defined in Clause 1,
Article 12 of this Law has additionally one or several indefinite-term labor
contracts or labor contracts of 3-month or longer term, he/she shall pay health
insurance premium according to the contract with the highest salary or
remuneration level.
3. The Government shall specify premium
and support rates referred to in Clause 1 of this Article.
Article 14. Salaries, remuneration,
allowances serving as a basis for health insurance premium payment
1. Employees salaried under state
regulations shall pay health insurance premiums based on their monthly salaries
paid according to their ranks or grades, and position, extra-seniority or trade
seniority allowances (if any).
2. Employees salaried or remunerated
according to their employers’ regulations shall pay social insurance premiums
based on their monthly salaries or remunerations indicated in their labor
contracts.
3. Persons on monthly pension, working
capacity loss allowance or job-loss allowance shall pay health insurance
premiums based on their monthly pensions, working capacity loss allowances or
job-loss allowances.
4. Other persons shall pay health
insurance premiums based on the minimum salary.
5. The maximum remuneration or salary
level used for the calculation of health insurance premiums is 20 times the
minimum salary.
Article 15. Methods of payment of health
insurance premiums
1. Monthly, employers shall pay health
insurance premiums for employees and make deductions from the latter’s salaries
and remuneration for payment of health insurance premiums into the health
insurance fund.
2. For agricultural, forestry, fishery
and salt-making enterprises which do not pay salaries on a monthly basis,
employers shall, once every three or six months, pay health insurance premiums
for employees and make health insurance premiums from the latter’s salaries or
remuneration for paying into the health insurance fund.
3. Monthly, social insurance
institutions shall pay health insurance premiums for persons defined in Clauses
3, 4, 5, 6 and 8, Article 12 of this Law, into the health insurance fund.
4. Annually, agencies and organizations
managing persons defined in Clauses 7, 9, 10, 11. 12, 13, 14, 17 and 18,
Article 12 of this Law shall pay health insurance premiums for these persons
into the health insurance fund.
5. Annually, agencies and organizations
managing people with meritorious services to the revolution and persons defined
at Points a, b and c, Clause 16, Article 12 of this Law shall pay health
insurance premiums for their relatives into the health insurance fund.
6. Monthly, scholarship-awarding
agencies, organizations and units shall pay health insurance premiums for
persons defined in Clause 19, Article 12 of this Law, into the health insurance
fund.
7. The Government shall specify methods
of payment of health insurance premiums for persons defined in Clauses 20, 21,
22, 23, 24 and 25, Article 12 of this Law.
Chapter III
HEALTH INSURANCE CARDS
Article 16. Health insurance cards
1. A health insurance card is granted
to an insured as a basis for enjoying health insurance benefits under this Law.
2. Everyone may be granted only one
health insurance card.
3. The time when a health insurance
card becomes valid is prescribed as follows:
a/ For an insured defined in Clause 3,
Article 50 of this Law who pays health insurance premiums continuously from the
second time on or an insured defined in Clause 2, Article 51 of this Law,
his/her health insurance card will become valid on the date of payment of
health insurance premiums.
b/ For an insured defined in Clause 3,
Article 50 of this Law who pays health insurance premiums for the first time or
fails to pay health insurance premiums continuously, his/her health insurance
card will become valid 30 days after the date of payment of health insurance
premiums; particularly for entitlement to hi-tech services, his/her health
insurance card will become valid 180 days after the date of payment of health
insurance premiums;
c/ With regard to a child under 6
years, his/her health insurance card is valid until he/she reaches full 72
months of age.
4. A health insurance card is invalid
in the following cases:
a/ Its validity duration expires;
b/ It has been modified or erased;
c/ The card holder no longer joins
health insurance.
5. Health insurance institutions shall
provide the model of health insurance card, manage health insurance cards
uniformly nationwide, and issue health insurance cards attached with photos of
the insured by January 1, 2014 at the latest.
Article 17. Grant of health insurance cards
1. A dossier of request for the grant
of a health insurance card comprises:
a/ A written registration of health
insurance participation by an agency or organization responsible for paying
health insurance premiums defined in Clause 1, Article 13 of this Law;
b/ A list of the insured, made by the
agency or organization responsible for paying health insurance premiums defined
in Clause 1, Article 13 of this Law or by the representative of the voluntary
insured;
c/ A written declaration of the
individual or household participating in health insurance.
2. A dossier of request for the grant
of a health insurance card to an under-6 child comprises:
a/ A copy of the birth proof paper or
birth certificate. In case the child has no such a paper or certificate, a
written certification by the People’s Committee of the commune, ward or
township where the child’s father, mother or guardian resides is required;
b/ A list or written request for the
grant of health insurance cards by the People’s Committee of the commune, ward
or township where the child resides.
3. Within 10 working days after
receiving a complete dossier prescribed in Clauses 1 and 2 of this Article, the
health insurance institution shall grant a health insurance card to the
insured.
Article 18. Re-grant of health insurance
cards
1. Health insurance cards may be
re-granted to replace the lost ones.
2. A person who loses his/her health
insurance card shall file a written request for the re-grant of the card.
3. Within 7 working days after
receiving a written request for the re-grant of a card, the health insurance
institution shall re-grant the card to the insured. Pending the re-grant of a
card, the card holder is still entitled to health insurance benefits.
4. A person who is re-granted a health
insurance card shall pay a charge. The Minister of Health shall set charge
rates for the re-grant of health insurance cards.
Article 19. Exchange of health insurance
cards
1. A health insurance card may be
exchanged in the following cases:
a/ It is torn, rumpled or damaged:
b/ The registered primary care provider
is changed;
c/ The information printed in the card
is incorrect:
2. A dossier of request for the
exchange of a health insurance card comprises:
a/ The insured’s written request for card
exchange;
b/ The health insurance card.
3. Within 7 working days after
receiving a complete dossier prescribed in Clause 2 of this Article, the health
insurance institution shall exchange the card for the insured. Pending the card
exchange, the card holder is still entitled to health insurance benefits.
4. A person who has a torn, rumpled or
damaged health insurance card exchanged shall pay a charge. The Minister of
Finance shall set charge rates for the exchange of health insurance cards.
Article 20. Revocation, seizure of health
insurance cards
1. A health insurance card may be
revoked in the following cases:
a/ There is fraud in its grant;
b/ The card holder no longer joins
health insurance.
2. A health insurance card shall be
seized when a person seeks medical care services with another’s card. A person
whose health insurance card is seized shall show up in order to receive back
the card and pay a fine in accordance with law.
Chapter IV
SCOPE OF HEALTH INSURANCE BENEFITS
Article 21. Scope of health insurance
benefits
1. The insured has the following costs
covered by the health insurance fund:
a/ Costs of medical examination and
treatment, function rehabilitation, regular pregnancy check-ups and birth
giving;
b/ Costs of medical examination for
screening and early diagnosis of some diseases;
c/ Costs of transferal from district
hospitals to higher-level hospitals, for persons defined in Clauses 9, 13. 14,
17 and 20, Article 12 of this Law in case of emergency or for inpatients who
need technical transferal.
2. The Minister of Health shall specify
Point b, Clause 1 of this Article: and assume the prime responsibility for. and
coordinate with relevant agencies in. promulgating lists of medicines,
chemicals, medical supplies and equipment as well as technical services which
the insured is entitled to.
Article 22. Levels of health insurance
benefits
1. An insured who uses medical care
services defined in Articles 26, 27 and 28 of this Law has medical care costs
covered by the health insurance fund at the following levels:
a/ 100% of the costs, for persons
defined in Clauses 2, 9 and 17, Article 12 of this Law;
b/ 100% of the costs, for cases in
which the cost of a check-up is below the level prescribed by the Government
and conducted at a commune hospital;
c/ 95% of the costs, for persons
defined in Clauses 3, 13 and 14, Article 12 of this Law;
d/ 80% of the costs, for other persons.
2. If the insured belongs to different
categories, he/she is eligible for the highest benefit for an insured of a
category.
3. The Government shall specify levels
of medical care costs paid for the cases of transferal to higher-level
hospitals, medical examination and treatment at upon request, and use of
hi-tech and expensive services and other cases not specified in Clause 1 of
this Article.
Article 23. Cases not eligible for health
insurance benefits
1. Cases specified in Clause 1 of
Article 21 in which costs have been paid by the state budget.
2. Convalescence at sanatoria or
convalescence establishments.
3. Medical check-up.
4. Prenatal tests and diagnosis for
non-treatment purposes.
5. Use of obstetric supportive
techniques, family planning services or abortion services, except for cases of
discontinuation of pregnancy due to fetal or maternal diseases.
6. Use of aesthetic services.
7. Treatment of squint,
short-sightedness and refractive defects.
8. Use of prostheses including
artificial limbs, eyes, teeth, glasses, hearing aids or movement aids in
medical examination, treatment and function rehabilitation.
9. Medical examination, treatment and
function rehabilitation in case of occupational diseases, labor accidents or
disasters.
10. Medical examination and treatment
in case of suicide or self-inflicted injuries.
11. Medical examination and treatment
for addiction to drugs, alcohol or other habit-forming substances.
12. Medical examination and treatment
of physical or mental injuries caused by the injured’s law-breaking acts.
13. Medical assessment, forensic
examination, forensic mental examination.
14. Participation in clinical trials or
scientific research.
Chapter V
ORGANIZATION OF MEDICAL CARE FOR THE
INSURED
Article 24. Health insurance-covered medical
care providers
1. A health insurance-covered medical
care provider is a health establishment which signs a medical care contract
with a health insurance institution.
2. Health insurance-covered medical
care providers include:
a/ Commune health stations and the
equivalent, maternity houses;
b/ General and specialized clinics;
c/ General and specialized hospitals.
Article 25. Contracts on health
insurance-covered medical care
1. A health insurance-covered medical
care contract is a written agreement between a health insurance institution and
a medical establishment on the provision of health insurance-covered medical
care services and payment for these services.
2. A health insurance-covered medical
care contract has the following principal details:
a/ Service beneficiaries and quality
requirements;
b/ Method of payment of medical care
costs;
c/ Rights and duties of the contractual
parties;
d/ Term of the contract;
e/ Liabilities for breach of the
contract;
f/ Conditions for modification,
liquidation and termination of the contract.
3. Any agreement on conditions for
modification, liquidation and termination of a contract defined at Point e.
Clause 2 of this Article must not interrupt medical care for the concerned
insured.
4. The Ministry of Health shall provide
a model contract on health insurance-covered medical care.
Article 26. Registration for health
insurance-covered medical care services
1. The insured may register for health
insurance-covered primary care services at medical establishments of commune
and district or equivalent levels, except for cases in which they are entitled
to register at provincial or central medical establishments under regulations
of the Minister of Health.
If an insured works on a mobile basis
or moves in a different locality, he/she may seek primary care services at a
medical establishment of corresponding technical line in the locality where
he/she works or resides under regulations of the Minister of Health.
2. The insured may change the
registered primary care provider at the beginning of every quarter.
3. The name of the primary care
provider shall be specified in a health insurance card.
Article 27. Treatment-line transfer
For a case falling beyond the
professional and technical capacity of a health insurance-covered medical care
provider, such provider may transfer the patient to another provider according
to regulations on technical transfer.
Article 28. Procedures for health
insurance-covered medical care
1. An insured seeking medical care
service shall present his/her health insurance card attached with his/her
photo; a card without photo must be produced together with a written proof of
persona identity of the card holder; for children under 6 years, only health
insurance cards need to be produced.
2. In case of emergency, an insured may
seek medical care services at any medical establishment and shall produce
his/her health insurance card together with papers defined in Clause 1 of this
Article before he/she is discharged from hospital.
3. In case of treatment-line
transferal, an insured shall obtain a transferal dossier from the concerned
medical establishment.
4. In case of re-examination to meet
treatment requirements, an insured shall obtain a note of appointment from the
concerned medical establishment.
Article 29. Health insurance assessment
1. Health insurance assessment covers:
a/ Scrutinizing medical care procedures;
b/ Checking and evaluating the order of
treatment, prescription, and the use of medicines, chemicals, medical supplies
and technical services for patients;
c/ Inspecting and determining costs of
health insurance-covered medical care.
2. Health insurance assessment must
ensure accuracy, publicity and transparency.
3. Health insurance institutions shall
conduct health insurance assessment and take responsibility before law for
assessment results.
Chapter VI
PAYMENT OF COSTS OF HEALTH
INSURANCE-COVERED MEDICAL CARE
Article 30. Methods of payment of costs of
insured medical care
1. Costs of health insurance-covered
medical care shall be paid by one of the following methods:
a/ Rate-based payment, which means
payment according to medical care cost norms and the premium rate fixed on each
health insurance card as registered with a health insurance-covered medical
care provider during a certain period;
b/ Service charge-based payment, which
means payment on the basis of costs of medicines, chemicals, medical supplies
and equipment as well as technical services provided for patients;
c/ Disease-based payment, which means
payment according to medical care costs pre-determined for each case based on
diagnosis.
2. The Government shall specify the
application of methods of payment of health insurance-covered medical care
costs defined in Clause 1 of this Article.
Article 31. Payment of costs of health
insurance-covered medical care
1. Health insurance institutions shall
pay costs of health insurance-covered medical care to medical care providers
according to health insurance-covered medical care, contracts
2. Health insurance institutions shall
pay medical care costs directly to health insurance card holders who use
medical care services in the following cases:
a/ At a health insurance-covered
medical care provider which has no health insurance-covered medical care
contract;
b/ The medical care is provided not in
accordance with Articles 26, 27 and 28 of this Law;
c/ In foreign countries;
d/ Other special cases as specified by
the Minister of Health.
3. The Ministry of Health shall assume
the prime responsibility for, and coordinate with the Ministry of Finance in,
specifying payment procedures and levels for cases defined in Clause 2 of this
Article.
4. Health insurance institutions shall
pay medical care costs on the basis of hospital charges according to the
Government’s regulations.
Article 32. Advancement, payment, settlement
of costs of health insurance-covered medical care
1. Health insurance institutions shall
quarterly pay in advance to health insurance-covered medical care providers at
least 80% of the costs of health insurance-covered medical care of the
preceding quarter which have been settled. With regard to a health
insurance-covered medical care provider which signs a health insurance-covered
medical care contract for the first time, the first advance will at least equal
80% of the medical care cost of one quarter under the signed contract.
2. An health insurance-covered medical
care provider and a health insurance institution shall make payment and
settlement on a quarterly basis as follows:
a/ In the first month of every quarter,
the health insurance-covered medical care provider shall send a report on
settlement of costs of health insurance-covered medical care in the previous
quarter to the health insurance institution;
b/ Within 30 days after receiving the
settlement report from the health insurance-covered medical care provider, the
health insurance institution shall consider and notify the latter of the
results of settlement. Within 15 days after notifying the settlement results,
the health insurance institution shall complete the settlement with the health
insurance-covered medical care provider.
3. Within 40 days after receiving a
complete dossier of request for payment of medical care costs from an insured
under Points a and b, Clause 2, Article 31 of this Law or 60 days, for cases
defined at Points c and d. Clause 2, Article 31 of this Law, the health
insurance institution shall pay the medical care costs to that insured.
Chapter VII
HEALTH INSURANCE FUND
Article 33. Sources for setting up the health
insurance fund
1. Health insurance premiums prescribed
in this Law.
2. Profits from investments by the
fund.
3. Financial aid from domestic and
foreign organizations.
4. Other lawful revenues.
Article 34. Management of the health
insurance fund
1. The health insurance fund shall be
managed in a centralized, uniform, public and transparent manner with
management decentralization within the system of health insurance institutions.
2. The Government shall specify the
management of the health insurance fund; decide on financial sources to ensure
health insurance-covered medical care in case the health insurance fund faces a
revenue-expenditure imbalance.
Article 35. Use of the health insurance fund
1. The health insurance fund is used
for the following purposes:
a/ Payment of health insurance-covered
medical care costs;
b/ Payment of costs of organizational
management of health insurance institutions, according to the administrative
spending norms applicable to state agencies;
c/ Investment for preservation and
growth purposes on the principle of safety and efficiency;
d/ Setting up of a provision fund for
health insurance-covered medical care. The provision must be at least equal to
the total costs of health insurance-covered medical care of the two consecutive
previous quarters and not exceed the total health insurance-covered medical
care costs of the two last consecutive years.
2. In case a province or centrally run
city’s health insurance premium payments are bigger than the health
insurance-covered medical care costs, the locality may use part of the balance
for the provision of medical care services.
3. The Government shall detail this
Article.
Chapter VIII
RIGHTS AND RESPONSIBILITIES OF PARTIES
INVOLVED IN HEALTH INSURANCE
Article 36. Rights of the insured
1. To be granted health insurance cards
if paying health insurance premiums.
To select a primary care provider under
Clause 1, Article 26 of this Law.
3. To be entitled to medical care.
4. To get medical care costs paid by
health insurance institutions.
5. To request health insurance
institutions, health insurance-covered medical care providers and relevant
agencies to explain and provide information on health insurance.
6. To complain about or denounce
violations of the health insurance law.
Article 37. Responsibilities of the insured
1. To pay health insurance premiums
fully and on time.
2. To use health insurance cards for
proper purposes, not to lend their cards to others.
3. To abide by the provisions of
Article 28 of this Law when using medical care services.
4. To comply with regulations and
guidance of health insurance institutions and medical establishments when using
medical care services.
5. To pay medical care costs to medical
establishments, in addition to the costs-covered by the health insurance fund.
Article 38. Rights of organizations and
individuals paying health insurance premiums
1. To request health insurance
institutions and competent state agencies to explain and provide information on
health insurance regimes.
2. To complain about and denounce
violations of the health insurance law.
Article 39. Responsibilities of organizations
and individuals paying health insurance premiums
1. To make dossiers of request for the
grant of health insurance cards.
2. To pay health insurance premiums
fully and on schedule.
3. To hand health insurance cards to
the insured.
4. To provide full and accurate
information and documents related to the health insurance duties of employers
and their representatives to the insured upon request of health insurance
institutions, employees or their representatives.
5. To be subject to examination and
inspection of the observance of the health insurance law.
Article 40. Rights of health insurance institutions
1. To request employers,
representatives of the insured and the insured to provide full and accurate
information and documents related to their health insurance duties.
2. To inspect and evaluate the
provision of health insurance-covered medical care services; to revoke or seize
health insurance cards, for cases defined in Article 20 of this Law.
3. To request health insurance-covered
medical care providers to provide patient files and records and medical care
documents for health insurance assessment.
4. To refuse payment of costs of health
insurance-covered medical care which violate this Law or the health
insurance-covered medical care contracts.
5. To request persons who are liable to
pay damages to the insured to refund medical care costs which have been paid by
health insurance institutions.
6. To propose competent state agencies
to revise health insurance policies or law and handle organizations and
individuals that violate the health insurance law.
Article 41. Responsibilities of health
insurance institutions
1. To popularize and disseminate health
insurance policies and law.
2. To provide dossier and procedural
guidance, to organize the implementation of health insurance regimes in a
quick, simple and convenient manner for the insured.
3. To collect health insurance premiums
and grant health insurance cards.
4. To manage and use the health
insurance fund.
5. To sign health insurance-covered
medical care contracts with medical establishments.
6. To pay health insurance-covered
medical care costs.
7. To provide information on health
insurance-covered medical care providers and guide the insured in selecting
primary care providers.
8. To check the quality of medical care
services; to conduct health insurance assessment.
9. To protect interests of the insured:
to settle according to their competence petitions, complaints and denunciations
on health insurance regimes.
10. To archive files and data on health
insurance according to law; to apply information technology to health insurance
management and establish a national database on health insurance.
11. To organize statistics and
reporting work, provide professional guidance on health insurance; to make
reports on the management and use of the health insurance fund on a periodical
basis or upon request.
12. To organize professional training
and retraining, scientific research and international cooperation on health
insurance.
Article 42. Rights of health
insurance-covered medical care providers
1. To request health insurance
institutions to provide full and accurate information on the insured and the
fund allocated to them for the provision of medical care for the insured.
2. To be entitled to fund advance and
payment of medical care costs by health insurance institutions in accordance
with the signed health insurance-covered medical care contracts.
3. To propose competent state agencies
to handle organizations and individuals that violate the health insurance law.
Article 43. Responsibilities of health
insurance-covered medical care providers
1. To provide quality medical care
services according to simple and convenient procedures for the insured.
2. To provide patient files and records
and documents on medical care and the payment of medical care costs at the
request of health insurance institutions and competent state agencies.
3. To ensure necessary conditions for
health insurance institutions to conduct assessment; to coordinate with health
insurance institutions in propagating and explaining health insurance regimes
to the insured.
4. To inspect, detect and inform health
insurance institutions of the misuse of health insurance cards; to coordinate
with health insurance institutions in revoking and seizing health insurance
cards in cases defined in Article 20 of this Law.
5. To manage and use money from the
health insurance fund strictly according to law.
6. To make statistics and reports on
health insurance in accordance with law.
Article 44. Rights of organizations
representing employees and those representing employers
1. To request health insurance
institutions, care providers and employers to provide full and accurate
information on health insurance for employees.
2. To request competent state agencies
to handle violations of the health insurance law which affect the lawful rights
and interests of employees and employers.
Article 45. Duties of organizations
representing employees and those representing employers
1. To popularize and disseminate health
insurance policies and law to employees and employers.
2. To participate in the formulation of
health insurance policies and law. and propose amendments or supplements
thereto.
3. To join in the supervision of
enforcement of the health insurance law.
Chapter IX
INSPECTION, COMPLAINT, DENUNCIATION,
SETTLEMENT OF DISPUTES AND HANDLING OF VIOLATIONS IN HEALTH INSURANCE
Article 46. Health insurance inspectorate
The health insurance inspectorate shall
conduct specialized inspection in the health insurance domain.
Article 47. Complaint, denunciation on health
insurance
The lodging and settlement of
complaints about administrative decisions and administrative acts related to
health insurance; the lodging and settlement of denunciations about violations
of the health insurance law comply with the law on complaints and denunciations.
Article 48. Health insurance disputes
1. Health insurance disputes are
disputes related to health insurance rights, duties and liabilities of the
following:
a/ The insured defined in Article 12 of
this Law and their representatives;
b/ Health insurance premium-paying
organizations and individuals defined in Clause 1, Article 13 of this Law;
c/ Health insurance institutions;
d/ Health insurance-covered medical
care providers.
2. Health insurance disputes shall be
settled as follows:
a/ The disputing parties shall
reconcile their dispute;
b/ In case of unsuccessful
reconciliation, the disputing parties may initiate a lawsuit at a court in
accordance with law.
Article 49. Handling of violations
1. Any person who violates the
provision of this Law and relevant provisions of law on health insurance shall,
depending on the nature and severity of their violations, be disciplined,
administratively sanctioned or examined for penal liability; and, if causing
damage, they shall pay compensation in accordance with law.
2. Agencies, organizations and
employers that are responsible to pay health insurance premiums but fail to pay
or fully pay them shall, according to law, fully pay the deficit together with
the interest arising in the late payment period at the prime interest rate
announced by the Slate Bank; if failing to do so, upon request of persons
competent to handle administrative violations, banks or other credit
institutions, the state treasury shall make deductions from their deposit
accounts to pay the arrears and interest arising on these arrears into the
account of the health insurance fund.
Chapter X
IMPLEMENTATION PROVISIONS
Article 50. Transitional provisions
1. Health insurance cards and free
medical care cards granted to under-6 children before the effective date of
this Law will be valid:
a/ Until their expiration, for cards
valid through
December 31, 2009;
b/ Until December 31, 2009, for cards
valid beyond December 31, 2009.
2. The benefits of persons who were
granted health insurance cards before this Law takes effect will be effective
according to current legal provisions on health insurance until December 31,
2009.
3. Persons defined in Clauses 21, 22,
23, 24 and 25, Article 12 of this Law may, pending the implementation of Points
b, c, d and e, Clause 2, Article 51 of this Law, voluntarily participate in
health insurance under the Government’s regulations.
Article 51. Effect
1. This Law takes effect on July 1,
2009.
2. The roadmap for achieving all-people
health insurance is provided for as follows:
a/ Persons defined in Clauses 1 thru
20, Article 12 of this Law shall participate in health insurance from the
effective date of this Law.
b/ Persons defined in Clause 21,
Article 12 of this Law shall participate in health insurance from January 1,
2010;
c/ Persons defined in Clause 22,
Article 12 of this Law shall participate in health insurance from January 1,
2012;
d/ Persons defined in Clauses 23 and
24, Article 12 of this Law shall participate in health insurance from January
1, 2014;
e/ Persons defined in Clause 25,
Article 12 of this Law shall participate in health insurance under the
Government’s regulations from January 1, 2014 at the latest.
Article 52. Implementation detailing and
guidance
The Government shall detail and guide
the implementation of the articles and clauses of this Law as assigned, and
guide other necessary provisions of this Law to meet state management
requirements.
This Law was passed on November 14,
2008. by the XIIth National Assembly of the Socialist Republic
of Vietnam at its 4th session.
CHAIRMAN OF THE NATIONAL ASSEMBLY
Nguyen Phu Trong |
Ý KIẾN