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THE GOVERNMENT
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THE SOCIALIST
REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
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No. 105/2014/ND-CP
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Hanoi, November
15, 2014
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DECREE
PROVIDING
DETAILS AND DIRECTIVES ON THE IMPLEMENTATION OF SEVERAL ARTICLES OF THE LAW ON
HEALTH INSURANCE
Pursuant to the Law on Government Organization
dated December 25, 2001;
Pursuant to the Law on Health Insurance dated
November 14, 2008 and the Law on amending and supplementing the Law on Health
Insurance dated June 13, 2014;
At the request of the Minister of Health,
The Government hereby promulgates the Decree on
providing directives on the implementation of a number of articles of the Law
on Health Insurance.
Chapter I
CONTRIBUTING ENTITIES,
CONTRIBUTION RATES, SUBSIDY AMOUNTS, AND STATE EXPENDITURES ON THE CONTRIBUTION
AND SUBSIDIZATION OF HEALTH INSURANCE PREMIUMS
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In addition to the entities stipulated in Clause 1,
2, 3, 4 and 5 Article 12 on amending and supplementing the Law on Health
Insurance, other entities stipulated in Clause 6 Article 12 on amending and
supplementing the Law on Health Insurance include:
1. Rubber plantation workers who are entitled to
the monthly allowance under the Decision No. 206/CP dated May 30, 1979 adopted
by the Governmental Council (now called the Government) on the government
incentives for post-Liberation workers who used to work in a hazardous and
arduous working condition but now quit their jobs due to old age as stipulated
in Clause 2 Article 12 on amending and supplementing the Law on Health
Insurance.
2. Those who belong to family households, work in
agriculture, forestry, aquaculture and salt farming sectors, and only afford an
average standard of living as stipulated in Clause 4 Article 12 on amending and
supplementing the Law on Health Insurance.
Article 2. Contribution rates
1. As from January 1, 2015, the rate of monthly
health insurance contribution for eligible contributing entities shall be
specified as follows:
a) Equal 4.5% of monthly pay per an employee who
belongs to the entities stipulated at Point a Clause 1 Article 12 on amending
and supplementing the Law on Health Insurance.
In respect of female employees entitled to paid
maternity leaves from work as stipulated by the Social Security Law, the
monthly contribution rate shall equal 4.5% of monthly pay that they receive before
taking their maternity leave;
In respect of employees entitled to paid sick
leaves from work for the period of more than 14 days off as stipulated by the
Social Security Law, their pay shall be exempt from health insurance
contribution but still eligible to enjoy the entitlement to their health
insurance benefits;
In respect of employees held in detention, custody
or temporarily suspended from their work before being investigated or judged
guilty or not guilty of their offences, the monthly contribution rate shall
equal the proportion of 4.5% to 50% of monthly pay that these employees receive
in accordance with laws. Where employees are judged not guilty of any offence
by competent agencies, they are required to make retrospective payment for
their health insurance contribution arrears in proportion to the amount of
retrospective salary payments that they are entitled to receive before being
away from work;
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Employees shall be exempt from health insurance
contribution for the period when they work abroad; within a period of 60 days
since their entry into their home country, if they start participating in the
health insurance, a full length of the time when they work overseas and an
entire span ranging from the time when they return to the time when they
commence their health insurance contribution shall be considered as a
continuous term of health insurance contribution.
For the period when employees are processing
procedures for their entitlement to unemployment benefits in accordance with
regulations laid down in the Law on Employment, if they have not participated
health insurance as other groups of the insured have done, such period shall be
recorded as their term of health insurance contribution.
b) Equal 4.5% of base pay per an employee who belongs
to the entities stipulated at Point b Clause 1 Article 12 on amending and
supplementing the Health Insurance Law.
c) Equal 4.5% of retirement pension or incapacity
benefit per an employee who belongs to the entities stipulated at Point a
Clause 2 Article 12 on amending and supplementing the Law on Health Insurance.
d) Equal 4.5% of base pay per an employee who
belongs to the entities stipulated at Point b, c Clause 2 Article 12 on
amending and supplementing the Law on Health Insurance, and the entities
stipulated at Clause 1 Article 1 hereof.
dd) Equal 4.5% of unemployment benefit per an
employee who belongs to the entities stipulated at Point d Clause 2 Article 12
on amending and supplementing the Law on Health Insurance.
e) Equal 4.5% of base pay per an employee who
belongs to the entities stipulated at Point b, c, d, dd, e, g, h, i, k, l, m
and n Clause 3, and Clause 4, 5 Article 12 on amending and supplementing the
Law on Health Insurance, and the entities stipulated at Clause 2 Article 1
hereof.
Where infants have reached the age of 72 months but
still wait for the school term, the health insurance card shall be valid till
September 30 of such year without having to pay contributions to their health
insurance policies.
g) In respect of the health insurance contribution
rate for all members of family households stipulated in Clause 5 Article 12 on
amending and supplementing the Health Insurance Law, the contribution rate for
the first contributor shall equal 4.5% of his/her base pay while the second,
third and fourth contributor shall pay 70%, 60% and 50% of the first
contributor’s contribution rate respectively; the fifth contributor and so
forth shall pay contributions to the health insurance policy at the
contribution rate equal to 40% of the first contributor’s contribution rate.
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2. Based on the practical condition, the Ministry
of Health shall take charge of cooperating the Ministry of Finance and relevant
entities to send a written request to the Government to adjust the rate of
health insurance contributions in order to keep the health insurance fund
balanced.
Article 3. State expenditures
on the subsidization of health insurance contributions of several contributing
entities
1. The subsidization rate for health insurance
contributions of members of families living in near poverty in accordance with
regulations laid down at Point a Clause 4 Article 12 on amending and
supplementing the Health Insurance Law shall conform to the followings:
a) Subsidize 100% of health insurance contributions
to which nearly-poor members of families are entitled after newly escaping from
poverty with the 5-year subsidization term. Where nearly-poor members of
families have escaped from poverty before January 1, 2015 but the span ranging
from the poverty escape to January 1, 2015 is less than 05 years, the residual
subsidization time shall be at least 01 year;
b) Subsidize 100% of health insurance contributions
to which nearly-poor families residing at poor districts are entitled in
accordance with regulations laid down in the Government’s Resolution No.
30a/2008/NQ-CP dated December 27, 2008 on incentive programs for quick and
sustainable reduction in poverty at 61 poor districts and districts with high
poverty rate that are eligible for infrastructural investment mechanism and
policy in accordance with the Government’s Resolution No. 30a/2008/NQ-CP dated
December 27, 2008;
c) Subsidize at least 70% of health insurance
contributions per each of the rest of nearly-poor families.
2. Subsidize at least 30% of health insurance
contributions per each learner or student in accordance with regulations laid
down at Point b Clause 4 Article 12 on amending and supplementing the Health
Insurance Law.
3. Subsidize at least 30% of health insurance
contributions per each member of families working in agriculture, forestry,
aquaculture and salt farming sectors and just affording an average standard of
living under the Prime Minister’s Decision No. 32/2014/QD-TTg dated May 27,
2014 as prescribed in Clause 2 Article 1 hereof.
4. The People’s Committee of centrally-affiliated
cities and provinces (hereinafter referred to as provincial People’s
Committees) shall refer to the affordability of local government budget and
other financial sources, inclusive of 20% of total residual expenditures on
health check and disease cure within a specified year in accordance with
regulations set out in Clause 3 Article 35 on amending and supplementing the
Health Insurance Law (if any) in order to define and request the provincial
People’s Councils to define the higher subsidization rate of health insurance
contributions to which the entities stipulated at Point c Clause 1, 2, 3 of
this Article are entitled.
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HEALTH INSURANCE
COVERAGE RATE AND METHOD OF PAYMENT FOR THE POLICY-HOLDER’S MEDICAL EXPENSES
Article 4. Health insurance
coverage rate for the cases stipulated in Clause 1, 7 Article 12 on amending
and supplementing the Law on Health Insurance
1. Where the holder of health insurance policy
takes the medical care as regulated in Article 26, 27 and 28 of the Health
Insurance Law, and Clause 4, 5 Article 22 on amending and supplementing the
Health Insurance Law, the health insurance fund shall be liable for covering
medical expenses within the scope of insurance coverage defined at the rate as
follows:
a) 100% of medical expenses per each policy-holder
who belongs to the entities stipulated at Point d, e, g, h, i Clause 3 Article
12 on amending and supplementing the Law on Health Insurance;
b) 100% of medical expenses, and no imposition of
restraint on the rate of payments on several medicines, chemicals, medical
supplies and technical services in accordance with regulations enforced by the
Minister of Health on revolutionary activists, who took part in revolutionary
activities before January 1, 1045, from January 1, 1945 to the August
revolution date of 1945; Vietnamese heroic mothers; wounded or injured warriors
or those eligible for the entitlement to government benefits the same as
wounded warriors, Class-B wounded warriors, ill soldiers who have a 81% or
greater disability rating on their labor capacity losses; wounded or injured
warriors or those eligible for the entitlement to government benefits the same
as wounded warriors, Class-B wounded warriors, ill soldiers in treatment for
their injuries or relapse; children under 6 years of age;
c) 100% of medical expenses, when medical care is
taken at communal health centers;
d) 100% of medical expenses, when the cost incurred
by each medical care remains lower than 15% of base pay;
dd) 100% of medical expenses, when insured patients
have experienced 5 years of their uninterrupted participation in health
insurance that lasts for a period from the time when such patients start
participating in the health insurance to the time when they receive such
medical care, and make the co-payment greater than their 6-month base pay for
an accrued amount of medical expenses within an insurance year beginning on the
time when their participation in health insurance has fully reached 5
continuous years, except for the case in which insured patients are covered for
their medical expenses incurred from healthcare providers outside of the
insurance network.
a) 95% of medical expenses per each policy-holder
who belongs to the entities stipulated at Point a Clause 2, Point k Clause 3,
and Point a Clause 4 Article 12 on amending and supplementing the Law on Health
Insurance;
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2. Where the holder of health insurance policy receives
medical care at healthcare centers located in the close proximity of other
centrally-affiliated cities and provinces (hereinafter referred to as cities or
provinces), the health insurance fund shall cover medical expenses incurred
within the limit on benefit and coverage rate stipulated in Clause 1 of this
Article, which shall apply to the following cases:
a) Medical care provided by commune’s health
stations, general clinics and district’s hospitals;
b) Transfer of insured patients to professional and
technical healthcare network of a commune, district or province.
Presidents of the provincial People’s Committees
shall direct the Department of Health to take charge of cooperating with Social
Security Offices of cities or provinces in managing healthcare services
provided for policy-holders at such neighboring areas in accordance with the
joint instructions from the Ministry of Health and the Ministry of Finance on
the medical care under health insurance policies at the neighboring areas.
3. In respect of on-demand medical care, the health
insurance fund shall make a payment within the limit on its benefit and
coverage rate in accordance with the regulations laid down in:
a) Clause 1 Article 4 hereof that applies to
policy-holders entitled to healthcare services enshrined in Article 26, 27 and
28 of the Law on Health insurance, and amended or supplemented Clause 4, 5 and
6 Article 22 of the Law on Health insurance in which case the insured patient
shall be liable for medical expenses incurred in excess of the statutory limit
on benefit and coverage rate;
b) Amended and supplemented Clause 3 Article 22 of
the Law on Health Insurance applied to the insured patients who receive medical
care outside of the insurance network in which case such patients shall be
liable for medical expenses incurred in excess of the statutory limit on
benefit and coverage rate.
Article 5. Use of method of
payment for medical expenses according to amended and supplemented Article 30
of the Law on Health insurance
1. Capitation payment method shall be applicable to
the primary healthcare providers.
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a) Healthcare providers that do not use the
capitation payment method;
b) Payments for non-capitated medical services
provided by the healthcare provider who uses the capitation payment method;
c) Payments for medical services to insured
patients transferred to the healthcare provider who uses the capitation payment
method.
3. The Ministry of Health shall direct and
cooperate with the Ministry of Finance in providing detailed instructions on
and preparing specific plans for healthcare providers’ proper use of payment
methods as stipulated in Clause 1 and 2 of this Article.
Chapter III
MANAGEMENT AND UTILIZATION
OF HEALTH INSURANCE FUND
Article 6. Distribution and
utilization of health insurance fund
Total revenues from the contribution of health
insurance premiums generated in a centrally-affiliated city and province at the
contribution rate enshrined in Article 2 hereof shall be distributed and
utilized as follows:
1. 90% of health insurance contributions to
healthcare services (hereinafter referred to as healthcare fund) that serves
the following purposes:
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b) Reserve a portion of health insurance
contributions at educational institutions that belong to the national education
system and conform to the requirements set out by the Ministry of Health with
the intent of purchasing medicines, medical consumables, general medical
equipment and devices in order to serve the purpose of making arrangements for
the practice of primary healthcare services provided for children, learners and
students.
The reserved amount of health insurance
contributions for educational institutions that belong to the national
education system shall make up 7% of total revenues in proportion to the
contribution of total number of insured learners or students studying at
educational institutions (including learners and students participating in the
health insurance in other groups of contributing entities), and the equivalent
rate of health insurance contributions for which each contributing entity shall
be liable as stipulated in Article 2 hereof; 5% of total revenues in proportion
to total children under 6 years of age studying at kindergartens.
In the first month of an academic year or course,
social insurance offices shall be responsible to transmit the aforementioned
sum to educational institutions and account for such expenditures into a
general medical expense statement within their authority. Educational institutions
being expenditure receivers shall be responsible for using, accounting for and
making financial statements on expenditures, which shall be then reported to
superior administrators in accordance with legal regulations.
c) Retain an amount of health insurance
contributions in order for agencies, organizations or enterprises that operate
their own healthcare facilities to provide primary healthcare services for
their staff (except for those that enter into a contract for primary healthcare
services covered by health insurance with social insurance organizations). The
rate of reserved health insurance contributions shall equal 1% of total sum of
health insurance contributions that agencies, organizations or enterprises have
paid to social insurance organizations.
The Ministry of Health and the Ministry of Finance
shall provide detailed instructions on the implementation of Point b, c Clause
1 of this Article on requirements, scale, spending items, management and
financial statements concerning this source of expenditures.
2. 10% of health insurance contributions set aside
for the reserve fund and pay expenses incurred by the management of health
insurance fund in which at least 5% of health insurance contributions is used
for the reserve fund and regulated as follows:
a) Total amount of annual administrative
expenditures for the health insurance fund the shall be decided by the General
Director of Vietnam Social Security in proportion to total administrative
expenditures allocated to Vietnam Social Security after being approved by the
Prime Minister;
b) Reserve fund is created by the retained amount
of deductions from payments for administrative expenses of the health insurance
fund.
3. The management and utilization of revenues
gained from the contribution of health insurance premiums shall be regulated as
follows:
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b) Vietnam Social Security shall be responsible for
timely transferring a full amount of expenditures to meet the demand of Social
Insurance Offices at provincial and municipal levels for advances or payments
on medical expenses covered by health insurance in accordance with legal
regulations.
4. Based on the data available on the financial
statement approved by the Management Council of Vietnam Social Security, an
amount of expenditures that has not been used up at cities or provinces where
revenues gained from the contribution of health insurance premiums used for
medical services are greater than medical expenses within an insurance year
shall be distributed as follows:
a) With regard to the amount of expenditures used
to cover medical expenses that have not been used up in 2014, Vietnam Social
Security shall be responsible for accounting for the whole remaining amount
into the reserve fund;
b) From January 1, 2015 to December 31, 2020,
Vietnam Social Security shall be responsible for accounting for 80% of that
amount into the reserve fund, simultaneously report 20% of that amount of
expenditures to local social insurance organizations to prepare their spending
plan in accordance with regulations laid down at amended and supplemented Point
a Clause 3 Article 35 of the Law on Health Insurance.
Based on the amount of expenditures that has not
been locally used up, the Department of Health shall direct and cooperate with
the Department of Finance and Social Security Office of cities or provinces in
preparing the use plan for submission to the provincial People’s Committees to obtain
their approval and send a report to the provincial People’s Councils. Based on
the approval of provincial People’s Committees, Social Security Office of
cities or provinces shall allocate expenditures to relevant entities for their
spending plan.
Entities that receive such budget shall be
responsible for carrying out management and utilization in accordance with
applicable laws, work with the Social Security Office of cities of provinces to
make the account settlement for the purpose of recording all of payments into
the health insurance fund of cities or provinces, which must ensure the
conformity with the given purposes, efficiency, public disclosure and
transparency.
c) From January 01, 2021, Vietnam Social Security
shall be responsible for bringing forward the entire budget that have not been
used up into the reserve fund that serves as the regulator for all operations.
Article 7. Management and
utilization of the reserve fund
1. The reserve fund managed by Vietnam Social
Security shall be entitle to use to provide supplement to the budget for
medical expenses covered by Social Insurance Offices of cities or provinces in
case the amount of revenue gained from the contribution of health insurance
premiums used to make payment for medical expenses in accordance with
regulations laid down in Clause 1 Article 6 hereof remains less than the amount
of payments for medical expenses within an insurance year. After completing the
report on inspection of annual account settlement, Social Insurance Offices of
cities or provinces must send such report to Vietnam Social Security for their
verification in order to supplement total differential rate of expenditures
with the amount derived from the reserve fund.
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The Ministry of Health shall direct and cooperate
with the Ministry of Finance in sending a report to the Government to seek any
possible solution in order to ensure the adequate and timely-distributed amount
of budget for medical expenses covered under health insurance policies as
prescribed by laws.
Article 8. Expenses for the
administration of health insurance fund
1. Recurrent expenditures that conform to legal regulations
shall include:
a) Spending on particular works such as:
- Communicative and cooperative activities that
work towards the growth of health insurance;
- Activities concerning the task of collecting
revenues and paying expenses for the health insurance fund;
- Cooperative activities relating to the
inspection, examination and supervision of health insurance operations.
b) Operating expenses for health insurance
mechanism that help to manage health insurance funds at all administrative
levels.
2. Non-recurring expenses shall include:
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b) Spending on scientific researches, training,
education and international cooperation in the health insurance sector.
3. Other expenses in accordance with laws.
The Ministry of Finance shall provide detailed
instructions on spending accounts and rates enshrined in this Article.
Article 9. Investment
activities of health insurance fund
1. Temporarily idle cash available at the health
insurance fund shall be used to carry out the investment tasks which conform to
the investment types regulated in the Law on Social Insurance.
2. The Management Council of Vietnam Social
Security shall decide and be held accountable to the Government for the investment
type and structure of the health insurance fund upon the request of Vietnam
Social Security.
3. All of annual net income yielded from the
investment activities of the health insurance fund shall be set aside to
complement the reserve fund that serves as the regulator for entire operations.
Article 10. Financial
settlement and plan preparation
1. Vietnam Social Security must complete the report
on financial settlement by October 01 of the subsequent year in accordance with
the regulations laid down in amended and supplemented Article 32 of the Law on
Social Insurance.
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The Ministry of Finance shall take charge of
cooperating with the Ministry of Health in submitting a summary report to the
Prime Minister for the decision on annual financial plan.
3. Within a period of 15 days from the receipt of
the Prime Minister’s decision on the budget plan, Vietnam Social Security shall
be responsible for allocating the estimated norms of revenues and expenditures
to relevant regulatory bodies.
Chapter IV
IMPLEMENTARY PROVISIONS
Article 11. Transitional
provisions
1. Where persons participating in the health
insurance keep health insurance cards that are still valid after the date on
which the Law on amending and supplementing the Health Insurance Law takes
effect, the limit on insurance benefits and coverage rates shall comply with
the regulations laid down in the Law on amending and supplementing the Health
Insurance Law and in Article 4 hereof.
2. Where the holders of health insurance cards take
the medical care provided by a healthcare provider but their health insurance
cards have expired, their medical expenses incurred until they are discharged
from the hospital or finish their outpatient treatment shall be covered within
the limit on insurance benefits and coverage rates.
3. Where persons participating in the health
insurance are hospitalized before January 01, 2015 but have been discharged
from the hospital since January 01, 2015, their medical expenses shall be
covered within the limit on insurance benefits and coverage rates in accordance
with the regulations set out in the Law on amending and supplementing the
Health Insurance Law and in Article 4 hereof.
4. In respect of the entities stipulated in amended
and supplemented Point a Clause 3 Article 12 of the Health Insurance Law, who
are retired, discharged from military service, change or quit their jobs, the
length of time when they study or work in the people's army, public security
and cipher organizations shall be counted in the insurance time span.
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6. Educational institutions affiliated to the
national education system that have already received a portion of medical funds
to provide the primary healthcare for their learners or students before January
01, 2015 must comply with instructions of the Ministry of Finance till the end
of the academic year 2014 – 2015.
Article 12. Effect
This Decree shall come into force from January 01,
2015.
The Government’s Decree No. 62/2009/ND-CP dated
July 27, 2009 on specifying and guiding the implementation of a number of
articles of the Law on Health Insurance shall become defunct from the date on
which this Decree takes effect.
Article 13. Responsibility for
providing guidance on the implementation of this Decree
1. The Ministry of Health shall preside over their
coordination with the Ministry of Finance to provide guidance on the implementation
of binding provisions set out in this Decree, the individual participation in
the family household’s health insurance policies, and study and make a proposal
for solutions to involving all of the population in the health insurance.
2. The Ministry of Finance shall be responsible for
properly distributing the central budget to assist local insurance
administrators that do not have ability to carry out the budget self-control
for the purpose of implementing the health insurance policy as stipulated in this
Decree; providing guidance on transferring expenditures derived from the
administrative expenditures of the health insurance fund to the People’s
Committees of communes in order to compile a list of health insurance policy
holders in the given area; providing instructions on implementing binding
provisions laid down in this Decree.
3. The Ministry of National Defense and the
Ministry of Public Security shall preside over the coordination with the
Ministry of Health and the Ministry of Finance to provide guidance on the
health insurance policies for the entities stipulated in amended and
supplemented Point a, Point 1, Point n Clause 3 and Point b Clause 4 Article 12
enshrined in the Law on Social Insurance.
4. Vietnam Social Security shall be responsible for
determining the amount of co-payments accrued every month which serves as the
basis for the determination of insurance benefit amounts to which policy
holders participating in the health insurance for 05 continuous year are
entitled.
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Provide instructions on compiling the list of
family members who work in agriculture, forestry, aquaculture and salt farming
sectors, and only afford the average standard of living.
6. Other relevant ministries and agencies within
their functions, tasks and powers shall be responsible for providing guidance
on the implementation of this Decree.
Article 14. Responsibility for
implementation
Ministers, Heads of ministerial-level agencies,
Heads of Governmental agencies, the Presidents of People’s Committees of
central-affiliated cities and provinces shall assume their responsibility for
implementing this Decree./.
PP. THE
GOVERNMENT
PRIME MINISTER
Nguyen Tan Dung