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THE NATIONAL
ASSEMBLY
OF VIETNAM
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THE SOCIALIST
REPUBLIC OF VIETNAM
INDEPENDENCE - FREEDOM – HAPPINESS
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Law No.
51/2024/QH15
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Hanoi, November
27, 2024
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LAW
AMENDMENTS
TO SOME ARTICLES OF THE LAW ON HEALTH INSURANCE
Pursuant to the Constitution of the Socialist
Republic of Vietnam;
The National Assembly promulgates the Law on
Amendments to some Articles of the Law on Health Insurance No. 25/2008/QH12,
which is amended by Law No. 32/2013/QH13, Law No. 46/2014/QH13, Law No.
97/2015/QH13, Law No. 35/2018/QH14, Law No. 68/2020/QH14 and Law No.
30/2023/QH15.
Article 1. Amendments to some
Articles of the Law on Health Insurance
1. Addition of Clause 9 after Clause 8 of Article
2:
“9. Reference level is an amount decided by the
Government to calculate the premiums and payouts (reimbursements) of certain
types of health insurance specified in this Law.”.
2. Amendments to Clause 2 of Article 3:
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3. Amendments to some Clauses of Article 6:
a) Amendments to Clause 1:
“1. Promulgating or propose promulgation of health
insurance policies and law, organizing the health care system, financial
sources for the protection, care and improvement of the people’s health based
on universal health coverage;
b) Amendments to Clause 3 and Clause 4:
“3. Promulgate regulations, procedures,
professional instructions on medical examination and treatment (hereinafter
referred to as “medical care” or “medical services”); frequently review and
update instructions on diagnosis and treatment; regulations on assessment of
rationality of provision of medical services; regulations on application of
information technology, digital transformation, sharing of information about
health insurance, synchronization of paraclinical results among health
insurance-covered health facilities in a manner that satisfies professional
requirements;
4. Implement or propose implementation of solutions
for balancing the health insurance fund;”.
4. Amendments to Article 7a:
Article 7a. Responsibilities of the Ministry of
Labor, War Invalids and Social Affairs
1. Provide instructions on the determination and
management of health insurance participants under the management of the
Ministry of Labor, War Invalids and Social Affairs that are prescribed in
Points e, h, i, k, o, r, s and t Clause 3, Points a, b, d and g Clause 4
Article 12 of this Law.
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5. Amendments to some Clauses of Article 7c:
a) Amendments to Clause 1:
“1. Administer and provide instructions on the
determination, management and compilation of the list of health insurance
participants under the management of the Ministry of National Defense and the
Ministry of Public Security prescribed in Points a, c, e, h and i Clause 1,
Points a, b, c, d, l and n Clause 3, Point b Clause 4 Article 12 of this Law.”;
b) Amendments to Clause 3:
“3. Carry out inspection of the implementation of
regulations of law on the responsibility to participate in health insurance of
persons under the management of the Ministry of National Defense and the
Ministry of Public Security prescribed in Points a, c, e, h and i Clause 1,
Points a, b, c, d, l and n Clause 3, Point b Clause 4 Article 12 of this Law.”.
6. Amendments to Clause 2 and Clause 3 of Article
8:
“2. The People’s Committees of central-affiliated
cities and provinces (hereinafter referred to as “provinces”), in addition to
fulfillment of the responsibilities specified in Clause 1 of this Article,
shall provide instructions on development of apparatus and resources to serve
state management of health insurance in their provinces.
3. The People’s Committees of communes, wards and
commune-level towns (hereinafter referred to as “communes”) shall:
a) Fulfill the responsibilities specified in Clause
1 of this Article;
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c) Compile a list of health insurance card issuance
for children as the same time as issuance of birth certificates.”.
7. Amendments to Article 9:
“Article 9. Health insurance authorities
1. Social insurance authorities are responsible for
implementation of health insurance policies and laws, management and use of the
health insurance funds.
2. The Government shall elaborate the functions,
tasks, powers and organizational structure of social insurance authorities with
regard to implementation of health insurance.”.
8. Amendments to Article 10:
“Article 10. Audit of the health insurance fund
1. State Audit Office of Vietnam shall carry out
audit of the health insurance fund every three years and submit reports to the
National Assembly; carry out ad hoc audit of the health insurance fund at the
request of the National Assembly, Standing committee of the National Assembly,
the President of Vietnam, the Government, the Prime Minister of Vietnam.
2. Annually, State Audit Office of Vietnam shall
carry out audit of the expenditures on organization and operation of health
insurance during audit of the statement of organization and operation of social
insurance.”.
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“1. Late payment, evasion of health insurance
premiums.”.
“Article 12. Eligible participants in health
insurance (insured individuals)
1. Participants whose insurance premiums are paid
by the employers, the employees, or both:
a) Employees working under indefinite-term
contracts or fixed-term contracts with duration of at least 01 month, even if
these contracts are referred to as other names by employees and employers as
long as they have contents about payment of wage or salary, the management and
supervision by a party; business executives, controllers, state capital
representatives, enterprise’s capital representative prescribed by law; members
of the Board of Directors, General Director, Director, members of the Board of
Controllers or controllers and other elected managerial positions of
cooperatives, cooperative unions under regulations of the Law on Cooperatives
who receive salaries;
b) Business executives, state capital
representatives, enterprise’s capital representative prescribed by law;
salaried members of the Board of Directors, General Director, Director, members
of the Board of Controllers or controllers and other elected managerial
positions of cooperatives, cooperative unions under regulations of the Law on
Cooperatives who do not receive salaries;
c) Employees who are foreign citizens working in
Vietnam under fixed-term employment contracts that last at least 12 months with
employers in Vietnam, except persons reassigned within an enterprise according
to regulations of law on foreign workers in Vietnam or those ho have reached
the retirement age upon the conclusion of the employment contracts according to
Clause 2 Article 169 of the Labor Code, or otherwise prescribed by an
international treaty to which the Socialist Republic of Vietnam is a signatory;
d) Employees working under indefinite-term
contracts or fixed-term contracts with duration of at least 01 month, even if
these contracts are referred to as other names by employees and employers as
long as they have contents about payment of wage or salary, the management and
supervision by a party; having agreements with employers on part-time
work and receiving a monthly salary that is equal to or higher than the
lowest salary as the basis for compulsory social insurance payment according to
social insurance laws;
dd) Owners of registered household businesses that
are compulsory social insurance participants according to social insurance
laws;
e) Officials and public employees;
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h) Family of national defense workers and public
employees who are serving in the army, family of police workers who are working
for the police who are not eligible participants specified in Points a, b, c,
d, dd, e, g and h of this Clause, Clause 2 and Clause 3 of this Article.
2. Participants whose insurance premiums are paid
by the social insurance authorities:
a) People who are receiving monthly retirement
pensions, incapacity allowances;
b) People who are taking leave and receiving
monthly occupational accident or occupational disease allowance; people who are
taking leave and receiving sickness benefits due to diseases on the list of
diseases requiring long-term treatment or employees who are taking leave and
receiving sickness benefits for at least 14 working days in the month according
to social insurance laws; people who are taking leave and receiving maternity
benefits for at least 14 working days in the month according to social
insurance laws;
c) Retired officials of communes who are receiving
monthly social insurance benefits;
d) People who are receiving unemployment benefits.
3. Participants whose insurance premiums are paid
by the State budget:
a) Officers and career military personnel of the
people's army; officers and non-commissioned officers in police forces; and
people doing cipher work and receiving the same salaries as military personnel;
b) Non-commissioned officers and soldiers of the
people’s army; non-commissioned officers and conscripts of the police;
military, police and cipher cadets who are receiving subsistence allowances and
are Vietnamese citizens;
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d) Reserve officer trainees for at least 03 months
who have not participated in social insurance or health insurance;
dd) Standing militia personnel;
e) Revolutionary contributors as prescribed by the
Ordinance on preferential treatment for revolutionary contributors; veterans;
g) Incumbent deputies of the National Assembly or
the People’s Councils at all levels;
h) Children under the age of 6;
i) Family of martyrs or caregivers of martyrs
according to the Ordinance on preferential treatment for revolutionary
contributors;
k) Family of revolutionary contributors, spouses of
martyrs who have remarried and are receiving monthly death benefits, and
relevant individuals according to the Ordinance on preferential treatment for
revolutionary contributors, except for those specified in Point i of this
Clause;
l) Family of the persons specified in Point a and
Point b of this Clause as prescribed by law;
m) Persons who have donated body parts under the
regulations of the law;
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p) Retired officials of communes who are receiving
monthly allowances from state budget;
q) People who have stopped receiving incapacity
allowances and are receiving monthly allowances from state budget;
r) People who are receiving monthly social
allowances; people who are receiving monthly nursing allowances according to
relevant laws; people who are receiving monthly death benefits and are also
eligible for social allowances;
s) People aged 75 or older who are receiving
monthly death benefits; people aged 70 to under 75 who are members of near-poor
households and receiving monthly death benefits;
t) People receiving social retirement benefits
according to social insurance laws;
u) Employees who are not eligible for pension, have
not reached the age for social retirement benefits and are receiving monthly
allowances according to social insurance laws.
4. Participants whose insurance premiums are
subsidized by state budget:
a) Members of near-poor households;
b) Students;
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d) Members of households doing agriculture,
forestry, aquaculture and salt production with average living standards as
prescribed by law;
dd) Health workers of villages; midwives of villages;
e) Part-time workers of villages and neighborhoods
as prescribed by law;
g) Ethnics living in communes that are no longer
disadvantaged or exceptionally disadvantaged areas will have health insurance
premiums subsidized by state budget according to regulations of the Government.
h) People who are awarded the title of “Nghệ nhân
nhân dân” (“People's Craftsperson”) or “Nghệ nhân ưu tú” (“Eminent
Craftsperson”) according to the Law on Cultural Heritage;
i) Human trafficking victims defined by the Law on Prevention
of Human Trafficking.
5. Participants who pay health insurance premiums
themselves:
a) Members of households that buy health insurance
for the entire household;
b) People living and working, being raised or cared
for in charitable or religious organizations;
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d) People who are not in the cases specified in
Points a, b and c of this Clause.
6. Participants other than those specified in
Clause 1, 2, 3, 4 and 5 of this Article according to regulations of Laws and
Ordinances.
7. The Government shall specify participants other
than those specified in Clause 1, 2, 3, 4, 5 and 6 of this Article, including:
a) Eligible health insurance participants
prescribed by law before January 1st 2025;
11. Amendments to Article 13:
“Article 13. Health insurance premium rates and responsibilities
to pay health insurance premiums
1. Health insurance premiums paid by the employers,
the employees, or both:
a) The monthly premium of a participant prescribed
in Points a, c, d and e Clause 1 Article 12 of this Law must not exceed 6% of the
monthly salary, two thirds of which is paid by the employer and the remaining
one third is paid by the employee;
b) The monthly premium of a participant prescribed
in Point b Clause 1 Article 12 of this Law must not exceed 6% of the monthly
salary as the basis for payment of compulsory social insurance and shall be
paid by the participant;
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d) The monthly premium of a participant prescribed
in Point g Clause 1 Article 12 of this Law must not exceed 6% of the reference
level, two thirds of which is paid by the employer and the remaining one third
is paid by the employee;
d) The monthly premium of a participant prescribed
in point h Clause 1 Article 12 of this Law must not exceed 6% of the monthly
salary and the liability prescribed by the Government;
e) The monthly premium of a participant prescribed
in point i Clause 1 Article 12 of this Law must not exceed 6% of the reference
level and the liability prescribed by the Government.
2. Health insurance premiums paid by social
insurance authorities:
a) The monthly premium of a participant prescribed
in Point a Clause 2 Article 12 of this Law must not exceed 6% of the pension or
incapacity allowance;
b) The monthly premium of a participant prescribed
in Point b and Point c Clause 2 Article 12 of this Law must not exceed 6% of
the reference level;
c) The monthly premium of a participant prescribed
in Point d Clause 2 Article 12 of this Law must not exceed 6% of the
unemployment benefit.
3. Health insurance premiums paid and subsidized by
state budget:
a) The monthly premium of a participant prescribed
in Point a Clause 3 Article 12 of this Law must not exceed 6% of the monthly
salary and shall be paid by state budget;
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c) The monthly premiums of the participants
prescribed in Point n Clause 3 Article 12 of this Law must not exceed 6% of the
reference level and shall be paid by state budget via the scholarship
providers;
4. The monthly premiums of the participants
prescribed in Clause 5 Article 12 of this Law must not exceed 6% of the
reference level and shall be paid for the entire household or each individual.
5. Order of health insurance payment in case an
individual is eligible for more than one form of health insurance
participation:
a) In case an individual is an eligible participant
under multiple scenarios prescribed in Article 12 of this law, he/she shall pay
health insurance according to the first applicable scenario listed in Article
12, except in the cases specified in Points c, d, dd, e and g of this Clause;
b) A participant specified in Points a, c, d, dd
and e Clause 1 Article 12 of this Law who has one or multiple employment
contracts shall pay health insurance under the employment contract used as the
basis for compulsory social insurance participation;
c) In case a participant prescribed in Point g
Clause 1 Article 12 of this Law is also an eligible participant in multiple
cases specified in Article 12 of this Law, health insurance premiums shall be
paid in the following order: paid by social insurance authority, paid by state
budget, subsidized by state budget, shared between the participant and the
People’s Committee of the commune;
c) In case a participant prescribed in Point a and
Point c Clause 2 Article 12 of this Law is also an eligible participant in
multiple cases specified in Article 12 of this Law, health insurance premiums
shall be paid by the social insurance authority;
dd) In case a participant prescribed in Points s, t
and u Clause 3 Article 12 of this Law is also an eligible participant in
multiple cases specified in Article 12 of this Law, health insurance premiums
shall be paid by state budget;
e) In case a participant prescribed in Points a, c,
d, dd, e, g, h and i Clause 4 Article 12 of this Law is also an eligible
participant prescribed in Point a Clause 5 Article 12 of this Law, he/she may
choose a form of health insurance participation according to his/her
preference;
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e) In case a participant prescribed in Point b and
Point c Clause 5 Article 12 of this Law is also an eligible participant
prescribed in Point a Clause 5 Article 12 of this Law, he/she may choose to
participate in health insurance as a household.
6. Members of a household prescribed in Point a
Clause 5 Article 12 of this Law who participate in health insurance as a
household in a fiscal year will be eligible for the following reductions:
b) The second, third, fourth participants shall pay
70%, 60%, 50% of the premiums paid by the first participant respectively;
c) The premiums paid by the fifth participant
onwards shall be equal to 40% of the premiums paid by the first participant.
7. The Government shall elaborate the following
regulations:
a) Rates of health insurance premiums and
subsidization mentioned in this Article;
b) Responsibility for payment, rates of health
insurance premiums and subsidization for the participants specified in Clause 6
and Clause 7 Article 12 of this Law.”.
12. Amendments to Clause 4 and Clause 5 of Article
14:
“4. The basis for health insurance payment by
participants other than those prescribed in Clauses 1, 2 and 3 of this Article
is the reference level.
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13. Amendments to some Clauses of Article 15:
a) Amendments to Clauses 2, 3, 4 and 5:
“2. Enterprises, artels, cooperatives, cooperative
unions, household businesses that operate in the fields of agriculture,
forestry, fishery, salt production and pay piece-rate or project-based
salaries, health insurance premiums shall be paid every 01, 03 or 06 months.
3. Social security authorities shall pay monthly
health insurance premiums prescribed in Clause 2 Article 13 of this Law to the
health insurance fund.
4. Scholarship providers shall pay quarterly health
insurance premiums prescribed in Point c Clause 3 Article 13 of this Law to the
health insurance fund.
5. The State budget shall transfer quarterly health
insurance premiums and health insurance subsidies prescribed in Points a, b and
d Clause 3 Article 13 of this Law to the health insurance fund.”;
b) Addition of Clause 7 and Clause 8 after Clause
6:
“7. The participants prescribed in Point b and Point
c Clause 1 Article 12 of this Law shall fully pay the amounts payable by
themselves directly to the social security authorities or via the household
businesses, enterprises, cooperatives, cooperative unions every 01, 03 or 06
months.
8. Deadlines for health insurance payment by
employers:
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b) The last day of the month succeeding the payment
cycle for quarterly or biannual payment.”.
14. Amendments to some Clauses of Article 16:
a) Amendments to Clause 1 and Clause 2:
“1. A health insurance card has a unique health
insurance number, is issued to a participant and used as a basis for enjoying
health insurance benefits prescribed by this Law. Health insurance cards are
issued in electronic and physical forms with equal legal value.
2. Each individual has only one health insurance
number.”;
“c) In case a health insurance participant
prescribed in Clause 4 and Clause 5 Article 12 of this Law either participates
in health insurance for the first time or has participated intermittently for
at least 90 days under any of the scenarios specified in Article 12 of this
Law, the health insurance card will become effective after 30 days from the day
on which health insurance is fully paid;”;
c) Amendments to Clause 5:
“5. Vietnam Social Security shall issue the health
insurance card template after reaching a consensus with the Ministry of
Health.”.
15. Amendments to Article 17:
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1. 1. Applications for the issuance of health
insurance cards include:
a) Declaration forms submitted by agencies,
organizations, units, individuals, households participating in social insurance
for the first time;
b) The list of health insurance participants
prescribed in Clause 1 Article 12 of this Law which is compiled by the employer
within 30 days from the day on which the employees are eligible for health
insurance participation. In case of participants prescribed in Point b and
Point dd Clause 1 Article 12 of this Law, the application shall be the
declaration form mentioned in Point a of this Clause submitted to the social
security authority within 30 days from the day on which the individual is
eligible for health insurance participation;
c) The list of health insurance participants
prescribed in Clauses 2, 3, 4 and 5 Article 12 which is compiled by the
People’s Committee of the commune by household, except for the participants on
the list mentioned in Point d and Point dd of this Clause;
d) The list of health insurance participants under
the management of The Ministry of Education and Training, the Ministry of
Labor, War Invalids and Social Affairs, other Ministries and central
authorities prescribed in Point n Clause 3 and Point b Clause 4 Article 12 of
this Law compiled by educational institutions and vocational education
institutions;
dd) The list of health insurance participants under
the management of the Ministry of National Defense and the Ministry of Public
Security Points a, c, e and h Clause 1, Points a, b, c, d, l and n Clause 3,
Point b Clause 4 Article 12 of this Law compiled by the Ministry of National
Defense and the Ministry of Public Security.
2. Within 05 working days from the receipt of the
valid application prescribed in Clause 1 of this Article, the social security
authority shall issue health insurance cards to participants and notify or send
the cards to the applying organization.
3. The Government shall promulgate regulations on
issuance of physical and electronic health insurance cards.”.
“Article 21. Health insurance coverage
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a) Costs of medical care, including telemedicine
services, telemedicine assistance, family medicine services, at-home medical
care, rehabilitation, regular prenatal care check-ups and childbirth;
b) Costs of patient transports for participants
prescribed in Points a, b, c, d, dd, e, h, i, o and r Clause 3 Article 12 of
this Law who are undergoing inpatient treatment or have to be referred to
another health facility as prescribed in Article 27 of this Law;
c) Costs of medical services, medicines, use of
medical devices, blood, blood products, medical gas, supplies, tools,
instruments, chemicals for medical services covered by the health insurance
fund.
2. The Minister of Health shall elaborate the
following regulations:
a) Rules and criteria for compilation of lists of
medicines, rules for compilation of lists of medical devices and services
covered by health insurance;
b) The promulgation of lists of medicines, rules
for compilation of lists of medical devices and services covered by health
insurance on the basis of the rules and criteria mentioned in Point a of this
Clause;
c) Ratios of payment for medicines, medical devices
and medical services covered by health insurance;
c) Rates and conditions for payment for medicines,
medical devices and medical services covered by health insurance;
dd) The payment for blood, blood products, medical
gas, supplies, tools, instruments, chemicals for medical services covered by
the health insurance fund.
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a) The payment for patient transport mentioned in
Point b Clause 1 of this Article;
b) Coverage for the participants prescribed in
Points a, b, c, d and dd Clause 3 Article 12 of this Law;
c) Participants to whom the co-payment rates
mentioned in Point c Clause 2 of this Article do not apply.”.
“Article 22. Health insurance reimbursement
rates
1. When health insurance participants receives
medical care as prescribed in Article 26 and Article 27 of this Law, they will
be reimbursed by the health insurance fund for the covered medical costs as
follows:
a) 100% of the medical costs for the participants
prescribed in Points a, b, c, d, dd, e, h, i, o, r and s Clause 3 Article 12 of
this Law. The uncovered medical costs incurred by the participants prescribed
in Points a, b, c, d and dd Clause 3 Article 12 of this Law shall be paid by
the health insurance budget for medical care of these participants; in case
this budget is insufficient, they will be covered by state budget;
b) 100% of the medical costs if the cost of one
medical examination/treatment occasion is lower than the level prescribed by
the Government;
c) 100% of the medical costs at primary healthcare
facilities, including: health stations, family medicine facilities; civil – military
health station, civil – military health clinics; medical centers of districts
that provide medical care and are licensed to operate as clinics; health
departments of agencies, units and organizations prescribed by the Minister of
Health; primary healthcare facilities of the army and the police prescribed by
the Minister of National Defense and the Minister of Public Security. 100% of
the costs outpatient care at local general clinics;
d) 100% of the medical costs when the patient has a
period of health insurance participation of at least 5 consecutive years and
has paid a co-payment of more than 6 times the reference level in the year
prescribed in Clause 3, points a, b, c, dd and e Clause 4, Clause 5 of this
Article, Article 26 and Article 27 of this Law;
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e) 80% of the medial costs for other participants.
2. An individual who is eligible for multiple forms
of health insurance participation will be entitled to the most advantageous
health insurance benefits.
4. In case a health insurance participant visits a
health facility that is not the registered primary care provider or against
regulations on referral prescribed in Article 26 and Article 27 of this Law,
except for the cases specified in Clause 3 and Clause 5 of this Article, he/she
will be reimbursed by the health insurance funds at the rates specified in
Clause 1 of this Article. To be specific:
a) 100% reimbursement when receiving medical care
at a secondary health facility or tertiary health facility in case of
definitive diagnosis and treatment of certain rare diseases, terminal diseases,
diseases that require surgery or high technology prescribed by the Minister of
Health;
b) 100% reimbursement for ethnics and poor
household members living in disadvantaged and extremely disadvantaged areas;
people living on commune-level and district-level islands when they receive
inpatient care at tertiary health facilities;
c) 100% reimbursement when using receiving medical
care at primary healthcare facilities;
d) 100% reimbursement when receiving inpatient care
at secondary health facilities;
dd) 100% reimbursement when using medical services
at secondary and tertiary health facilities that have been classified as
district-level health facilities by competent authorities before January 1st
2025;
e) 50% - 100% reimbursement when receiving
outpatient care at secondary health facilities according to their professional
classification and specific reimbursement rates prescribed by the Government,
except in the cases specified in Point a and Point dd of this Clause;
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h) 50% reimbursement when receiving outpatient care
following the road map of the Government and 100% reimbursement when receiving
inpatient care at tertiary health facilities that have been classified as
province-level health facilities by competent authorities before January 1st
2025.
5. Health insurance participants will be entitled
to 100% reimbursement prescribed in Clause 1 of this Article when receiving
emergency care at any health facility.
6. The Government shall specify the reimbursement
rates for the participants prescribed in Points a, b, c, d and dd Clause 3
Article 12 of this Law; reimbursement rates for health insurance participants
using medical service on demand and other cases not specified in Clause 1 of
this Article.”.
18. Amendments to Clause 7 and Clause 8 of Article
23:
8. Use of prostheses including artificial limbs,
eyes, teeth, glasses, hearing aids or movement aids in medical examination,
treatment and function rehabilitation.”.
19. Amendments to Article 24:
“Article 24. Covered facilities
Health insurance-covered facilities (hereinafter
referred to as “covered facilities”) are health facilities that have signed
health insurance-covered medical care contracts with the social security
authority as per regulations of the Government.”.
20. Amendments to some Points and Clauses of
Article 25:
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“e) Conditions for revision, finalization,
suspension and termination of the contract.”;
b) Amendments to Clause 3 and Clause 4:
“3. Any agreement on conditions for revision,
finalization, suspension and termination of a contract prescribed in Point e
Clause 2 of this Article must not interrupt the provision of medical care for
the participant.
4. The Government shall elaborate this Article and
provide a model contract for covered medical services.”.
21. Amendments to Article 26:
“Article 26. Registration of health
insurance-covered primary care providers
1. Health insurance participants may register a
primary healthcare facility or secondary health facility as a health
insurance-covered primary care provider, and may change this primary care
provider within the first 15 days of each quarter.
2. The distribution of health insurance card to
health insurance-covered primary care providers must be balanced, appropriate
for the primary care demand of the people, capacity of the health facilities
and the local area.
3. The Minister of Health shall elaborate Clause 1
and Clause 2 of this Article; specify the cases in which tertiary health
facilities may be registered as health insurance-covered primary care
providers.
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22. Amendments to Article 27:
“Article 27. Patient referral among covered
facilities
1. The patient referral among health facilities
shall be carried out according to the professional requirements and capacity of
the involved health facilities.
3. The Minister of Public Security and the Minister
of National Defense shall promulgate regulations on referral of patients under
their management among covered facilities under their management.”.
23. Amendments to Article 28:
“Article 28. Procedures for health
insurance-covered medical care
1. When receiving medical care, the health
insurance participant shall present information about the health insurance
card, his/her identification; children under 6 and people who have donated
human organs and have not been issued with health insurance cards shall present
other valid documents. In case of emergency, the patient must present the
information specified in this Clause before the end of the treatment.
The Government shall elaborate this Clause.
2. In case of follow-up examination according to
professional requirements, health insurance participants shall get appointments
following the procedures established by the Minister of Health.
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24. Amendments to Article 30:
“Article 30. Methods of payment of costs of
health insurance-covered medical care
1. Costs of health insurance-covered medical care
shall be paid by one of the following methods:
a) Rate-based payment;
b) Service price-based payment;
c) Diagnosis-related group payment.
2. The Government shall elaborate Clause 1 of this
Article and regulations on application of methods of payment of health
insurance-covered medical care costs.”.
25. Amendments to Article 31:
“Article 31. Payment of health insurance-covered
medical care costs
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2. social security authorities shall pay the costs
of health insurance-covered medical care directly to health insurance card
holders when they receive medical care in the following cases:
a) Medical care is provided at a health facility
without a health insurance-covered medical care contract;
b) Medical care is provided against Article 28 of
this Law;
c) Other cases prescribed by the Government.
The covered facility that receives the medicine,
medical device, refers the patient or sends the specimen shall prepare a
statement of the costs of these medicine, medical device or paraclinical
service and receive payment from the social security authority.
4. The Government shall elaborate the following
regulations:
a) Conditions, authority for deciding the cases in
which a health facility may receive medicines and medical devices from other
covered facilities for treatment of patients and the payment of these medicines
and medical devices prescribed in Clause 3 of this Article;
b) Management, use of funds for health
insurance-covered medical care, assessment, payment and statement of health
insurance-covered medical care costs incurred by the participants prescribed in
Points a, b, c, d and dd Clause 3 Article 12 of this Law;
c) Payment and statement of health
insurance-covered medical care costs incurred by participants in the people’s
armed forces, the people living in bordering areas, on islands, particularly
disadvantaged villages and communes in order to ensure defense and security.
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26. Amendments to Article 32:
”Article 32. Advance payment, payment, statement
of health insurance-covered medical care costs
1. The advance payment by social security
authorities to covered facilities shall be carried out quarterly as follows:
a) Within 05 working days from the receipt of the
previous quarter’s statement from the health facility, the social security
authority shall advance a lump sum of 90% of the health insurance-covered
medical care costs in the statement;
b) In case a health facility that signs the first
contract for health insurance-covered medical care, the social security
authority shall, on the basis of the medical costs of the month preceding the
month in which the contract is signed, advance 90% of the costs for the first
month of executing the contract; after one month, the social security authority
shall estimate and advance 90% of the health insurance-covered medical care
costs in the quarter according to Point a of this Clause;
2. The payment and statement between the heath
facilities and the social security authorities shall be carried out as follows:
a) Within the first 15 days of every month, covered
facilities shall send a written request for payment of health insurance-covered
medical care costs of the previous month to the social security authority; within
the first 15 days of every quarter, covered facilities shall submit the
statements of health insurance-covered medical care costs of the previous
quarter to the social security authority;
b) Within 30 days from the receipt of the previous
quarter’s statement from each covered facility, the social security authority
shall notify the verification result and the agreed payment for health
insurance-covered medical care, including the covered medical costs. For the
fourth quarter of the year, the time limit for notifying the verification
result and the agreed payment for health insurance-covered medical care shall
be 60 days from the day on which the social security authority receives the
fourth quarter’s statement from the health facility;
c) Within 10 days from the notification of the
verification result, the social security authority must fully pay the health
facility;
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3. Within 40 days from the receipt of the
satisfactory application for the payment from the health insurance participant
in the cases specified in Clause 2 Article 31 of this Law, the social security
authority shall pay the health insurance-covered medical care costs directly to
the participant.”.
27. Amendments to Article 35:
“Article 35. Allocation and use of the health
insurance fund
1. The health insurance fund shall be allocated and
used as follows:
a) 92% of the health insurance premiums shall be
used to pay for medical care;
b) 8% of the health insurance premiums shall be
used to contribute to the reserve fund, cover the expenditures on health
insurance organization and operation, at least 4% of which shall be contributed
to the reserve fund.
2. Investment of the temporarily idle money of the
health insurance fund shall comply with regulations of the Law on Social
Insurance on the principles, portfolio, methods and management of investment of
the social insurance fund.
3. In case the collected health insurance premiums
are greater than the payment for medical care in the year, the remainder shall
be transferred in full to the reserve fund for general use.
5. The Government shall elaborate this Article and
regulations on health insurance organization and operation.”.
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“2. Select a health insurance-covered primary care
provider according to Article 26 of this Law.”.
29. Amendments to Clause 3 of Article 39:
“3. Provide the health insurance card or notify the
health insurance card issuance result to the health insurance participant
within 03 working days from the receipt of the card or the notification from
the social security authority.”.
30. Amendments to Clause 2 of Article 40:
“2. Inspect the execution of health
insurance-covered medical care contracts; carry out health insurance
assessment; revoke, suspend health insurance cards in the cases specified in
Article 20 of this Law.”.
31. Amendments to Clause 8 of Article 41:
“8. Inspect the execution of health
insurance-covered medical care contract; carry out health insurance
assessment.”.
32. Addition of Clause 9 after Clause 8 of Article
43:
“9. Maintain the fulfillment of conditions for
health insurance-covered medical care in accordance with regulations of law on
health insurance, medical care, and health insurance-covered medical care
contracts.”.
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“Article 48a. Late payment of health
insurance premiums
Late payment of health insurance premiums is the
act of the employer in one of the following cases:
1. Failure to pay or fully pay the health insurance
premiums payable after the deadline for payment of health insurance premiums
specified in Clause 8 Article 15 of this Law, except the cases specified in
Point c Clause 1 Article 48b of this Law;
2. Failure to compile a list or a full list of
health insurance participants within 60 days from the deadline specified in
Point b Clause 1 Article 17 of this Law;
3. It will be considered evasion of health
insurance payment in the case specified in Clause 2 Article 48b of this Law.
Article 48b. Evasion of health insurance payment
1. Evasion of health insurance payment is the act
of the employer in one of the following cases:
a) Failure to compile a list or a full list of
health insurance participants after 60 days from the deadline specified in
Point b Clause 1 Article 17 of this Law;
b) Registering a lower salary as the basis for
health insurance payment than that specified in Article 14 of this Law;
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2. The Government shall elaborate this Article and
specifies the cases mentioned in Clause 1 of this Article that are not
considered evasion of health insurance payment for justifiable reasons.”.
34. Amendments to Article 49:
“Article 49. Actions against violations of
health insurance laws
1. Agencies, organizations and individuals that
commit violations against health insurance laws shall, depending on the nature
and severity of the violations, face disciplinary actions, administrative
penalties, or criminal prosecution, and pay recompense for any damage caused.
2. Actions against late payment of health insurance
premiums:
a) Enforced payment of the arrears plus an interest
of 0,03%/day on the arrears multiplied by (x) the number of days of late
payment to the health insurance fund;
b) Administrative penalties as prescribed by law;
c) Disqualification from commendation and awards.
3. Actions against evasion of health insurance
payment:
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b) Administrative penalties or criminal prosecution
as prescribed by law;
c) Disqualification from commendation and awards.
4. Agencies, organizations, employers that commit
evasion or late payment of health insurance for employees shall return all the
covered medical costs to the employees which accrue over the time health
insurance cards are not issued due to such evasion or late payment.
5. The Government shall elaborate Point a Clause 2,
Point a Clause 3 and Clause 4 of this Article.”.
35. Replacement of certain phrases:
a) The phrase “health insurance organization” is
replaced with “social security authority” in Clause 3 and Clause 6 Article 2,
Clause 2 and Clause 4 Article 7c, Clause 3 Article 18, Clause 3 Article 19,
Clause 1 Article 25, Clause 3 Article 29, Clause 1 Article 34, Clause 4 and
Clause 5 Article 36, Clause 4 Article 37, Clause 1 Article 38, Clause 4 Article
39, the title of Article and Clause 5 Article 40, the title of Article 41,
Clause 1 and Clause 2 Article 42, Clauses 2, 3 and 4 Article 43, Clause 1
Article 44, Point c Clause 1 Article 48;
b) The phrase “Vietnam Social Security Management
Council” is replaced with “Social Insurance Management council” in Clause 1
Article 34.
Article 2. Amendments to the
Law on Internal Security Forces No. 30/2023/QH15
Article 3. Implementation
clauses
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2. Regulations on healthcare levels, registration
of health insurance-covered primary care providers, patient referral among
covered facilities, procedures for health insurance-covered medical care in
Clauses 3, 16, 17, 21, 22, 23 and 28 Article 1 of this Law comes into force
from January 1st 2025.
3. Regulations on health insurance coverage in
Clause 16 Article 1 of this Law, except regulations on telemedicine,
telemedicine assistance, family medicine services, at-home medical care, rules
for compilation of covered medical devices and medical services and health
insurance reimbursement rates in Clause 17 Article 1 applied to the following
participants shall come into force from January 1st 2025:
a) Participants prescribed in Clause 10 Article 1
of this Law that are also prescribed in Article 12 of the Law on Health
Insurance No. 25/2008/QH12, which is amended by Law No. 32/2013/QH13, Law No.
46/2014/QH13, Law No. 97/2015/QH13, Law No. 35/2018/QH14, Law No. 68/2020/QH14
and Law No. 30/2023/QH15.
b) The participants prescribed in Point a of this
Clause when they receive medical care at health facilities before January 1st
2025 and end their treatment from January 1st 2025.
4. Paraclinical results shall be synchronized among
covered facilities by January 1st 2027 in accordance with
regulations of the Government.
5. Transition clauses:
a) Participants that are not prescribed in Point a
and Point b Clause 3 of this Article, receive medical care at health facilities
before July 1st 2025 and end their treatment from July 1st
2025 shall apply the regulations of this Law;
b) The reference level prescribed in this Law shall
be the statutory pay rate. In case salary policies are changed, the Government
shall prescribe a specific reference level;
c) Health insurance-covered medical care contracts
that are signed before July 1st 2025 and enter into force after July
1st 2025 shall be executed in accordance with regulations of the
Government;
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This Law was passed by the 15th National
Assembly of the Socialist Republic of Vietnam during the 8th session
on November 27th 2024.
PRESIDENT OF
THE NATIONAL ASSEMBLY
Tran Thanh Man