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THE
NATIONAL ASSEMBLY
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SOCIALIST
REPUBLIC OF VIET NAM
Independence - Freedom - Happiness
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No.
25/2008/QH12
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Hanoi,
November 14, 2008
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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.
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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
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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.
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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;
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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
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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
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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
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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.
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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;
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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.
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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;
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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.
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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.
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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.
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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.
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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
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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
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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;
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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.
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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.
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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:
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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;
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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
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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;
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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.
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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.
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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.
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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;
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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.
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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
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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.
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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.
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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.
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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
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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.
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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;
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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;
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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;
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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