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THE MINISTRY OF HEALTH - THE MINISTRY OF FINANCE
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SOCIALIST
REPUBLIC OF VIET NAM
Independence - Freedom – Happiness
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No. 39/2011/TT-BYT-BTC
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Hanoi, November 11, 2011
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JOINT CIRCULAR
GUIDING THE PROCEDURES FOR PAYMENT OF MEDICAL
EXAMINATION AND TREATMENT EXPENSES FOR HEATH INSURANCE PARTICIPANTS MEETING
WITH TRAFFIC ACCIDENTS
Pursuant to the November 14, 2008 Law on Insurance Health;
Pursuant to the November 13, 2008 Law on Road Traffic;
Pursuant to the June 14, 2005 Law on Railway Traffic;
Pursuant to the June 15, 2005 Law on Waterway Traffic;
Pursuant to the Government's Decree No. 62/2009/ND-CP of July 27, 2009,
detailing and guiding a number of articles of the Law on Health Insurance;
The Ministry of Health and the Ministry of Finance guide procedures for
payment of medical examination and treatment expenses for health insurance
participants meeting with traffic accidents as follows:
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1.
Pending the collection of sufficient grounds to determine whether or not a
traffic accident occurred due to the accident victim's violation of traffic
rules, when receiving medical care, the accident victim who is a health
insurance participant will be eligible for health insurance benefits according
to regulations.
2.
When there are sufficient grounds to determine that a traffic accident occurred
due to the accident victim's violation of traffic rules or a traffic accident
victim falls outside the payment coverage of the health insurance fund, such
accident victim will be ineligible for health insurance benefits and must fully
refund medical examination and treatment expenses to the health insurance fund.
3.
The following persons will be eligible for health insurance-covered medical
care according to regulations without having to go through the procedures for
determining violations of traffic rules prescribed in Article 2 of this
Circular:
a/
Children aged under 14;
b/
Elderly persons aged 80 or older.
Article 2. Order, procedures and responsibilities for determining
violations of traffic rules
1.
For health insurance participants meeting with traffic accidents:
When
seeking medical care, a health insurance participant meeting with a traffic
accident shall, apart from producing papers required for health
insurance-covered medical care, provide to the medical examination and
treatment establishment information on his/her full name, date of birth; place
of residence; time and place of the accident and cause of the accident (if
any).
In
case the accident victim has fallen into a coma and is unable to provide the
above-mentioned information, his/her relatives or persons who escort the victim
to the hospital shall provide information on what they know about the accident.
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2.
For medical examination and treatment establishments receiving accident
victims:
Everyday,
medical examination and treatment establishments shall make a list of health
insurance participants meeting with traffic accidents who come for medical
examination or treatment or emergency treatment on the day (according to the
form provided in Appendix 1 to this Circular, not printed herein) and transfer
such list to social security agencies or social security officers based in
their establishments.
3.
For social security agencies:
a/
Within 2 working days after receiving a list of health insurance card holders
meeting with traffic accidents from a medical examination and treatment
establishment, a social security agency shall send written requests for
verification of accident victims' violations of traffic rules to the traffic
police offices or social order-related crime investigation police offices
(below collectively referred to as police offices) of the localities where the
traffic accidents occurred (according to the form provided in Appendix 2 to
this Circular, not printed herein).
In
case an accident victim or his/her relative has provided the medical
examination and treatment establishment or social security agency with one of
the documents mentioned in Article 3 of this Circular or the social security
agency has previously sent a written verification request, the social security
agency is not required to re-send such request.
b/
Three months after a verification request is sent, if the social security
agency receives no reply from the police office or receives a notice informing
that the police office has not yet investigated or is incapable of
investigating into violations of traffic rules, the social security agency
shall pay and settle medical examination and treatment expenses as for cases in
which accident victims do not violate traffic rules.
Article 3. Grounds for payment or nonpayment of medical examination and
treatment expenses for health insurance participants meeting with traffic accidents
according to regulations
Social
security agencies shall base themselves on any of the following documents to
decide whether or not to pay medical examination and treatment expenses for
health insurance participants meeting with traffic accidents:
1.
Copy of the traffic accident minutes made by a police office.
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3.
Copy or extract of the final conclusion of the court that has handled the case
(containing the court's certification), provided by the accident victim or
his/her relative.
Article 4. Payment of medical examination and treatment expenses for
traffic accidents involving violations of traffic rules
When
there are sufficient grounds to determine that a traffic accident occurred due
to the accident victim's violation of traffic rules, the social security agency
shall pay medical examination and treatment expenses as follows:
1.
If the victim is being treated at a medical examination and treatment
establishment, the social security agency shall notify the victim or his/her
relative (natural parent, spouse or natural child of full 18 years or older)
that the victim violated traffic laws and is ineligible for payment of medical
examination and treatment expenses from the health insurance fund.
2.
If the victim has been discharged from hospital, the social security agency
shall recover medical examination and treatment expenses already paid by the
health insurance fund under Article 5 of this Circular.
3.
If the victim dies, the social security agency shall pay and settle medical
examination and treatment expenses with the medical examination and treatment
establishment according to health insurance regulations (in this case, the paid
expenses are not recovered).
Article 5. Recovery of medical examination and treatment expenses
already paid by the health insurance fund
1.
The social security agency shall notify the accident victim or his/her relative
of the results of verification of violation of traffic rules by the police
office and request him/her to refund medical examination and treatment expenses
already paid by the social security agency to the health insurance fund
(according to the form provided in Appendix 3 to this Circular, not provided
herein).
2.
Thirty days after the first refund request is sent, if the accident victim or
his/her relative fails to refund the paid expenses, the social security agency
shall issue a follow-up notice to further request the refund.
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4.
At the end of the fiscal year, Vietnam Social Security shall sum up and report
all medical examination and treatment expenses which have been paid for health
insurance participants meeting with traffic accidents but cannot be recovered
to the Ministry of Health for the latter to, in coordination with the Ministry
of Finance, propose the Prime Minister to permit the settlement of these
expenses with the health insurance fund.
Article 6. Effect
1.
This Circular takes effect on December 26,2011.
2.
To annul Clause 3, Article 8 of Joint Circular No. 09/2009/TTLT-BYT-BTC of
August 14, 2009, of the Ministry of Health and the Ministry of Finance, guiding
the implementation of health insurance, on the effective date of this Circular.
Article 7. Organization of implementation
1.
To assign Vietnam Social Security to promulgate the form of the report on
medical examination and treatment expenses which have been paid but cannot be
recovered mentioned in Clause 3, Article 5 of this Circular and guide social
security agencies of all levels in implementing this Circular.
2.
This Circular also applies to health insurance participants who met with
traffic accidents before the effective date of this Circular and are receiving
treatment at medical examination and treatment establishments.
Any
problems arising in the course of implementation should be reported to the
Ministry of Health and the Ministry of Finance for study and settlement.-
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FOR THE MINISTER OF FINANCE
DEPUTY MINISTER
Nguyen Thi Minh