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MINISTRY OF
HEALTH
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SOCIALIST
REPUBLIC OF VIETNAM
Independence – Freedom – Happiness
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No. 30/2020/TT-BYT
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Hanoi, December
31, 2020
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CIRCULAR
ON
ELABORATING TO DECREE NO. 146/2018/ND-CP DATED OCTOBER 17, 2018 OF THE
GOVERNMENT ON ELABORATING TO LAW ON HEALTH INSURANCE
Pursuant to Law on Medical Insurance No.
25/2008/QH12 dated November 14, 2008 receiving amendments according to the Law
No. 46/2014/QH13 dated June 13, 2014;
Pursuant to Decree No. 146/2018/ND-CP dated
October 10, 2018 of the Government on elaborating to Law on Health Insurance;
Pursuant to Decree No. 75/2017/ND-CP dated June
20, 2017 of Government on functions, tasks, powers, and organizational
structure of Ministry of Health;
At request of Director General of the Department
of Health Insurance, Ministry of Health,
Minister of Health promulgates Circular on
elaborating to Decree No. 146/2018/ND-CP dated October 17, 2018 of the
Government on elaborating to Law on Health Insurance
Chapter I
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Article 1. Scope
This Circular prescribes:
1. Payment of health
insurance, reduction to health insurance payment for certain beneficiaries.
2. Conversion of health
insurance level, payment of medical examination and treatment costs covered by health
insurance of certain beneficiaries.
3. Application of information
technology in management, assessment and payment of medical examination and
treatment costs covered by health insurance for certain cases.
Article 2. Term interpretation
In this Circular, “adjacent communes of adjacent
provinces” refers to when commune(s) of a province directly connect (share
administrative border) with commune(s) of another province.
Example: Province A adjoins Province B, Province A
consists of Commune 1, Commune 2, and Commune 3 while Province B consists of
Commune 4, Commune 5, and Commune 6; administrative border of Commune 1 of
Province A directly adjoins Commune 4 of Province B, in this case, Commune 1 of
Province A and Commune 4 of Province B are considered 2 adjacent communes of 2
adjacent provinces. Thus, if a holder of health insurance card who
applies for initial medical examination and treatment in Medical Station of
Commune 1 of Province applies for medical examination and treatment under medical
insurance in Medical Station of Commune 4 of Province B (or vice versa), he/she
remains eligible for benefiting from 100% of medical examination and treatment
costs covered by his/her health insurance according to Clause 1 Article 14 of
Decree No. 146/2018/ND-CP dated October 17, 2018 of the Government on
elaborating to Law on Health Insurance (hereinafter referred to as “Decree No.
146/2018/ND-CP”). Since administrative border of Commune 1 of Province A does
not directly adjoin Commune 5 and Commune 6 of Province 6, if a holder of
health insurance card who applies for initial medical examination and treatment
in Medical Station in Commune 1 of province A applies for medical examination
and treatment in Commune 5 or Commune 6 of Province B (or vice versa), he/she shall
not be eligible for application of regulations on receiving medical examination
and treatment in adjacent communes of adjacent provinces.
Chapter II
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Article 3. Payment of health
insurance for newborn babies that request immediate medical treatment upon
birth but decease
In case a newborn baby request immediate medical
treatment upon birth but decease, a medical examination and treatment
establishment shall send written notice and summary of medical record of the
baby to the social security agency which signs contracts for provision of
medical examination and treatment under health insurance to enable the agency
to produce list on such case and submit to Department of Finance where the
mother resides or Department of Finance where the medical examination and
treatment establishment is based (for cases where the newborn baby is abandoned
in the medical examination and treatment establishment) to request the Department
of Finance to provide fund according to Clause 5 Article 15 of Law on Health
Insurance.
Article 4. Identification of
health insurance payers, amount and reduction for family-based model
1. Identification of
individuals specified under Clause 3 Article 5 of Decree No. 146/2018/ND-CP
depends on following documents:
a) For dignitaries, sub-dignitaries and clergy:
family register or temporary residence register or lists bearing seals of
religious organizations directly overseeing dignitaries, sub-dignitaries and
clergy;
b) Persons residing in social security facilities:
family register or temporary residence register or lists bearing seals of
social security facilities where the individuals are residing.
2. Reduction of health
insurance amount for individuals under Article 5 of Decree No. 146/2018/ND-CP
shall be implemented as soon as a second individual whose name is included in
family register or temporary residence register or list bearing seal of
religious organizations, social security facilities specified under Clause 1 of
this Article participate in family-based health insurance.
Chapter III
CONVERSION OF HEALTH
INSURANCE LEVEL, PAYMENT OF MEDICAL EXAMINATION AND TREATMENT COSTS COVERED BY
HEALTH INSURANCE OF CERTAIN INDIVIDUALS
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1. In case a beneficiary is
eligible for multiple health insurance modes where code of level of benefit
shown on his/her health insurance card is not specifying the highest mode,
he/she shall be converted to the highest mode as soon as documents under
Clauses 2, 3, and 4 of this Article are available.
2. Documents proving that
health insurance participants are people with meritorious services to the
revolution, except for war veterans under Clause 3 of this Article; relatives
of people with meritorious services to the revolution, people nurturing
martyrs:
Conform to Article 5 of Circular No.
30/2019/TT-BLDTBXH dated December 26, 2019 of Ministry of Labor - War Invalids
and Social Affairs providing guidelines on producing lists of health insurance
participants under management of Ministry of Labor – War Invalids and Social
Affairs, to be specific:
a) People with meritorious services to the
revolution: rely on Decision on acknowledgement of competent agencies or
Decisions on processing policies of Directors of Departments of Labor, Invalids
and Social Affairs of provinces and central-affiliated cities;
b) Relatives of people with meritorious services to
the revolution, people nurturing martyrs: rely on Decisions on processing
policies of Directors of Departments of Labor, Invalids and Social Affairs of
provinces and central-affiliated cities; in case of no decisions available,
rely on list of benefit payment for people with meritorious services to the
revolution and relatives thereof.
3. Documents proving that
health insurance participants are war veterans:
a) In case of war veterans leaving, discharged from
the army, rely on one of the following documents:
- Decisions on demobilization,
discharge (dismissal);
- Official personal background
sheet or Excerpt No. 63 of officers;
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- Servicemen card;
- Servicemen background sheet;
- Background sheet of member of
the Communist Party produced before the date on which the servicemen leave or
are discharged (dismissed);
- Decision on receiving
benefits as per the law under any of the following documents:
+ Decree No. 500-ND/LB dated November 12, 1958 of
joint Ministry of National Defense, Ministry of Finance and Ministry of Social
Support on rules for long-term benefits for voluntary servicemen discharged due
to inability to work as a result of illnesses.
+ Decree No. 111-ND dated June 22, 1957 of Ministry
of National Defense on elaborating to benefits for discharged servicemen;
+ Decision No. 47/2002/QD-TTg dated April 11, 2002
of the Prime Minister on policies on servicemen and national defense employees
participating in resistance war against France discharged (dismissed, retired)
prior to December 31, 1960;
+ Decision No. 290/2005/QD-TTg dated November 8,
2005 of Prime Minister on policies on individuals participating in resistance
war against America without receiving policies of the Communist Party and the
Government;
+ Decision No. 188/2007/QD-TTg dated December 6,
2007 of the Prime Minister on amendment to Decision No. 290/2005/QD-TTg dated
November 8, 2005 of the Prime Minister;
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+ Decision No. 38/2010/QD-TTg dated May 6, 2010 of
the Prime Minister on amendment to Decision No. 142/2008/QD-TTg dated October
27, 2008 of the Prime Minister;
+ Decision No. 62/2011/QD-TTg dated November 9,
2011 of Prime Minister on benefits for individuals participating in war for
defending the country, participating in international missions in Cambodia,
assisting Laos after April 30, 1975 who have been demobilized, discharged or
retired.
b) War veterans retiring, receiving monthly social
benefits: rely on Decisions on receiving monthly pension or Decisions on
receiving monthly social benefits issued by competent agencies.
c) War veterans who have reassigned shall rely on
any of the following documents:
- Decisions on demobilization,
discharge (dismissal), reassignment;
- Official personal
information background sheet or Excerpt No. 63 of officers;
- Servicemen personal
background sheet;
- Servicemen card;
- Servicemen background sheet;
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- Background sheet of member
of the Communist Party produced before the date on which the servicemen leave or
are discharged (dismissed), reassigned;
d) In case war veterans lose documents:
- War veterans who lose
documents proving war veteran status but instead obtain any of the following
documents:
+ Decision on enlistment;
+ Decisions on employment;
+ Decision on promotion, pay raise;
+ Decision mobilization, assignment;
+ Documents rewarding for merits in resistance war,
rewarding for participation in the war;
+ Documents confirming war veteran status of
People’s Committees of communes where the beneficiaries reside according to
Point b Clause 7 Article 2 of Decree No. 150/2006/ND-CP dated December 12, 2006
of the Government on elaborating to Ordinance on War Veterans (applicable to
individuals obtaining documents issued before December 29, 2006 which prove
their status as war veterans).
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- War veterans enlisted after
April 30, 1975 who directly fought, served the war, and obtained documents
which do not specify time, unit, location of service: Excerpt from presentation
regarding units, time and location of service during national defense war
issued by Commanding Officers of Military Commands of districts where the
veterans reside according to Guidelines No. 3386/LC-CTC-CCS dated November 15,
2012 of joint Department of Operations, Department of Policies guiding
implementation of Decision No. 2084/QD-BBTM dated November 9, 2012 of Chief of
the General Staff on issuance of list of locations, time and units directly
fighting national defense war and participating in international missions after
April 30, 1975.
4. Other beneficiaries:
Rely on documents proving eligibility for receiving
benefits at a level higher than the level they are currently benefitting from
issued by their superior agencies.
Example: Mr. Nguyen Van A is a serviceman serving
national defense war in the northern border, was discharged in 1980 and later
enters into employment contract with Company B, participates in health
insurance for employees (benefit level according to health insurance card is 80%).
As soon as Mr. A provides Decision on discharge, he
is determined eligible for health insurance for war veterans. In such case,
social security agency shall re-issue health insurance card, convert benefit
level of Mr. A from 80% to 100% with limits on percentage of payment for
certain medicines, chemicals, medical materials, medical technical service
conforming to regulations of Minister of Health.
5. The new benefit level of
health insurance of beneficiaries under Clauses 2, 3, and 4 of this Article shall
start from the date on which the new health insurance card is effective on
information system of social security agencies. Social security agencies are
responsible for informing beneficiaries of upgraded benefit level as soon as
the new benefit level comes into effect on the information system.
Article 6. Medical examination
and treatment under health insurance in appropriate level
1. Health insurance
participants apply for medical examination and treatment in initial medical
examination and treatment establishments specified on their health insurance
cards.
2. Health insurance
participants who apply for initial medical examination and treatment in medical
examination and treatment establishments of communes or general clinics or
district hospitals may receive medical examination and treatment covered by
health insurance in other medical stations of communes or general clinics or
district hospitals in the same provinces. Children who have not obtained
health insurance cards since birth declaration procedures have not been adopted
may use birth certificates to receive medical examination and treatment in
medical examination and treatment establishments specified under this Clause.
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Doctors or physicians shall assess and identify
state of emergency of the patients, specify in patients’ medical records and be
responsible for their decisions.
4. Health insurance
beneficiaries who benefit from transfer of administrative levels for receiving
medical examination and treatment under health insurance as per the law,
including:
a) May transfer according to Article 10 and Article
11 of Circular No. 40/2015/TT-BYT dated November 16, 2015 of Minister of Health
on registration for initial medical examination and treatment under health
insurance and transfer of administrative level for receiving medical
examination and treatment under health insurance. Applications for transfer
consist of transfer documents using Form No. 6 attached to Decree No.
146/2018/ND-CP and other documents (if any);
b) May transfer according to Clause 3 Article 14 of
Decree No. 146/2018/ND-CP, including: emergency medical aid; cases where
beneficiaries are diagnosed with other diseases exceeding the specialty of
medical examination and treatment establishments during inpatient treatment
process; disease development exceeds capacity of medical examination and
treatment establishments during inpatient or outpatient treatment process;
c) May transfer according to Clause 2 Article 6 of
Circular No. 04/2016/TT-BYT dated February 26, 2016 of Minister of Health on
elaborating to medical examination, treatment and payment for medical
examination, treatment covered by health insurance relating to examination and
treatment of tuberculosis.
5. Health insurance
participants who obtain documents proving their stay in other administrative
divisions when they go on working trips, participate in concentrated education
in training programs, semi-boarding programs and apply for initial medical
examination, treatment in medical examination and treatment establishments of
the same or equivalent administrative level as their initial medical
examination and treatment establishments specified on health insurance cards
according to Clause 7 Article 15 of Decree No. 146/2018/ND-CP. Medical
examination and treatment establishments are responsible for storing photocopy
of documents specified under this Point in medical records of beneficiaries.
6. Holders of notice of
re-examination appointment in case they have been transferred according to
Clause 5 Article 15 of Decree No. 146/2018/ND-CP.
7. Individuals who have
donated their organs and require immediate treatment after donating organs.
8. Newborn babies who must
receive treatment upon birth.
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1. Healthcare Insurance Fund
(HIF) shall pay for medical examination and treatment of individuals who have
donated their organs according to regulations and law on donating, harvesting,
grafting tissues, human organs and donating, collecting corpses in case
immediate treatment is required as soon as surgeons complete technical
procedures for extracting organs of donors.
2. The HIF shall not pay for
medical examination and treatment costs that have been included in costs for collecting
organs of donors or costs that have been paid for by other financial sources.
3. Medical examination and
treatment establishments that adopt technical procedures for collecting organs
of donors are responsible for:
a) consolidating list of donors and costs for
medical examination and treatment and sending to social security agencies for
payment as per Clause 4 Article 15 of Decree No. 146/2018/ND-CP;
b) excerpting and transferring electronic data
according to Clause 2 Article 10 hereof.
Article 8. Guidelines for
providing medical examination and treatment under health insurance in initial
healthcare
1. Medical examination and
treatment practitioners, other than testing personnel, X-ray technicians,
physical therapy technicians and midwives, may provide initial healthcare in
education institutions or vocational education institutions, agencies,
organizations and enterprises (hereinafter referred to as “agencies”) on a
full-time or part-time basis according to Point a Clause 1 Article 34 of Decree
No. 146/2018/ND-CP as soon as they obtain any of the following documents:
a) Written assignment in case practitioners are
officials or employees of agencies;
b) Written agreement in case practitioners are not
specified under Point a of this Clause.
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a) Employer of part-time medical examination and
treatment practitioner: Name and address of agency; full name of head of the
agency; phone number;
b) Provider of part-time medical examination and
treatment in initial healthcare: Full name, date of birth, gender, residence
address, ID Card number or other legitimate documents; phone number in case of
signing written agreements with practitioners or name, address, full name of
head of medical examination and treatment establishment in case of signing
written agreements with medical examination and treatment establishments;
c) Task details, working locations and working
time, where working time shall be agreed upon by the employer and the provider;
d) Implementation period of written agreements (in
financial year or school year);
dd) Commitment of the employer and provider
regarding assuming legal responsibilities for agreement details and task implementation
results.
3. Written agreement shall
only be signed by agencies with medical examination and treatment
establishments or with part-time medical examination and treatment
practitioners in initial healthcare when:
A) Medical examination and treatment establishments
are located in the same communes as the agencies or in communes adjacent to
communes where the agencies are based; or
b) Medical examination and treatment practitioners
register for practice during office hours in communes where the agencies are
based or in communes adjacent to communes where the agencies are based.
Article 9. Transfer for
provision of subclinical service
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a) Subclinical services which are under list of
medical technical services approved by competent authorities for medical
examination and treatment establishments, currently being provided in medical
examination and treatment establishments but cannot be implemented by the
medical examination and treatment establishments when the services are
designated for the patients;
b) Subclinical services which are not under list of
medical technical services approved by competent authorities for medical
examination and treatment establishments but are necessary for specialized
activities according to regulations of Minister of Health on management,
diagnosis and treatment in medical examination and treatment shall be paid by
the HIF for cases of patients receiving inpatient treatment in district level
hospitals or higher.
Heads of medical examination and treatment
establishments accepting health insurance shall rely on functions, tasks and
scope of specialized operations approved by competent authorities to produce
list of subclinical services that require transfer and send to social security
agencies where contracts for provision of medical examination and treatment
under health insurance are signed to enable both parties to add annexes thereto
prior to implementation.
2. Medical examination and
treatment establishments may only transfer patients or specimen to
establishments approved by competent authorities to be eligible for provision
of subclinical services and must sign contracts on provision principles with
subclinical service providers (contracts must include the fact that social
security agencies where contracts for provision of medical examination and
treatment under health insurance are signed have assessed subclinical services
received and provided in subclinical service providers).
3. Subclinical service
providers, after receiving patients or specimen in order to perform subclinical
services, must not transfer the patients and specimen to another establishment.
4. Encoding of subclinical
services:
Medical examination and treatment establishments
that transfer patients or specimen (hereinafter referred to as “transferors”)
shall encode as follows: XX.YYYY.ZZZZ.K.WWWWW, in which:
a) XX.YYYY.ZZZZ is code of subclinical services;
b) K means subclinical services are provided by
other service providers;
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5. Payment:
a) Payment of costs for provision of subclinical
services shall conform to Clause 6 Article 27 of Decree No. 146/2018/ND-CP and
conform to price of service providers receiving transferred patients or
specimen without exceeding medical examination and treatment costs specified
under Circular No. 13/2019/TT-BYT dated July 5, 2019 of Minister of Health on
amendment to Circular No. 39/2018/TT-BYT dated November 30, 2018 of Minister of
Health on costs for medical examination and treatment covered by health
insurance among hospitals on the same administrative level and guidelines for
application and settlement of costs for medical examination and treatment
covered by health insurance in some cases.
In case a subclinical service is provided by multiple
service providers simultaneously, the HIF shall only pay for a single provision
of the subclinical service.
b) Subclinical service providers receiving
transferred patients and specimen must not charge the patients additional costs
for medical examination and provision of subclinical services.
Article 10. Application of
information technology in management, assessment and payment of medical
examination and treatment costs covered by health insurance for certain cases
1. In case of children who
benefit from health insurance right upon birth according to Law on Health
Insurance but have not been issued with health insurance cards by social
security agencies due to incompletion of birth declaration procedures, medical
examination and treatment establishments shall:
a) produce provisional health insurance cards,
consisting of:
- Beneficiary code: specify
TE;
- Health insurance benefit
code: specify number 1;
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- Medical ID code: specify
according to Decision No. 2153/QD-BYT date May 25, 2020 of Minister of Health
on Regulations on establishing, using and managing medical ID code (hereinafter
referred to as “Decision No. 2153/QD-BYT”).
Example: Provisional code for a child receiving
medical examination and treatment whose mother resides in Hanoi shall be
encoded as: TE101 and followed by medical ID code (10 digits).
b) Specify name of newborn babies who have not been
named in medical records for medical examination and treatment, extraction and
transfer of electronic data serving management, assessment and payment of
medical examination and treatment costs covered by health insurance as follows:
- If a newborn baby is
accompanied by either parent: specify full name of that parent;
- If a new born baby is not
accompanied by any parent but by a guardian: specify full name of the guardian;
- If a newborn baby is not accompanied
by anyone or is abandoned in a medical examination and treatment establishment:
specify name of the medical examination and treatment establishment that is
currently providing treatment.
2. In case individuals who
have donated their organs have not been issued with health insurance cards by
social security agencies, medical examination and treatment establishments
shall produce provisional health insurance cards to extract, transfer
electronic data and serve management, assessment and payment of medical
examination and treatment under health insurance and:
a) Beneficiary code: specify HG;
b) Benefit code: specify number 4;
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d) Medical ID code: specify according to Decision
No. 2153/QD-BYT.
Example: in case of a donor residing in Hanoi,
encode as follow: HG401 followed by medical ID code (10 digits).
3. Medical examination and
treatment establishments shall send data requested for assessment and payment
of medical examination and treatment costs covered by health insurance of
beneficiaries under management of Politburo, Secretariat in writing until new
regulations, guidelines on extraction and transmission of electronic data are
issued; data on consolidated costs for medical examination and treatment
covered by health insurance of these beneficiaries using Form No. C79-HD
attached to Circular No. 102/2018/TT-BTC dated November 14, 2018 of Ministry of
Finance guiding accounting affairs for social security.
Article 11. Immediate
suspension or termination of health insurance cards
1. Social security agencies
shall immediately suspend, terminate health insurance cards on their
information system for health insurance beneficiaries as follows:
c) In case health insurance beneficiaries decease
in medical examination and treatment establishments, social security agencies
shall immediately suspend, terminate health insurance cards of the deceased
beneficiaries after receiving electronic data where field 22 (KET_QUA_DTRI) of
Schedule 1 attached to Decision No. 4210/QD-BYT dated September 20, 2017 of
Minister of Health contains a “5” transferred by medical examination and
treatment establishments to data receipt portal within information system of
social security agencies;
b) In case health insurance beneficiaries decease
outside of medical examination and treatment establishments, social security
agencies shall immediately suspend, terminate health insurance cards of the
deceased beneficiaries as soon as People’s Committees of communes where the
deceased health insurance beneficiaries reside issue notice on information
system of social security agencies.
2. If medical examination and
treatment establishments incur medical examination and treatment costs covered
by health insurance and request payment after the medical examination and
treatment establishments have extracted and transmitted data to data receipt
portal within information technology system of social security agencies according
to Point a Clause 1 of this Article or after People’s Committees of communes
where deceased health insurance beneficiaries reside have issued death
certificates and uploaded on information systems of social security agencies
according to Point b Clause 1 of this Article, proceed as follows:
a) The HIF shall pay for medical examination and
treatment costs covered by health insurance according to Article 4 of Circular
no. 09/2019/TT-BYT dated June 10, 2019 of Minister of Health guiding inspection
of conditions for signing contracts for initial medical examination and
treatment under health insurance, transfer for provision of subclinical
services and cases of direct cost settlement in medical examination and
treatment under health insurance in case of health insurance card’s error or
faulty information update by medical examination and treatment establishments
or People’s Committees of communes;
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Chapter IV
IMPLEMENTATION
Article 12. Entry into force
1. This Circular comes into
force from March 1, 2021.
2. Article 3 of Circular No.
09/2019/TT-BYT dated June 10, 2019 of Minister of Health guiding inspection of
conditions for signing contracts for provision of initial medical examination
and treatment under health insurance, transfer for provision of subclinical
services and cases of direct cost settlement in medical examination and
treatment under health insurance expires from the effective date hereof.
Article 13. Terms of reference
In case documents referred to in this Circular are
replaced or revised, the new versions shall prevail.
Article 14. Responsibilities
for implementation
1. Responsibilities of
People’s Committees of provinces:
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b) directing People’s Committees of communes that
oversee the deceased health insurance beneficiaries to issue death certificates
and declare as soon as death certificate is issued on information systems of
social security agencies as per the law.
2. Responsibilities of Vietnam
Social Security:
a) guiding implementation of issuance and revision
of health insurance cards as a result of changes to health insurance benefit
levels according to Article 5 hereof and issuance of health insurance cards for
organ donors;
b) upgrading and completing information systems to:
- Adequately comply with
Decree No. 146/2018/ND-CP, Circular No. 48/2017/TT-BYT dated December 28, 2017
of Minister of Health on extraction, transmission of electronic data in
management and payment of medical examination and treatment costs under health
insurance and other regulations of Minister of Health;
- Implement management and
automatic issuance of medical ID code according to Decision No. BYT;
- Maintain receipt,
management, extraction, use and promptly provide feedback for medical
examination and treatment establishments and health insurance beneficiaries
regarding whether or not health insurance beneficiaries participate in health
insurance for more than 5 consecutive years and incur more than 6 months’ worth
of statutory pay rate of medical examination and treatment bill in one year
according to Clause 3 Article 27 of Decree No. 146/2018/ND-CP.
3. Responsibilities of
Departments of Health of provinces and central-affiliated cities and medical
authorities of ministries:
a) taking charge, cooperating with Social Security
of provinces in publicizing, directing medical examination and treatment
establishments that accept health insurance in the provinces or under their
management to organize provision of medical examination and treatment for health
insurance beneficiaries according to regulations and law on medical
examination, treatment, Law on Health Insurance, Decree No. 146/2018/ND-CP and
this Circular;
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4. Responsibilities of medical
examination and treatment establishments accepting health insurance:
Cooperating with social security agencies that sign
contracts for provision of medical examination and treatment under health
insurance in adequately complying with regulations and law on medical examination,
treatment, Law on Health Insurance, Decree No. 146/2018/ND-CP and this
Circular.
Difficulties that arise during the implementation
of this Circular should be reported to the Ministry of Health for
consideration./.
PP. MINISTER
DEPUTY MINISTER
Nguyen Truong Son