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THE
GOVERNMENT
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SOCIALIST
REPUBLIC OF VIETNAM Independence
- Freedom – Happiness
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No.
62/2009/ND-CP
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Hanoi,
July 27, 2009
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DECREE
DETAILING AND GUIDING A NUMBER OF ARTICLES OF THE LAW ON
HEALTH INSURANCE
THE GOVERNMENT
Pursuant to the December 25,
2001 Law on Organization of the Government;
Pursuant to the November 14, 2008 Law on Health Insurance;
At the proposal of the Minister of Health,
DECREES:
Chapter 1
HEALTH INSURANCE PREMIUM
PAYERS, PREMIUM AND SUPPORT RATES, PAYMENT RESPONSIBILITY AND METHODS
Article 1.
Health insurance participants defined in Clause 25, Article 12 of the Law on
Health Insurance
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2. Youth volunteers in the
anti-French resistance war period under the Prime Minister's Decision No.
170/2008/QD-TTg of December 18, 2008, on health insurance benefits and burial
allowances for youth volunteers in the anti-French resistance war period.
3. Laborers who are entitled to
illness allowance under the social insurance law as they suffer from diseases
on the Health Ministry-promulgated list of diseases which need longterm
treatment.
4. Part-time
commune/ward/township (below collectively referred to as commune) officials
under the law on cadres and civil servants.
Article 2.
Roadmap for health insurance premium payment by the insured defined in Article
1 of this Decree
1. The insured defined in
Clauses I and 2 shall pay health insurance premiums from July 1,2009.
2. The insured defined in
Clauses 3 and 4 shall pay health insurance premiums from January 1, 2010.
Pending participation in health insurance under regulations, they may
voluntarily pay health insurance premiums through December 31, 2009.
Article 3.
Health insurance premium rates and support rates provided for in Article 13 of
the Law on Health Insurance and those applicable to the insured defined in
Article 1 of this Decree
1. From July 1, 2009 to December
31, 2009. the insured shall pay monthly health insurance premiums at the
following rates:
a/ 3% of their monthly salaries
or remuneration, for those defined in Clauses 1 and 2, Article 12 of the Law on
Health Insurance;
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c/ 3% of the monthly minimum
salary, for those defined in Clauses 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 16,
17, 18, 19 and 20, Article 12 of the Law on Health Insurance and those defined
in Clauses 1 and 2, Article 1 of this Decree.
2. From January 1, 2010, the
insured shall pay monthly health insurance premiums at the following rates:
a/ 4,5% of their monthly
salaries or remuneration, for those defined in Clauses 1 and 2, Article 12 of
the Law on Health Insurance;
b/ 4,5% of the monthly pensions
or working capacity loss allowances, for those defined in Clause 3, Article 12
of the Law on Health Insurance;
c/ 4.5% of the monthly minimum
salary, for those defined in Clauses 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 16,
17, 18, 19 and 20, Article 12 of the Law on Health Insurance and those defined
in Article 1 of this Decree;
d/ 4.5% of the unemployment
allowance, for those defined in Clause 8, Article 12 of the Law on Health
Insurance;
e/ 3% of the monthly minimum
salary, for those defined in Clause 21. Article 12 of the Law on Health
Insurance;
3. From January 1,. 2012, the
monthly premium rate applicable to those defined in Clause 22, Article 12 of
the Law on Health Insurance will be equal to 4.5% of the monthly minimum
salary.
4. From January 1, 2014, the
insured shall pay monthly health insurance premiums at the following rates:
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b/ 4,5% of the minimum salary,
for those defined in Clause 24, Article 12 of the Law on Health Insurance.
5. The state budget shall
provide partial supports to the insured for health insurance premium payment at
the following rates:
a/ At least 50% of the premium
rate from July 1, 2009, for those defined in Clause 20, Article 12 of the Law
on Health Insurance;
b/ At least 50% of the premium
rate from January 1, 2010, for those defined in Clause 21, Article 12 of the
Law on Health Insurance who are from households living just above the poverty
line; and at least 30% of the premium rate, for those defined in Clause 21,
Article 12 of the Law on Health Insurance who are not from households living
just above the poverty line;
c/ At least 30% of the premium
rate from January 1, 2012, for those defined in Clause 22, Article 12 of the
Law on Health Insurance who have an average living standard.
6. For the insured defined in
Clauses 20 and 22, Article 12 of the Law on Health Insurance who participate in
the capacity as households in health insurance with all individuals named in
the household registration book and co-living in the same house, and those
defined in Clause 23, Article 12 of the Law on Health Insurance who participate
in health insurance with two or more of their relatives, the premium rate for
each of these members is as follows:
a/ The prescribed rate, for the
first person;
b/ 90%. 80% and 70% of the
premium rate applicable to the first person, for the second, the third and the
fourth persons, respectively;
c/ 60% of the premium rate
applicable to the first person, for the fifth person on.
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1. Those defined in Clauses 1, 2
and 3 will have their health insurance premiums paid by the state budget
2. Those defined in Clause 4
will have two thirds of their health insurance premiums paid by commune
People's Committees and the remaining third by themselves.
Article 5.
Methods of health insurance premium payment by the insured defined in Clause 7,
Article 15 of the Law on Health Insurance and those defined in Article 1 of
this Decree
1. Once every six months, those
defined in Clauses 20, 22 and 24, Article 12 of the Law on Health Insurance
shall pay health insurance premiums to the health insurance fund.
2. Once every six months or
every year, organizations managing the insured defined in Clause 21. Article 12
of the Law on Health Insurance shall collect health insurance premiums from
them for payment to the health insurance fund.
3. Monthly, laborers who pay
health insurance premiums for their relatives defined in Clause 23, Article 12
of the Law on Health Insurance shall pay health insurance premiums via their
employers to the health insurance fund.
4. Monthly, social insurance
organizations shall pay health insurance premiums for those defined in Clauses
1 and 3, Article 1 of this Decree to the health insurance fund.
5. Annually, agencies,
organizations and units managing the insured defined in Clause 2, Article 1 of
this Decree shall pay health insurance premiums for them to the health
insurance fund.
6. Monthly, commune People's
Committees shall pay health insurance premiums for those defined in Clause 4.
Article 1 of this Decree and simultaneously make deductions from the latter's
allowances for payment to the health insurance fund.
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Article 6.
Health insurance premium rates and methods of health insurance premium payment
for voluntary health insurance participants defined in Clause 3, Article 50 of
the Law on Health Insurance and Clauses 3 and 4, Article 1 of this Decree
1. From July 1, 2009, to
December 31, 2009, the premium rates set for the insured are as follows:
a/ The six-month rate applicable
to those defined in Clause 21, Article 12 of the Law on Health Insurance who
are studying at school is VND 60.000/person for urban areas and VND
50.000/person. for rural and mountainous areas;
b/ The six-month rate applicable
to those defined in Clauses 22, 23 and 24 of the Law on Health Insurance and
those defined in Clauses 3 and 4, Article 1 of this Decree is VND 160,000/
person, for urban areas and VND 120,000/ person, for rural and mountainous
areas.
2. From January 1, 2010,
voluntary health insurance participants shall themselves pay health insurance
premiums at a monthly rate equal to 4,5% of the minimum salary. For voluntary
health insurance participants being households, the premium rates are those
provided for in Clause 6, Article 3 of this Decree.
3. Based on the health premium
rates, voluntary health insurance participants may pay health insurance
premiums either once every six months or in lump sum for the whole year to the
health insurance fund.
Chapter II
LEVELS OF HEALTH
INSURANCE BENEFIT AND METHODS OF PAYMENT OF COSTS OF INSURED HEALTH CARE
Article 7.
Levels of health insurance benefits for cases defined in Clauses 1 and 3,
Article 22 of the Law on Health Insurance
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a/ 100% of the costs, for those
defined in Clauses 2, 9 and 17, Article 12 of the Law on Health Insurance;
b/ 100% of the costs, for
medical examination and treatment provided at the commune level;
c/ 100% of the costs, provided
that the total cost of one-time medical examination and treatment is lower than
15% of the minimum salary; the Health Ministry shall assume the prime
responsibility for and coordinate with the Finance Ministry in specifying money
amounts and time of application when the minimum salary is adjusted for uniform
implementation:
d/ 95% of the costs, for those
defined in Clauses 3, 13 and 14, Article 12 of the Law on Health Insurance; the
remainder shall be paid by the patient directly to the medical examination and
treatment establishment;
e/ 80% of the costs, for other
categories of the insured: the remainder shall be paid by the patient directly
to the medical examination and treatment establishment;
f/ If the insured select doctors
and hospital rooms for themselves, they will get medical examination and
treatment costs paid by the health insurance fund according to current service
chargers stipulated by the State and applicable to the concerned medical
examination and treatment establishments, and at the levels of benefit
specified in Article 22 of the Law on Health Insurance and Article 7 of this
Decree.
2. Health insurance participants
who seek medical examination and treatment under Articles 26, 27 and 28 of the
Law on Health Insurance, involving the use of costly high technology will get
medical examination and treatment costs paid by the health insurance fund at
the following levels:
a/ 100% of the costs, for those
defined in Clause 17, Article 12 of the Law on Health Insurance and those who
were revolutionary activists prior to January 1, 1945; revolutionary activists
in the period between January I. 1945. and August 19, 1945; Vietnamese hero
mothers; war invalids and beneficiaries of policies for war invalids. class-B
war invalids, diseased soldiers who lose 81 % or more of their working
capacity; war invalids, beneficiaries of policies for war invalids, class-B war
invalids, and diseased soldiers when they have their recuring injuries or
diseases treated;
b/ 100% of the costs, for those
defined in Clause 2, Article 12 of the Law on Health Insurance, which, however,
must not exceed 40-month minimum salary for one-time use of the technological
service; the remainder shall be covered by the budget of the insured-managing
agency or unit:
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d/ 95% of the costs, for those
defined in Clauses 3, 13 and 14. Article 12 of the Law on Health Insurance,
which, however, must not exceed 40-month minimum salary for one-time use of the
technological service;
e/ 80% of the costs, for other
insured, which, however, must not exceed 40-month minimum salary for one-time
use of the technological service;
3. Health insurance participants
who use medical examination and treatment services not at the primary care
provider or the technical line prescribed by the Health Minister (except for
emergency cases) will get their medical examination and treatment costs paid by
the health insurance fund within the scope of their entitlement provided for in
Article 21 of the Law on Health Insurance as follows:
a/ 70% of the costs, for medical
examination and treatment provided by grade-Ill medical examination and
treatment establishments, and not exceeding 40-month minimum salary for each
use of costly hi-tech services;
b/ 50% of the costs, for medical
examination and treatment provided by grade-II medical examination and
treatment establishments, and not exceeding 40-month minimum salary for each
use of costly hi-tech services;
c/ 30% of the costs, for medical
examination and treatment provided by grade-I or special medical examination
and treatment establishments, and not exceeding 40-month minimum salary for
each use of costly hi-tech services;
4. Health insurance participants
using medical examination and treatment services at non-public medical
establishments will get paid by the health insurance fund at the levels
prescribed in Article 22 of the Law on Health Insurance and Clauses 1, 2 and 3
of this Article and service charges applicable to public medical establishments
of equivalent technical line.
Article 8.
Scope of entitlement and levels of benefit for voluntary health insurance
participants defined in Clause 3, Article 50 of the Law on Health Insurance and
Clauses 3 and 4, Article 1 of this Decree
The scope of entitlement and levels
of benefit for voluntary health insurance participants comply with Articles 21,
22 and 23 of the Law on Health Insurance and Article 7 of this Decree.
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1. The quota-based payment
method applies to primary care providers according to regulations of the Health
Ministry.
2. The service charge-based
payment and disease-based payment methods are applied additionally to pay for
extra-quota services at primary care providers and those medical examination
and treatment establishments which do not apply the quota-based payment method.
3. The Health Ministry shall
assume the prime responsibility for, and coordinate with the Finance Ministry
in. guiding and specifying the application of payment methods prescribed in
Clauses 1 and 2 of this Article as appropriate to medical examination and
treatment establishments.
Chapter
III
MANAGEMENT AND USE OF
THE HEALTH INSURANCE FUND
Article 10.
Allocation and management of the health insurance fund
Total health insurance
collections of Social Insurance of a province or centrally run city (below
referred to as provincial Social Insurance) shall be allocated and managed as
follows:
1. 90% (below referred to as the
medical care fund) shall be retained at and managed by the provincial Social
Insurance.
2. 10% shall be transferred to
the Vietnam Social Insurance for management and setting up of a provision fund
for insured medical care and covering health insurance management costs
according to the following provisions:
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b/ The provision fund for
insured medical care is the remainder after deduction of the health insurance
management cost.
Article 11.
Use of the medical care fund managed by the provincial Social Insurance
1. The medical care fund managed
by the provincial Social Insurance prescribed in Clause 1, Article 10 of this
Decree may be used to cover costs paid by bearers of health insurance cards
issued by the provincial Social Insurance, including:
a/ The costs prescribed in
Article 21 of the Law on Health Insurance;
b/ A 12% deduction to be
transferred to the medical care fund for pupils and students which are managed
by educational establishments of the national education system to serve primary
health care for pupils and students.
2. If the medical care fund
managed by the provincial Social Insurance is not used up in a year, the
remainder shall be used as follows:
a/ 60% for procurement and
maintenance of medical equipment and training to improve professional skills of
health workers and in service of local medical examination and treatment under
joint guidance of the Health Ministry and the Finance Ministry;
b/ 40% to be transferred to the
Vietnam Social Insurance for addition to the provision fund for insured medical
care.
3. In case of deficit of the
medical care fund managed by the provincial Social Insurance in a year, the
provincial Social Insurance shall report such to the Vietnam Social Insurance
for handling according to Article 12 of this Decree.
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1. The provision fund for
insured medical care managed by the Vietnam Social Insurance shall be used for
addition to the medical care fund managed by the provincial Social Insurance in
case of the latter fund is insufficient.
The director general of the
Vietnam Social Insurance shall, based on the deficit of the medical care fund
managed by the provincial Social Insurance, decide on the supplementation and
report such to the management council of the Vietnam Social Fund at the nearest
meeting of the council. If the provision fund is insufficient for
supplementation, such must be reported to the management council for solution
before it is reported to the Healthy Ministry and the Finance Ministry.
2. If the provision fund for
insured medical care is smaller than the total insured medical care costs of
the two preceding quarters or larger than the total insured medical care costs
in the two preceding years, the Vietnam Social Insurance shall report such to the
management council, the Health Ministry and the Finance Ministry.
The Health Ministry shall assume
the prime responsibility for, and coordinate with the Finance Ministry in,
proposing handling measures to the Prime Minister.
Article 13.
Investment, growth of the health insurance fund
1. The Vietnam Social Insurance
shall take measures to preserve and increase the health insurance fund with the
temporarily idle money amount in the fund. The health insurance fund's
investment activities must ensure safety, efficiency and recoverability in case
of necessity.
2. The management council of the
Vietnam Social Insurance shall decide on the investment in the following forms:
a/ Buying treasury bills and
bonds of the State;
b/ Lending to state-owned
commercial banks. Vietnam Development Bank or Social Policy Bank at market
interest rate;
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3. Annual earnings from the
investment and growth of the health insurance fund shall be added to the
provision fund for insured medical care.
Article 14.
Financial plan
1. Annually, the Vietnam Social
Insurance shall make a financial plan on revenue and expenditure of the health
insurance fund: cost of management, investment and growth of the health
insurance fund, to be submitted to the management council of the Vietnam Social
Insurance for approval and reporting to the Finance Ministry and the Health
Ministry.
The Finance Ministry shall
assume the prime responsibility for. and coordinate with the Health Ministry
in. considering and making a sum-up to the Prime Minister for decision on
assignment of the financial plan.
2. Based on the financial plan
assigned by the Prime Minister, the general director of the Vietnam Social
Insurance shall decide to allocate revenue and expenditure estimates to
concerned units for implementation.
Article 15.
Responsibility for management of the health insurance fund
1. The Vietnam Social Insurance shall
take charge of collection, spending, management and settlement of the health
insurance fund in accordance with law.
2. The Vietnam Social Insurance
may open health insurance fund deposit accounts at state treasuries and
state-owned commercial banks. Balances on those deposit accounts are eligible
for deposit interest rates set by the concerned state treasuries or state-owned
commercial banks.
Chapter IV
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Article 16.
Transitional provisions
1. The free medical examination
and treatment policy continues applying to under-6 children based on actual
payment and spending according to the Government's Decree No. 36/2005/ND-CP of
March 17. 2005, detailing the implementation of a number of articles of the Law
on Protection, Care and Education of Children until this Decree takes effect.
2. Cases of participation in
health insurance from July 1, 2009, till the effective date of this Decree will
comply with the Government's Decree No. 63/2005/ND-CP of May 16, 2005,
promulgating the Health Insurance Regulation till the end of December 31, 2009.
Article 17.
Effect
1. This Decree takes effect on
October 1, 2009.
2. To annul the Government's
Decree No. 63/2005/ND-CP of May 16, 2005, promulgating the Health Insurance
Regulation, and Article 18 of the Government's Decree No. 36/2005/ND-CP of
March 17, 2005, detailing a number of articles of the Law on Protection. Care
and Education of Children and other provisions on health insurance which are
contrary to the provisions of this Decree.
Article 18.
Implementation guidance responsibility
1. The Health Ministry shall
assume the prime responsibility for, and coordinate with the Finance Ministry
in. guiding the implementation of articles of the Law on Health Insurance and
this Decree as assigned; issue legal documents on professional and technical
guidance for and quality management of establishments providing insured medical
examination and treatment.
2. The Ministry of Labor. War
Invalids and Social Affairs shall study and formulate criteria to identify
households living just above the poverty line and those achieving the average
living standards, and submit them to the Prime Minister for promulgation. For
2009, criteria for identifying households living just above the poverty line
comply with the Prime Minister's Decision No. 117/2008/QD-TTg of August 27,
2008. adjusting health insurance premium rates applicable to social policy
beneficiaries.
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Article 19.
Implementation responsibility
Ministers, heads of
ministerial-level agencies, heads of government-attached agencies and chairmen
of provincial-level People's Committees shall implement this Decree.-
ON
BEHALF OF THE GOVERNMENT PRIME MINISTER
Nguyen Tan Dung