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Decision No. 05/TC/BH dated January 2, 1993, promulgation of the schedule of disability insurance coverage rates applying to personal insurance operations

Nội dung toàn văn Decision No. 05/TC/BH promulgation disability insurance coverage rates personal insurance operations


THE MINISTRY OF FINANCE
--------

SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness
---------------

No. 05/TC/BH

Hanoi, January 2, 1993

 

DECISION

PROMULGATION OF THE SCHEDULE OF DISABILITY INSURANCE COVERAGE RATES APPLYING TO PERSONAL INSURANCE OPERATIONS

THE MINISTER OF FINANCE

- Pursuant to the Decree No. 155/HDBT dated 15-10-1988 of the Ministerial Council on definition of functions, duties and organizational structure of the Ministry of Finance;

- Pursuant to the Decision No. 45/QDTC dated 2-3-1989 of the Minister of Finance on introduction of the organizational and operational charter of Vietnam Insurance Incorporation;

For the purposes of providing the uniform method of insurance payment made in personal insurance operations;

After considering the request of the General Director of Vietnam Insurance Incorporation;

HEREBY DECIDES

Article 1: This Decision is enclosed herewith the schedule of disability insurance coverage rates applying to personal insurance operations.

Article 2: This Decision shall enter into force from the signature date. Any preexisting regulations relating to disability insurance payments that apply to personal insurance operations in contravention of this Decision shall be rendered null and void.

Article 3: The General Director of Vietnam Insurance Incorporation, the Chief of the Ministry of Finance’s Office, the Director of the Department of Financial Balancing – Finance, the Directors of the Finance Departments of centrally-affiliated cities and provinces, and Heads of relevant agencies, shall be responsible for enforcing this Decision./.

 

 

 

PP. THE MINISTER OF FINANCE
THE DEPUTY MINISTER




Pham Van Trong

 

SCHEDULE OF DISABILITY INSURANCE COVERAGE RATES

(Issued together with the Decision No. 05/TC-BH dated 2/01/1993 of the Ministry of Finance)

Scope of benefits

Insurance coverage rate

I – TOTAL DISABILITY

100%

1. Blindness or total loss of two eyes

100%

2. Incurable psychological disorder

100%

3. Total impairment of chewing and talking capacity

100%

4. Total loss or paralysis of two arms (from the shoulders or elbows) or two legs (from the crotch or knees) 

100%

5. Loss of two hands or two feet, one arm and one foot, or one arm and one shank, or one hand and one shank, or one hand and one foot

100%

6. Loss of ability to work (complete paralysis, injuries that lead to immobilization or total permanent disability) 

100%

7. Removal of a complete lung and a part of the other lung

100%

II – PARTIAL DISABILITY

 

A. UPPER LIMBS

 

8. Loss of one arm from the shoulder (shoulder disarticulation)

75 85%

9. Amputation of an arm below the shoulder

70 80%

10. Amputation of one arm at the elbow (elbow disarticulation)

65 75%

11. Loss of a complete hand or five fingers

60 70%

12. Loss of 4 fingers, except the thumb

40 50%

13. Loss of the thumb and index finger

35 45%

14. Loss of 3 fingers: 3rd, 4th and 5th ones

30 35%

15. Loss of 1 thumb and 2 other fingers

35 40%

16. Loss of 1 thumb and 1 other finger

30 35%

17. Loss of 1 index finger and 2 other fingers

35 40%

18. Loss of 1 index finger and 1 middle finger

30 35%

19. Loss of one thumb and one metacarpal

25 30%

Loss of one thumb

Loss of the distal phalange

Loss of ½ of the distal phalange

20 25%

10 15%

07 10%

20. Loss of one index finger and one metacarpal

Loss of 1 index finger

Loss of 2nd and 3rd phalange

Loss of 3rd phalange

20 25%

18 22%

10 12%

08 10%

21. Complete loss of 1 middle finger or ring finger (a whole metacarpal)

Loss of 1 middle finger or ring finger

Loss of 2nd and 3rd phalange

Loss of 3rd phalange

18 22%

15 18%

08- 12%

04 07%

22. Loss of 1 little finger and metacarpal

Loss of a complete little finger

Loss of 2nd and 3rd phalange

Loss of 3rd phalange

15 20%

10 15%

08 10%

04 07%

23. Stiff shoulder joint

24. Stiff elbow joint

25. Stiff wrist

25 35%

25 35%

25 35%

26. Fractured arm distraction or bone loss that shortens the limb by more than 3 cm and impedes the ability to turn the palm up and down or creates false joints

25 35%

27. Arm bone fracture at the anatomical neck, bad callus, limited movement of shoulder joints

28. Fracture of wrist bones

- Good callus, normal movement

- Bad callus, atrophy

29. Fracture of the radius and ulna

30. Fracture of either radius or ulna

31. False joint of both radius and ulna

35 45%

 

15 25%

25 30%

12 25%

10 – 20%

25 35%

32. False joint of either radius or ulna

33. Fracture of the lower extremity of the radius

34. Fracture of the styloid process of the radius or ulna

35. Fracture of wrist bones

36. Fracture of metacarpals (depending on the fracture level ranging from 1 to many metacarpals)

37. Fracture of collar bone: Good callus

Bad callus, stiff shoulder

Compression of axilarry nerve

38. Scapula fracture: - Fractured or missing main part of scapula

- Horizontal fracture

- Shoulder joint fracture

39. Fracture of finger bones (depending on fracture level ranging from one to many fingers)

15 20%

10 –18%

08 15%

10 18%

08 15%

08 12%

18 25%

30 35%

10 15%

17 22%

30 40%

03 12%

B. LOWER LIMBS

 

40. Loss of one leg from the crotch (hip disarticulation)

41. Amputation of one thigh:

1/3 upper

1/3 middle or below

42. Amputation of 1 leg below the knee (knee disarticulation)

43. Ankle disarticulation or loss of 1 foot

44. Loss of talus

45. Loss of calcaneus

46. Loss of part of the tibia, fibula that causes false joints

47. Partial loss of the fibula

48. Loss of ankles:

- Outer ankle

- Inner ankle

49. Loss of all 5 toes

50. Loss of 4 toes including the big toe

51. Loss of 4 toes excluding the big toe

52. Loss of 3rd, 4th and 5th toe

53. Loss of 3 toes including 1st, 2nd and 3rd toe

54. Loss of the big toe and 2nd toe

55. Loss of 1 big toe

56. Loss of 1 toe excluding the big toe

57. Loss of 1 big toe phalanx

58. Hip stiffness

59. Knee joint stiffness

75 85%

 

70 80%

55 75%

60 70%

55 65%

35 40%

35 45%

35 45%

20 30%

 

10 15%

15 20%

45 55%

38 48%

35 45%

25 30%

30 35%

20 25%

15 20%

10 15%

08 12%

45 55%

30 40%

60. Loss of most of the patella and serious limitation to the ability to stretch the upper thigh

45 55%

61. Leg fracture distraction or loss of bone that leads to the limb shortening

- by 3 - 5 cm

- from 3 to 5 cm

62. Complete paralysis of lateral popliteal nerve

63. Complete paralysis of medial popliteal nerve

64. Fracture of thigh bone at 1/3 middle or below

- Good callus

- Bad callus, malunion, varus or valgus, atrophy

(In case of surgery, the maximum amount of insurance coverage shall be paid)

65. Fracture of the upper 1/3 or femur neck (in case of surgery, the maximum amount of insurance coverage shall be paid)

- Good callus, straight axis

- Bad callus, valgus, walking with pain, atrophy

66. False joint of the femur neck

67. Fracture of the fibula and tibia

68. Fracture of the tibia

69. Fracture of the tibial plateau

70. Fracture of the fibula

71. Patellar tendon rupture

72. Fracture of the patella (in case of surgery, the maximum amount of insurance coverage shall be paid)

73. Fracture of the patella, knee stiffness, or quadriceps atrophy (depending on disability levels)

74. Achilles tendon rupture (stitched)

75. Fracture of metacarpals (depending on the level ranging from 1 to many metacarpals)

76. Fracture of the calcaneus

77. Fracture of the navicular

78. Fracture of toe bones (depending on the level ranging from 1 to many phalanges)

79. Fracture of ramus superior ossis pubis

80. Fracture of the ischium

81. Fracture of 1 ilium

82. Fracture of 2 ilium, pelvic deformity (depending on the level of impact on reproduction)

 

40 45%

35 40%

35 45%

25 35%

 

20 30%

30 40%

 

 

25 35%

35 45%

45 55%

20 30%

15 22%

15 25%

10 20%

15 25%

10 –20%

25 30%

15 20%

07 12%

15 25%

15 22%

04 12%

25 32%

25 30%

20 30%

40 60%

83. Fracture of the sacrum:

Without a sphincter disorder.

With a sphincter disorder.

 

10 15%

25 35%

C. SPINE

84. Removal of posterior vertebral arch:

of 1 vertebra

of 2 – 3 vertebrae or more

85. Compression fracture of 1 vertebra (without paralysis of the spinal cord)

86. Compression fracture of more than 2 vertebrae or more (without paralysis of the spinal cord)

87. Fracture of the spinous process or transverse process

of 1 vertebra

of 2 – 3 vertebrae

 

 

35 40%

45 60%

30 40%

45 60%

 

10 17%

25 45%

D. SKULL AND BRAIN

88. Skull defect (no sign of psychological and psychiatric disorder)

+ Diameter < 6 cm

+ Diameter from 6 - 10 cm

+ Diameter > 10 cm

89. Language disorder due to brain injuries

+ Idioglossia or spasmophemia that affect communication

Mutism due to injury to the Broca’s area

+ Loss of ability to use written language (asphasia due to injury to the Wernicke’s area)

 

 

25 40%

40 60%

50 70%

 

30 40%

60 70%

55 70%

90. Total scalping (or partial scalping according to ratios)

91. Open head injuries:

Cracked or broken skull

Depressed skull

Deep penetration of many pieces of fractured bones into the brain

92. Closed head injury

+ Fracture of calvaria (usual crack or depressed fracture)

+ Bone fracture that spreads to the basilar skull without paralysis of cranial nerve

+ Bone fracture that spreads to the basilar skull with paralysis of cranial nerve

93. Brain injury

+ Cerebral concussion

+ Cerebral edema

+ Cerebral contusion, compression

+ Subarachnoid hemorrhage

+ Intracranial haematoma (epidural, subdural and intracerebral)

45 55%

 

40 50%

30 40%

50 60%

 

20 –30%

30 40%

40 50%

 

08 15%

40 50%

50 60%

40 50%

30 40%

E. CHEST

94. Removal of 1 – 2 ribs

95. Removal of 3 ribs or more

96. Removal of each rib section

97. Fracture of 1 – 2 ribs

98. Fracture of 3 ribs or more

99. Mere fracture of the sternum (cardiovascular and refractory functions are normal)

100. Fissure of the sternum

101. Complete removal of one lung

102. Removal of multiple lobes of 2 lungs, DTS is reduced by over 50%

 

15 20%

25 35%

8 10%

7 12%

15 25%

15 20%

10 15%

70 80%

65 75%

103. Removal of multiple lobes of a lung

104. Removal of a lung lobe

105. Pleural effusion, pneumothorax, hemothorax (paracentesis only)

106. Pneumothorax, hemothorax (drainage)

107. Heart valve and septum defects due to injuries (without a heart failure)  

108. Pericardial sewing:

Bad surgery result

Good surgery result

50 60%

35 45%

04 10%

20 30%

50 60%

 

60 70%

35 45%

G. ABDOMEN

109. Complete removal of the stomach

110. Segmental resection of the stomach

111. Removal of most of the small intestine (less than 1 m remaining)

112. Segmental resection of the small intestine

113. Complete removal of the large intestine

114. Segmental resection of the large intestine

115. Mere removal of the right liver

116. Mere removal of the left liver

117. Removal of liver lobes, depending on the position, number, and surgery results

118. Removal of the gall bladder

119. Removal of the spleen

120. Removal of the tail of pancreas or spleen

121. Gastric perforation sewing

122. Small intestine perforation sewing (1 or multiple perforations)

123. Large intestine perforation sewing

124. Liver contusion, liver sewing

125. Splenic capsule sewing

126. Pancreas sewing

 

75 85%

50 60%

75 85%

40 50%

75 85%

50 60%

70 80%

60 70%

40 60%

45 55%

40 50%

60 70%

25 35%

30 45%

30 40%

35 45%

25 35%

30 35%

H. UNIRARY AND REPRODUCTIVE ORGANS

127. Removal of 1 kidney, the remaining kidney is functional

128. Removal of 1 kidney, the remaining kidney is damaged or sick

129. Segmental resection of the left or right kidney

130. Kidney injury (depending on the seriousness and the number of kidneys injured)

Slight (not special treatment is required, shorter than 5 days of monitoring)

Medium (special medication is required, longer than 5 days of monitoring)

Serious (contusion, surgical intervention is required)

131. Segmental resection of the bladder

132. Permanent bladder stoma surgery

133. Bladder perforation sewing

 

50 60%

70 80%

30 40%

 

04 08%

10 15%

47 55%

27 35%

70 80%

30 35%

134. Loss of the penis and 2 testicles of:

A woman under 55 years of age without children

A women under 55 years of age with children

A women over 55 years of age

135. Removal of the womb and one ovary of

Women under 45 years of age without children

Women under 45 years of age with children

Women over 45 years of age

136. Removal of 1 breast of women under 45 years of age: 1 side

              2 sides

              Women over 45 years of age  

              1 side

              2 sides

 

70 80%

55 65%

35 40%

 

60 70%

30 40%

25 30%

20 30%

45 55%

15 20%

30 40%

I. EYE

137. Loss or total loss of sight of 1 eye

Failure to implant an artificial eye

Possibility of implantation of an artificial eye

138. The 1/10 vision of one eye

139. The 2/10 – 4/10 vision of one eye

140. The 5/10 – 7/10 vision of one eye

141. Loss or total loss of sight of 1 eye, but the other eye is already lost or blind before the accident

 

 

55 65%

50 60%

30 45%

12 20%

07 15%

80 90%

K. EAR – NOSE - THROAT

142. Deafness of 2 ears: unrecoverable

Serious (able to hear when being screamed at)

Medium (able to hear loud voices at 1 – 2 m)

Slight (able to hear loud voices at 2 – 4 m)

143. Deafness of 1 ear: unrecoverable

Medium

Slight

144. Loss of 2 pinna

145. Loss of 1 pinna

146. Shriveled pinnae, ear canal stenosis

147. Loss of nose, nose deformity

148. Esophageal stricture causing swallowing difficulties

 

75 85%

60 70%

35 45%

15 25%

30 40%

15 20%

8 15%

20 40%

10 25%

20 25%

18 40%

20 40%

L. TOOTH – JAW – FACE

149. Lost of part of the upper jawbone and part of the lower jawbone from the ramus and under:

at a different side

at the same side

150. Total loss of the upper jawbone or lower jawbone

151. Loss of part of the upper jawbone or part of the lower jawbone (1/3 – 1/2 of the jawbone is lost) under the ramus

 

 

80 90%

70 80%

70 80%

35 45%

 

152. Fracture of the upper jawbone and the lower jawbone, mal union, dislocation of temporomandibular joint which cause swallowing and chewing difficulties

153. Fracture of the zygomatic bone, which causes slight the temporomandibular joint disorder and chewing difficulties

30 35%

15 25%

154. Artificial temporomandibular joint due to nonunion or bone defects

155. Loss of teeth: more than 08 teeth without possibility of implantation of false teeth

From 5 – 7 teeth

From 3 – 4 teeth

From 1 – 2 teeth

156. Loss of 3/4 of the tongue without losing the root (from the V line outwards)

157. Loss of 2/3 of the tongue from the tip

158. Loss of 1/3 of the tongue that causes pronunciation difficulties

159. Loss of less than 1/3 of the tongue that causes pronunciation difficulties

20 25%

30 40%

15 25%

8 12%

3 -6 %

75 85%

50 – 60%

15 25%

10 15%

M. SOFT TISSUE INJURIES, BURNS

160. Soft tissue injuries include skin scratch, mucous membrane scratch, sprain, luxation, etc. which causes no impact on muscular energy (depending on the seriousness level such as serious, slight, much or less)

161. Soft tissue injuries that cause pain, numbness, convulsive movements (depending on the extent and seriousness), affect tendons, muscles, major blood vessels, and nerves

162. Chest and abdominal soft tissue injuries that affect respiration

163. Soft tissue injuries that leave sclerosis and cause difficulties in eating, chewing, and neck movement

164. Soft tissue injuries that cause large openings around the mouth cavity, lip and cheek injuries that seriously affect eating and drinking

165. Loss of part of the palate that connect the nose and the mouth

166. Superficial burn (first-degree, second-degree)

Less than 5% of skin area

From 5-15% and more than 15% of skin area

167. Deep burn (third-degree, fourth-degree, fifth-degree)

Less than 5% of skin area

5-15% of skin area

More than 15% of skin area

 

02 12%


12 25%


35 45%

40 60%


50 60%


20- 30%

 

3 7%

10 15%

15 25%

20 35%

35 60%

60 80%

 

PRINCIPLES OF INSURANCE CLAIM CONSIDERATION

Insurance claim consideration according to this schedule shall be based on insured patients’ medical treatment invoices and the following regulations:

1- The complete incapacity of each organ or permanent limb damage shall be considered as loss of such organ or loss of limbs.

When any disability is not specified in this schedule, claims on such disability shall be paid based on the comparison of its seriousness with other disability cases defined in this schedule.

3- Commonly treated injuries and those without infection shall be eligible for insurance payments in proportion to the lowest level of insurance payment in the scale of insurance coverage rates applicable to this case.   

4- Complicatedly treated injuries and those with infection or with any sequela after being treated shall be based on their seriousness to be eligible for insurance payments which are gradually increased to the maximum level of insurance payment in the scale of insurance payment coverage applicable to this case. 

5- With respect to multiple injuries, insurance payments shall be made to single injury but the total of insurance payment to the insured is not allowed to exceed the insurance cover agreed in an insurance policy.  If multiple injuries occur at the same limb, the total sum paid to such injuries is not allowed to exceed the ratio of such limb loss.

6- With respect to injuries subject to re-operation and breaking of callus for remodeling, 50% of the minimum level of insurance payment in the scale of insurance coverage rate applied to such case shall be additionally paid but the total sum of insurance payment is not allowed to exceed the insurance cover agreed in an insurance policy.

 


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              Decision No. 05/TC/BH promulgation disability insurance coverage rates personal insurance operations
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