Nghị định 63/2005/ND-CP

Decree no. 63/2005/ND-CP of May 16, 2005 promulgating the medical insurance regulation

Decree no. 63/2005/ND-CP of May 16, 2005 promulgating the medical insurance regulation đã được thay thế bởi Decree No. 62/2009/ND-CP of July 27, 2009, detailing and guiding a number of articles of the Law on Health Insurance và được áp dụng kể từ ngày 01/10/2009.

Nội dung toàn văn Decree no. 63/2005/ND-CP of May 16, 2005 promulgating the medical insurance regulation


THE GOVERNMENT
-------

SOCIALIST REPUBLIC OF VIET NAM
Independence - Freedom - Happiness
----------

No. 63/2005/ND-CP

Hanoi, May 16, 2005

 

DECREE

PROMULGATING THE MEDICAL INSURANCE REGULATION

THE GOVERNMENT

Pursuant to the December 25, 2001 Law on Organization of the Government;
At the proposals of the Minister of Health and the Minister of Finance,

DECREES:

Article 1.- To promulgate together with this Decree the Medical Insurance Regulation.

Article 2.- This Decree takes effect from July 1, 2005 and replaces the Government’s Decree No. 58/1998/ND-CP of August 13, 1998, promulgating the Medical Insurance Regulation. All previous regulations contrary to the provisions of this Decree are hereby annulled.

Article 3.- The Ministry of Health shall assume the prime responsibility for, and coordinate with the Ministry of Finance and the concerned ministries and branches in, guiding the implementation of this Decree.

Article 4.- The ministers, the heads of ministerial-level agencies, the heads of Government-attached agencies, the presidents of People’s Committees of provinces and centrally-run cities, and the general director of Vietnam Social Insurance shall have to implement this Decree.

 

 

ON BEHALF OF THE GOVERNMENT
PRIME MINISTER




Phan Van Khai

 

MEDICAL

INSURANCE REGULATION
(Promulgated together with the Government’s Decree No. 63/2005/ND-CP of May 16, 2005)

Chapter I

GENERAL PROVISIONS

Article 1.- General objectives

1. Medical insurance stipulated in this Regulation constitutes a social policy the implementation of which is organized by the State with the aim of mobilizing contributions from labor users, laborers, organizations and individuals to pay for medical examination and treatment expenses according to this Regulation for medical insurance card bearers when they are ill.

2. Medical insurance under this Regulation is of a social and not-for-profit nature, aiming to achieve equality and efficiency in medical examination and treatment and participation by all the people.

Article 2.- Interpretation of terms

In this Regulation, the following terms are construed as follows:

1. Compulsory medical insurance means a form of medical insurance in which participation is compulsory.

2. Voluntary medical insurance means a form of medical insurance in which participation is voluntary.

3. Medically insured patients mean patients who have compulsory or voluntary medical insurance cards, and, when having medical examination or treatment, are entitled to the regime of medical examination and treatment and payment of medical examination and treatment expenses according to regulations of competent agencies.

4. Relatives include blood father and mother; blood father and mother of one’s spouse; adoptive father and mother or lawful nurturing person of oneself and one’s spouse; spouse; blood children, lawfully adopted children under 18 years; blood children or lawfully adopted children who are full 18 years or older but disabled, thus having no working capacity according to the provisions of law.

5. Medical insurance card means a certificate showing that its bearer has fulfilled his/her obligations and is entitled to medical examination and treatment benefits according to regulations, which is issued by a competent medical insurance agency.

6. Medical insurance premium means a sum of money payable by medical insurance participants, labor users or the state budget to the Medical Insurance Fund according to regulations.

7. Medical Insurance Fund means a monetary fund formed from collected medical insurance premiums and other lawful revenues. It is used to pay medical examination and treatment expenses and other lawful expenses according to regulations for medical insurance participants.

8. Medical examination and treatment establishments engaged in medical insurance mean state-owned and private medical establishments which have signed contracts with medical insurance agencies on providing medical examination and treatment for medical insurance card bearers.

9. Scope of medical insurance benefits covers medical examination and treatment, health care and rehabilitation or pecuniary benefits which medical insurance participants are entitled to according to regulations of competent agencies.

10. Hi-tech services mean complicated and specialized medical techniques which must be performed by highly qualified or skilled persons or with expensive modern medical equipment and supplies.

11. Forms of medical insurance payment mean methods and modes which are applied according to regulations to payment of medical examination and treatment expenses by the Medical Insurance Fund-managing agency to medical examination and treatment establishments engaged in medical insurance or medical insurance participants.

12. Direct payment means a form of payment in cash made by the Medical Insurance Fund-managing agency directly to medical insurance participants , not through medical examination and treatment establishments engaged in medical insurance.

13. Payment based on service charge means a form of payment based on the rates of charges applicable to medical services used by medically insured patients.

14. Payment based on fixed amount means a form of payment based on the fixed package sum per card registered with medical examination and treatment establishments engaged in medical insurance for a given period of time. When applying this form of payment, medical examination and treatment establishments engaged in medical insurance are not permitted to collect any other charges.

15. Payment based on group of diseases means a form of payment based on expenses for a specific disease or group of diseases already diagnosed.

Article 3.- Subjects of compulsory medical insurance

Compulsory medical insurance shall apply to the following subjects:

1. Vietnamese laborers (hereinafter referred to as laborers for short) working under labor contracts with a term of full 3 months or more and labor contracts with an indefinite term in enterprises of all economic sectors, agencies, non-business units and armed forces units as follows;

a/ Enterprises established and operating under the State Enterprise Law;

b/ Enterprises established and operating under the Enterprise Law;

c/ Enterprises established and operating under the Law on Foreign Investment in Vietnam;

d/ Enterprises in the fields of agriculture, forestry, fishery and salt-making;

e/ Cooperatives established and operating under the Cooperative Law;

f/ Enterprises of political organizations or socio-political organizations;

g/ State agencies, non-business units, political organizations, socio-political organizations, socio-politic-professional organizations, socio-professional organizations, other social organizations; armed force units;

h/ Commune, ward or township health stations;

i/ Preschools;

j/ Foreign agencies and organizations or international organizations based in Vietnam, except for cases otherwise provided for by international treaties, multilateral or bilateral agreements which the Socialist Republic of Vietnam has signed or acceded to;

k/ Semi-public, people-founded and private establishments in the cultural, health, education and training, scientific, sport and physical training and other non-business branches;

l/ Other organizations employing laborers.

2. Public employees and servants under the Ordinance on Public Employees.

3. People who are enjoying the retirement regime or monthly social insurance allowances.

4. People with meritorious services to the revolution as provided for by law.

5. Resistance war activists and their blood children affected by toxic chemicals used by the US in the wars in Vietnam and currently enjoying monthly allowances.

6. Incumbent National Assembly deputies who are not on the state payroll and payrolls of socio-political organizations; incumbent deputies to People’s Councils at al levels not on the state payroll or not enjoying the monthly social insurance regime.

7. Commune, ward or township cadres who have retired and are enjoying monthly social insurance allowances and old and weak commune cadres who have retired and are enjoying monthly allowances from the state budget under the Government Council’s Decision No. 130/CP of June 20, 1975 and the Ministers’ Council’s Decision No. 111/HDBT of October 13, 1981.

8. Relatives of people’s army officers on active service; relatives of professional officers working in the people’s police force.

9. People enjoying social support in the form of monthly allowances.

10. People aged 90 years or more and elderly people defined in Article 6 of the Government’s Decree No. 30/2002/ND-CP of March 26, 2002 stipulating and guiding the implementation of the Ordinance on the Elderly.

11. People entitled to medical examination and treatment under the Prime Minister’s Decision No. 139/2002/QD-TTg of October 15, 2002 on medical examination and treatment for the poor.

12. Veterans in anti-French and anti-US wars other than those who have participated in compulsory medical insurance mentioned above.

13. Foreign students who are studying in Vietnam with the Vietnamese State’s scholarships.

14. For laborers working in enterprises, agencies and organizations defined in Clause 1 of this Article, working under labor contracts with a term of under 3 months, at the expiration of their labor contracts, if they continue working or enter into new labor contracts with the employing enterprises, organizations or individuals, they must participate in compulsory medical insurance.

Article 4.- Participants in voluntary medical insurance

Voluntary medical insurance shall apply to all subjects that need to participate in voluntary medical insurance, including those who have participated in compulsory medical insurance but wish to participate in voluntary medical insurance so as to enjoy higher medical insurance service levels as compared to participants in compulsory medical insurance. The objectives, principles and forms of organization and management of voluntary medical insurance are provided for in Articles 24, 25, 26 and 27 of this Regulation.

Article 5.- The Medical Insurance Fund

1. The Medical Insurance Fund shall be formed from the following sources:

a/ Medical insurance premiums contributed by labor users and medical insurance participants;

b/ State contributions to medical insurance for subjects according to regulations and other state supports (if any);

c/ Profits generated from lawful measures taken to preserve and develop the Medical Insurance Fund;

d/ Financial supports and aid of organizations and individuals at home or abroad;

e/ Other lawful revenues.

2. The Medical Insurance Fund shall be used to pay medical examination and treatment and functional rehabilitation expenses for medical insurance participants within the scope of their benefits, and other expenses according to regulations.

Article 6.- Medical insurance cards

1. Medical insurance cards shall be issued to medical insurance participants. They shall have a design which is distinctive, convenient and appropriate for use and management.

2. Vietnam Social Insurance shall promulgate the form, uniformly manage and issue medical insurance cards.

3. Medical insurance cards shall be valid for immediate and constant use when medical insurance premiums are contributed according to regulations. The issue, replacement and renewal of cards must ensure continuity, without affecting the benefits of medical insurance participants.

4. For voluntary medical insurance, medical insurance cards shall become valid 30 days after the date of contribution of medical insurance premiums in the following cases:

a/ First-time contribution of medical insurance premiums;

b/ Continued contribution of medical insurance premiums after a period of interruption for any reason.

5. Medical insurance cards shall be invalid in the following cases:

a/ They have expired;

b/ They are issued by incompetent agencies;

c/ Their bearers die;

d/ They have been modified, erased…

Chapter II

MEDICAL INSURANCE REGIME AND PAYMENT OF EXPENSES FOR MEDICAL EXAMINATION AND TREATMENT COVERED BY MEDICAL INSURANCE

Article 7.- Scope of benefits of participants in compulsory medical insurance

Bearers of compulsory medical insurance cards shall be entitled to the medical insurance regime for medical examination and treatment of inpatients and outpatients at state-owned and private medical establishments having contracts with social insurance agencies on providing medical examination and treatment for medically insured patients, including:

1. Medical examination, diagnosis, treatment and functional rehabilitation during the treatment period at medical examination and treatment establishments;

2. Medical test, image diagnosis and functional probe;

3. Medicines on the list promulgated by the Ministry of Health;

4. Blood, transfusion fluids;

5. Surgeries, operations;

6. Access to medical supplies, equipment and patient beds;

7. Expenses for prenatal checks and delivery;

8. Transportation freight in case of transfer to higher specialized or technical levels for the poor, social policy beneficiaries, people living or working in mountainous, deep-lying or remote areas.

Article 8.- Payment of medical examination and treatment expenses for participants in compulsory medical insurance

1. Expenses of medical examination and treatment of participants in compulsory medical insurance defined in Article 7 of this Regulation shall be wholly covered by the Medical Insurance Fund at current hospital charge rates set by the State, except for cases using expensive hi-tech services for which payment shall be made according to the provisions of Clause 2 of this Article.

2. Cases using expensive hi-tech services shall be also covered by the Medical Insurance Fund within the maximum payment percentage and amount according to regulations. The Ministry of Health shall coordinate with the Ministry of Finance in drawing up a specific list of hi-tech services and appropriate maximum payments to be made by the Medical Insurance Fund for each hi-tech service.

3. Medically insured patients shall pay by themselves for amounts in excess of the maximum levels provided for in Clause 2 of this Article, except for the subjects defined in Clauses 3, 4, 5, 9, 10 and 11, Article 3 of this Regulation for whom payments shall be made by the Medical Insurance Fund within the limits jointly set by the Ministry of Health and the Ministry of Finance.

Article 9.- Medical examination and treatment establishments engaged in medical insurance

1. The Ministry of Health shall provide professional and technical standards for medical establishments qualified to provide medical examination and treatment under medical insurance, serving as a basis for social insurance organizations to sign contracts on providing medical examination and treatment for medical insurance card bearers.

2. Private medical establishments signing with social insurance organizations contracts on providing medical examination and treatment for medical insurance card bearers must satisfy all professional and technical standards and observe all regulations on the payment regime for medically insured patients like state-owned ones.

Article 10.- Registration for medical examination and treatment under medical insurance

1. Medical insurance card bearers shall be entitled to select medical establishments for original registration of medical examination and treatment and to receive medical examination and treatment at medical establishments at a professional and technical level suitable to the conditions of their illness.

2. Bearers of compulsory medical insurance cards shall enjoy the medical insurance payment regime provided for in Article 8 of this Regulation when:

a/ They have the medical examination and treatment at the medical examination and treatment establishments registered in their cards for health management and care;

b/ They have medical examination and treatment at other medical examination and treatment establishments engaged in medical insurance at the recommendation for transfer to hospitals of a suitable technical and professional level according to regulations of the Ministry of Health;

c/ They have medical examination and treatment at medical examination and treatment establishments engaged in medical insurance in case of emergency;

d/ They have medical examination and treatment at medical examination and treatment establishments engaged in medical insurance which have not been originally registered or are not at a suitable treatment level for some special cases according to separate specific agreements between social insurance organizations and labor users.

Article 11.- Payment in case of medical examination and treatment at personal requests of medical insurance card bearers; medical examination and treatment at private medical establishments

1. In cases where medical insurance card bearers have medical examination and treatment at their personal requests such as selecting doctors, patient’s rooms, medical examination and treatment establishments and medical services by themselves; having medical examination and treatment at medical establishments at a technical and professional level higher than that stipulated by the Ministry of Health; or having medical examination and/or treatment at medical establishments which do not sign contracts with social insurance organizations; have medical examination and treatment in foreign countries; Medical Insurance Fund shall only cover medical examination and treatment expenses at current hospital charge rates applied by state-owned medical establishments of an appropriate professional level in accordance with the Ministry of Health’s regulations and within the scope of benefits defined in Article 7 of this Regulation.

2. If medical insurance card bearers have medical examination and treatment at the registered level at private medical establishments, the Medical Insurance Fund shall only cover their medical examination and treatment expenses at the hospital charge rates applied by state-owned medical establishments of the equivalent level.

Medical insurance card bearers shall have to pay the difference (if any) between the actual medical examination and treatment expenses and the payment amounts covered by the Medical Insurance Fund in the cases stated in Clause 1 and Clause 2 of this Article.

Article 12.- Cases which shall not benefit from medical insurance

The Medical Insurance Fund shall not cover expenses in the following cases:

1. Treatment of leprosy, specific drugs for the treatment of tuberculosis, malaria, schizophrenia, epilepsy and other diseases, which have been covered by the state budget.

2. Diagnosis and treatment of HIV/AIDS (excluding HIV tests according to medical requirements and the subjects defined in the Prime Minister’s Decision No. 265/2003/QD-TTg of December 16, 2003, on the regime for persons exposed to HIV or infected with HIV/AIDS in occupational accidents or risks); gonorrhea and syphilis.

3. Vaccination, sanatorium, convalescence, early pregnancy tests and diagnosis, health checks, family planning services, and treatment of infertility.

4. Orthopedics and aesthetic plastics, making of artificial limbs, spurious eyes, dentures, optical glasses, hearing-aids.

5. Occupational diseases, labor accidents, war casualties.

6. Treatment expenses in cases of suicide, intentionally caused injuries, drug addiction, or in cases of committing violations of law.

7. Medical expertise; forensic medicine; psychiatric expertise.

8. Cases of medical examination and treatment, functional rehabilitation and birth delivery at home.

Article 13.- Forms of payment of medical examination and treatment expenses covered by medical insurance

Medical examination and treatment expenses covered by medical insurance shall be paid in either of the following two forms:

1. Social insurance organizations make payment to medical examination and treatment establishments engaged in medical insurance under the contracts signed between them.

2. Social insurance organizations pay medical examination and treatment expenses directly to medically insured patients in the cases stated in Clause 1, Article 11 of this Regulation.

Article 14.- Payment between social insurance agencies and medical examination and treatment establishments

1. Forms of payment between medical insurance agencies and medical examination and treatment establishments engaged in medical insurance:

a/ Payment based on service charges;

b/ Payment based on fixed amount;

c/ Payment based on group of diseases;

d/ Other appropriate forms of payment.

2. Social insurance organizations shall apply specific forms of payment under the joint guidance of the Ministry of Health and Ministry of Finance.

3. On the basis of ensuring the benefits of medical insurance participants, medical examination and treatment establishments engaged in medical insurance, the safety of the Medical Insurance Fund and compliance with hospital charge policies and convenience for the involved parties, Vietnam Social Insurance shall guide the experimental application of new forms of payment after reaching agreement with the Ministry of Health and the Ministry of Finance.

Chapter III

RESPONSIBILITY AND MODE FOR PAYMENT OF COMPULSORY MEDICAL INSURANCE PREMIUMS AND PREMIUM LEVELS

Article 15.- Medical insurance premiums and responsibility to pay compulsory medical insurance premiums

1. For subjects defined in Clauses 1 and 2, Article 3 of this Regulation: their monthly medical insurance premiums shall be equal to 3% of their monthly salaries, wages or subsistence allowances plus position-based allowances, working seniority allowances, beyond-bracket seniority allowances, region-based allowances and difference coefficient in reservation (if any), of which 2% shall be paid by labor users and 1%- by laborers.

2. For subjects who are pensioners or provided with working capacity loss allowances: their monthly medical insurance premium shall be equal to 3% of their pensions or social insurance allowances, which shall be paid directly by social insurance agencies.

3. For subjects who are provided with monthly labor accident or occupational disease allowances; rubber workers who are laid off and provided with monthly allowances; those who are provided with allowances under the Prime Minister’s Decision No. 91/2000/QD-TTg of August 4, 2000 and subjects defined in Clauses 4, 5, 6, 7, 8, 9 and 12, Article 3 of this Regulation, their monthly medical insurance premiums shall be equal to 3% of the minimum salary currently in force.

4. For subjects defined in Clauses 10 and 11, Article 3 of this Regulation: a temporary annual premium shall be VND 50,000/person/year.

5. For subjects defined in Clause 13, Article 3 of this Regulation (foreign students studying in Vietnam with Vietnam’s scholarships): their monthly medical insurance premiums shall be equal to 3% of their monthly scholarships, which shall be paid by scholarship-granting agencies.

6. The state budget shall cover payable medical insurance premiums for subjects entitled to social insurance before October 1, 1995 and subjects defined in Clauses 4, 5, 6, 7, 8, 9, 10, 11 and 12, Article 3 of this Regulation. The Social Insurance Fund shall cover payable medical insurance premiums for subjects no longer entitled to social insurance from October 1, 1995.

7. The Government shall adjust the levels of compulsory medical insurance premiums when necessary.

8. Labor users in enterprises are encouraged to pay all medical insurance premiums for laborers (in this case, medical insurance premiums 2% shall be accounted into production costs and 1% shall be covered by the enterprises’ funds).

9. If participants in compulsory medical insurance also participate in voluntary medical insurance, they shall have to pay, apart from compulsory medical insurance premiums as stated above, voluntary medical insurance premiums according to regulations for voluntary medical insurance services they are entitled to.

Article 16.- Modes of payment of medical insurance premiums

1. Agencies, enterprises, organizations or individuals (hereinafter referred to as labor users) that manage subjects defined in Article 3 of this Regulation shall deduct or collect medical insurance premiums according to the percentage or at the level stated in Article 15 of this Regulation and pay them to social insurance agencies once a month for those who participate in both social insurance and medical insurance and at least once every three months for other subjects.

2. In special cases, social insurance organizations and labor users may agree under contracts on payment of medical insurance premiums and issue of long-term medical insurance cards in a way different from the provisions of Clause 1 of this Article.

Chapter IV

RIGHTS AND RESPONSIBILITIES OF PARTIES TO MEDICAL INSURANCE

Article 17.- Rights and responsibilities of medical insurance participants

1. Medical insurance card bearers shall have the rights:

a/ To have medical examination and treatment under the medical insurance regime as provided for in Chapter II of this Regulation;

b/ To choose one of the convenient primary healthcare establishments at their places of residence or workplaces under the guidance of social insurance organizations for health management and care and medical examination and treatment;

c/ To change their registered primary healthcare establishments at the end of every quarter;

d/ To request social insurance agencies and medical examination and treatment establishments to ensure their benefits according to the provisions of this Regulation;

e/ To lodge complaints or denunciations about violations of this Regulation.

2. Medical insurance card bearers shall have the responsibilities:

a/ To pay medical insurance premiums in full and on time;

b/ To produce their medical insurance cards upon medical examination and treatment;

c/ To preserve and not to let others borrow their medical insurance cards;

d/ To observe regulations and guidance of medical insurance agencies and medical establishments when having medical examination and treatment.

Article 18.- Rights and responsibilities of labor users

1. Labor users shall have the rights:

a/ To refuse to meet the requests of social insurance agencies and medical examination and treatment establishments which are contrary to the provisions of this Regulation and guiding documents of competent state agencies;

b/ To complain about acts of violation of this Regulation. Pending the settlement of their complaints, they shall still have to pay medical insurance premiums according to regulations.

2. Labor users shall have the following responsibilities:

a/ To pay medical insurance premiums in full amount and on time according to the provisions of this Regulation;

b/ To supply documents on medical insurance participants’ labor, salaries, wages and allowances at the request of social insurance organizations and implement the medical insurance payment regime according to regulations;

c/ To submit to the supervision and inspection by competent State agencies in the implementation of the regime of contribution and payment of medical insurance premiums for laborers.

Article 19.- Rights and responsibilities of social insurance organizations

1. Social insurance organizations shall have the rights:

a/ To request labor users to pay medical insurance premiums and implement the medical insurance regime; to supply documents related to the payment of medical insurance premiums and the implementation of the medical insurance regime;

b/ To organize agents for issuance of medical insurance cards;

c/ To sign contracts with qualified medical examination and treatment establishments on providing medical examination and treatment for medical insurance card bearers;

d/ To request medical examination and treatment establishments to supply dossiers, patients’ records and documents related to the payment of medical examination and treatment expenses covered by medical insurance;

e/ To refuse to pay medical examination and treatment expenses which are contrary to the provisions of the Medical Insurance Regulation or to the terms of contracts signed between social insurance organizations and medical examination and treatment establishments;

f/ To seize fake medical insurance documents and cards and transfer them to the competent state agencies for handling according to the provisions of law;

g/ To propose competent state agencies to handle labor users and laborers that violate this Regulation.

2. Social insurance organizations shall have the responsibilities:

a/ To implement medical insurance programs, attract more participants in compulsory and voluntary medical insurance according to the provisions of this Regulation;

b/ To collect medical insurance premiums, issue, and guide the management and use of, medical insurance cards;

c/ To provide information on medical examination and treatment establishments for medical insurance participants and guide them to select establishments for registration;

d/ To manage the Medical Insurance Fund and pay all medical insurance sums according to regulations and in time;

e/ To inspect and evaluate the implementation of the medical examination and treatment regime and the payment of expenses of medical examination and treatment covered by medical insurance;

f/ To organize the dissemination of information on medical insurance;

g/ To settle complaints about the implementation of the medical insurance regime according to its competence;

h/ To implement the provisions of law and requests of competent agencies regarding the statistical regime, professional operation reports, financial statements, inspection and supervision;

i/ To study, plan and submit to competent agencies for promulgation measures to expand and develop medical insurance in order to realize the goal of medical insurance for all the people;

j/ To study, propose and submit to competent agencies measures to increase the benefits of medical insurance participants, improve forms of payment, ensure the balance of funds for medical examination and treatment covered by medical insurance, and medical insurance-related issues.

Article 20.- Rights and responsibilities of medical examination and treatment establishments engaged in medical insurance

1. Medical examination and treatment establishments shall have the rights:

a/ To request social insurance organizations to make advance payments and pay medical examination and treatment expenses in accordance with the provisions of this Regulation and the signed contracts on medical examination and treatment;

b/ To provide medical examination and treatment as well as medical services for medically insured patients in strict compliance with professional regulations;

c/ To request social insurance organizations to supply data on the numbers of people who have registered with medical examination and treatment establishments engaged in medical insurance;

d/ To refuse to meet requests outside this Regulation and the contracts signed with social insurance agencies or requests contrary to hospitals’ professional regulations promulgated by the Ministry of Health;

e/ To use funds paid by social insurance organizations according to regulations;

f/ To complain to competent agencies about violations of this Regulation or initiate lawsuits against breaches of social insurance organizations of contracts on medical examination and/or treatment covered by medical insurance.

2. Medical examination and treatment establishments shall have the responsibilities:

a/ To strictly comply with contracts on medical examinations and treatment covered by medical insurance;

b/ To record, compile and supply documents related to medical examination and treatment for medically insured patients, which shall serve as a basis for the payment of expenses and settlement of medical insurance-related disputes;

c/ To prescribe medicines, biologicals, surgeries or operations, tests, hospital transfer as well as medical services in a safe and reasonable manner for medically insured patients according to professional regulations of the Ministry of Health;

d/ To create favorable conditions for social insurance organizations’ personnel working in the establishments to propagate and explain medical insurance; give guidance on the benefits and responsibilities of medical insurance participants, and settle medical insurance card bearers’ complaints about medical examination and treatment;

e/ To check medical insurance cards, detect and notify social insurance organizations of cases of violating regulations on the use of medical insurance cards and abusing the medical insurance regime;

f/ To manage and use funds paid by social insurance organizations according to regulations;

g/ To implement the provisions of law regarding the statistical regime, professional operation reports, financial statements, inspection and supervision related to medical insurance.

Chapter V

MANAGEMENT AND USE OF THE MEDICAL INSURANCE FUND

Article 21.- Management and use of the Medical Insurance Fund

1. The Medical Insurance Fund constitutes part of the Social Insurance Fund, is managed in a centralized, uniform, democratic and public manner in accordance with the financial management regulations applicable to Vietnam Social Insurance.

2. The Ministry of Finance and the Ministry of Health shall guide in detail the management and use of the Medical Insurance Fund.

Article 22.- Regimes of accounting and financial statements

Social insurance organizations must implement the regimes of accounting and financial statements applicable to the Medical Insurance Fund in accordance with the provisions of law.

Article 23.- Financial publicity

At the end of a fiscal year, social insurance organizations must publicize financial statements regarding the use of the Medical Insurance Fund in accordance with the provisions of law.

Chapter VI

VOLUNTARY MEDICAL INSURANCE

Article 24.- Objectives

Voluntary medical insurance provided for in this Regulation aims to realize social policy on medical examination and treatment not for commercial purposes and not according to the provisions of law on insurance business.

Article 25.- Subjects, principles

1. Voluntary medical insurance shall apply to all subjects that need to participate in voluntary medical insurance, including those who have participated in compulsory medical insurance but wish to participate in voluntary medical insurance so as to enjoy higher medical insurance service levels as compared to participants in compulsory medical insurance, and to foreigners working, studying or touring in Vietnam.

2. Voluntary medical insurance is implemented based on administrative territories or groups of subjects in an organized manner and based on agencies and organizations managing voluntary participants.

3. Participants in voluntary medical insurance shall have their medical examination and treatment expenses covered by the Medical Insurance Fund according to the level of contributed premiums and the selected form of voluntary medical insurance.

4. The State encourages the diversification of forms of voluntary medical insurance on the basis of observance of the objectives defined in Article 24 of this Regulation. The Ministry of Health and the Ministry of Finance shall guide the registration and implementation of voluntary medical insurance in accordance with the provisions of this Regulation.

5. Provincial/municipal People’s Committees shall arrange local budgets and mobilize contributions of agencies, organizations and individuals to support voluntary medical insurance premiums for local people, especially the poor, so that more and more people will participate in voluntary medical insurance.tc "5. Provincial/municipal People’s Committees shall arrange local budgets and mobilize contributions of agencies, organizations and individuals to support voluntary medical insurance premiums for local people, especially the poor, so that more and more people will participate in voluntary medical insurance."

Article 26.- Forms, benefits of voluntary medical insurance and levels of medical insurance premiums

1. Forms of voluntary medical insurance shall include:

a/ Medical examination and treatment insurance for inpatients and outpatients;

b/ insurance additional to compulsory medical insurance;

c/ Community health insurance; household health insurance and other types of medical insurance.

2. The Ministry of Health and the Ministry of Finance shall provide for the scope of benefits and the bracket of voluntary medical insurance premiums on the basis of medical service prices, current benefits, socio-economic conditions and the number of participants for different target groups. On the basis of the regulations of the Ministry of Health and the Ministry of Finance, Vietnam Social Insurance shall determine the specific levels of premiums suitable to each target group and socio-economic conditions of each locality.

3. Participants in compulsory medical insurance may participate in voluntary medical insurance, pay premiums and enjoy benefits according to regulations on voluntary medical insurance. The Ministry of Health shall reach agreement with Vietnam Social Insurance before implementing this form of medical insurance on an experimental basis.

Article 27.- Management of the Voluntary Medical Insurance Fund

1. Revenues from voluntary medical insurance shall be accounted, allocated and used to cover medical examination and treatment expenses for participants and serve the cause of development of voluntary medical insurance.

2. Organizations providing voluntary medical insurance may deduct part of total voluntary medical insurance revenues for payment for the collection of premiums, issue of voluntary medical insurance cards and additional payment for propaganda, mobilization and commendation work. The percentage of deduction shall be jointly specified by the Ministry of Health and the Ministry of Finance.

3. After each year of operation, if the Voluntary Medical Insurance Fund has any positive balance, it shall transfer all the balance to the subsequent year for use for medical examination and treatment of participants in voluntary medical insurance. If its total revenue is small than its expenditure, the fund shall be allowed to use the balance of the Compulsory Medical Insurance Fund or other support sources according to regulations to ensure full and timely payment of regimes to beneficiaries according to regulations.

4. The Ministry of Finance and the Ministry of Health shall jointly guide in detail the implementation, management and use of the Voluntary Medical Insurance Fund according to the provisions above and the Financial Management Regulation of Vietnam Social Insurance.

Chapter VII

ORGANIZATION AND MANAGEMENT OF MEDICAL INSURANCE

Article 28.- Organizational system

1. The Prime Minister shall provide for a uniform and synchronous organizational system for implementing medical insurance policies from the central to the grassroots levels.

2. Vietnam Social Insurance is the agency organizing the implementation of medical insurance policies according to the provisions of this Regulation.

Article 29.- State management of medical insurance

1. The Government performs unified State management over medical insurance nationwide.

2. The Government assigns the Ministry of Health to exercise the function of State management of medical insurance, embracing the following contents:

a/ To assume the prime responsibility for, and coordinate in, formulating laws and policies on medical insurance then submit them to superior authorities for promulgation or promulgate them according to its competence;

b/ To formulate and promulgate according to its competence regulations, professional and technical standards for medical establishments which satisfy all conditions for providing medical examination and treatment for medical insurance participants;

c/ To guide, supervise, inspect, and settle problems in, the implementation of the provisions of law on medical insurance in order to ensure the benefits and responsibilities of medical insurance participants, medical examination and treatment establishments engaged in medical insurance according to the provisions of law.

3. The Ministry of Finance, the Ministry of Labor, War Invalids and Social Affairs and the Ministry of Home Affairs shall, within the scope of their respective tasks and powers, have the responsibility to perform the function of State management over medical insurance.

4. The presidents of provincial/municipal People’s Committees shall have the responsibility to perform the function of State management over medical insurance in their provinces or cities, embracing the following contents:

a/ To direct and organize the implementation of policies on medical insurance, both compulsory and voluntary, in their provinces or cities;

b/ To supervise and inspect the implementation of the provisions of law on medical insurance and settle problems related to medical examination and treatment of medical insurance card bearers in their provinces or cities.

Chapter VIII

COMMENDATION, DISCIPLINING, SETTLEMENT OF COMPLAINTS AND DENUNCIATIONS AND HANDLING OF VIOLATIONS

Article 30.- Commendation

Organizations and individuals that have recorded achievements in the cause of medical insurance shall be commended and/or rewarded in accordance with the provisions of law on stimulation and commendation.

Article 31.- Settlement of complaints and denunciations

1. Organizations and individuals shall have the right to complain about or denounce acts that violate the provisions of the Medical Insurance regulation.

2. When medical insurance-related complaints or denunciations are lodged, depending on the nature of the subject matters, competent state agencies, inspection agencies or courts shall settle them according to the provisions of law on complaints and denunciations.

3. The Ministry of Health shall be responsible for settling complaints and denunciations in the domain of medical examination and treatment covered by medical insurance. The Ministry of Finance shall settle complaints and denunciations in the domain of management and use of the Medical Insurance Fund. The Ministry of Home Affairs shall settle complaints and denunciations in the domain of management of medical insurance personnel. Provincial/municipal People’s Committees shall settle medical insurance-related complaints and denunciations in localities according to the provisions of law and their competence.

4. The Ministry of Health shall assume the prime responsibility for setting up joint working teams to settle medical insurance-related complaints and denunciations falling under the scope of state management of many ministries, branches and agencies.

Article 32.- Handling of violations

1. Those who violate the provisions of the Medical Insurance Regulation shall, depending on the seriousness of their violations, be disciplined, handled for administrative violations or examined for penal liability; if causing damage, they shall have to pay compensation therefor according to the provisions of law.tc "1. Those who violate the provisions of the Medical Insurance Regulation shall, depending on the seriousness of their violations, be disciplined, handled for administrative violations or examined for penal liability; if causing damage, they shall have to pay compensation therefor according to the provisions of law."

2. The Ministry of Health, the Ministry of Finance, specialized inspectorates, and provincial/municipal People’s Committees shall, within the scope of their respective tasks and powers, have to conduct supervision and inspection to detect and handle violations.

Article 33.- Supervision and inspection related to medical insurance

1. Medical examination and treatment establishments engaged in medical insurance, the Medical Insurance Fund, and social insurance organizations shall submit to the supervision and inspection by competent state management agencies and specialized inspectorates of medical insurance-related issues.

2. The supervision and inspection must be conducted in accordance with the functions, competence, procedures and order as provided for by law. Inspection shall be conducted only when there are decisions of competent persons; upon completion of inspection, conclusion reports must be made.

Chapter IX

IMPLEMENTATION PROVISIONS

Article 34.- Implementation effect

1. This Regulation takes effect as from the effective date of the Decree promulgating this Regulation.

2. All previous regulations on medical insurance contrary to the provisions of this Regulation are hereby annulled.

Article 35.- Implementation guidance

The Ministry of Health shall assume the prime responsibility for, and coordinate with the concerned ministries and branches in, guiding the implementation of this Regulation.

Đã xem:

Đánh giá:  
 

Thuộc tính Văn bản pháp luật 63/2005/ND-CP

Loại văn bảnNghị định
Số hiệu63/2005/ND-CP
Cơ quan ban hành
Người ký
Ngày ban hành16/05/2005
Ngày hiệu lực01/07/2005
Ngày công báo...
Số công báo
Lĩnh vựcThể thao - Y tế, Bảo hiểm
Tình trạng hiệu lựcHết hiệu lực 01/10/2009
Cập nhật4 năm trước
Yêu cầu cập nhật văn bản này

Download Văn bản pháp luật 63/2005/ND-CP

Lược đồ Decree no. 63/2005/ND-CP of May 16, 2005 promulgating the medical insurance regulation


Văn bản bị sửa đổi, bổ sung

    Văn bản sửa đổi, bổ sung

      Văn bản bị đính chính

        Văn bản được hướng dẫn

          Văn bản đính chính

            Văn bản hiện thời

            Decree no. 63/2005/ND-CP of May 16, 2005 promulgating the medical insurance regulation
            Loại văn bảnNghị định
            Số hiệu63/2005/ND-CP
            Cơ quan ban hànhChính phủ
            Người kýPhan Văn Khải
            Ngày ban hành16/05/2005
            Ngày hiệu lực01/07/2005
            Ngày công báo...
            Số công báo
            Lĩnh vựcThể thao - Y tế, Bảo hiểm
            Tình trạng hiệu lựcHết hiệu lực 01/10/2009
            Cập nhật4 năm trước

            Văn bản được dẫn chiếu

              Văn bản hướng dẫn

                Văn bản được hợp nhất

                  Văn bản hợp nhất

                    Văn bản gốc Decree no. 63/2005/ND-CP of May 16, 2005 promulgating the medical insurance regulation

                    Lịch sử hiệu lực Decree no. 63/2005/ND-CP of May 16, 2005 promulgating the medical insurance regulation