Thông tư liên tịch 09/2009/TTLT-BYT-BTC

JOINT CIRCULAR

PROVIDING GUIDANCE ON HEALTH INSURANCE

THE MINISTRY OF HEALTH - THE MINISTRY OF FINANCE

Pursuant to the November 14, 2008 Law on Health Insurance;
Pursuant to the Government's Decree No. 62/2009/ND-CP of July 27, 2009, detailing and guiding a number of articles of the Law on Health Insurance;
Pursuant to the Government's Decree No. 60/2003/ND-CP of June 6, 2003, detailing and guiding the implementation of the Law on the State Budget;
The Ministry of Health and the Ministry of Finance jointly guide a number of articles of the Law on Health Insurance and the Government's Decree No. 62/2009/ND-CP of July 27, 2009, detailing and guiding a number of articles of the Law on Health Insurance (below referred to as Decree No. 62/2009/ND-CP) as follows:

Chapter I

PAYERS, RATES OF, AND RESPONSIBILITY TO PAY, HEALTH INSURANCE PREMIUMS

Article 1. Health insurance participants defined in Article 12 of the Law on Health Insurance and Article 1 of Decree No. 62/2009/ ND-CP

1. Laborers, business managers, cadres, civil servants and employees defined in Clause 1, Article 12 of the Law on Health Insurance include:

a/ Laborers, including foreigners, working in the following agencies, units, organizations and enterprises:

- Enterprises established and operating under the Enterprise Law and the Investment Law;

- Cooperatives and cooperative unions established and operating under the Law on Cooperatives:

- State agencies, non-business units, armed forces units, political organizations, sociopolitical organizations, socio-political-professional organizations, socio-professional organizations and other social organizations:

- Foreign agencies and organizations or international organizations based in Vietnam, unless otherwise provided for in a treaty to which the Socialist Republic of Vietnam is a contracting party:

- Other laborer-employing organizations established and operating under law.

b/ Cadres and civil servants defined in the law on cadres and civil servants, including:

- Cadres who are elected, approved or appointed to hold term-based certain posts or titles in Party and State agencies, central and local socio-political organizations, are on payrolls and salaried by the state budget;

- Civil servants who are recruited or appointed to certain ranks, posts or titles in Party and State agencies and central, provincial- and district-level socio-political organizations; civil servants other than officers or professional army men: defense workers in agencies and units under the Ministry of National Defense; cadres and civil servants other than officers or professional noncommissioned officers working in agencies and units of the People's Public Security force and in leading and managerial apparatuses of Party and State public non-business units or political organizations, are on payrolls and salaried by the state budget;

- Commune, ward and township cadres who are elected to hold term-based certain posts in the standing boards of People's Councils, People's Committees, secretaries or deputy secretaries of party committees and heads of socio-political organizations; commune-level civil servants who are recruited to hold professional titles under commune-level People's Committees.

c/ Part-time officials in communes, wards and townships under the law on cadres and civil servants.

2. Officers and non-commissioned officers, technical officers and non-commissioned officers, and non-commissioned officers and soldiers who are serving in the People's Public Security force for a definite period.

3. People on pension or monthly working capacity loss allowance.

4. People on monthly social insurance allowances for labor accident or occupational disease.

5. People who have stopped receiving working capacity loss allowances and are enjoying monthly allowances from the state budget: retired rubber workers who are enjoying monthly allowances under Decision No. 206/CP of May 30, 1979. of the Government Council (now the Government).

6. Retired commune, ward and township cadres who are enjoying monthly social insurance allowances.

7. Retired commune, ward and township cadres who are enjoying monthly allowances from the state budget, including entities defined in Decision No. 130/CP of June 20, 1975, of the Government Council (now the Government), and Decision No. 111/HDBT of October 13. 1981, of the Council of Ministers (now the Government)

8. People on unemployment allowance under the law on unemployment insurance.

9. People with meritorious services to the revolution under the law on preferential treatment towards people with meritorious services to the revolution.

10. War veterans who participated in resistance wars on or before April 30, 1975, under Clause 6. Article 5 of the Government's Decree No. 150/2006/ND-CP of December 12, 2006, detailing and guiding a number of articles of the Ordinance on War Veterans; 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 funeral allowances for youth volunteers in the anti-French resistance war period.

11. People who personally participated in the anti-US resistance war for national salvation under the Prime Minister's Decision No. 290/ 2005/QD-TTg of November 8,2005, on regimes and policies towards people that personally participated in the anti-US resistance war for national salvation but have not yet enjoyed Party or State policies, and the Prime Minister's Decision No. 188/2007/QD-TTg of December 6, 2007, supplementing and amending the Prime Minister's Decision No. 290/2005/QD-TTg of November 8, 2005, on regimes and policies towards people that personally participated in the anti-US resistance war for national salvation but have not yet enjoyed Party or State policies.

12. Incumbent deputies of the National Assembly and People's Councils at all levels.

13. People on monthly social relief allowance under the Government's Decree No. 67/2007/ND-CP of April 13, 2007, guiding support policies towards social relief beneficiaries.

14. Poor household members; ethnic minority people living in areas with difficult or exceptionally difficult socio-economic conditions under the Prime Minister's regulations.

15. Relatives of people with meritorious services to the revolution under the law on preferential treatment towards people with meritorious services to the revolution.

16. Relatives of persons defined at Points a, b and c. Clause 16, Article 12 of the Law on Health Insurance.

17. Under-6 children.

18. People who have donated their body organs under the law on donation, removal and transplantation of tissues and human organs and donation and recovery of cadavers.

19. Foreign students in Vietnam who are granted scholarships from the Vietnamese State's budget.

20. Members of households living just above the poverty line under the Prime Minister's regulations.

21. Pupils and students who are studying at educational institutions within the national education system.

22. Members of agricultural, forestry, fishery and salt-making households.

23. Relatives of laborers defined in Clause 1, Article 12 of the Law on Health Insurance, including blood parents; parents-in-law; adoptive parents or lawful fosterers; spouses; blood children and lawfully adopted children whom laborers are obliged to rear and who live together in the same households.

24. Members of cooperatives or individual business households.

25. Retired laborers who are enjoying sickness allowances under the law on social insurance as they suffer from diseases on Health Minister-promulgated list of diseases which need long-term treatment.

Article 2. Health insurance premium rates and reductions, and determination of slate budget supports for health insurance premium payment

1. Health insurance premium rates, methods of paying, and responsibility of entities to pay. health insurance premiums comply with Articles 13 and 14 of the Law on Health Insurance and Articles 3 thru 6 of Decree No. 62/2009/ND-CP.

2. When the State adjusts the minimum wage level, those who are defined in Clauses 20 thru 24. Article 1 of this Circular and have paid health insurance premiums on a biannual basis or a lump sum for the whole year are not required to additionally pay the difference as a result of such adjustment.

3. To reduce health insurance premiums under Clause 6. Article 3 of Decree No. 62/2009/ND-CP as follows:

a/ Those defined in Clauses 20 and 22. Article 1 of this Circular are entitled to the reduction of health insurance premiums when all persons named in the household status book and living in the same house are insured.

b/ Those defined in Clause 23. Article 1 of this Circular are entitled to the reduction of health insurance premiums when two or more of their relatives are insured.

4. To decide on support levels and determination of state budget amounts used as support in case of reduction of health insurance premiums:

a/ Based on the local budget capacity and other mobilized sources, provincial-level People's Committees may decide on the levels of support for health insurance premium payment for entities higher than (he minimum support levels specified in Clause 5, Article 3 of Decree No. 62/2009ND-CP.

b/ In case an insured is given by the State an amount as partial support for health insurance premium payment, such amount shall be calculated based on the specific health insurance premium to be paid by each household member.

Example: Mrs. As agricultural household has 3 members with average living standards and is entitled to 30% reduction of health insurance premiums. In 2010. all these 3 members pay health insurance premiums per household at the rate of 4.5% of the minimum wage (presuming that the minimum wage at this time is VND 650.0(H)). The health insurance premium Mrs. As household has to pay and the state budget support for her household to pay health insurance premiums in 2010 will be determined as follows:

The total health insurance premium Mrs. A's household has to pay is VND 663.390, consisting of:

- The premium to be paid by the first member at the rate of 4.5% of the minimum wage:

VND 650,000 x 4.5% x 70% x 12 months = VND 245,700

- The premium to be paid by the second member equal to 90% of that payable by the first member:

VND 245,700 x 90% = VND 221,130

- The premium to be paid by the third member equal to 80% of that payable by the first member:

VND 245,700 x 80% = VND 196,560

The total state-budget support for Mrs. A's household to pay health insurance premiums is:

VND 663,390 x 30% : 70% = VND 284,310.

5. Each person may be insured in the capacity as only one category. If a person concurrently falls into different categories of the insured under Article 1 of this Circular, he/she shall pay health insurance premiums in the capacity as the first category in the order specified in Article 1 of this Circular.

Article 3. Methods of paying and responsibility of some categories of the insured to pay health insurance premiums

1. For those defined in Clauses 14, 17 and 18, Article 1 of this Circular:

a/ Based on the number of health insurance cards already issued to these persons, social insurance agencies of provinces or centrally run cities (below referred to as provincial-level social insurance agencies) shall sum up and send it to provincial-level Finance Departments for the latter to transfer funds into the health insurance fund under Clause 9 of this Article.

b/ By December 31 every year at the latest, provincial-level social insurance agencies shall sum up the number of health insurance cards valid in the year and support funds for payment of health insurance premiums and send them to provincial-level Finance Departments for payment and finalization under regulations (according to Appendix 1 to this Circular).

2. For those defined in Clause 20. Article 1 of this Circular:

a/ Biannually or annually, members of households living just above the poverty line shall pay their payable amounts of health insurance premium to social insurance agencies;

b/ Biannually or annually, provincial-level social insurance agencies shall sum up the number of issued health insurance cards, actually collected amounts and projected state budget supports and send them to provincial-level Finance Departments for the latter to transfer funds into the health insurance fund under Clause 9 of this Article.

3. For those defined in Clause 21. Article 1 of this Circular who are studying at educational institutions within the national education system (below referred to as schools):

a/ Biannually or annually, schools shall collect health insurance premiums from pupils and students and pay them to social insurance agencies;

b/ State budget supports for health insurance premium payment are specified as follows:

- For pupils and students studying at locally managed schools: Social insurance agencies shall sum up the number of issued health insurance cards, amounts actually collected from pupils and students and proposed state budget supports, then send them to district-level finance agencies or provincial-level Finance Departments (according to local budget decentralization) for the latter to provide support funds under Clause 9 of this Article;

- For pupils and students studying at schools managed by ministries or central agencies; Vietnam Social Security shall sum up the number of issued health insurance cards, amounts actually collected from pupils and students and proposed state budget supports, then send them to the Ministry of Finance for the latter to provide support funds under Clause 9 of this Article.

4. For those defined in Clause 22, Article 1 of this Circular:

a/ Biannually or annually, members of agricultural, forestry, fishery and salt-making households shall pay health insurance premiums directly to social insurance agencies.

b/ For members of households with average living standards:

- Biannually or annually, they shall pay their payable amounts directly to social insurance agencies.

- Biannually or annually, provincial-level social insurance agencies shall sum up the number of issued health insurance cards, actually collected amounts and proposed state budget supports, then send them to provincial-level Finance Departments for the latter to transfer funds to the social insurance fund under Clause 9 of this Article.

5. For those defined in Clause 23, Article 1 of this Circular:

a/ Employees shall list their relatives and send the lists to their employers for registration to buy health insurance cards;

b/ Based on the registered lists of relatives of employees, employers shall monthly deduct from salaries or wages of employees for remittance into the health insurance fund together with health insurance premiums paid by employees.

6. For those defined in Clause 24, Article 1 of this Circular:

Biannually or annually, they shall pay health insurance premiums directly to social insurance agencies.

7. For those defined in Clause 25, Article 1 of this Circular:

Social insurance agencies shall pay monthly health insurance premiums for these persons. Vietnam Social Security shall annually sum up lists of the insured who have been issued health insurance cards and their payable health insurance premiums and send them to the Ministry of Finance for the latter to transfer funds to the social insurance fund.

8. For commune, ward and township part- time officials defined at Point c. Clause 1 .Article 1 of this Circular:

Commune, ward or township Peoples Committees shall pay monthly health insurance premiums for these officials and deduct health insurance premiums from their monthly allowances for simultaneous payment into the health insurance fund.

9. For finance agencies at all levels:

In the first month of every quarter, based on health insurance premiums paid for those defined in Clauses 14, 17, 18 and 25, Article 1 of this Circular and support amounts for health insurance premium payment for those specified in Clauses 20 and 21, and those defined in Clause 22, Article 1 of this Circular with average living standards, finance agencies at all levels shall transfer funds to the social insurance fund managed by social insurance agencies of the same level.

10. Those defined in Clauses 1, 2 and 16, Article 1 of this Circular who are managed by the Ministry of National Defense, the Ministry of Public Security or the Government Cipher Committee shall comply with separate guiding documents.

Article 4. State budget funds used to wholly or partially pay health insurance premiums

1. The central budget shall wholly or partially pay health insurance premiums for the following categories of the insured:

a/ It shall wholly pay health insurance premiums for those defined in Clauses 1 and 2, Article 1 of this Circular (funds payable by employers whose regular activities are wholly or partially financed by the central budget) according to current slate budget decentralization;

b/ It shall wholly pay health insurance premiums for those defined in Clauses 3. 4 and 5, Article 1 of this Circular (who enjoy state budget allocations) and in Clauses 9. 15. 16. 19 and 25, Article 1 of this Circular;

c/ It shall partially pay health insurance premiums for those defined in Clause 21, Article 1 of this Circular who are studying at schools managed by ministries or central agencies.

2. Local budgets shall wholly or partially pay health insurance premiums for the following categories of the insured:

a/ It shall wholly pay health insurance premiums for those defined in Clauses 1 and 2, Article 1 of this Circular (funds payable by employers whose regular activities are wholly or partially financed by local budgets) according to current state budget decentralization;

b/ It shall wholly pay health insurance premiums for those defined in Clauses 7, 10, 11, 12, 13, 14, 17 and 18, Article 1 of this Circular;

c/ It shall partially pay health insurance premiums for those defined in Clause 20, Article 1 of this Circular; those defined in Clause 21, Article 1 of this Circular who are studying at locally managed schools; and those defined in Clause 22, Article 1 of this Circular who have average living standards.

For localities which cannot themselves balance their budgets and are provided with the central budget's financial allocations as support in implementation of health insurance regulations, competent agencies shall decide on specific support levels.

3. Annually, while making state budget estimates, agencies, organizations and units managing the insured shall make budget estimates for whole or partial payment of health insurance premiums for them according to current state budget management decentralization. Specifically:

a/ At the central level:

- Employers whose regular activities are wholly or partially financed by the central budget shall make budget estimates for whole payment of health insurance premiums for those defined in Clauses 1 and 2, Article 1 of this Circular (health insurance premiums payable by employers).

- Vietnam Social Security shall make budget estimates for whole payment of health insurance premiums for those defined in Clauses 3, 4 and 5 (who have their health insurance premiums paid by the state budget) and those defined in Clause 25. Article 1 of this Circular; and partially pay health insurance premiums for those defined in Clause 21, Article 1 of this Circular who are studying at schools managed by ministries or central agencies (including schools of enterprises of all economic sectors).

- The Ministry of Labor. War Invalids and Social Affairs shall make budget estimates for whole payment of health insurance premiums for those defined in Clauses 9 and 15, Article 1 of this Circular.

- The Ministry of National Defense, the Ministry of Public Security and the Ministry of Home Affairs shall make budget estimates for whole payment of health insurance premiums for those defined in Clause 16, Article I of this Circular.

- Scholarship-granting agencies, organizations and units shall make budget estimates for whole payment of health insurance premiums for those defined in Clause 19, Article 1 of this Circular.

b/ At the local level:

- Employers whose activities are wholly or partially financed by local budgets shall make budget estimates for whole payment of health insurance premiums for those defined in Clauses 1 and 2, Article 1 of this Circular (health insurance premiums payable by employers).

- Labor, War Invalids and Social Affairs agencies shall make budget estimates for whole payment of health insurance premiums for those defined in Clauses 10, 11. 13. 14 and 17, Article 1 of this Circular; and partially pay health insurance premiums for those defined in Clause 20, and those defined in Clause 22, Article 1 of this Circular who have average living standards.

- Social insurance agencies shall make budget estimates for whole payment of health insurance premiums for those defined in Clause 18, Article 1 of this Circular: and partially pay health insurance premiums for those defined in Clause 21. Article 1 of this Circular who are studying at locally managed schools (including schools of enterprises of all economic sectors).

- Provincial-level People's Councils shall make budget estimates for whole payment of health insurance premiums for National Assembly deputies of local delegations of National Assembly deputies. People's Councils at each level shall make budget estimates for whole payment of health insurance premiums for their deputies.

- Commune-level People's Committees shall make budget estimates for whole payment of health insurance premiums for those defined at Point c, Clause 1, and Clause 7, Article 1, of this Circular.

Chapter II

PAYERS AND RATES OF, AND METHODS OF PAYING, HEALTH INSURANCE PREMIUMS ON A VOLUNTARY BASIS

Article 5. Payers

1. Payers of health insurance premiums on a voluntary basis defined in Article 51 of the Law on Health Insurance and Clause 2, Article 2 of Decree No. 62/2009/ND-CP include:

a/ Part-time officials in communes, wards and townships under the law on cadres and civil servants:

b/ Retired laborers who are enjoying sickness allowances under the law on social insurance as they suffer from diseases on the Health Ministry -promulgated list of diseases which need prolonged treatment;

c/ Pupils and students studying at schools, except those insured of other categories;

d/ Members of agricultural, forestry, fishery and salt-making households;

e/ Relatives of laborers who are salary and wage earners under the law on salaries and wages; members of cooperatives and individual business households.

2. Those defined at Points a, d and e, Clause 1 of this Article shall be determined based on administrative boundaries: those defined at Points b and c, Clause 1 of this Article shall be determined based on their agencies and schools.

3. Vietnam Social Security shall specifically guide the issuance of health insurance cards to the insured, ensuring non-interruption upon shifting from voluntary payment of health insurance premiums to compliance with the Law on Health Insurance.

Article 6. Health insurance premium rates and their reduction

1. Health insurance premium rates for the insured defined in Clause 1. Article 5 of this Circular are specified as follows:

a/ Payment for 3 months from October 1, 2009, to December 31, 2009:

- Those defined at Point c. Clause 1, Article 5 of this Circular shall pay VND 30,000/person for those in urban centers; or VND 25,000/person, for those in rural and mountainous areas:

- Those defined at Points a. b. d and e. Clause 1. Article 5 of this Circular shall pay VND 80,000/person, for those in urban centers; or VND 60.000/person, for those in rural and mountainous areas;

- Commune, ward and township cadres in charge of population, family and children affairs shall comply with the Prime Minister's Decision No. 240/2006/QD-TTg of October 25, 2006, on voluntary health insurance for commune, ward and township cadres in charge of population, family and children affairs.

b/ From October 1.2009, those who continue to voluntarily pay health insurance premiums shall pay them at the rate equal to 4.5% of the current minimum wage level.

2. The reduction of health insurance premium rates for insured households complies with Clauses 3 and 4, Article 2 of this Circular.

3. Health insurance premiums paid by the voluntary insured shall be uniformly managed and used according to regulations on the management and use of the health insurance fund under the Law on Health Insurance. Articles 10 thru 13 of Decree No. 62/2009/ND-CP and Article 20 of this Circular.

Chapter III

LEVELS OF HEALTH INSURANCE BENEFITS

Article 7. Levels of health insurance benefits

1. The levels of health insurance benefits of the insured are specified in Article 22 of the Law on Health Insurance and Article 7 of Decree No.62/2009/ND-CP.

2. Costs for each medical care not simultaneously paid as specified at Point c, Clause 1, Article 7 of Decree No. 62/2009/ND-CP is 15% lower than the current minimum wage level. When the State adjusts the minimum wage level, these costs shall be adjusted from the date the new minimum wage level is applied.

3. Costs for medicines, medical supplies, costly hi-tech services or technical services on functional rehabilitation shall be covered by the health insurance fund based on the Health Ministry-prescribed list.

4. The health insurance fund shall cover 50% of costs for cancer treatment medicines and immunosuppresseurs which are outside the Health Ministry-prescribed list but have been permitted forcirculation in Vietnam as prescribed by medical care providers (below referred to as health establishments) at the levels of health insurance benefits specified in Clause 1. Article 7 of Decree No. 62/2009/ND-CP and Article 9 of this Circular, for:

a/ Patients who have participated in health insurance for full 36 or more consecutive months.

b/ Under-6 children.

c/ The insured who are managed by the Ministry of National Defense, the Ministry of Public .Security or the Government Committee for Cipher, are entitled to free medical care under regulations and now retire or shift to other jobs outside these agencies.

Article 8. Levels of health insurance benefits in some cases

1. The scope and levels of, and persons eligible for, health insurance benefits in case of medical examination for screening and early diagnosis of some diseases as specified at Point b, Clause I, Article 21 of the Law on Health Insurance comply with the Health Ministry's guidance.

2. Payment of expenses for the transportation of patients from district- or higher-level hospitals for those defined in Clauses 9, 13, 14, 17 and 20. Article 12 of the Law on Health Insurance, in case of emergency or in-patient treatment beyond the professional capacity of health establishments, shall be made as follows:

a/ The health insurance fund shall pay return transportation expenses to patient-transporting health establishments at the level equal to 0.2 liter of petrol/km and based on the distance of transportation and petrol price at the time of transportation. If more than one patient is transported on the same vehicle, the level of payment will be only the same as in case of transportation of one patient:

b/ In case patients are not transported on vehicles of health establishments, payment shall be made at the level equal to 0.2 liter of petrol/ km for single transportation based on the distance of transportation and petrol price at the time of transportation. Health establishments designating hospital transfer shall pay transportation expenses to patients and then get them refunded by the health insurance fund.

3. In case of traffic accidents:

a/ In case a traffic accident is determined as not violating traffic law. the health insurance fund shall make payment under regulations:

b/ In case a traffic accident cannot yet be determined as whether violating traffic law or not. the traffic accident victim shall him/herself pay treatment expenses to the health establishment, Upon obtaining a competent agency's certification of non-violation of traffic law. the patient shall bring receipts to the social insurance agency to get payment under regulations. Payment procedures and time limit are specified in Article 19 of this Circular:

c/ The health insurance fund will not pay in case traffic accidents are caused due to violations of traffic law and in case traffic accident victims enjoy payment under the law on labor accidents.

4. The health insurance fund will not pay treatment expenses to labor accident victims who have such expenses paid by their employers under the Labor Code.

5. In case due to overload of patients, a health establishment has to provide medical care outside working hours or on weekends or holidays, health insurance card holders may have medical care expenses paid within the scope of health insurance benefits like in case medical care is provided on working days. The Ministry of Health shall provide direction to health establishments under its management. Provincial-level Health Departments shall assume the prime responsibility for. and coordinate with provincial-level social insurance agencies in, providing uniform direction appropriate to the practical conditions of local health establishments.

Article 9. Levels of payment in case medical care is provided not by health establishments with which primary medical care is registered, not at the prescribed technical line, or overseas

1. The health insurance fund shall pay for medical care provided not by health establishments with which primary medical care is registered or not at the prescribed technical line, under Clause 3, Article 7 of Decree No. 62/2009/ND-CP The Minister of Health shall prescribe the consideration and determination of whether medical care is provided by improper technical lines and the ranking of hospitals, including public and non-public health establishments, in order to decide on the application of payment levels.

2. In case medical care is provided by health establishments not having signed health insurance-covered medical care contracts or by health establishments having signed health insurance-covered medical care contracts without fully carrying out medical care procedures specified in Article 28 of the Law on Health Insurance: Patients shall themselves pay medical care expenses to health establishments, then bring receipts to social insurance agencies to get payments. Based on technical services provided to patients, health establishments' technical lines and lawful receipts, social insurance agencies shall pay for actual expenses, which must not exceed the levels specified at Point 1 of Appendix 2 to this Circular.

3. In case medical care is provided overseas: Patients shall themselves pay medical care expenses and then bring receipts to social insurance agencies to get payments based on actual expenses, which must not exceed the levels specified at Point 2 of Appendix 2 to this Circular.

4. Payment procedures in cases specified in Clauses 2 and 3 of this Article comply with Article 19 of this Circular.

Article 10. Levels of benefits for the voluntary insured

1. The time for the voluntary insured to enjoy benefits after the payment of health insurance premiums is specified at Points a and b. Clause 3, Article 16 of the Law on Health Insurance. For people who participated in voluntary health insurance before the effective date of the Law on Health Insurance, the duration in which they previously participated in health insurance shall be counted as in case they continuously pay health insurance premiums from the second time on, and they will enjoy benefits under regulations.

2. The scope and levels of health insurance benefits, provision of medical care, and methods of paying medical care expenses by the voluntary insured are the same as those for the compulsory insured.

Chapter IV

ORGANIZATION OF HEALTH INSURANCE-COVERED MEDICAL CARE

Article 11. Health insurance-covered medical care providers, registration of primary medical care providers and treatment-line transferal for health insurance card holders

1. Health insurance-covered medical care providers are specified in Article 24 of the Law on Health Insurance.

2. Conditions on a non-public health establishment to provide health insurance-covered medical care:

a/ Having a head office and the legal entity status:

b/ Possessing a business registration certificate or an investment license as provided for by law:

c/ Possessing an operation license or practice eligibility certificate, issued by a competent health agency under regulations;

d/ Fully satisfying conditions on human resources, infrastructure and equipment meeting medical care requirements specified by the Minister of Health;

e/ Accepting payment prices and methods as for public health establishments of the same technical line or the same rank under the Health Ministry's regulations.

3. Based on the local practical situation, provincial-level Health Departments shall determine commune, ward and township health stations (below collectively referred to as commune health stations) that fully satisfy conditions on human resources, infrastructure and equipment for providing medical care, and prescribe the permitted scope of professional operations and lists of medicines and technical services to be provided by commune health stations and agencies' and schools' health sections in their localities in order to provide health insurance-covered medical care.

4. The registration of primary medical care providers and treatment-line transferal for health insurance-covered patients comply with the Health Minister's regulations.

Article 12. Health insurance-covered medical care contracts

1. Social insurance agencies shall sign contracts with health establishments. A health insurance-covered medical care contract shall be made according to the form provided in Appendix 3 to this Circular. Based on the scope and nature of professional operations and applicable payment methods, both parties shall agree to supplement and complete contractual terms. Annually, both parties shall liquidate contracts and supplement contractual terms for the subsequent year.

2. Contracts on health insurance-covered medical care provided at commune health stations or health sections of the same level:

a/ For commune health stations:

- Social insurance agencies shall sign contracts with district hospitals or regional general hospitals (where no district hospital exists) or district health centers in localities where district hospitals are not yet separated, for providing health insurance-covered primary medical care at commune health stations.

- Within the allocated funds for health insurance-covered medical care, district hospitals or district health centers shall supply medicines, chemicals and medical supplies to commune health stations and pay for the use of patient beds (if any) and technical services provided by commune health stations within the scope of their prescribed professional operations; and at the same time monitor, supervise and sum up such payments for settlement with social insurance agencies. Patients shall be kept for monitoring and treatment at commune health stations under the Health Minister's regulations for 3 (three) days at most. Particularly for commune health stations in difficulty-hit areas under the Prime

- Minister's Decision No. 30/2007/QD-TTg of March 5, 2007, promulgating the list of administrative units in difficulty-hit areas, directors of provincial-level Health Departments shall, pursuant to Clause 3. Article 11 of this Circular, prescribe in-patient treatment at commune health stations, which must not exceed 5 (five) days. The total fund for medical care at commune health stations must not be lower than 10% of the health insurance-covered medical care fund, based on the number of registered cards of health insurance-covered medical care at commune health stations.

- Based on local health organizations and commune health stations qualified to provide medical care as prescribed by provincial-level Health Departments, provincial-level Health Departments shall assume the prime responsibility for. and coordinate with social insurance agencies in. directing the signing of contracts with district hospitals or regional general hospitals or district health centers for providing health insurance-covered medical care at commune health stations.

b/ For health sections of agencies, units and schools:

Social insurance agencies shall directly sign contracts with agencies or units managing health sections. These agencies or units shall supply medicines, chemicals and medical supplies for consumption to meet medical care requirements at their health sections.

3. For regional general clinics under district hospitals, or district health centers, medical care contracts comply with regulations applicable to district hospitals' departments or district health centers. Based on prescribed professional operations and technical service charge rates approved by competent authorities and applicable at these clinics, social insurance agencies and district hospitals or district health centers shall agree in contracts on medical care at regional general clinics.

Article 13. Procedures for health insurance-covered medical care

1. An insured seeking medical care services shall produce his/her health insurance card stuck with his/her photo; a card without photo must be produced together with another identity paper stuck with the holder's photo.

2. For under-6 children seeking medical care services, their health insurance cards must be produced; if health insurance cards are unavailable yet. birth registration certificates or birth certificates must be produced, In case treatment is needed right after birth when birth certificates are unavailable yet. heads of health establishments and fathers (or mothers) or guardians of children shall sign for certification the medical files as a basis for settlement with social insurance agencies and take responsibility for such certification.

3. In case of emergency, an insured may seek medical care services at any health establishment having signed a health insurance-covered medical care contract and shall produce papers specified in Clause 1 or 2 of this Article before he/she is discharged from hospital in order to enjoy health insurance benefits.

If emergency treatment is provided at a health establishment which has not signed a medical care contract with the social insurance agency, the health establishment shall supply sufficient papers certifying the pathological status and valid documents on medical care expenses to the patient for settlement with the social insurance agency.

4. In case of treatment-line transferal, an insured shall produce papers specified in Clauses 1 or 2 of this Article and a hospital transferal dossier as prescribed by the Ministry of Health.

5. In case of re-examination to meet treatment requirements of a higher-level health establishment not through the establishment with which primary medical care is registered, papers specified in Clause 1 or 2 of this Article and the health establishment's re-examination appointment paper are required. Each appointment paper is valid only once within the duration stated therein. The health establishment shall make re-examination appointment to meet treatment requirements only when treatment falls beyond the professional capacity of the lower-level health establishment.

6. If health insurance card holders who are on working trips, do mobile jobs or temporarily reside in other localities seek medical care when they are not in the state of emergency, they will receive primary medical care at health establishments equivalent to those indicated in their cards and shall, in addition to papers specified in Clause 1 or 2 of this Article, produce working trip or temporary residence registration papers as a basis for enjoying benefits under regulations.

Article 14. Health insurance assessment

1. Social insurance agencies shall conduct health insurance assessment and take responsibility for their assessment results under the law on health insurance.

2. Health insurance assessment covers:

a/ Scrutinizing health insurance-covered medical care procedures:

- Coordinating with health establishments in scrutinizing health insurance-covered medical care procedures under regulations:

- Working with medical workers at health establishments in solving problems related to medical care procedures and benefits and responsibilities of the insured and health establishments;

- Proposing reform of administrative procedures in medical care to ensure convenience and reduce cumbersome procedures for health insurance card holders.

b/ Inspecting and evaluating the indication of treatment and the use of medicines, chemicals, medical supplies and medical technical services for patients:

- Inspecting and crosschecking hospitalization periods, medical services, medicines and medical supplies actually provided for patients:

- Inspecting the prescription of treatment and the use of medicines, chemicals, medical supplies and equipment and technical services according to the severity of illnesses and prescribed lists;

- Directly meeting patients at departments and patient rooms for supervising and evaluating the quality of treatment provided to health insurance card holders.

c/ Checking and determining health insurance-covered medical care expenses:

- Checking receipts made out for patients and lists of in-patient and out-patient medical care expenses, ensuring that they truly reflect expenses and are made according to set forms;

- Determining advanced funds:

- Checking to-be-finalized expenses of health establishments.

3. Health insurance assessment shall be conducted simultaneously or after patients are discharged from hospital and must ensure accuracy, publicity and transparency. Assessment results shall be recorded and notified to health establishments.

4. Health establishments shall observe assessment results already agreed between health establishments and social insurance agencies. In case of disagreement, both parties' opinions must be reported to superior agencies for settlement.

5. Vietnam Social Security shall specify contents and process of health insurance assessment at health establishments.

Chapter V

PAYMENT OF HEALTH INSURANCE-COVERED MEDICAL CARE COSTS BETWEEN SOCIAL INSURANCE AGENCIES AND HEALTH ESTABLISHMENTS

Article 15. Quota-based payment 1, General principles:

a/ Quota-based payment means payment based on the average norm of medical care costs for each health insurance card according to groups of the insured (below referred to as cost quota) during the period registered at a health establishment.

b/ The total fund for quota-based payment is the amount of money calculated according to the number of registered health insurance cards and the determined cost quota.

c/ When applying the method of quota-based payment, health establishments may proactively use fund amounts annually determined. They shall provide medical services to the insured without collecting any costs falling within the benefit scope of the insured. Social insurance agencies shall supervise and ensure the benefits of the insured.

2. Determination of the quota-based payment fund

a/ The quota-based payment fund allocated to a health establishment is the total fund for quota-based payment for six groups of the insured below:

- Group 1 includes those specified in Clauses 1, 2, 8 and 12. Article 1 of this Circular:

- Group 2 includes those specified in Clauses 3, 4, 5, 6, 7, 9, 10, 11, 13, 15, 16, 18 and 25, Article 1 of this Circular;

- Group 3 includes those specified in Clauses 14 and 20, Article 1 of this Circular;

- Group 4 includes those specified in Clause 17, Article 1 of this Circular:

- Group 5 includes those specified in Clauses 19 and 21, Article 1 of this Circular;

- Group 6 includes those specified in Clauses 22, 23 and 24, Article 1 of this Circular.

b/ The quota-based payment fund for each group of the insured is determined as follows:

- The total cost of medical care for a group of the insured in the province in the previous year include costs of medical care at primary care providers, costs of medical care at health establishments not at prescribed lines and costs directly paid for ihe insured of this group (except costs specified al Point c of this Clause).

- k means the adjustment coefficient to be used upon occurrence of fluctuations in medical care costs and changes in other related factors in the subsequent year.

c/ Transportation costs, costs for hemodialysis, implantation of human body organs, heart surgeries, treatment of cancer or hemophilia and the amounts paid by patients are not accounted in the total fund for quota-based payment.

d/ The total quota-based payment fund allocated to health establishments applying the method of quota-based payment in a province must not exceed the total medical care fund of these establishments. In special cases, the provincial-level social insurance agency shall send reports to the Vietnam Social Security for consideration and adjustment but the adjusted cost quota must not exceed the national average payment level for the concerned group which is annually determined and notified by the Vietnam Social Security.

e/ The temporarily applied coefficient k is 1.1. The Ministry of Health and the Ministry of Finance shall consider and adjust this coefficient upon occurrence of fluctuations in medical care costs and changes in the scope of health insurance benefits. In special cases, the Vietnam Social Security shall make a report to the Ministry of Health and the Ministry of Finance for consideration and settlement.

3. Monitoring and adjustment of the quota-based payment fund

Quarterly, social insurance agencies shall notify health establishments of any change in the number of health insurance cards and the total quota-based payment fund.

4. Use of the quota-based payment fund:

a/ The quota-based payment fund of a health establishment is used to pay costs for medical care under the health insurance regime for health insurance card holders who register for medical care at the establishment, including costs for medical care at commune health stations and other health establishments and directly paid amounts as prescribed. Social insurance agencies shall notify the health establishment of costs incurred by other health establishments.

b/ In case the quota-based payment fund sees a surplus, the health establishment may use it like a non-business unit's revenue but the used amount must not exceed 20% of the quota-based payment fund: the remainder shall be carried forward to the establishment's medical care fund of the subsequent year. If the quota-based payment fund also includes costs for medical care at commune-level establishments, the unit assigned to sign medical care contracts with commune health stations shall deduct part of the surplus for these commune health stations in proportion to the numbers of health insurance cards registered at these stations.

c/ In case the quota-based payment fund sees a deficit:

- For objective reasons such as an increase in the frequency of medical care provision or application of new costly techniques, the social insurance agency shall consider and pay at least 60% of the deficit;

- For force majeure reasons such as epidemic outbreak or the ratio of patients suffering from serious diseases requiring costs much higher than initial estimations, the provincial-level social insurance agency shall, together with the provincial-level Health Department, consider and make additional payments to the health establishments.

In case the medical care fund of the province is not enough to make additional payments, the provincial-level social insurance agency shall send a report to Vietnam Social Security for consideration and settlement.

5. Health establishments shall monitor and sum up medical care costs for health insurance card holders who register for primary care at other establishments and costs beyond the cost quota prescribed at Point c, Clause 2 of this Article for settlement with social insurance agencies.

Article 16. Service charge-based payment

1. Service charge-based payment means the method of payment based on costs of technical services, medicines, chemicals and medical supplies provided for patients at health establishments.

2. Service charge-based payment is applied in the following cases:

a/ Health establishments have not yet applied the method of quota-based payment;

b/ Health insurance card holders fail to register for primary care at health establishments where they seek medical care services;

c/ For some diseases, disease groups or services not covered by the quota-based payment fund of health establishments which apply the method of quota-based payment under Point c. Clause 2, Article 15 of this Circular.

3. Payment bases: Costs of medical technical services shall be calculated according to the table of technical service charges at health establishments approved by competent agencies under regulations on collection of hospital charges; costs of medicines, chemicals and medical supplies shall be calculated according to the purchase prices paid by health establishments; costs of blood and blood preparations shall be paid at prices prescribed by the Ministry of Health.

4. Determination of medical care funds of primary care providers:

a/ Health establishments which provide both out-patient and in-patient medical care services may use 90% of the medical care fund calculated on the total number of cards registered at their establishments to:

- Pay for medical care at their establishments;

- Pay for medical care at other establishments, in case of treatment-line transferal, emergency case, medical care upon request and transportation costs, if any.

The remaining 10% of the medical care fund shall be used to make additional payments under Clause 5 of this Article.

b/ Health establishments which provide only out-patient medical care services may use 45% of the medical care fund calculated on the number of health insurance cards registered at their establishments to:

- Pay for out-patient medical care at their establishments;

- Pay for out-patient medical care at other establishments and out-patient medical care upon request at other establishments.

Five percent of the medical care fund shall be used to make additional payments under Clause 5 of this Article. Social insurance agencies shall use the remaining 50% of the medical care fund to pay for in-patient medical care.

c/ Social insurance agencies shall pay medical care costs for health insurance card holders who have sought medical care at other health establishments and account them into the funds of health establishments with which these health insurance card holders have registered for primary care.

5. In case medical care costs exceed the total medical care fund, social insurance agencies shall make adjustment as follows:

a/ To make additional payment from the remaining amount of 10% of the medical care fund, for establishments providing both outpatient and in-patient medical care services:

b/ To make additional payment from the remaining amount of 5% of the medical care fund, for establishments providing only outpatient medical care services;

c/ If, after making additional payment, the medical care fund is still not enough to cover medical care costs, the provincial-level social insurance agency shall consider and assess the deficit to make additional payment from the local medical care fund. If the local fund is not enough, it shall report the case to the Vietnam Social Security for consideration and settlement.

6. From 2010. the total payment for a health establishment (of provincial or higher level) for cases of treatment-line transferal must not exceed the average actual cost paid in these cases within the scope of insurance benefits for a course of in-patient treatment and a turn of out-patient medical care under each medical specialty in the previous year multiplied by the total turns of medical care provision in that year, which may be adjusted according to coefficient of 1.1 in case of annual fluctuation in medical care costs. Upon occurrence of big fluctuations in medical care costs due to change in hospital charge policies, disease structures, application of new technical services or change in functions and tasks of health establishments, the Vietnam Social Security shall report them to the Ministry of Health and the Ministry of Finance for consideration and adjustment of this coefficient as appropriate.

Article 17. Disease-based payment

1. Disease- or disease group-based payment is the method of package payment to ensure the provision of medical care for patients whose diseases have been diagnosed and identified.

2. Bases for classification, identification and diagnosis of diseases or groups of diseases comply with the Ministry of Health's regulations on disease statistics and classification.

3. Package costs of each disease or group of diseases shall be determined under current regulations on collection of hospital charges.

4. The Ministry of Health shall guide the pilot application of the method of disease- or disease group-based payment.

Article 18. Advance, payment and finalization

Social insurance agencies shall advance funds for, pay and finalize health insurance-covered medical care costs for health establishments under Clauses 1 and 2, Article 32 of the Law on Health Insurance, which shall be clearly indicated in health insurance-covered medical care contracts to suit the applied payment method.

Chapter VI

DIRECT PAYMENT OF MEDICAL CARE COSTS BETWEEN SOCIAL INSURANCE AGENCIES AND THE INSURED

Article 19. Procedures for direct payment of medical care costs to health insurance card holders under Clause 2, Article 31 of the Law on Health Insurance

1. A payment request dossier comprises:

a/ A payment request made by the health insurance card holder (according to the form issued by Vietnam Social Security);

b/ The health insurance card (copy):

c/ The hospital discharge paper or the medical file (the original or copy):

d/ Valid vouchers (prescriptions, medical records, medicine purchase receipts, hospital charge receipts and other relevant vouchers);

e/ In case of having sought medical care overseas, apart from papers specified at Points a, b, c and d. Clause 1 of this Article, the written certification of the disease status and treatment direction, made by a provincial- or central-level health establishment, is required;

f/ In case the health insurance card holder is sent to work or study abroad, apart from papers specified at Points a, b. c and d. Clause 1 of this Article, the decision of a competent authority to send the card holder to work or study abroad is required;

In case dossiers and vouchers are made in a foreign language, their notarized Vietnamese versions are required.

2. Time limits for payment:

Within 40 days after the receipt of a complete payment request dossier, for the cases of having sought medical care at a health establishment within the province or city, or within 60 days after the receipt of a complete payment request dossier, for cases of having sought medical care at a health establishment in another province or overseas, health insurance agencies shall appraise the dossier and make payment to the insured.

Chapter VII

MANAGEMENT AND USE OF THE HEALTH INSURANCE-COVERED MEDICAL CARE FUND

Article 20. Management and use of the fund amount specified at Point b. Clause 1, Article 11 of Decree No. 62/2009/ND-CP

1. The medical care fund for pupils and students is determined on the basis of the total number of pupils and students participating in health insurance (including pupils and students participating in health insurance in other categories of the insured) and the level of health insurance premiums specified at Point e, Clause 2, Article 3 and Point a, Clause 1, Article 6 of Decree No. 62/2009/ND-CP.

2. The social insurance agency shall deduct and transfer 12% of the medical care fund determined under Clause 1 of this Article to education institutions for the provision of primary health care to pupils and students and account this amount into heath insurance-covered medical care costs in the province.

3. Education institutions shall manage and use this fund amount for the provision of primary health care to pupils and students under the Finance Ministry's Circular No. 14/2007/TT-BTC of March 8, 2007, guiding the use of funds for health care work in education institutions.

Article 21. Management and use of the fund amount specified at Point a. Clause 2, Article 11 of Decree No. 62/2009/ND-CP

1. Spending contents:

a/ Procuring and maintaining necessary medical equipment and devices for local health establishments with priority given to commune health stations and health establishments in areas meeting with socio-economic difficulties.

b/ Organizing training and re-training courses to raise professional qualifications of health workers and cadres of relevant branches who are engaged in the implementation of health insurance policies in localities;

c/ Providing supports for inter-sectoral examination and inspection and commendation and reward for collectives and individuals that record outstanding achievements in the implementation of policies on health insurance-covered medical care in localities.

2. Based on the annual fund balance permitted for use in the locality reported by the provincial-level social insurance agency, the provincial-level Health Department shall assume the prime responsibility for. and coordinate with the provincial-level Finance Department and the social insurance agency in. formulating a plan on use of this amount for submission to the provincial-level People's Committee for approval.

3. Based on the approval decision of the provincial-level People's Committee, the provincial-level social insurance agency shall transfer this fund amount to relevant units. The provincial-level social insurance agency shall examine and supervise the use of this amount by relevant units so as to ensure that this amount is used in a proper, public and transparent manner.

4. Units allocated with this fund amount shall manage and use it according to current regulations, and finalize it with the provincial-level social insurance agency for inclusion in the finalized expenditures of the health insurance fund of the province. By June 30 of the subsequent year, if this fund amount is not used up. the remainder shall be transferred to the health insurance fund of the province in the subsequent year.

Chapter VIII

IMPLEMENTATION PROVISIONS

Article 22. Implementation in the transitional period under Clauses 1 and 2. Article 50 of the Law on Health Insurance

1. For cases of participating in health insurance, both compulsory and voluntary, before the Law on Health Insurance takes effect:

a/ For health insurance cards issued before October 1, 2009, and valid through December 31, 2009, the scope of benefits will comply with Decree No. 63/2005/ND-CP of May 16, 2005. and relevant guiding circulars.

b/ For health insurance cards granted before October 1, 2009, and valid beyond December 31, 2009, the scope of benefits will still comply with Decree No. 63/2005/ND-CP and relevant guiding documents through December 31.2009; from January 1. 2010. it will comply with the Law on Health Insurance and guiding documents. In case persons participating in voluntary health insurance have paid premiums for the whole year (including a period after January 1. 2010) at old rates, premiums shall not be retrospectively collected and funds shall be allocated and used under Decree No. 63/2005/ND-CP of May 16. 2005. and relevant guiding circulars: those who have not yet fully paid premiums shall pay premiums for the remaining period at the prescribed rate applicable from January 1, 2010.

2. For undcr-6 children:

a/ By the end of September 2009, health establishments shall stop the payment of medical care costs for under-6 children under Joint Circular No. 15/2008/TTLT-BTC-BYT of February 5, 2008. of the Ministry of Finance and the Ministry of Health guiding the provision of medical care and the management, use and finalization of medical care funds for free medical care for under-6 children at public health establishments, and shift to pay costs of health insurance-covered medical care under the Law on Health Insurance and guiding documents.

b/ Social insurance agencies shall advance and pay costs of medical care for under-6 children arising from October 1, 2009 (including cases in which a child is admitted to a hospital before October 1, 2009, and still in hospital for whom medical care costs have not yet been settled by the health establishment) under regulations on payment of health insurance-covered care costs.

c/ Health establishments shall make reports on finalization of state budget funds allocated for the provision of medical care for undcr-6 children in 2009 under the guidance of the Ministry of Finance.

d/ The provincial-level Finance Department shall assume the prime responsibility for, and coordinate with the provincial-level Health Department and Labor. War Invalids and Social Affairs Department in. on the basis of the projected number of under-6 children in the locality by October 1,2009, determining the total state budget funds used to pay health insurance premiums in the last three months of 2009 for under-6 children at the rate of 3% of the minimum wage level (VND 58,500/child) for submission to the provincial-level People's Committee chairperson for decision. The provincial-level Finance Department shall transfer this amount to the health insurance fund managed by the provincial-level social insurance agency.

e/ The health insurance fund shall pay for medicines in the list prescribed by the Ministry of Health, including those in forms suitable to children such as syrup, flavored powder and granules.

Article 23. Effect

1. This Circular takes effect on October 1, 2009.

2. The documents below cease to be effective upon the expiration of the transitional period applicable to cases prescribed in Clauses 1 and 2, Article 50 of the Law on Health Insurance and Clause 2, Article 16 of Decree No. 62/2009/ND-CP.

a/ Joint Circular No. 14/2002/TTLT-BYT-BTC of December 16, 2002, of the Ministry of Health and the Ministry of Finance, guiding the provision of medical care for the poor and the establishment, management, use, payment and finalization of the medical care fund for the poor under the Prime Minister's Decision No. 139/ 2002/QD-TTg of October 15. 2002;

b/ Joint Circular No. 21/2005/TTLT-BYT-BTC of July 27, 2005, of the Ministry of Health and the Ministry of Finance, guiding the implementation of compulsory health insurance;

c/ Joint Circular No. 16/2006/TTLT-BYT-BTC of December 6, 2006, of the Ministry of Health and the Ministry of Finance, amending and supplementing a number of points of Joint Circular No. 21/2005/TTLT-BYT-BTC of July 27, 2005. of the Ministry of Health and the Ministry of Finance, guiding the implementation of compulsory health insurance;

d/ Joint Circular No. 06/2007/TTLT-BYT-BTC of March 30, 2007, of the Ministry of Health and the Ministry of Finance, guiding the implementation of voluntary health insurance:

e/ Joint Circular No. 14/2007/TTLT-BYT-BTC of the Ministry of Health and the Ministry of Finance, amending and supplementing a number of articles of Joint Circular No. 06/2007/TTLT-BYT-BTC of March 30. 2007, of the Ministry of Health and the Ministry of Finance, guiding the implementation of voluntary health insurance;

f/ Joint Circular No. 15/2008/TTLT-BYT-BTC of February 5, 2008, of the Ministry of Health and the Ministry of Finance, guiding the provision of medical care; and management, use and finalization of funds for free medical care for under-6 children at public health establishments;

g/ Joint Circular No. 10/2008/TTLT-BYT-BTC of September 24, 2008, of the Ministry of Health and the Ministry of Finance guiding the implementation of health insurance for members of households living just above the poverty line.

Article 24. Organization of implementation

1. The Vietnam Social Security shall guide the order of and procedures for the issuance, reissuance and renewal of health insurance cards. The minimum validity period of cards is one year. For under-6 children. People's Committees of communes, wards and townships shall make and transfer a list of children born in the month to social insurance agencies for the issue of health insurance cards. For under-6 children who have not yet been issued health insurance cards, their valid free medical care cards may be further used until they are issued health insurance cards.

2. Expenses for collection of health insurance premiums applicable to some categories of the insured comply with the Prime Minister's regulations on financial management of the Vietnam Social Security.

3. Criteria for identifying members of poor households, households living just above the poverty line and agricultural, forestry. Fishery and salt-making households with average living standards comply with the Prime Minister's decision and the guidance of the Ministry of Labor. War Invalids and Social Affairs.

4. Provincial-level Health Departments shall:

a/ Assume the prime responsibility for. and coordinate with provincial social insurance agencies in. directing health establishments to provide medical care for the insured in localities under this Circular.

b/ Direct and formulate a table of charges of technical services and provide medicines and medical supplies and manage their charges and prices according to regulations. For new technical services and technical services not yet included in the bracket of charges for medical services promulgated by the Ministry of Health and the Ministry of Finance, provincial-level Health Departments shall assume the prime responsibility for. and coordinate with relevant branches in. calculating their charges for submission to provincial-level People's Committees lor approval and use as a basis for payment of health insurance-covered medical care costs.

5. Health establishments shall:

a/ Receive health insurance card holders and perform administrative procedures prescribed for health insurance card holders:

b/ Provide sufficient medicines, chemicals and medical supplies for health insurance-covered medical care:

c/ Prescribe the safe and reasonable use of medicines, medical supplies and technical services according to professional regulations of the Ministry of Health and apply measures to fight the abuse of services, medicines or fluids and the prescription of services which are unnecessary or inappropriate to the disease status.

d/ Proactively and actively apply information technology to the management of health insurance-covered medical care. Health establishments which have developed or are developing management software shall reach agreement with social insurance agencies on statistical indicators to meet requirements of management of health insurance-covered medical care; establishments which have no management software yet shall study and apply the statistical software currently applied by the Vietnam Social Security so as to develop a common management software.

e/ Formulate and submit to competent authorities for approval the table of charges of technical services applicable at their establishments. For new technical services and technical services not yet included in the bracket of charges for technical services promulgated by the Ministry of Health and the Ministry of Finance, health establishments shall explain the formulation thereof when submitting such charges to competent authorities for approval.

f/ Assume the prime responsibility for. and coordinate with social insurance agencies in. formulating and applying programs on medical care management and cost control.

6. Roadmap for application of the method of quota-based payment:

a/ Provincial-level Health Departments shall assume the prime responsibility for, and coordinate with provincial-level social insurance agencies in, directing the application of the method of quota-based payment according to an appropriate roadmap under which at least 30%, 60% and 100% of local primary care providers shall apply this method in 2011, 2013 and 2015, respectively.

b/ Health establishments which are applying on a pilot basis the method of quota-based payment and other payment methods under approved schemes shall continue implementing plans under these schemes. When these schemes end, if finding that these payment methods are appropriate, provincial-level Health Departments and provincial-level social insurance agencies shall direct health establishments to continue applying these methods on the principle of making adjustments to suit the scope of benefits as prescribed and. at the same time, report such to the Ministry of Health, the Ministry of Finance and the Vietnam Social Security for further direction.

7. Provincial-level Health Departments, provincial-level health insurance agencies and health establishments shall make reports according to regulations of the Ministry of Health and the Vietnam Social Security.

8. For under-6 children whose health insurance cards expire while they are receiving treatment at health establishments, the health insurance fund shall pay all medical care costs until these children are discharged.

9. The Ministry of National Defense, the Ministry of Public Security and the Government Cipher Committee shall assume the prime responsibility for, and coordinate with the Ministry of Health and the Ministry of Finance in, guiding the implementation of health insurance for persons under their management specified in Clauses 1, 2 and 16, Article 1 of this Circular.

9. Any problems arising in the course of implementation of this Circular should be reported to the Ministry of Health and the Ministry of Finance for study and settlement.

APPENDIX 01

MODEL TABLE OF THE INSURED AND STATE BUDGET SUPPORTS ALLOCATED FOR PAYMENT OF HEALTH INSURANCE PREMIUMS
(To Joint Circular No. 09/2009/TTLT-BYT-BTC of August 14. 2009, of the Ministry of Health and the Ministry of Finance)

TABLE OF THE INSURED AND STATE BUDGET SUPPORTS ALLOCATED FOR PAYMENT OF HEALTH INSURANCE PREMIUMS FOR.

(Name of the group of the insured)

APPENDIX 02

AVERAGE COST RATES AT TECHNICAL LINES APPLIED TO DIRECT PAYMENT FOR HEALTH INSURANCE CARD HOLDERS
(To Joint Circular No. 09/2009/TTLT-BYT-BTC of August 14. 2009, of the Ministry of Health and the Ministry of Finance)