Circular 40/2015/tt-Byt: Registration Regulations, Cure The Original Medical Insurance And Transit Care, Cure Health Insurance

Original Language Title: Thông tư 40/2015/TT-BYT: Quy định đăng ký khám bệnh, chữa bệnh bảo hiểm y tế ban đầu và chuyển tuyến khám bệnh, chữa bệnh bảo hiểm y tế

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The CIRCULAR regulates registration, healing the original medical insurance and transit consultation, healing health insurance _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ health insurance pursuant to the law No. 25/2008/QH12 on November 14, 2008 and the law amending and supplementing some articles of the law on health insurance of 46/2014/QH13 on June 13, 2014;
Pursuant to the law examinations, cure of 40/2009/QH12 on November 23, 2009;
Pursuant to Decree No. 105/2014/ND-CP on November 15, 2014 the Government detailing and guiding the implementation of some articles of the law on health insurance;
Pursuant to Decree No. 63/2012/ND-CP on August 31, 2012 of the Government functions, tasks, powers and organizational structure of the Ministry of health;
At the suggestion of the Director of medical insurance, the Ministry of health;
The Minister of Health issued a circular regulating registration, healing the original medical insurance and transit consultation, healing health insurance.
Chapter I GENERAL PROVISIONS article 1. Scope this circular regulates the registration, healing the original medical insurance and transit consultation, healing health insurance.
Article 2. Principle 1. The basis of registration, cure health insurance initially prescribed in this circular are defined under the medical facility within the system, the healing of the State and the equivalent.
2. People who have health insurance card to be moved online examinations, cure according to the regulations on transit technical expertise between the base doctor, cure and as prescribed in this circular.
Chapter II the BASE DOCTOR, cure the INITIAL health insurance article 3. The base doctor, cure the original medical insurance online and the equivalent of 1. Clinics communes, wards and towns;
2. Clinic, clinics, medical offices, divisions, organizations;
3. family doctor clinic private independent;
4. military clinics-medical, military clinic population-the population of y, Army Medical Battalion unit and the base doctor, healing others as specified by the Minister of national defence.
Article 4. The base doctor, cure the original medical insurance online and the equivalent of 1. District Hospital, district, town, city in the province;
2. the District Health Center consultation functions; District Health Center clinic;
3. Clinic; clinic area;
4. General Hospital's class III, IV and class not yet rated in the ministries or subordinated units of the ministries;
5. private hospital the equivalent grades III, IV class equivalent or not equivalent rank;
6. traditional medicine hospital of equivalent private first class III, class IV or equivalent has not been rated equivalent;
7. Medical Clinic, affiliated to the Ministry of public security, the clinic, the central cities;
8. Medical Center of Army-civilian army medical clinic, medicine, military medical clinic-population of medicine, military hospital, class III, class IV or not yet rated, military hospital-class III, class IV medical people or has not yet been rated, the base doctor, healing others as specified by the Minister of national defence.
Article 5. The base doctor, cure health insurance provincial initially and the equivalent of 1. The hospital, central cities;
2. class I, hospital grade II in the ministries, or subordinate units in the ministries;
3. Specialty Hospital, specialist Institutes, clinics, health centres in the province, the central cities have clinics;
4. Children's Hospital-Children's Hospital, the province, the central cities;
5. private hospital the equivalent grades I, II equivalent;
6. the traditional medicine hospital, central cities, ministries;
7. traditional medicine hospital of equivalent private first class I, class II equivalent;
8. The clinic Protection Commission health officer of the province, central cities;
9. class II hospital in the Department of Defense, the military hospital-grade II, the population health, medical facilities, other healing according to the regulations of the Minister of national defence.
Article 6. The basis of registration, cure health insurance initially Central and the equivalent of 1. General Hospital affiliated to the Ministry of health, except for the hospital specified in Paragraph 3 of this article;
2. Specialty Hospital, specialty Institute Ministry of health clinics;
3. The friendship hospital, hospital C Da Nang and Unity hospital affiliated to the Ministry of health;
4. special class hospital, the Hospital of Ministry of Defense of the I class, Institute for traditional medicine, military medical establishments, other healing prescribed by the Minister of national defence.
Article 7.  Conditions of registration facility, healing the original medical insurance 1. The base doctor, healing must have active license examinations, cure.
2. medical practitioners, healing must have the certificate of practice examinations, cure.
3. The basis of examination and treatment specified in the paragraph 1, 2 and 4 of article 3 of this circular if not yet have active license examinations, cure it must have qualified manpower, facilities, equipment, ensuring patient needs, healing and treating the initial emergency supply, medications, within the scope of professional activities in accordance with the law on examination and treatment.
4. family doctor clinics independent private: are eligible under the rules of the Ministry of health on licensing conditions of activity for the family doctor clinic independent private.
5. for the Private clinic, they must have at least 2 (two) and specialty; For the clinic has a doctor, healing for children, in addition to 2 (two) specialist on pediatric specialist must have.
Chapter III REGISTRATION, cure the INITIAL health insurance article 8. Registration, cure health insurance initially at the base hospital, cure the initial health insurance online, online district health insurance participants is entitled to registration, healing the original medical insurance (hereinafter referred to as examination, initial cure) at one of the facilities examined the healing, the provisions of article 3 and article 4 this circular irrespective of administrative boundaries, in accordance with the place of work, place of residence and the ability to meet the base's Hospital, healing.
Article 9. Registration, cure health insurance initially at the base hospital, cure health insurance provincial originally, Central 1. Health insurance participants are registration, initial cure at one of the base doctor, cure prescribed in paragraphs 1, 2, 3, 4, 5, 6, 7 and 9 Article 5 and article 6 of this circular in the following cases: a) permanent duration, staying or working in the County the district, town or city in the unfounded medical examination and treatment as defined in article 3 and article 4 this circular or facilities that do not meet the medical examination, the original healing for participants health insurance according to regulations of the Director of the Department of health after the unity in writing of the Director of social insurance the , central cities;
b) People often stay duration, staying or working in the County, district, town, city in the province was registration, initial healing at the medical facility and treatment specified in the paragraph 1, 2, 3, 4, 5, 6, 7 and 9 Article 5 and article 6 of this circular by the Director of the Department of health regulations after having the consistency of The Director of social insurance in the province, the central cities.
2. medical insurance participants are registration, initial cure at one of the base doctor, cure the provisions of article 8, paragraph 1 article 9 of this circular or registration, initial cure at the base hospital, healing other health insurance in the following cases : a) in an object is managed, health protection under the guidance of 52 HD/BTCTW on 02 December 2005 of the Party Central Committee on the adjustment object additional treatment at some medical facilities are of central registration, initial healing Friendship hospital Hospital C, Da Nang, Unity hospital affiliated to the Ministry of health or medical facility, other healing specified in article 5 (except clause 4) 1.2 and paragraphs 4 and 6 of this circular;
b) in an object is managed, health protection officers of the province, the city was registration, initially at the healing clinic in Ban protects health officer of the province or the base doctor, cure at the 1, 2, 3, 5, 6, 7 and 8 article 5 of this circular;
c) people to the revolution, people from 80 years old to be registration, initial cure at the base hospital, healing specified in the paragraph 1, 2, 3, 5, 6, 7 and 8 article 5, paragraphs 1, 2 and 3 article 6 of this circular;
d) children under 6 years old are registration, initial cure at the base hospital, healing specified in the paragraph 1, 2, 4 and 5 article 5 this circular;
DD) Who work in the army when his retirement was registration, initial healing at the medical facility and treatment prescribed in clause 9 Article 5, paragraph 4 Article 6 of this circular.
3. health insurance participants are living in island Township, district of the island are registration, initial healing in a patient base, convenient cure for on the Mainland if the island Township, the district on the island have no basis of examination and treatment prescribed in articles 3, 4 , 5 and 6 of this circular.
Chapter IV TRANSFER of ONLINE examinations, CURE health insurance article 10. Transit consultation, healing health insurance The transit consultation, healing health insurance is done according to circular No. 14/2014/TT-BYT on 14 April 2014 of the Ministry of health about the transit technical expertise between the base doctor, cure, except in some specific cases are made according to the provisions of article 11 of this circular.
Article 11. The case was determined to be true online examinations, cure health insurance 1. People who have medical insurance card registration, initial cure at the base hospital, healing or online clinic or hospital district was online consultation rights, healing health insurance at clinics or online clinic, or hospital district lines in the same province.

2. People who have medical insurance card registration, initial cure at the base hospital, healing transit township line to district hospitals, including the hospital district has been rated class I, II and the traditional medicine hospital (in the case of the hospital district has no traditional medicine).
3. People who have health insurance cards are online hospital district, including the hospital has been rated class I, II and General Hospital, clinics, specialist institutes, specialist centre online the transit to the online specialist centres or clinics, specialty hospital provincial Professional Institute class or the lower class.
4. in case of emergency: a) the patient is any emergency medical treatment facility. The doctor or the patient receiving medical evaluation, identify the emergency status and profile, history.
b) After the period of emergency treatment, the patient is transferred to inpatient treatment at the medical facility where the healing took emergency disease or be transferred to the base hospital, healing to continue treatment as required expertise or be moved to the place of registration the original, healing after treatment were stable.
5. in case the patient is transferred online examinations, other disease cure, the disease was discovered or arisen in addition to sick notes on paper, transit base hospital, where the patient receiving healing made investigations, the cure for the disease that in the scope of expertise.
6. where the participants health insurance travel, study, work or staying under 12 months at another local was the doctor, cure at the base hospital, healing on the local equivalent of online consultation facility, the original healing items on the health insurance card. The local cases that do not have equivalent health facilities, the health insurance participants were selected to the base doctor, healing others organized consultations, healing the original medical insurance.
Article 12. Use paper to transfer online and paper appointment back in examinations, cure health insurance 1. Use the transit for Paper patient medical insurance card: a) the case of the patient was transferred to the base hospital, healing others only need the transit base Paper examinations, cure where direct patients away;
b) where a patient to patient basis, healing is not the base doctor, cure health insurance initially and then be forwarded to the base doctor, heal others just transit base Paper examinations, cure where direct patients away;
c) transit valuable Papers used in 10 working days from the date of registration;
d) patients have health insurance card getting the disease, group of diseases and cases of used Paper transit provisions in Appendix No. 1 attached to this circular, the Paper had transit value used to end on December 31 of that calendar year. The case to end on December 31 of the year in which the patient is still being treated at the base hospital, then healing the transit valuable Papers to use the remainder of the inpatient treatment.
2. Use a paper appointment again: each paper appointment again using only 1 (one) time according to the time stated in the appointment of base Paper examinations, cure. Sample appointment back for medical insurance disease specified in Appendix No. 2 attached to this circular.
Chapter V the RESPONSIBILITY to IMPLEMENT article 13. The responsibility of the Department of health 1. Hosted, in collaboration with the social insurance Department, central cities, the basis of the consultation, the Ministry of health and healing ministries, sectors close to done: a) defined, created and published a list of the base registration, initial healing according to the province's online , city;
b) guide the registration, initial healing for the object specified in paragraph 3 article 9 of this circular;
c) guide the registration, initial healing for children under 6 years of age specified in point d, item 2 article 9 of this circular.
d) guide the transit between the base doctor, cure for sick people join health insurance according to regulations.
2. Hosted, in cooperation with the social insurance Department, central cities, the base doctor, healing Ministry of health and the Ministry of Industry, regulatory, structural, object-group objects, the number of participants health insurance registration, initial healing prescribed in article 8 , Article 9 of this circular line with the actual conditions of the locality and the ability to meet the base's Hospital, healing.
3. Hosted, in cooperation with the social insurance the city, centrally guided objects, object-group structure and the number of participants health insurance registration, initially at the Healing Center, Institute, specialty hospital, the hospital, the Institute of traditional medicine to ensure conformity with the actual conditions of the base and the base system organization visit locally, healing diseases, promote the effective use of human resources, facilities, equipment, the range of expertise and the quality of medical examination and treatment.
4. Organizing and directing the implementation of the provisions of this circular for the base doctor, healing in the scope of management.
Article 14. The responsibilities of the social insurance, city in Central 1. Contracting Organization examined, cure health insurance with the base doctor, cure have qualified consultation organization, the original healing according to the Department of health has approved.
2. In coordination with the Department of health guidelines participants registration health insurance or change where registration, initial healing at the medical facility, healing on the province, the central city in accordance with the provisions of this circular.
3. Guide the doctor, cure health insurance for people who have medical insurance card to the provisions in Paragraph 6 article 11 of this circular.
Article 15. Responsibility of health ministries, sectors 1. Army Medical Department-the Department of Defense, the Department of health, Ministry of public security: a) directing, instructing the patient base, the healing Ministry of Defense, Ministry of public security organization-qualified doctor, cure originally registered with the local Health Department;
b) instructions implementing the registration, initial healing and patient organization, cure health insurance medical establishments, the healing Ministry of Defense, Ministry of public security. 2. The Health Ministry, other Industries: a) directing the base doctor, healing ministries in eligible patients, healing organization originally registered with the local Health Department;
b) instructions implementing the registration, initial healing and patient organization, cure health insurance according to regulations.
Article 16. The responsibility of the base doctor, cure 1. Perform the examination, treatment, transfer route between the base doctor, healing and ensure benefits for insured participants as defined.
2. The Base Organization activity condition of the unit, the head of the medical facility and treatment assigned person responsible acknowledge receiving the patient was moved to in or out of office hours in time.
Chapter VI article 17 ENFORCEMENT TERMS. Effect 1. This circular has effect from January 1, 2016.
2. Circular No. 36/2014/TT-BYT on November 17 in 2014 of the Health Minister instructed the registration, initial healing and patient transit, cure health insurance expired from the date of this circular are enforceable.
Article 18. Transitional provisions participants have medical insurance registration, initial cure at the base on the health insurance card before the date of this circular in force shall continue to be consultation, initial healing at that base until there is a change in the place of registration the initial healing, then follow the instructions in this circular.
Article 19. The terms of reference of cases the text referenced in this circular are replaced or modified, the supplement shall apply according to the text have been replaced or the text has been modified and supplemented.
In the process of implementation, if there are difficult obstacles suggest that the agencies, organizations, personal reflections on the Health Ministry to consider, resolve./.