DECREE

Regulatory Regulation and Guide to some of the provisions of the Health Insurance Law

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Government Law Base December 25, 2001;

The Health Insurance Law Base on 14 November 2008 and the Amendment Law, which complements some of the provisions of the Health Insurance Law June 13, 2014;

At the request of the Minister of Health,

The government issued a regulatory regulation and guidelines for the implementation of a number of provisions of the Health Insurance Act.

Chapter I

SUBJECT, CLOSED LEVELS, SUPPORT LEVELS AND FUNDING FROM THE STATE BUDGET CLOSED, SUPPORT FOR THE CLOSING OF HEALTH INSURANCE.

What? 1. The Subject to Health Insurance

In addition to the specified object at Clause 1, 2, 3, 4 and Clause 5 Articles 12 amendments, additional provisions of the Health Insurance Law, other subjects stipulate at paragraph 6 Article 12 amended, the addition of the Health Insurance Act include:

1. The rubber worker who is enjoying the monthly allowance under Decision No. 206 /CP on 30 May 1979 of the Government Council (now Government) on policy towards new workers released as a labelery, harmful to health today is weak. participate in the health insurance in accordance with Article 2 of the Article 12 amendment, the addition of the Health Insurance Law.

2. Family occupiers for agricultural, forestry, fishing, and matchmaking have a moderate standard of life participation in accordance with provisions at Clause 4 Articles 12 amended, supplematuation of the Health Insurance Law.

What? 2. Health insurance levels

1. From January 1, 2015, the monthly level of health coverage of the subjects is regulated as follows:

a) By 4.5% of the worker's monthly wages on the subject of regulation at the Point A 1 Article 12 amendment, the addition of the Health Insurance Law.

Workers at the time of the time of the abortion in terms of the law of social insurance, the monthly closing is equal to 4.5% of the worker's monthly wages before the maternity leave;

Workers at the time of taking a 14-day period of pain from 14 days or more in the month under the rule of law on social insurance do not have to pay health insurance but are still entitled to the benefits of health insurance;

Workers in the time of detention, detention, or temporary suspension of work to investigate, consider whether or not a violation of a violation of the law, 4.5% of 50% of the monthly wages the worker is entitled to. of the law. The case for the authority to conclude is not to violate the law, the worker must pursue health insurance on the amount of wages being pursued;

Employees of the time being sent to study or work abroad do not have to pay health insurance; that time is calculated as the time to take part in health insurance until the date of the decision to return to the office of the agency, the organization sent;

Workers in the time of overseas labour do not have to pay health insurance; in the 60-day period since the date of entry to the country if participation in health insurance is the whole time to go to labor abroad and time since the arrival of the country. to the time of medical insurance participation is calculated as time to participate in the constant health insurance.

Workers in the time of the procedure for the employment of the unemployment allowance under the provisions of the Employment Law if not participating in health insurance according to other groups, the time being charged is the time to take part in health insurance.

b) By 4.5% of the base salary to the specified object at point b 1 Article 12 modification, addition of the Health Insurance Law.

c) By 4.5% of the pension, the pension benefits the subject of regulation at Point A 2 Article 12 amendment, the addition of the Health Insurance Law.

d) By 4.5% of the base salary to the specified object at point b, Section 2 Article 12 amendments, the addition of the Health Insurance Law and the specified object at 1 Article 1 This decree.

Between 4.5% of the unemployment allowance on the subject of regulation at point 2 Article 12 amendments, additional of the Health Insurance Act.

e) By 4.5% of the base salary to the specified object at points b, c, d, e, g, g, h, i, k, l, m and point n Section 3; Claim 4 and Clause 5 Articles 12 amended, supplemated by the Health Insurance Law and the specified object at paragraph 2 Article 1 This decree.

A 72-month-old child case without any admission, the health insurance card was used by 30 September of that year without having to close the health insurance.

g) The closing level of all household members of the household pursuits at paragraph 5 Article 12 amendments, additions of the Health Insurance Act as follows: The first closed by 4.5% of the base salary; second, third, fourth in turn by 70%, 60%, 50%. to the first person; from the fifth onwards to the first 40% of the first.

For a state budget that is supported by the state budget, it does not apply to a reduction in the prescribed level at Point 1 This Article.

2. Based on the actual situation, the Ministry of Health presided over, in coordination with the Ministry of Finance, the agency, the government-related organization regulating the level of health insurance to ensure the balance of the health insurance fund.

What? 3. The funding level from the state budget supports closed health insurance for some of the subjects.

1. The level of support for a health insurance coverage for holders of the poor family of the poor by regulation at Point A 4 Article 12 amendment, the addition of the Health Insurance Law is prescribed as follows:

a) Support 100% of the health insurance coverage of the newly freed poor family of the poor, the time of support for 5 years after the exit of poverty. The poor midterm case had escaped poverty before 1 January 2015 but the time of poverty as of 1 January 2015 was not nearly five years, and the remainder of the time was given at least 01 years.

b) Support 100% of the health insurance coverage for poor family members living in poor districts by regulation at Resolution 30a/2008/NQ-CP on December 27, 2008 by the Government on the Program Assistance Program to reduce poverty and sustainability. for the 61 poor districts and the districts with high rates of poverty imposed on the basis, the infrastructure investment policy by Resolution 30/2008/NQ-CP on December 27, 2008 of the Government;

c) Support a minimum of 70% of the health insurance coverage for those of the remaining poor family household.

2. Support a minimum of 30% of the health insurance coverage of student subjects, students by regulation at point b 4 Article 12 modification, additional of the Health Insurance Act.

3. Support a minimum of 30% of the health insurance coverage for household holders as agriculture, forestry, fishing and matches have a median standard of life under Decision No. 1. 32 /2014/QĐ-TTg May 27, 2014, of the Prime Minister, stipulated at Article 2 of Article 1 of this decree.

4. The Provincial Committee of the Provincial People, the Central Committee of the Central Committee (later called the Provincial People's Committee) bases the ability to budget local budgets and other legal sources, including 20% of the funds spent on medical treatment, unusable treatment in the year under the rule. At Section 3 Article 35 amendments, the addition of the Health Insurance Act (if any) builds and the Provincial People's Council decides to provide higher health insurance for the specified object at Point 1, Clause 2 and Clause 3 This.

Chapter II

HEALTH INSURANCE AND THE COST OF THE COST OF HEALTH CARE, CURE HEALTH INSURANCE.

What? 4. Health coverage for regulatory cases at Clause 1 and Clause 7 Articles 22 amended, additional of the Health Insurance Law of the United States.

1. The person who participated in health insurance on an examination of the disease, treated as prescribed at Articles 26, 27, and Article 28 of the Health Insurance Law and Clause 4, Clause 5 Articles 22, the addition of the Health Insurance Act is funded by the health insurance fund, The treatment of the disease in the range is entitled to the following:

a) 100% of the cost of the disease, cure for the specified object at d, e, g, h, and point of paragraph 3 Article 12 modification, addition of the Health Insurance Law;

b) 100% of the cost of the disease, cure and non-imposed limit of the rate of payment of certain drugs, chemicals, medical supplies and technical services under the provisions of the Minister of Health for: Person of the operation before 1 January 1945; the activist. The revolution from January 1, 1945 to the August 1945 uprising of August 1945; Vietnamese mothers; wounded, policymaking such as traders, Class B casualties, patients declining labor capacity from 81% or more; wounded, people, and others. policy such as commerce, type B infantry, hospital treatment for wound treatment, recurve illness; children under 6 years of age;

c) 100% of the cost of discovery, healing at the township;

d) 100% of the cost of discovery, healing for the cost case for a medical examination, treating the disease less than 15% of the base salary;

100% of the cost of the disease, treating patients with a five-year medical insurance-related illness from the time of the person to participate in health insurance, to the time of medical treatment, medical treatment, and the amount of money to pay for the costs of the disease, the treatment of the accumulation. In the year larger than six months ' pay, from the time of the health insurance participation of five consecutive years, except for the self-discovery, the disease is not on the line;

e) 95% of the cost of the examination, the treatment of the specified object at Point 2, Point 3 and Point A 4 Articles 12 modification, addition of the Health Insurance Law;

g) 80% of the cost of discovery, healing for other subjects.

2. The person who participated in health insurance on a visit to the disease, cured the disease at the clinic, treated the thyroid disease of two provinces, the Central City of China (later known as the province, city) was paid by the health insurance fund in the range of rights and benefits. according to the stipulation at this 1 Article, in the circumstances:

a) Discovery, healing at the township health station, polyclinic clinic, district hospital;

b) Transline the technical technical route, the district, the provincial line.

The chairman of the Provincial People ' s Committee directed the Department of Maintenance of Maintenance, in coordination with the Provincial Social Insurance, the city of the organization of the disease, cure health insurance at sites bordering on the guidance of the medical association-the Ministry of Finance for the examination, healing of the disease. It ' s a health hazard in the neighboring borders.

3. The medical examination cases, the treatment required by the request to be paid by the health insurance fund in the scope of the rights and the degree of regulation at:

a) Clause 1 Article 4 This decree for the case of a medical examination, the prescribed treatment at Articles 26, 27, and Article 28 of the Health Insurance Law and Clause 4, 5, and paragraph 6 Articles 22 amended, additional of the Health Insurance Act; the patient pays the portion of the cost. outside of the range of rights and levels;

b) Clause 3 Articles 22 amendments, the addition of the Health Insurance Act on the case of self-discovery, non-linear healing; the patient pays off the cost of the cost outside of the range of rights and benefits.

What? 5. Apply the cost payment methods of discovery, healing under Article 30 of the amendment, the addition of the Health Insurance Law.

1. The method of payment by definition is applied to the facility of the disease, treating the initial medical insurance.

2. The method of payment in service fees and payment in case the disease is applied:

a) For the basis of the disease, healing does not perform the method of payment by the definition;

b) Payment for external health services at the facility of the disease, treating the health insurance that performs the payment in accordance with the definition;

c) The cost of the examination, the treatment for the cases being transferred to the medical examination facility, cure the health insurance that performs the payment by the definition.

3. The Ministry of Health chaired, in collaboration with the Ministry of Finance to detail the details and apply the specific method of payment methods at Clause 1 and Clause 2 This for the facilities of the disease, healing accordingly.

Chapter III

MANAGEMENT AND USE OF HEALTH INSURANCE FUNDS

What? 6. Deliver and use the health insurance fund

The total number of health insurance revenues on the province, the central city of the Central to the specified level at Article 2 of this Decree is allocated and used as follows:

1. 90% of the amount of health insurance premiums devoted to the medical examination, healing (later called the medical examination, healing) are used for purposes:

a) The cost of the cost of the extent of the person's range of the health insurance participant in accordance with the provisions of Article 22 amended, the addition of the Health Insurance Law and Article 4 of this decree.

b) Quote for educational institutions of the national education system are eligible under the provisions of the Ministry of Health to purchase medicines, medical supplies, equipment, and conventional medical equipment for the organization of the disease, healing in the health care business. It was originally for children, students, students.

The level of extracts for educational institutions in the national education system by 7% of the total health insurance fund's total of students, students are attending educational institutions with health insurance (including students, students participating in health insurance). according to the other group of subjects) and the corresponding level of closure for each object by regulation at Article 2 of this Decree; by 5% of total health insurance revenues on the total number of children under the age of 6 are studying in preschool education.

In the first month of the school year or the course, the Social Insurance organization is responsible for transferring the amount above the basis of educational institutions and aggregation of these funds to the cost of the cost of the disease, treating health insurance within the management range. The educational institution receives the responsibility for use, payment of accounting with the prescribed management authority.

c) Quote to the agency, organization, business has an agency health organization to carry out the examination, healing in the initial health care work for subjects due to agency, organization, enterprise management (excluding agency, organization, organized business, organization, organization, etc.) The medical authorities have contracted medical treatment, treating the health insurance initially with the Social Insurance organization. The level left by 1% of the total amount of health insurance of the agency, the organization, businesses closed to the Social Insurance organization.

The Ministry of Health, the Ministry of Finance instructs point b and Point 1 This Article on the condition, size of the organization; contents; management and payment of this funding.

2. 10% of the amount of health insurance is spent on the reserve fund and the cost of the management of the health insurance fund, which spends a minimum of 5% of the amount of health insurance premiums for the reserve fund and is regulated as follows:

a) The total cost of the annual health insurance fund management costs by the Director General of the Social Insurance of Vietnam in the total cost of the Social Insurance of Vietnam are approved by the Prime Minister;

b) The backup fund is the remainder after it has been extracts the cost of managing the health insurance fund.

3. The management and use of the amount of medical insurance proceeds as follows:

a) Social Insurance of the ranks of the Vietnamese Social Insurance directly directly enclosing the health insurance of the subjects and moved to Vietnam Social Insurance for management in accordance with the guidelines of the Social Insurance of Vietnam;

b) The Social Insurance of Vietnam is responsible for transferring enough and timely need for funding for provincial social insurance, city to advance, payment of the cost of the disease, to treat health insurance by regulation.

4. Every year, the five-year-old decision base has been approved by the Vietnam Social Insurance Board, the unusable budget of the provinces, and the city has a number of medical insurance for the disease, treating the disease much greater than the number of medical clinics. the year is used as follows:

a) Part of the funding for the disease, the treatment that has not been used in 2014, the Social Insurance of Vietnam is responsible for accounting for the entire amount of money to the fund fund;

b) From January 1, 2015 to December 31, 2020, Vietnamese Social Insurance has an 80% accounting liability in the backup fund, while announcing 20% of the funding for the disease, it has not been used locally to be done on a scale. At the point a 3 Article 35 amendment, the addition of the Health Insurance Act.

The unusable budget base is used locally, the Department of Maintenance, in collaboration with the Department of Finance and Social Insurance, the city of planning to use the Provincial People's Committee to approve and report the Provincial People's Council. The decision base approved by the Provincial People's Committee, the Provincial Social Insurance, the city transferred funds to the units to implement.

The units that are allocated funding are responsible for management, use under the current regulation and decision-making with the Provincial Social Insurance, the city to sum up on the cost of the provincial health insurance fund, the city secured the right purpose, efficiency, public and business. Open, transparent.

c) Since 1 January 2021, the Vietnam Social Insurance is responsible for accounting for the entire portion of the budget that has not been used to the reserve fund for general regulation.

What? 7. Manage and use the backup fund

1. The reserve fund administered by the Social Insurance of Vietnam is used to supplement the source of the medical treatment, cure health insurance for the province, the city in the case of the amount of medical insurance proceeds for the disease, treating the disease according to Article 1 of 1 Article 6. This decree is smaller than the number of clinics, which cure the disease of the year. After an audit editor of the year, the Provincial Social Insurance, the city reported the Vietnam Social Insurance appraisal to complement the entire portion of the gap funding from the backup fund.

2. The backup fund case is not enough to supplement the medical examination, cure for the provinces, the city by regulation at Clause 1 This, Vietnam Social Insurance reported the Vietnam Social Insurance Management Council resolution resolution prior to the report of the Ministry of Education. Health, Ministry of Finance.

The Ministry of Health presided over, in coordination with the Ministry of Finance of the Government of the Government of the resolution to ensure sufficient assurance and time for the funding of the disease, the treatment of health insurance.

What? 8. Health Insurance fund management costs

1. The genus regularly followed by the rule of law including:

a) The specific genus includes:

-Propaganda, coordinated in the propaganda industry that develops health insurance;

-Chi for operation related to the recording mission, the fund ' s expense;

-Coordination in the inspection, inspection, monitoring of health insurance.

b) The social security apparatus serves the management of the health insurance fund.

2. The genus is not frequent, including:

a) Chi developed and modernized information technology;

b) The study of science, training, fostering, international cooperation related to the field of health insurance.

3. Other limb duties under the rule of law.

The Ministry of Finance specifically instructs the content, the level of regulation at this.

What? 9. Investment activity from the health insurance fund

1. The idle temporary amount of the health insurance fund is used to invest in the regulatory forms of the Social Insurance Law.

2. Vietnam Social Insurance Management Council decides and is accountable to the Government in the form and investment structure of the health insurance fund on the basis of the recommendation of the Social Insurance of Vietnam.

3. All proceeds from the investment activity from the annual health insurance fund are added to the reserve fund for general regulation.

What? 10. Decision and Financial Planning

1. Vietnam Social Insurance implementation of the annual decision report dated 1 October next year following regulation at Article 32 of the amendment, the addition of the Health Insurance Law.

2. Every year, Vietnam Social Insurance plans financial planning on the collection, cost of health insurance; the cost of managing the health insurance fund and investments from the amount of idle temporary funds of the health insurance fund, the Vietnam Social Insurance Management Council passed, and the report. The Ministry of Finance and the Ministry of Health.

The Ministry of Finance chaired, in coordination with the Ministry of Health review, the Prime Minister ' s total contract decided to hand over the annual financial plan.

3. In the 15-day period, since the date received the decision to hand over the Prime Minister's bill, the Vietnam Social Insurance is responsible for the complete implementation of the delivery of the collection, the genus to the units made.

Chapter IV

EXECUTION CLAUSE

What? 11. The transition clause

1. The case of health insurance participants with a health insurance card and shelf life after the revised law day, the addition of some of the provisions of the Health Insurance Law valid, the scope of the rights and the degree of execution under the regulation of the Amendment Law, adds some. The provisions of the Law of Health Insurance and regulations at Article 4 of this decree.

2. The case of a person with a health insurance card is treating at the clinic, treating the disease but the expired health insurance card is still paid by the health insurance fund to pay for the disease, healing within the range of rights and the degree of regulatory regime. until the hospital or the rest of the outpatient treatment.

3. The person who joined the health insurance entered the treatment before January 1, 2015 but the hospital since 1 January 2015 was paid by the health insurance fund in the scope of the rights and the degree of regulation at the Amendment Law, adding some provisions. of the Law of Health Insurance and provisions in Article 4 of this decree.

4. Subject to regulation at Point A 3 Article 12 amendment, additional of the Health Insurance Act of retirement, discharge, transfer, or quitting time, the time of learning, business in the people 's military, the people' s public and the basic organization is counted as the time. It's medical insurance.

5. Students, students who have been involved in health insurance for the 2014-2015 academic year are not required to be traced to the extent of the health insurance policy stipulated at Section 1 Article 2 of this decree.

6. For educational institutions belonging to the national education system that has been extracted from the hospital fund, treating health insurance to perform initial health care for students, students before January 1, 2015, performed in the direction of the study of the health care system. It was the Treasury Department for the end of the 2014-2015 school year.

What? 12.

This decree came into effect on 1 January 2015.

Number Protocol 62 /2009/NĐ-CP July 27, 2009 by the Government of the Government Regulation and guidelines for the implementation of some of the provisions of the Health Insurance Act expired since this Decree is valid.

What? 13. Guide to execute

1. The Ministry of Health presided over, in coordination with the Ministry of Finance for the implementation of the provisions, the amount delivered in this decree; the guide to the health insurance participation in the household and the study, which proposes solutions to the implementation of the full-population health insurance.

2. The Ministry of Finance is in charge of balance, the central budget layout that supports unbalanced localities on the budget to ensure the source of the provisions of the health insurance policy under regulation at this decree; instructs the transfer of funds from the cost. Health insurance fund management fee for the Social People's Committee to implement a list of health insurance participants on the site; guidelines for the implementation of the provisions, the admission to this decree.

3. Ministry of Defence, Ministry of Public Security, in coordination with the Ministry of Health, Ministry of Finance guidelines for the implementation of the health insurance against the specified subjects at Point a, Point 1, Point 3 and point b Section 4 Article 12 amendments, additional of the Health Insurance Act.

4. Vietnam Social Insurance has the responsibility to determine the amount of money and the monthly cumulative cost of the year to do the base that determines the health insurance participant ' s degree to have enough time to participate in the five-year health insurance.

5. Ministry of Labor-Trade and Social Studies, which builds family-defined criteria for agricultural, forestry, fishing, and matches, has the average standard of Prime Minister.

The direction of the list of household people as agriculture, forestry, fishing and matchmaking has an average standard of living.

6. The ministries, other branches involved in the scope of their functions, duties, and powers are responsible for guiding the implementation of this decree.

What? 14.

The ministers, the Prime Minister, the Head of the Government, the Chairman of the Government, the Chairman of the People's Committee of the provinces, the Central City of the Central Committee, is responsible for the implementation of this decree.