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Decree 62/2009/nd-Cp: Detailing And Guiding The Implementation Of Some Articles Of The Law On Health Insurance

Original Language Title: Nghị định 62/2009/NĐ-CP: Quy định chi tiết và hướng dẫn thi hành một số điều của Luật Bảo hiểm y tế

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The DECREE detailing and guiding the implementation of some articles of the law on health insurance _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ the GOVERNMENT pursuant to the law on organization of the Government of 25 December 2001;
Pursuant to the law on health insurance, November 14, 2008;
Considering the recommendation of the Minister of health, the DECREE: chapter I objects, CLOSE RATES, LEVEL of SUPPORT, the RESPONSIBILITIES and the METHOD of medical INSURANCE PREMIUMS article 1. Participants health insurance as defined in paragraph 25 of the medical insurance Law article 12 1. Rubber workers are entitled to monthly allowance by decision No. 206/CP dated May 30, 1979 the Government Council (now the Government).
2. Youth Volunteer period resistance against France by decision No. 170/2008/QD-TTg dated April 18, 2008 by the Prime Minister on the health insurance regime and burial fees for youth volunteer period resistance against France.
3. Workers enjoyed sickness mode according to the provisions of the law on social insurance by disease category disease treatment on long due to the Ministry of Health issued.
4. The professional activities in the communes, wards and towns (hereafter referred to collectively as the commune) under the provisions of the law on public officials.
Article 2. The roadmap implemented health insurance of the objects specified in article 1 of this Decree 1. The object prescribed in clause 1 and clause 2 carry health insurance from July 1, 2009.
2. The object prescribed in clause 3 and 4 make health insurance from July 01, 2010. These objects when not made health insurance under the provisions then have the right to join the voluntary medical insurance to the end of December 31, 2009.
Article 3. The closed level, support level health insurance according to article 13 of law and health insurance of the object as defined in article 1 of this Decree 1. From 1 July 2009 to 31 December 2009 monthly closing levels of the objects as follows: a. equal to 3% of salary, monthly wages of workers for the object specified in item 1 and item 2 article 12 Health Insurance Law;
b. By 3% salary, retirement pension monthly labour power loss for the object specified in paragraph 3 article 12 Health Insurance Law;
c. equal to 3% of the minimum wage for the object specified in paragraphs 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 and 20 article 12 Health Insurance Law and the object specified in item 1 and item 2 article 1 of this Decree.
2. From 1 January 2010 in the level of monthly closing of the objects as follows: a. equal to 4.5% of salary, monthly wages of workers for the object specified in item 1 and item 2 article 12 Health Insurance Law;
b. By 4.5% of salary, retirement pension monthly labour power loss for the object specified in paragraph 3 article 12 Health Insurance Law;
c. By 4.5% of the minimum wage for the object specified in paragraphs 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 and 20 article 12 Health Insurance Law and the provisions of article 1 of this Decree.
d. By 4.5% rate of unemployment for the object specified in clause 8 article 12 Health Insurance Law;
Sync By 3% of the minimum wage for the object specified in clause 21 Article 12 Health Insurance Law.
3. From 1 January 2011 monthly closing levels of the object prescribed in clause 22 article 12 Health Insurance Law by 4.5% of the minimum wage.
4. From 1 January 2014 monthly closing level of the object, as follows: a. equal to 3% of the minimum wage for the object specified in clause 23 article 12 Health Insurance Law;
b. By 4.5% of the minimum wage for the object specified in clause 24 Article 12 Health Insurance Law.
5. The State budget contributes a level close to the objects as follows: a. a minimum of 50% of the level close to the object specified in clause 20 article 12 Health Insurance Law from 1 July 2009;
b minimum level by 50% ... played for the object specified in clause 21 Article 12 Health Insurance Law that in households and poor access to support a minimum of 30% of the closing levels for the object specified in clause 21 Article 12 Health Insurance Law does not reach poor households in from January 1, 2010;
c. minimum by 30% the level close to the object prescribed in clause 22 article 12 Health Insurance Law that have average living standards from January 1, 2012.
6. The case of the object prescribed in clause 20 and clause 23 article 12 Health Insurance Law to join health insurance under household includes the entire people with the name in the shared household and are living in a House and the object prescribed in clause 23 article 12 Health Insurance Law there from two relatives over to join , the level of the Member as follows: a. The first played by the prescribed level;
b. the second, third, fourth played in turn by 90%, 80%, 70% of people.
c. From the Thursday onwards close by 60% the level of the person.
Article 4. The responsibility of the medical insurance of the object as defined in article 1 of this Decree 1. The object specified in the paragraph 1, 2 and 3 by the State budget.
2. The object prescribed in clause 4 by the people's Committee and the close object, in which the closed Town Committee 2/3 and object close 1/3 of the closed level.
Article 5. Method to close the health insurance of the objects specified in paragraph 7 article 15 the health insurance Law and of the objects specified in article 1 of this Decree 1. Periodically six months, subject to the provisions in paragraphs 20, 22 and 24 Article 12 of law health insurance medical insurance premiums on health insurance fund.
2. Periodically six months or a year, the organization managing the object prescribed in clause 21 Article 12 health insurance law to collect health premiums of subjects to submit to the health insurance fund.
3. Monthly Labor, health insurance premiums for the relative clause 23 article 12 of law for health insurance through the employer to submit to the health insurance fund.
4. Monthly social insurance organizations, close the health insurance for the object specified in item 1 and item 3 article 1 of this Decree on the health insurance fund.
5. Each year, agency, organization, unit management object specified in clause 2 1 of this Decree, the health insurance for these objects into the health insurance fund.
6. the people's committees, monthly premiums for the medical Township object specified in clause 4 1 of this Decree, and excerpts from their monthly allowance money to file at once into the health insurance fund.
7. Periodically six months, basing the list object, the total amount of health insurance premiums to the State budget support level to close due to social insurance organizations report and the level of State budget support as a rule, financial institutions transfer funds into the health insurance fund according to the hierarchy of the law on the State budget.
Article 6. The closing level and method of medical insurance premiums of voluntary subjects participated in medical insurance provided for in paragraph 3 to article 50 of the law on health insurance and provisions in clause 3 and 4 Article 1 of this Decree 1. From 1 July 2009 to 31 December 2009, the closing level of the objects as follows: a. the closing Levels of six months subject to the provisions in clause 21 Article 12 of law for health insurance are enrolled in with 60,000 VND/person for urban areas and by 50,000 VND/person for rural areas mountainous;
b. six month closing Levels of the object prescribed in clause 22, 23 and 24 Article 12 Health Insurance Law and subject to the provisions in clause 3 and 4 Article 1 of this decree by 160,000 VND/person for urban areas and by the 120,000 VND/person for rural areas , mountain time.
2. From 1 January 2010, the monthly closing levels for the subject voluntarily participated in medical insurance by 4.5% and the minimum wage because of the closed object. The voluntary object instances involved medical insurance under household, a level close to follow prescribed in clause 6 of article 3 of this Decree.
3. The base level of medical insurance premiums, who voluntarily join health insurance plays six months or even a year to close to the health insurance fund.
Chapter II medical INSURANCE RATES and PAYMENT METHODS COST DOCTOR, cure health insurance article 7. Health insurance rates for the cases specified in paragraph 1 and paragraph 3 Article 22 law on medical insurance 1. Health insurance participants when hospital treatment as prescribed in articles 26, 27 and 28 the health insurance Law is the health insurance fund to pay the doctor, healing in the range are affected as follows: a. 100% of the costs of medical examination and treatment for the objects specified in the item 2 , 9 and 17 article 12 Health Insurance Law;
b. 100% of the cost of hospital treatment in civil lines;
c. 100% of the cost of hospital treatment in the case of the cost of a consultation, healing times are lower than 15% of the minimum wage; The Ministry of health, in collaboration with the Ministry of Finance regulates the specific amount and time apply when adjusting the minimum wage to make;
d. 95% of the costs of medical examination and treatment for the objects specified in the paragraph 3, 13 and 14 article 12 Health Insurance Law; the rest of the payment by the disease with the base doctor, healing;
preferred medical costs of 80% cure for other objects; the rest of the payment by the disease with the base doctor, healing;
e. the case of physician, buffet, buffet cabins disease health insurance funds only to pay the doctor, cure rates to the current state of service applied to the base doctor, cure it and according to the level of enjoyment of the provisions of article 22 of the Health Insurance Act and article 7 of this Decree.
2. Participants health insurance when going to the doctor, cure prescribed in articles 26, 27 and 28 the health insurance Law are using high-tech services, major costs are paid medical insurance fund costs in the range are affected as follows:

a. 100% of the costs for the object specified in clause 17 article 12 Health Insurance Law and the object is the revolutionary activities before 1 January 1945; the revolutionary activities from January 1945 to General before 19 August 1945; Mother heroic Vietnam; the wounded, who enjoy the policy as wounded soldiers, wounded soldiers, sick type B lost labour power from 81%; the wounded, who enjoy the policy as wounded soldiers, wounded soldiers, sick type B when treating wounds, disease recurrence;
b. 100% of the costs for the object specified in item 2 article 12 Health Insurance Law but does not exceed 40, the minimum wage for a technical service to use it; the rest due to the Agency's budget, the management of object paid;
c. 100% of the costs for the object prescribed in clause 9 Article 12 Health Insurance Law (except for the beneficiaries as defined in art. 1 of this) but does not exceed 40, the minimum wage for a technical service to use it;
d. 95% of the costs for the object specified in the paragraph 3, 13 and 14 article 12 Health Insurance Law but does not exceed 40, the minimum wage for a technical service to use it;
Sync cost 80% for other objects but does not exceed 40, the minimum wage for a technical service to use it.
3. Participants health insurance when the hospital, not the correct cure patient base, early cure or healing, not by technical expertise by the Minister of Health Regulation (except in emergencies), the health insurance fund to pay hospital healing within enjoy the provisions of article 21 of the medical insurance Act as follows: a. 70% of costs for hospital treatment in medical establishments, healing class III standards and do not exceed 40 minimum wages per month using high technology service major cost;
b. 50% of the cost for medical examination and treatment in medical establishments, healing class II standard and not exceed 40 minimum wages per month using high technology services, major cost;
c. 30% of the cost for medical examination and treatment in medical establishments, healing class I standard, premium and not exceed 40 minimum wages per month to use the service, the big costs.
4. Participants health insurance when going to the doctor, healing at the medical facility outside of the health insurance fund were paid according to the level of enjoyment of the provisions of article 22 of the health insurance Law and the provisions of clause 1, 2 and 3 of this article according to the price of services applicable to the base hospital public healing, the equivalent online technical expertise.
Article 8. The scope of benefits, health insurance rates by voluntary subjects participated in medical insurance provided for in paragraph 3 to article 50 of the law on health insurance and provisions in clause 3 and 4 Article 1 of this Decree the scope of benefits, the level of audience participation voluntary medical insurance be made as prescribed in article 21 22 and 23, the health insurance Law and the provisions of article 7 of this Decree.
Article 9. Application of the method of payment the cost of examination and treatment under the health insurance Law article 30 1. Payment methods as are applicable to the base doctor, cure initially prescribed by the Ministry of health.
2. Method of payment according to the service fees and method of payment according to the conditions to be applied to the payment for the services to apply interest at the base hospital, early cure and apply to the base doctor, cure does not make payments under the plan.
3. The Ministry of health, in collaboration with the Ministry of finance detailed guidance and specific application of the method of payment specified in clause 1 and clause 2 of this Thing for the medical facility and treatment accordingly.
Chapter III MANAGEMENT and USE of the health insurance FUND article 10. Distribution and management of medical insurance fund total revenue for health insurance of the Social Security Department, central cities (hereafter called the social insurance Department) is allocated and managed as follows: 1.90% of the income for health insurance (hereinafter the consultation Fund , healing) to leave the management of social insurance.
2.10% of currency transfer medical insurance social insurance Vietnam managed to establish the Fund preventive examinations, cure health insurance and the cost of medical insurance management and are defined as follows: a. total management costs health insurance annually due to social insurance General Manager Vietnam decided in the total cost of the social insurance management Vietnam Association was approved by the Prime Minister;
b. reserve fund doctor, cure health insurance is the remainder after subtracting deductions management costs for health insurance.
Article 11. Use the consultation Fund, healing due to the social insurance management 1. Medical Foundation, healing due to the social insurance administration stipulated in clause 1 article 10 of this Decree was used to pay the expenses of people who have health insurance card, social security by the release, including: a. pay the expenses under the provisions of article 21 of law for health insurance;
b. Extract 12% consultation fund transfer, the healing of the audience of students, students for vocational education in national education systems to health for students, students.
2. in case the Foundation doctor, healing due to the social security administration in years not used up is used as follows: a. 60% used to shopping, medical equipment maintenance, training to improve the professionalism and the other to serve the foreseen examinations and treatment in local health insurance according to the instructions of the Health Ministry-finance;
b. 40% moved to the social insurance of Vietnam to additions to the reserve fund, the cure for health insurance.
3. in case the Foundation doctor, healing due to the social security administration in the social insurance spending the social security report Vietnam for processing as specified in article 12 of this Decree.
Article 12. Use the Fund preventive examinations, cure health insurance 1. The Fund preventive examinations, cure health insurance due to social insurance management Vietnam used to supplement patient Fund, healing due to the social insurance fund in case management of patients, healing due to the social security administration were overspending. social insurance General Manager Vietnam based reporting about overspending of the Foundation examination , healing due to the social insurance administration, decided the addition and Management Board report social insurance at the most recent session of Vietnam. Case reserve fund enough not to supplement the report to the Board of management options addressed before Health Minister reports-finance.
2. where the Fund preventive examinations, cure is smaller than the total costs of examinations, the healing of the previous two quarters adjacent to or greater than the total spent on examinations, cure health insurance two years ago adjacent, Vietnam social insurance is responsible for the management of the Council report, ministries of health and the Ministry of finance.
The Ministry of health, in coordination with the Finance Ministry the Prime measures to solve.
Article 13. Investment activity, increase health insurance fund 1. Social insurance in Vietnam is responsible for implementing measures to preserve and increase the health insurance fund from the amount of temporarily idle. Investment operations from the health insurance fund to ensure safe, efficient, and recovered when needed.
2. The Council of the Vietnam social insurance management decided the investment according to the following forms: a. purchase of bonds, bills, bonds of the State;
b. for the commercial banks of the State Bank of Vietnam Development, social policy Bank loans according to market rates;
c. other forms of investment by the Board of management of social insurance in Vietnam.
3. Money from investments, increase the annual health insurance funds are added to the Fund preventive examinations, cure health insurance.
Article 14. Financial planning 1. Every year, Vietnam social insurance financial planning of incomes and expenses of medical insurance funds; the cost of medical insurance management; investment, increase the health insurance fund to the Management Council of Vietnam through the social insurance and the Ministry of finance report, the Ministry of health.
The Ministry of finance, in cooperation with the Ministry of health review, synthesize the Prime financial planning decisions.
2. The base financial plan to be delivered by the Prime Minister, General Director of the Vietnam social insurance decisions estimation of incomes and expenses for units made.
Article 15. Responsible for managing the health insurance fund 1. Social insurance in Vietnam made the collection, management, and the health insurance funds according to provisions of the law.
2. social insurance for Vietnam is to open deposit accounts the health insurance fund in the State Treasury system and the State's commercial bank. The balance on deposit account are entitled to interest under the provisions of the State Treasury and State commercial bank.
Chapter IV the TERMS OF IMPLEMENTATION of article 16. Transitional provisions 1. Continue to implement the regime of free examination and treatment for children under 6 years of age in the form of real, actual as stipulated in Decree No. 36/2005/ND-CP dated 17 March 2005 from the Government detailing the implementation of a number of articles of the law on protection, care and education of children until the decree to this effect.
2. in case of taking health insurance during the period from January 2009 until the decree to this effect, the following provisions of Decree No. 63/2005/ND-CP dated 16 May 2005, the Government issued the Charter for health insurance until December 31, 2009.
Article 17. Effect 1. The Decree has effect from 1 October 2009.
2. Abolition of Decree No. 63/2005/ND-CP dated 16 May 2005, the Government issued the Charter for health insurance and 18 Decree No. 36/2005/ND-CP dated 17 March 2005 from the Government detailing the implementation of a number of articles of the law on protection, care and education of children and other regulations about health insurance as opposed to Decree This theorem.
Article 18. Responsible for implementation guides

1. The Ministry of health, in collaboration with the Ministry of Finance shall guide the implementation of the provisions in the health insurance Law and decrees; issued the guidance documents on technical expertise and quality control for the medical facility, the cure for health insurance.
2. The Ministry of labour, invalids and Social Affairs research, build the criteria determining the access of poor households, households have average living standards the Prime. In 2009 the criteria determining the access of poor households follow the decision 117/2008/QD-TTg dated August 27, 2008 by the Prime Minister on the adjusted level of medical insurance premiums for the objects in the social policy area.
3. The other relevant ministries in the scope, duties and functions of their powers is responsible for guiding the implementation of this Decree.
Article 19. Responsibility of Ministers, heads of ministerial agencies, heads of government agencies, the Chairman of the provincial people's Committee, the central cities is responsible for the implementation of this Decree.