CIRCULAR guide modify, supplement a number of circular No. 21/2004/TTLT-BYT-BTC dated 27/7/2005 of the Ministry of health, Ministry of Finance shall guide the implementation of compulsory health insurance _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Charter base health insurance attached to Decree No. 63/2005/ND-CP dated 16/5/2005 of the Government;
To promote the results achieved and remove promptly the point stuck in the process of implementing settlement costs patients health insurance, contact the Ministry of health and finance guide modify, supplement a number of circular No. 21/2004/TTLT-BYT-BTC dated 27/7/2005 of the Ministry of health-guidelines financial health insurance getting started bound as follows: i. CONTENT MODIFICATION, Supplement 1. Removal of content "temporary HEALTH INSURANCE at closing Rate is 50,000 VND/person/year" of points 11 and 12, section I, part i. 2. Supplement 15 points in section I, part I, as follows: "15. Health insurance rates for objects specified in points 11 and 12 as the level of annual State budget arranged the genus treatment for subjects because the approval authority ".
3. Modify, Supplement details a, point 3, section II, section III, as follows: "a. quarterly, social insurance agencies responsible provincial general situation use the Foundation treatment of the previous quarter of the treatment facility to regulate and timely payment of examination fees , healing for the basis of examination and treatment. In the case of examination and treatment Fund deficit the social security report Vietnam to resolve ".
4. Removal of content "-the agency responsible for advance BHXH basis a minimum funding for EXAMINATION by 80% of the money spent on KCB has been your settlement before, when the two sides balanced settlement and clearing BHXH do advance forward for the following Quarter. To the end of the year, in November, the agency responsible for BHXH advance funding to MEDICAL facility actively buy drugs, medical supplies serving the sick years later "(last paragraph of b, point 1.1, section II, part IV).
5. additional details on the point 1.1, item II c, part IV: "c) settlement term examination and treatment costs for health insurance:-quarterly, before the day of the first month following quarter, basis of examination and treatment costs, General healing practice with regard to the patient's health insurance of the previous quarter has to be the social insurance agency inspections , the social insurance agency sent to settlement.
-General report base costs, healing practice of examination and treatment facility and the expenses of sick people in emergency cases, transfer institution ... has been assessed, the social insurance agency is responsible for the billing and settlement costs of examination and treatment for the base visit slow healing, for after 25 days from the last day of the quarter. At the same time, based on settlement data between the two parties, the social insurance agency has the responsibility to advance treatment facility a minimum budget by 80% of the costs of examination and treatment prescribed reality was social insurance agency assessment of the previous quarter.
-In the case of settlement fund beyond actual treatment was delivered, the social insurance agency, the city made regulating the Fund resources are used within the province, city to pay for additional clinical facility, the slowest after 35 days from the last day of the quarter. Fund clinical cases are used by local not enough to pay the social insurance State social insurance report Vietnam to regulate.
-Periodic social insurance for six months, Vietnam made more timely medical insurance Fund for local payment for examination. Case reserve fund is no longer the ability to regulate the provisional implementation as specified in DD, point 1, section II, section III of the circular No. 21/2004/TTLT-BYT-BTC dated 27/7/2005, and reported The contact to resolve ".
The entire process is illustrated in the following example: suppose the first quarter of 2007, the hospital X in Y get clinical, outpatient treatment with the Fund was temporarily assigned as the 100 million dong (A). Costs of examination and treatment practice in the patient's medical insurance card at a hospital were two sides, unity is 70 million (B) and costs for emergency cases, transfer institution ... at the basis of treatment other than the hospital X is 40 million VND (C). The Foundation examination and treatment was given the rest of the hospital X will be A-C = 100 million-40 million VND = 60 million (D). In this case the hospital cost X (B = 70 million) larger than the Foundation examination and treatment assigned rest (D = 60 million) after subtracting costs of examination and treatment in the glands, thus: the costs exceeded the Fund's B-D = 70 million-60 million = 10 million (E) will be the social insurance agency paid the balance after additional consultation Funds treatment in the province. In the case of the Foundation treatment of the not enough to regulate the social insurance agency in the social insurance report Vietnam to have the General moderator (if available).
The amount of the social insurance agency in the next advance for hospital X to ensure the examination for the second quarter of 2007 will be: B x 80% = 70 million x 80% = 56 million.
(Also similarly to define, settlement and advance to the hospital in the next quarter)
II. ENFORCEMENT of the PROVISIONS of this circular in force enforced after 15 days from the date The report. The previous provisions to the contrary set forth in this circular are repealed.
In the process, if there are difficult obstacles suggest reflection on the Minister to consider, resolve./.