JOINT CIRCULAR NO. 03/2012/TTLT-BQP-BYT-BTC GUIDING THE IMPLEMENTATION OF HEALTH INSURANCE FOR PERSONNEL IN ORGANIZATIONS WITH SPECIAL SECURITY MEASURES AND THEIR DEPENDENTS

JOINT CIRCULAR

Guidelines for Implementing Health Insurance for Personnel Other Than Core Work in Confidential Organizations and Family Members of Core Work Personnel

__________________________

Pursuant to the Health Insurance Law dated November 14, 2008;

Pursuant to Decree No. 62/2009/NĐ-CP dated July 27, 2009 of the Government detailing and guiding the implementation of certain provisions of the Health Insurance Law;

Pursuant to Decree No. 60/2003/NĐ-CP dated June 6, 2003, promulgated by the Government detailing and guiding the implementation of the Law on State Budget;

The Ministry of National Defense, the Ministry of Health, and the Ministry of Finance provide guidelines for implementing health insurance (hereinafter referred to as BHYT) for personnel other than core work in confidential organizations and family members of core work personnel as follows:

PART I

OBJECTS, CONTRIBUTION LEVELS, RESPONSIBILITIES AND METHODS OF CONTRIBUTION, HEALTH INSURANCE BENEFIT LEVELS

Article 1. Scope of application

1. Personnel other than core work in confidential organizations working in agencies, units, enterprises, public service units (hereinafter collectively referred to as employing units) participating in BHYT include:

a) Personnel other than core work in confidential organizations classified under civil servant or public official ranks and grades and receiving national defense and security service allowances;

b) Contract workers within the authorized staffing quota receiving state budget salaries;

c) Contract workers outside the scope specified in Point b of this Clause working under indefinite-term contracts or fixed-term contracts of at least three months according to labor laws.

2. Personnel other than core work in confidential organizations as stipulated in Clause 1 of this Article who have ceased work and are currently receiving sickness benefits under social insurance laws due to diseases listed in the long-term treatment directory issued by the Ministry of Health.

3. Family members of core work personnel (excluding those eligible for BHYT under other categories of insured persons) as defined in Point c, Clause 16, Article 12 of the Health Insurance Law (hereinafter collectively referred to as family members), including:

a) Biological father, biological mother; father-in-law, mother-in-law, father-in-law, mother-in-law; legally recognized foster parents of the individual, spouse, including elderly individuals under social welfare protection;

b) Spouse;

c) Legitimate children, legally adopted children under 18 years old; legitimate children, legally adopted children over 18 years old but disabled and unable to work as prescribed by law.

Article 2. Contribution Levels and Responsibilities for Health Insurance Contributions

1. Objects as stipulated in Clause 1, Article 1 of this Joint Circular: Contribute at 4.5% of the monthly salary or wage of the worker, with the employer contributing two-thirds and the worker contributing one-third. The Government Office of Confidential Affairs shall implement BHYT contributions for objects as stipulated in Clause 1, Article 1 of this Joint Circular and family members of core work personnel at the Government Office of Confidential Affairs with the Social Insurance Department of the Ministry of National Defense.

During the period when workers are on maternity leave or caring for a child under four months old according to social insurance laws, workers and employing units are not required to contribute to BHYT but are still counted towards continuous BHYT participation to enjoy BHYT benefits.

2. Objects as stipulated in Clause 2, Article 1 of this Joint Circular: Contribute at 4.5% of the general minimum wage and be guaranteed by the Vietnam Social Security. Based on the list of objects proposed by the units, the Vietnam Social Security issues health insurance cards for these objects.

3. Objects as stipulated in Clause 3, Article 1 of this Joint Circular: Contribute at 4.5% of the general minimum wage and be guaranteed by the state budget annually according to the annual budget estimate of the Government Office of Confidential Affairs (for family members of core work personnel at the Government Office of Confidential Affairs) and the annual budget estimate of ministries, sectors, and localities (for family members of core work personnel at ministries, sectors, and localities). Agencies and units under ministries, sectors, and localities with confidential organizations shall make BHYT contributions for family members of core work personnel to the local social insurance department.

Article 3. Level of Health Insurance Benefits

1. The scope of benefits and level of enjoyment for individuals participating in Health Insurance as stipulated in Article 1 of this Joint Circular shall be implemented according to the provisions of the Health Insurance Law, Decree No. 62/2009/NĐ-CP dated July 27, 2009 of the Government detailing and guiding the implementation of certain articles of the Health Insurance Law, and other guidance documents applicable to each group of beneficiaries.

2. Individuals participating in Health Insurance as stipulated in Article 1 of this Joint Circular, when seeking medical examination and treatment at a facility not registered as their initial health insurance examination and treatment facility or not following the specialized technical levels prescribed by the Minister of Health (except in emergency cases), shall be reimbursed by the Health Insurance Fund for medical examination and treatment costs within the scope of benefits specified in Article 21 of the Health Insurance Law, as follows:

a) 70% of the cost for cases of medical examination and treatment at facilities meeting the standard of Class III and not exceeding 40 months of the national minimum wage for each high-cost, high-technology service usage;

b) 50% of the cost for cases of medical examination and treatment at facilities meeting the standard of Class II and not exceeding 40 months of the national minimum wage for each high-cost, high-technology service usage;

c) 30% of the cost for cases of medical examination and treatment at facilities meeting the standard of Class I and Special Class and not exceeding 40 months of the national minimum wage for each high-cost, high-technology service usage.

3. Individuals participating in Health Insurance who seek medical examination and treatment at health insurance examination and treatment facilities or abroad shall follow the provisions set out in Articles 8 and 9 of Joint Circular No. 09/2009/TTLT-BYT-BTC dated August 14, 2009 issued by the Ministry of Health and the Ministry of Finance guiding the implementation of Health Insurance (hereinafter referred to as Joint Circular No. 09/2009/TTLT-BYT-BTC). Rehabilitation treatment benefits shall be implemented according to the provisions of Circular No. 11/2009/TT-BYT dated August 14, 2009 of the Ministry of Health on the list of rehabilitation technical services and average number of days for a treatment course for certain diseases and disease groups covered by the Health Insurance Fund reimbursement. Early screening diagnostic benefits for certain diseases shall be implemented according to the guidelines of the Ministry of Health.

4. Beneficiaries participating in Health Insurance as stipulated in Article 1 of this Joint Circular, if they belong to multiple benefit levels, shall be issued a Health Insurance card with the highest benefit level.

5. The Health Insurance Fund will not reimburse in the following cases:

a) Cases stipulated in Article 23 of the Health Insurance Law;

b) Treatment of work-related accidents where the payment cost falls under the responsibility of the employer according to the Labor Code.

Chapter II

HEALTH INSURANCE CARD

Article 4. Issuance of Health Insurance Cards

1. The Social Insurance of the Ministry of National Defense shall print and issue Health Insurance cards for personnel working in confidential organizations and relatives of personnel working in confidential positions at the Confidential Service Management Board of the Government.

2. Local Social Insurances shall implement the printing and issuance of Health Insurance cards for relatives of personnel working in confidential positions at various Ministries, sectors, and localities.

3. Timeframe for issuing Health Insurance cards:

a) In October each year: The Confidential Service Management Board of the Government shall guide the declaration, review, consolidation, and submission of lists to the Social Insurance of the Ministry of National Defense; management agencies of personnel working in confidential positions at various Ministries, sectors, and localities shall guide the declaration, consolidation, and submission of lists to local Social Insurances; beneficiaries shall receive their Health Insurance cards before December 31 and enjoy Health Insurance benefits from January 1 of the following year;

b) Within the first 15 days of the last month of each quarter: The Confidential Service Management Board of the Government shall guide supplementary declarations, reviews, consolidations, and submissions of lists to the Social Insurance of the Ministry of National Defense; management agencies of personnel working in confidential positions at various Ministries, sectors, and localities shall guide declarations, consolidations, and submissions of lists to local Social Insurances; beneficiaries shall receive their Health Insurance cards before the end of that month and enjoy Health Insurance benefits from the first day of the following month;

c) The beneficiary code and benefit code for Health Insurance participants shall be implemented according to the guidelines of the Vietnam Social Security.

Article 5. Duration of Health Insurance Card Usage

The duration of using the Health Insurance Card (BHYT) for subjects managed by the Government Cryptographic Agency and their dependents is specified as follows:

1. Twelve (12) months for subjects specified in Point c Clause 1 and Clause 2, Article 1 of this Joint Circular.

2. Twenty-four (24) months for subjects specified in Points a and b Clause 1, Article 1 and Clause 3, Article 1 of this Joint Circular. For children under six years old, the BHYT card remains valid until the child reaches seventy-two (72) months of age.

Article 6. Documents for Issuing Health Insurance Cards

1. A declaration form of workers entitled to health insurance benefits, confirmed by the personnel management agency.

2. A declaration form of cryptographic workers regarding the situation of dependents eligible for health insurance benefits, confirmed by the personnel management agency.

3. A list of requests for issuing BHYT cards for workers or dependents signed and stamped by the direct supervisor.

Article 7. Procedure for Issuing Health Insurance Cards

1. The Government Cryptographic Agency shall submit a request for issuing BHYT cards along with a CD containing data to the Social Insurance Department of the Ministry of National Defense.

2. Agencies managing cryptographic workers at ministries, sectors, and localities shall submit a request for issuing BHYT cards along with a CD containing data to the local Social Insurance Department.

3. The Social Insurance Department of the Ministry of National Defense shall implement printing and issuing BHYT cards for subjects managed by the Government Cryptographic Agency and dependents of cryptographic workers at the Government Cryptographic Agency according to Article 4 of this Joint Circular.

4. The local Social Insurance Department shall implement printing and issuing BHYT cards for dependents of cryptographic workers at ministries, sectors, and localities according to Article 4 of this Joint Circular.

Article 8. Reissuing and Exchanging Health Insurance Cards

1. Reissuing and exchanging BHYT cards shall be carried out as follows:

a) Reissue the BHYT card in case it is lost;

b) Exchange the BHYT card in cases where the card is torn, damaged, or faulty; or when changing the initial healthcare registration; or when the information on the card is incorrect.

2. Documents and procedures for reissuing and exchanging BHYT cards:

a) The person receiving the BHYT card must submit a request for reissuing or exchanging the BHYT card, confirmed by the supervisor of the worker or cryptographic worker;

b) The procedures for reissuing and exchanging BHYT cards shall be carried out similarly to the first issuance:

The Government Cryptographic Agency shall submit a request along with a list and the old BHYT card (except in cases of loss) to the Social Insurance Department of the Ministry of National Defense; the agency managing cryptographic workers shall submit a request along with a list and the old BHYT card (except in cases of loss) to the local Social Insurance Department;

Within seven working days from the date of receipt of all required documents as stipulated in Clause 2 of this Article, the Social Insurance Department of the Ministry of National Defense and the local Social Insurance Department shall reissue the BHYT card; during the waiting period for reissuance or exchange, the holder still enjoys the rights of a health insurance participant;

Exchanging the BHYT card due to changes in the initial healthcare registration shall be carried out in the last fifteen days of the last month of each quarter. In cases of reissuance due to loss of the BHYT card, the information cannot be changed compared to the first issued card.

3. The person receiving a reissued or exchanged BHYT card must pay fees as prescribed in Circular No. 19/2010/TT-BTC dated February 3, 2010, of the Ministry of Finance, which stipulates the levels of collection, payment, management, and use of fees for reissuing and exchanging BHYT cards.

4. In cases where the BHYT card is left behind at a healthcare facility by the cardholder, the reissuance and fee collection for reissuing the card shall be guided by the Vietnam Social Insurance.

Article 9. Responsibilities of individuals in the declaration, acceptance, and use of health insurance cards

1. For employees:

a) Declare their personal situation eligible for health insurance benefits according to Model 01 issued together with this Circular, based on their identity card or other photo identification; choose and register the initial healthcare facility for health insurance services as stipulated in Article 11 of this Circular and bear responsibility for the truthfulness of the declaration;

b) When receiving the card, check and compare the information recorded on the card; if it is incorrect, return the card to the General Office of the Government to have the Ministry of Defense Social Insurance issue a new card according to regulations;

c) Shall fulfill all obligations of health insurance participants as prescribed in Article 37 of the Health Insurance Law; have the right to request social insurance organizations, health insurance service facilities, and related agencies to explain and provide information about health insurance benefits; have the right to lodge complaints and denunciations against violations of health insurance laws.

2. For those engaged in confidential work:

a) Accurately declare the situation of eligible dependents for health insurance benefits according to Models 02A and 02B issued together with this Circular, based on the identity card or other photo identification of the dependents; choose and register the initial healthcare facility for health insurance services as stipulated in Article 11 of this Circular and bear responsibility for the truthfulness of the declaration;

b) In cases where the dependent is of two or more persons engaged in confidential work, the declaration shall be made as follows:

The dependent who shares the same household registration with the person shall be responsible for declaring; if not sharing the same household registration, the person responsible for declaring shall be prioritized in the following order: son, daughter, daughter-in-law, son-in-law, legally adopted child (if in the same generation, the eldest child shall declare);

If both father and mother are engaged in confidential work, the mother shall be responsible for declaring for the children;

If not following the above order, the person with favorable conditions shall declare, but must report the reasons clearly and bear responsibility for the declaration, confirmed by the Head of the managing unit;

c) Upon receiving the health insurance card, check and compare the information recorded on the card; if correct, send the card to the dependent, if incorrect, return the card to have it transferred back to the Ministry of Defense Social Insurance or local Social Insurance;

d) Shall report to the Unit Head on the results of sending the health insurance card, changes in the dependent's situation, and the dependent's medical examination and treatment at healthcare facilities.

3. For dependents of those engaged in confidential work:

Shall fulfill all obligations of health insurance participants as prescribed in Article 37 of the Health Insurance Law; have the right to request social insurance organizations, health insurance service facilities, and related agencies to explain and provide information about health insurance benefits; have the right to lodge complaints and denunciations against violations of health insurance laws.

Article 10. Responsibilities of units managing personnel engaged in confidential work and employees

1. Implement and organize health insurance for employees managed by the unit and their dependents:

a) Guide the declaration process, registration of initial healthcare facilities for health insurance services, ensuring accuracy regarding beneficiaries, including factors such as surname, given name, middle name; date of birth; unit; place of residence; health insurance contribution salary or wage; initial healthcare facility for health insurance services;

b) Accept and deliver health insurance cards to employees and deliver health insurance cards to personnel engaged in confidential work to send to their dependents. In cases where personnel engaged in confidential work are located in remote areas, border regions, islands, the management agency of personnel engaged in confidential work shall be responsible for transferring the health insurance cards to the locality for delivery to the dependents.

2. Annually prepare a budget estimate for implementing health insurance for the managed subjects and their dependents according to the regulations of the health insurance law.

3. Pay health insurance contributions for employees and dependents in accordance with the provisions of the health insurance law.

4. Promote and disseminate policies and laws on health insurance to the managed subjects.

Chapter III

ORGANIZATION OF MEDICAL EXAMINATION AND TREATMENT AND PAYMENT OF MEDICAL EXPENSES

Article 11. Registration for initial medical examination and treatment

1. Persons participating in health insurance as stipulated in Article 1 of this Joint Circular, issued with health insurance cards by the Social Insurance under the Ministry of National Defense, shall register for initial health insurance medical examination and treatment as prescribed in Article 14 of Joint Circular No. 25/2010/TTLT-BQP-BYT-BTC dated March 5, 2010, guiding the management and implementation of health insurance for laborers in the military and dependents of active-duty military personnel by the Ministry of National Defense, the Ministry of Health, and the Ministry of Finance.

2. Subjects specified in Clause 3 of Article 1 of this Joint Circular, issued with health insurance cards by local social insurances, shall register for initial medical examination and treatment as prescribed for other subjects participating in health insurance at the locality according to Circular No. 10/2009/TT-BYT dated August 14, 2009, guiding the registration for initial medical examination and treatment and referral for health insurance medical examination and treatment (hereinafter referred to as Circular No. 10/2009/TT-BYT).

Article 12. Medical Examination and Treatment and Referral

1. Persons participating in health insurance, issued with health insurance cards by the Social Insurance under the Ministry of National Defense or local social insurances, shall undergo medical examination and treatment at the registered health insurance medical examination and treatment facility and be referred for medical examination and treatment according to the severity of their illness, within the scope of expertise of the nearest military and civilian medical facilities.

2. Referral for medical examination and treatment shall be carried out in accordance with the provisions of Article 8 of Circular No. 10/2009/TT-BYT.

3. The procedures for referral shall be carried out in accordance with the provisions of Article 9 of Circular No. 10/2009/TT-BYT.

Article 13. Advance Payment, Settlement, and Finalization of Medical Examination and Treatment Costs

1. The Social Insurance under the Ministry of National Defense and local social insurances shall carry out advance payment, settlement, and finalization of health insurance medical examination and treatment costs for the subjects specified in Article 1 of this Joint Circular with healthcare facilities as they would for other subjects managed by the Social Insurance under the Ministry of National Defense and local social insurances.

Advance payment, settlement, and finalization of medical examination and treatment costs between the Social Insurance under the Ministry of National Defense or local social insurances and healthcare facilities shall be carried out in accordance with Articles 15, 16, and 17 of Joint Circular No. 09/2009/TTLT-BYT-BTC.

2. In cases of direct payment:

a) For persons holding health insurance cards issued by the Social Insurance under the Ministry of National Defense, payment shall be made according to the guidelines of the Social Insurance under the Ministry of National Defense; for subjects holding health insurance cards issued by local social insurances, direct payment shall be made at the provincial or municipal social insurance office in accordance with Clause 2 and Clause 3 of Article 9 of Joint Circular No. 09/2010/TTLT-BYT-BTC;

b) The documentation and procedures for direct payment shall be carried out in accordance with the provisions of Article 19 of Joint Circular No. 09/2009/TTLT-BYT-BTC.

Chapter IV

IMPLEMENTATION

Article 14. Responsibilities of the Ministry of National Defense

1. Evaluation and summary of health insurance work for personnel working in confidential organizations and dependents of personnel working in confidential organizations.

2. Directing competent agencies under the Ministry of National Defense to organize the printing and provision of health insurance medical examination and treatment for personnel working in confidential organizations and dependents of personnel working in confidential organizations in accordance with the laws on health insurance.

3. The Government Confidential Service shall take the lead in coordinating with the Social Insurance under the Ministry of National Defense to implement the contents related to health insurance work for personnel working in confidential organizations and dependents of personnel working in confidential organizations at the Government Confidential Service in accordance with this Joint Circular.

Article 15. Responsibilities of Ministries, sectors, and localities directly managing personnel engaged in confidential work

1. Guide the preparation of registration forms for initial medical examination and treatment facilities for relatives of personnel currently engaged in confidential work as stipulated in this Joint Circular.

2. Annually, prepare the budget to pay health insurance premiums for relatives of personnel currently engaged in confidential work (both within the same working area and outside the working area) under their respective Ministries, sectors, and localities.

3. Receive health insurance cards for relatives of personnel currently engaged in confidential work under their respective Ministries, sectors, and localities (both within the same working area and outside the working area) and hand them over to the personnel engaged in confidential work to deliver to their relatives.

Article 16. Responsibilities of the Vietnam Social Security

Direct, guide, and inspect the Social Insurance of the Government Confidential Service; the Social Insurance of localities to implement health insurance for other personnel in confidential organizations and relatives of personnel currently engaged in confidential work in accordance with the organizational characteristics of the Confidential Service in compliance with the laws on health insurance.

Article 17. Implementation Provisions

1. This Joint Circular shall take effect from March 1, 2012.

2. Repeal Point 2.2, Point 2.4 Clause 2 Section I and Section III of Joint Circular No. 135/2007/TTLT-BQP-BYT-BTC dated September 5, 2007 issued by the Joint Ministries of National Defense, Health, and Finance guiding the implementation of certain provisions of Decree No. 153/2006/NĐ-CP dated December 22, 2006 of the Government on medical examination and treatment and material standards for medical supplies for personnel currently engaged in confidential work; mandatory health insurance for relatives of personnel currently engaged in confidential work.

3. In case of difficulties during the organization and implementation process, Ministries, sectors, and localities shall report to the Ministry of National Defense (through the Government Confidential Service) so that the Ministry of National Defense can coordinate with the Ministry of Health and the Ministry of Finance to consider and resolve the issues./.