Joint Circular No. 06/2007/TTLT-BYT-BTC guiding the implementation of voluntary health insurance

1. JOINT CIRCULAR

Guidelines for Implementing Voluntary Health Insurance

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Pursuant to Decree No. 63/2005/NĐ-CP dated May 16, 2005 of the Government promulgating the Health Insurance Regulations;

The Ministry of Health and the Ministry of Finance guide the implementation of voluntary health insurance as follows:

I. SCOPE, OBJECTS AND CONDITIONS FOR IMPLEMENTING VOLUNTARY HEALTH INSURANCE

Thông tư này quy định chi tiết khoản 4 Điều 38 Luật Thủy sản số 18/2017/QH14 đã được sửa đổi, bổ sung tại điểm c khoản 21 Điều 14 Luật số 146/2025/QH15.

This Circular guides the implementation of Health Insurance (HI) for voluntary outpatient and inpatient medical services.

Thông tư này áp dụng đối với tổ chức, cá nhân có liên quan đến hoạt động kinh doanh đối tượng thủy sản nuôi chủ lực trên lãnh thổ Việt Nam.

Voluntary health insurance applies to Vietnamese citizens (excluding those who already have mandatory health insurance cards under the Health Insurance Regulations issued together with Decree No. 63/2005/NĐ-CP dated May 16, 2005 of the Government and children under six years old), specifically as follows:

a) Members of a household, including those listed in the household registration book and living together in the same family; in cases where they are not listed in the household registration book but have registered temporary residence for at least one year and live together in the same household, they may join the household if there is a need.

b) Students and trainees currently studying at educational institutions within the national education system.

c) Population, family, and child officers at communes, wards, and towns (referred to collectively as commune level) pursuant to Decision No. 240/2006/QĐ-TTg dated October 24, 2006 of the Prime Minister on implementing voluntary health insurance for population, family, and child officers at commune level.

3. Conditions for Implementation

a) For household members: Implementation shall be carried out at the commune level when the following conditions are met:

- All members of the household specified in point a, Clause 2, Section 2 herein participate (except those participating in mandatory health insurance, voluntary health insurance under other groups of objects prescribed in this Circular, and children under six years old);

- Each issuance period must have at least 10% of households in the commune's jurisdiction participating (excluding households that are required to participate in mandatory health insurance). Households that have previously participated in voluntary health insurance and continue to participate are not subject to the ratio stipulated in this clause.

b) For students and trainees: Implementation shall be carried out at the school level provided that at least 10% of students and trainees listed in the school's student roster participate (excluding students and trainees participating in mandatory health insurance or voluntary health insurance under other groups of objects prescribed in this Circular).

II. FRAMEWORK OF CONTRIBUTION AMOUNTS AND METHODS OF PAYMENT FOR VOLUNTARY HEALTH INSURANCE

1. Framework of Contribution Amounts

a) The framework of contribution amounts for voluntary health insurance is defined according to region and group of objects as follows:

Unit of measurement: VND/person/year

- Urban areas include wards in cities and towns; rural areas include all remaining regions.

- The contribution amount for population, family, and child officers at commune level: implemented according to the provisions in Decision No. 240/2006/QĐ-TTg dated October 24, 2006 of the Prime Minister.

b) Based on the framework of contribution amounts for voluntary health insurance stipulated in point a, Clause 1, Section 2 herein, the Vietnam Social Security Organization shall specify the specific contribution amounts for each region and group of objects for each province and centrally-administered city based on the proposal of the provincial and centrally-administered city social security organizations, taking into account economic and social conditions, hospital fees, and the use of medical services by residents in each locality.

c) Reduction in contribution amounts for voluntary health insurance for households with many members participating: Households with three or more members participating in voluntary health insurance will see the third member's contribution reduced by 10% according to the regulations; from the fourth member onwards, each member's contribution will be reduced by 20% according to the regulations.

d) In cases where students and trainees enrolled in schools do not participate in health insurance through their school but instead participate through their household, they will be subject to the contribution amount for students and trainees and enjoy benefits as if they were students and trainees.

2. Methods of Collection and Payment for Voluntary Health Insurance

a) The collection and payment of voluntary health insurance contributions shall be conducted as follows:

- Household members: Pay health insurance contributions annually, semi-annually, or quarterly.

- Students and trainees: Pay health insurance contributions once or twice a year or for the entire duration of their studies.

b) The social security agency shall organize a system for collecting health insurance contributions and issuing health insurance cards to voluntary health insurance participants with a minimum validity period of six months, ensuring convenience, timeliness, safety, and compliance with regulations.

c) Support for voluntary health insurance contributions: Provincial People's Committees shall balance within local government budgets and mobilize contributions from agencies, organizations, and individuals to support the contribution amounts for voluntary health insurance for local residents, particularly those near poverty, to promote voluntary health insurance participation among residents. The provincial People's Committee shall submit proposals on the objects and support levels appropriate to the budget balancing capacity of the locality to the provincial People's Council for approval.

III. SCOPE OF RIGHTS AND BENEFITS FOR VOLUNTARY HEALTH INSURANCE PARTICIPANTS

1. Rights of Participants in Voluntary Health Insurance

a) Participants in voluntary health insurance shall be issued a health insurance card for medical treatment and shall enjoy rights and benefits as prescribed in this Circular, specifically:

- The health insurance card becomes valid and eligible for benefits as prescribed thirty days after payment of health insurance premiums for first-time participants or those rejoining after a break for any reason, except for high-cost technical services, maternity care, childbirth, and cancer treatment drugs, organ transplant rejection prevention drugs outside the list prescribed by the Ministry of Health, which are regulated as follows:

+ The health insurance card becomes valid and eligible for benefits for high-cost technical services thirty days after payment of health insurance premiums for first-time participants or those rejoining after a break for any reason.

+ The health insurance card becomes valid and eligible for maternity care and childbirth benefits ninety days after payment of health insurance premiums for first-time participants or those rejoining after a break for any reason.

+ Patients with health insurance cards who have continuously participated for at least 36 months, from the 37th month onwards, when using cancer treatment drugs and anti-rejection drugs outside the list prescribed by the Ministry of Health but permitted to circulate in Vietnam shall be reimbursed 50% of the costs of these drugs by the Social Insurance Authority..

- The health insurance card remains valid for continuous use upon payment of health insurance premiums as prescribed.

b) Individuals with health insurance cards when receiving outpatient and inpatient care at public and non-public healthcare facilities (hereinafter referred to as health insurance healthcare facilities) shall be reimbursed by the Social Insurance Authority for the following services:

- Medical examination, diagnosis, treatment, and rehabilitation during the treatment period at healthcare facilities (in accordance with the list prescribed by the Ministry of Health);

- Laboratory tests, imaging diagnostics, functional examinations;

- Medicines and intravenous fluids according to the list prescribed by the Ministry of Health;

- Blood and blood products;

- Surgical procedures and medical interventions;

- Maternity care and childbirth;

- Use of medical supplies, equipment, and hospital beds.

c) Voluntary health insurance participants when receiving care at the initially registered healthcare facility and at other healthcare facilities introduced according to the appropriate level of specialized technical expertise as prescribed by the Ministry of Health, and in emergency situations at health insurance healthcare facilities, shall be reimbursed by the Social Insurance Authority for the services specified in point b, clause 1 of this section at the current state hospital fee rates, specifically:

c.1. Outpatient medical examination and treatment:

+ Reimbursement of 100% of costs when the cost is under VND 100,000 (one hundred thousand dong) for one outpatient medical examination and treatment session;

+ Reimbursement of 80% of outpatient medical examination and treatment costs when the cost is VND 100,000 (one hundred thousand dong) or more; the remaining portion is to be paid by the patient to the healthcare facility.

c.2. Inpatient medical examination and treatment:

+ Reimbursement of 80% of inpatient medical examination and treatment costs; the remaining portion is to be paid by the patient to the healthcare facility.

d) In cases where high-cost advanced medical services (according to the list issued by the Ministry of Health after coordination with the Ministry of Finance) are used, the Social Insurance Authority shall reimburse 80% of the costs but not exceeding VND 20,000,000 (twenty million dong) for one use of such service; the remaining portion is to be paid by the patient to the healthcare facility.

đ) Voluntary health insurance participants when receiving care based on personal requests, at healthcare facilities that have not signed health insurance care contracts, or at foreign healthcare facilities, shall be reimbursed by the Social Insurance Authority based on actual costs according to the ratios specified in points c and d of this clause but not exceeding the limits set out in the Appendix of this Circular.

e) For students: When participating in voluntary health insurance, in addition to the benefits of medical care stipulated in points c and đ of this clause, they also enjoy initial health care services at school health centers as currently regulated. In case of death, a compensation of VND 1,000,000 (one million dong) shall be provided.

2. Cases Not Covered by the Social Insurance Authority

a) Treatment of leprosy;

b) Specific drugs for treating diseases such as tuberculosis, malaria, schizophrenia, epilepsy, HIV/AIDS, and other diseases if already covered by the state budget through national health programs, projects, or other funding sources;

c) Diagnosis and treatment of gonorrhea and syphilis;

d) Vaccination, convalescence, early pregnancy testing, general health check-ups including regular health check-ups (except for health check-ups at schools for students and pupils ;)employment health checks, university admission health checks, military service recruitment health checks; family planning services and infertility treatments;

đ) Aesthetic services, prosthetic limbs, artificial eyes, dentures, glasses, hearing aids;

e) Treatment of occupational diseases, war injuries, and disaster-related illnesses;

g) Treatment of cases involving suicide, intentional injury, drug addiction, other substance abuse, and injuries caused by illegal acts;

h) Costs associated with medical examinations, forensic medicine, and forensic psychiatric examinations;

i) Medical care, rehabilitation, and childbirth at home;

k) Use of drugs not listed (except for cancer treatment drugs and anti-rejection drugs outside the list prescribed by the Ministry of Health but permitted to circulate in Vietnam as stipulated in point a, clause 1, Section III), drugs requested by patients individually, unapproved medical methods by the Ministry of Health, and participation in research and clinical trials.

IV. MANAGEMENT AND USE OF VOLUNTARY HEALTH INSURANCE FUNDS

1. The voluntary health insurance fund is formed from the following sources:

a) Premium payments for voluntary health insurance made by participants;

b) State budget support;

c) Funds from agencies, sponsorships, and donations from domestic and international organizations and individuals;

d) Income generated from implementing measures to preserve and increase the voluntary health insurance fund.

đ) Other lawful revenues (if any).

2. The voluntary health insurance fund is managed centrally, uniformly, democratically, and transparently according to the current financial management regulations for the Social Insurance of Vietnam. Any temporarily unused funds (if any) of the voluntary health insurance fund shall be mobilized to implement measures to preserve and increase the fund as prescribed.

3. Allocation and Management of the Voluntary Health Insurance Fund

a) The income from voluntary health insurance premiums as stipulated in points a, b, and c of clause 1 of this section, within the planned year, shall be allocated and used as follows:

- 87% to establish the voluntary health insurance care fund;

- 2% to establish the voluntary health insurance care reserve fund;

- 8% reserved for coordinating activities, organizing premium collection, issuing voluntary health insurance cards, and supporting healthcare facilities to organize hospital fee collection and settle medical care expenses for voluntary health insurance patients;

- 3% reserved for training agents, supplementing promotional work, rewarding, and enhancing staff capabilities.

b) The income stipulated in points d and đ of clause 1 of this section (if any) shall be recorded in the voluntary health insurance care reserve fund.

4. The voluntary health insurance care fund shall be used to reimburse outpatient and inpatient care costs, care based on personal requests, initial health care costs at school, and death benefit payments for students and pupils as stipulated in this Circular.

5. Health Insurance Medical Care Fund Regulation

a) The Vietnam Social Security is responsible for allocating and regulating the amount collected to be used in the year for social security insurance in provinces and centrally governed cities, ensuring payment for voluntary health insurance medical expenses.

b) Any surplus from the annual medical care fund for voluntary health insurance will be transferred to the reserve fund for voluntary health insurance medical care.

c) If the expenditure on voluntary health insurance medical care exceeds the voluntary health insurance medical care fund available for use in the year, the Vietnam Social Security may use funds from the reserve fund for voluntary health insurance medical care or the reserve fund for mandatory health insurance medical care, or other sources as prescribed, to ensure full and timely payment of benefits to eligible recipients as stipulated.

6. The voluntary health insurance fund shall be recorded, statistically reported, and accounted for according to the current accounting regulations.

V. ORGANIZATION OF MEDICAL EXAMINATIONS, TREATMENTS AND PAYMENT OF MEDICAL EXPENSES FOR VOLUNTARY HEALTH INSURANCE

1. Organization of medical examinations and treatments

The organization of medical care for voluntary health insurance participants shall be carried out in accordance with the joint circular of the Ministry of Health and the Ministry of Finance regarding mandatory health insurance. Additionally, for students and trainees, the social security agency has the responsibility to guide and coordinate with schools and local healthcare facilities to implement medical care and payment of medical expenses for students and trainees with health insurance cards during periods of authorized leave, ensuring full rights and convenience for the beneficiaries.

2. Payment of medical examination and treatment expenses between the social security agency and healthcare facilities:

a) Principles:

- The social security agency pays medical care expenses to healthcare facilities based on the medical care health insurance contract for cases of appropriate medical care within the scope of technical expertise and emergency cases.

- Healthcare facilities select the payment method according to the joint circular of the Ministry of Health and the Ministry of Finance guiding the implementation of mandatory health insurance.

- The social security agency and healthcare facilities only enter into a single medical care health insurance contract covering both mandatory and voluntary health insurance participants.

b) Method of determining the temporary medical care health insurance fund for voluntary health insurance to contract with healthcare facilities:

- For household members: The medical care health insurance fund for voluntary health insurance is calculated based on the number of initial registration medical care cards at the healthcare facility and the average fee of voluntary health insurance participants in the household member category in the locality.

- For students and trainees: The medical care health insurance fund for voluntary health insurance is calculated based on the number of registration cards at the average fee of voluntary health insurance participants among students and trainees in the locality. Twenty percent of the medical care health insurance fund for students and trainees is allocated for primary health care activities at schools; eighty percent of the remaining medical care health insurance fund serves as the basis for determining the temporary fund when signing a contract with healthcare facilities and for death allowances.

c) Payment between the social security agency and schools that undertake primary health care responsibilities for students and trainees:

The budget for primary health care at schools is twenty percent of the medical care health insurance fund for voluntary health insurance calculated based on the voluntary health insurance revenue of students and trainees in the school. This amount is transferred to the school for management, use, and settlement according to current regulations, while reporting the results of use to the social security agency.

3. Direct payment between the social security agency and patients holding voluntary health insurance cards:

a) The social security agency only makes direct payments to voluntary health insurance participants for medical care under the following circumstances:

- Medical care exceeding the scope of technical expertise as defined by the Ministry of Health.

- Medical care at healthcare facilities not contracted for health insurance medical care.

- Medical care abroad.

b) In the cases specified in point a above, patients must pay the medical care expenses directly to the healthcare facility, while retaining all valid documentation (prescriptions, medical records, drug purchase receipts, discharge papers, hospital fee receipts as prescribed by the Ministry of Finance, and related documents) as the basis for the social security agency to reimburse part of the medical care expenses according to point d, Clause 1, Section III of this Circular.

c) In the case of student or trainee death, the social security agency pays a death allowance to the relatives of the student or trainee.

VI. RIGHTS AND RESPONSIBILITIES OF THE SOCIAL SECURITY AGENCY AND HEALTHCARE FACILITIES

1. Rights and responsibilities of the social security agency and healthcare facilities in implementing voluntary health insurance:

The social security agency and healthcare facilities have the responsibility to fulfill their obligations and rights as prescribed in the Health Insurance Charter and the joint circular of the Ministry of Health and the Ministry of Finance on the implementation of mandatory health insurance.

2. In addition, within its scope of responsibility, the social security agency shall perform the following tasks:

a) Implementing information dissemination, promotional, and training activities for agents to expand the pool of voluntary health insurance participants.

b) Developing inter-ministerial cooperation plans to implement voluntary health insurance for various groups.

c) Efficiently allocating and utilizing operational funds, enhancing activities aimed at developing and expanding voluntary health insurance.

d) When the voluntary health insurance contribution rate reaches the maximum level set by the joint ministries and the medical care health insurance fund for voluntary health insurance has less income than expenditure, the Vietnam Social Security shall report to the joint ministries of Health and Finance for consideration and resolution.

VII. IMPLEMENTATION PROVISIONS

1. This Circular takes effect fifteen days after its publication in the Official Gazette and replaces Circular Joint No. 22/2005/TTLT-BYT-BTC dated August 24, 2005, issued by the joint ministries of Health and Finance, guiding the implementation of voluntary health insurance.

2. Participants in voluntary health insurance who joined before this Circular takes effect and whose health insurance cards are still valid shall continue to enjoy health insurance benefits as stipulated in Circular Joint No. 22/2005/TTLT-BYT-BTC dated August 24, 2005, issued by the joint ministries of Health and Finance, guiding the implementation of voluntary health insurance until the expiration date indicated on the card.

During the implementation process, if there are difficulties or obstacles, units are advised to report them to the joint ministries for consideration and resolution./.