JOINT CIRCULAR No. 09/2009/TTLT-BYT-BTC guiding the implementation of health insurance

JOINT CIRCULAR

Guidelines for Implementing Health Insurance

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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 Law on Health Insurance;

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

The Ministry of Health and the Ministry of Finance hereby issue guidelines for implementing certain provisions of the Law on Health Insurance and Decree No. 62/2009/NĐ-CP dated July 27, 2009 of the Government detailing and guiding the implementation of certain provisions of the Law on Health Insurance (hereinafter referred to as Decree No. 62/2009/NĐ-CP) as follows:

PART I

OBJECTS, CONTRIBUTION LEVELS AND RESPONSIBILITY FOR HEALTH INSURANCE CONTRIBUTIONS

Article 1. Objects participating in health insurance as stipulated in Article 12 of the Law on Health Insurance and Article 1 of Decree No. 62/2009/NĐ-CP

1. Workers, managers of enterprises, civil servants, and public officials as provided for in Clause 1 of Article 12 of the Law on Health Insurance (BHYT) include:

a) Workers, including foreign workers, working at the following organizations:

- Enterprises established and operating under the Enterprise Law and Investment Law;

- Cooperatives and cooperative unions established and operating under the Cooperative Law;

- State agencies, public service units, armed forces, political organizations, political-social organizations, political-social-professional organizations, and other social organizations;

- Foreign or international organizations in Vietnam, except where international treaties to which the Socialist Republic of Vietnam is a party provide otherwise;

- Other organizations employing labor that are established and operate in accordance with the law.

b) Civil servants as defined by laws on civil servants and public officials, including:

- Cadres elected, approved, or appointed to positions or titles during their term in Party and State agencies, central and local political-social organizations, within the establishment and receiving salaries from the state budget;

- Public officials recruited and appointed to ranks, positions, or titles in Party and State agencies at the central, provincial, and district levels; public officials who are not officers or professional military personnel; defense workers employed in agencies or units under the Ministry of National Defense; public officials who are not officers or professional non-commissioned officers working in agencies or units under the People's Public Security Force and in leadership and management bodies of public service establishments of the Party and State, central and local political-social organizations within the establishment and receiving salaries from the state budget;

- Village, town, and township cadres elected to positions during their term in the Standing Committee of the People's Council, People's Committee, Secretary, Deputy Secretary of the Party Committee, and heads of political-social organizations; village-level public officials recruited to hold specialized positions or roles in the People's Committee at the village level.

c) Non-professional staff members at villages, towns, and townships as defined by laws on civil servants and public officials.

2. Officers, non-commissioned officers in technical and professional fields, and non-commissioned officers and soldiers serving on fixed-term contracts in the People's Public Security Force.

3. Persons receiving monthly pension or disability benefits.

4. Persons currently receiving monthly social insurance benefits due to work-related accidents or occupational diseases.

5. Persons who have ceased receiving disability benefits and are now receiving monthly benefits from the state budget; rubber plantation workers who have stopped working and are now receiving monthly benefits according to Decision No. 206/CP dated May 30, 1979 of the Council of Ministers (now the Government).

6. Village, town, and township cadres who have retired and are now receiving monthly social insurance benefits.

7. Village, town, and township cadres who have retired and are now receiving monthly benefits from the state budget, including those specified in Decision No. 130/CP dated June 20, 1975 of the Council of Ministers (now the Government) and Decision No. 111/HĐBT dated October 13, 1981 of the Council of Ministers (now the Government).

8. Persons currently receiving unemployment benefits as stipulated by laws on unemployment insurance.

9. Persons with meritorious service to the revolution as defined by laws on preferential treatment for persons with meritorious service to the revolution.

10. Former combatants who participated in the resistance war before April 30, 1975 as stipulated in Clause 6 of Article 5 of Decree No. 150/2006/NĐ-CP dated December 12, 2006 of the Government detailing and guiding the implementation of certain provisions of the Ordinance on Former Combatants; young volunteers during the anti-French resistance war as stipulated in Decision No. 170/2008/QĐ-TTg dated December 18, 2008 of the Prime Minister regarding health insurance and funeral expenses for young volunteers during the anti-French resistance war.

11. Persons directly involved in the resistance war against the United States to save the country as defined in Decision No. 290/2005/QĐ-TTg dated November 8, 2005 of the Prime Minister on policies and benefits for certain individuals directly involved in the resistance war against the United States but not yet enjoying the policies of the Party and State, and Decision No. 188/2007/QĐ-TTg dated December 6, 2007 of the Prime Minister amending and supplementing Decision No. 290/2005/QĐ-TTg dated November 8, 2005 of the Prime Minister on policies and benefits for certain individuals directly involved in the resistance war against the United States but not yet enjoying the policies of the Party and State.

12. Current members of the National Assembly and People's Councils at all levels.

13. Persons eligible for monthly social assistance benefits as defined in Decree No. 67/2007/NĐ-CP dated April 13, 2007 of the Government guiding policies for assisting social welfare beneficiaries.

14. Members of poor households; ethnic minorities living in areas with difficult socio-economic conditions as defined by the Prime Minister.

15. Relatives of persons with meritorious service to the revolution as defined by laws on preferential treatment for persons with meritorious service to the revolution.

16. Relatives of the objects specified in point a, b, and c of Clause 16 of Article 12 of the Law on BHYT.

17. Children under six years old.

18. A person who has donated a human organ or tissue in accordance with the laws on donation, collection, transplantation of tissues and organs, and donation and collection of corpses.

19. Foreign students studying in Vietnam who are granted scholarships from the State budget of the Socialist Republic of Vietnam.

20. Members of households classified as near-poor households according to the Prime Minister's regulations.

21. Students enrolled at educational institutions within the national education system.

22. Members of households engaged in agriculture, forestry, fishery, and salt production.

23. Relatives of workers specified in Clause 1, Article 12 of the Health Insurance Law include: biological father, biological mother; father-in-law, mother-in-law, father, mother of spouse; adoptive father, adoptive mother, or legal guardian; spouse; biological child, legally adopted child whom the worker is responsible for supporting and living together in the same household.

24. Cooperative members and individual business households.

25. Workers who have stopped working and are currently receiving sickness benefits under the social insurance law due to long-term treatment illnesses listed in the Ministry of Health's regulations.

Article 2. Contribution levels, reduction in contribution levels, and determination of the amount of state budget support for health insurance contributions

1. The contribution levels, methods of payment, and responsibilities for health insurance contributions of the subjects shall be implemented in accordance with the provisions of Articles 13 and 14 of the Health Insurance Law and Articles 3, 4, 5, and 6 of Decree No. 62/2009/ND-CP.

2. For the subjects specified in Clauses 20, 21, 22, 23, and 24 of Article 1 of this Circular who have made health insurance contributions every six months or once for the entire year, when the state adjusts the minimum wage, they will not need to make up the difference in contributions due to the adjustment of the minimum wage.

3. Reduction in health insurance contribution levels as stipulated in Clause 6, Article 3 of Decree No. 62/2009/ND-CP:

a) Subjects specified in Clauses 20 and 22 of Article 1 of this Circular will have their health insurance contribution levels reduced if all individuals named in the household registration and living together in the same house participate in health insurance.

b) Subjects specified in Clause 23 of Article 1 of this Circular will have their health insurance contribution levels reduced if two or more relatives participate in health insurance.

4. Determining the level of support and the amount of state budget support when there is a reduction in health insurance contribution levels:

a) Based on local government budgets and funds raised from other sources, provincial People's Committees may decide to provide higher levels of financial support for health insurance contributions for these subjects than the minimum support level prescribed in Clause 5, Article 3 of Decree No. 62/2008/ND-CP.

b) In cases where individuals participating in health insurance receive partial financial support from the state for their health insurance contributions, the amount of state budget support will be calculated based on the specific contribution level of each individual in the household.

Example: Family A has three members belonging to a medium-income agricultural household, supported by the state at 30% of the contribution level. In 2010, all three members participated in health insurance and contributed collectively at a rate of 4.5% of the minimum wage (assuming the minimum wage at that time was 650,000 VND). The total amount that Family A had to contribute and the amount of state budget support for health insurance contributions for Family A in 2010 were determined as follows:

The total amount that Family A had to contribute was 663,390 VND, including:

- The first person's contribution at 4.5% of the minimum wage:

650,000 VND x 4.5% x 70% x 12 months = 245,700 VND

- The second person's contribution at 90% of the first person's contribution:

245,700 VND x 90% = 221,130 VND

- The third person's contribution at 80% of the first person's contribution:

245,700 VND x 80% = 196,560 VND

The total amount of state budget support for health insurance contributions for Family A was: 663,390 VND x 30% : 70% = 284,310 VND.

5. Each person can only participate in health insurance under one category. If a person simultaneously belongs to multiple categories of health insurance participants as specified in Article 1 of this Circular, they will pay health insurance contributions according to the first category they are identified under the order of the categories specified in Article 1 of this Circular.

Article 3. Methods and responsibilities for paying health insurance of certain subjects

1. For the subjects specified in Clauses 14, 17, and 18 of Article 1 of this Circular:

a) Based on the number of health insurance cards issued to the subject, the Social Insurance of the province or centrally governed city (hereinafter referred to as the Social Insurance of the province) shall aggregate and send to the Department of Finance to transfer funds into the health insurance fund according to Clause 9 of this Article.

b) By no later than December 31 each year, the Social Insurance of the province shall aggregate the number of health insurance cards with valid usage during the year and the health insurance payment amount to be settled and transferred according to regulations (as per Appendix 01 attached to this Circular).

2. For the subject specified in Clause 20 of Article 1 of this Circular:

a) Every six months or once a year, members of households near poverty shall pay their portion of the responsibility to the Social Insurance.

b) Every six months or once a year, the Social Insurance of the province shall aggregate the number of health insurance cards issued, the actual revenue amount, and the amount requested for state budget support, and send to the Department of Finance to transfer funds into the health insurance fund according to Clause 9 of this Article.

3. For the subject specified in Clause 21 of Article 1 of this Circular who are studying at educational institutions within the national education system (hereinafter referred to as schools):

a) The school shall collect the health insurance payment from students every six months or once a year and submit it to the Social Insurance.

b) The financial support for health insurance payments from the state budget shall be implemented as follows:

- For students studying at schools managed by local authorities: The Social Insurance shall aggregate the number of health insurance cards issued, the actual revenue from students, and the amount requested for state budget support, and send to the district-level finance authority or the Department of Finance (according to the local budget classification) to transfer support funds according to Clause 9 of this Article;

- For students studying at schools managed by central ministries and agencies: The Vietnam Social Insurance shall aggregate the number of health insurance cards issued, the actual revenue from students, and the amount requested for state budget support, and send to the Ministry of Finance to transfer support funds according to Clause 9 of this Article.

4. For the subject specified in Clause 22 of Article 1 of this Circular:

a) Every six months or once a year, members of households engaged in agriculture, forestry, fisheries, and salt production shall directly pay to the Social Insurance.

b) For members of households with average living standards:

- Every six months or once a year, the subject shall directly pay their portion of the responsibility to the Social Insurance.

- Every six months or once a year, the Social Insurance of the province shall aggregate the number of health insurance cards issued, the actual revenue amount, and the amount requested for state budget support, and send to the Department of Finance to transfer funds into the health insurance fund according to Clause 9 of this Article.

5. For the subject specified in Clause 23 of Article 1 of this Circular:

a) Workers have the responsibility to declare the list of their dependents to the employer to register for health insurance cards.

b) Monthly, based on the list of dependents registered by workers, the employer has the responsibility to deduct from the wages or salaries of workers to pay into the health insurance fund along with the worker's own health insurance payment.

6. For the subject specified in Clause 24 of Article 1 of this Circular:

Every six months or once a year, the subject shall directly pay health insurance to the Social Insurance.

7. For the subject specified in Clause 25 of Article 1 of this Circular:

Monthly, the Social Insurance shall pay health insurance for this subject. Annually, the Vietnam Social Insurance shall aggregate the list of subjects who have been issued health insurance cards and the amount due for health insurance payments, and send to the Ministry of Finance to transfer funds into the health insurance fund.

8. For persons working part-time in communes, wards, and towns as specified in point c, Clause 1 of Article 1 of this Circular:

Monthly, the People's Committee of the commune, ward, or town shall be responsible for paying health insurance for this subject and deducting the health insurance payment from their monthly allowances to pay simultaneously into the health insurance fund.

9. For finance authorities at all levels:

At the beginning of each quarter, based on the amount paid for health insurance for the subjects specified in Clauses 14, 17, 18, and 25 of Article 1 of this Circular; the amount supporting the health insurance payment for the subjects specified in Clauses 20 and 21 and the subjects specified in Clause 22 of Article 1 of this Circular with average living standards to transfer funds into the health insurance fund managed by the Social Insurance at the same level.

10. Subjects managed by the Ministry of National Defense, Ministry of Public Security, and the Government Cryptographic Office as specified in Clauses 1, 2, and 16 of Article 1 of this Circular shall implement according to separate guidance documents.

Article 4. Sources of funds from the state budget for paying and supporting payments for health insurance premiums for certain groups

1. The central budget ensures the source of funds for health insurance premiums and supports part of the health insurance premium levels for the following groups:

a) Paying health insurance premiums for the groups specified in Clauses 1 and 2 of Article 1 of this Circular (the portion of the funding responsibility for the employer's regular operating expenses that is fully or partially guaranteed by the central budget) according to the current state budget classification;

b) Paying health insurance premiums for the groups specified in Clauses 3, 4, and 5 of Article 1 of this Circular (groups supported by the state budget) and the group specified in Clause 9, 15, 16, 19, and 25 of Article 1 of this Circular;

c) Supporting part of the health insurance premium level for the group specified in Clause 21 of Article 1 of this Circular who are currently studying at schools under the management of Ministries and Central Agencies;

2. The local budget ensures the source of funds for health insurance premiums and supports part of the health insurance premium levels for the following groups:

a) Paying health insurance premiums for the groups specified in Clauses 1 and 2 of Article 1 of this Circular (the portion of the funding responsibility for the employer's regular operating expenses that is fully or partially guaranteed by the local budget) according to the current state budget classification;

b) Paying health insurance premiums for the groups specified in Clauses 7, 10, 11, 12, 13, 14, 17, and 18 of Article 1 of this Circular;

c) Supporting part of the health insurance premium level for the group specified in Clause 20 of Article 1 of this Circular; the group specified in Clause 21 of Article 1 of this Circular who are currently studying at schools managed by localities and the group specified in Clause 22 of Article 1 of this Circular with a medium standard of living;

For localities that have not yet achieved balanced budgets, the central budget will support the implementation of health insurance policies according to regulations. The specific level of support is determined by the competent authority.

3. Annually, along with the time stipulated for preparing the state budget estimate, agencies, organizations, and units managing the groups prepare the state budget estimate for health insurance premiums and supporting part of the health insurance premium levels for the groups according to the current state budget classification, specifically as follows:

a) At the Central Level:

- Employers whose regular operating expenses are fully or partially guaranteed by the central budget prepare the state budget estimate for health insurance premiums for the groups specified in Clauses 1 and 2 of Article 1 of this Circular (the portion of the funding responsibility for health insurance premiums of the employer).

- The Vietnam Social Security prepares the state budget estimate for health insurance premiums for the groups specified in Clauses 3, 4, and 5 (groups supported by the state budget) and the group specified in Clause 25 of Article 1 of this Circular; supports the health insurance premium level for the group specified in Clause 21 of Article 1 of this Circular who are currently studying at schools under the management of Ministries and Central Agencies (including schools under economic sectors);

- The Ministry of Labor, Invalids, and Social Affairs prepares the state budget estimate for health insurance premiums for the groups specified in Clauses 9 and 15 of Article 1 of this Circular;

- The Ministry of Defense, the Ministry of Public Security, and the Ministry of Interior prepare the state budget estimate for health insurance premiums for the group specified in Clause 16 of Article 1 of this Circular;

- Agencies, organizations, and units providing scholarships prepare the state budget estimate for health insurance premiums for the group specified in Clause 19 of Article 1 of this Circular;

b) At the local level:

- Employers whose regular operating expenses are fully or partially guaranteed by the local budget prepare the state budget estimate for health insurance premiums for the groups specified in Clauses 1 and 2 of Article 1 of this Circular (the portion of the funding responsibility for health insurance premiums of the employer);

- The Department of Labor, Invalids, and Social Affairs prepares the state budget estimate for health insurance premiums for the groups specified in Clauses 10, 11, 13, 14, and 17 of Article 1 of this Circular; supports the health insurance premium level for the group specified in Clause 20 and the group specified in Clause 22 of Article 1 of this Circular with a medium standard of living;

- The Social Insurance Agency prepares the state budget estimate for health insurance premiums for the group specified in Clause 18 of Article 1 of this Circular; supports the health insurance premium level for the group specified in Clause 21 of Article 1 of this Circular who are currently studying at schools managed by localities (including schools under economic sectors);

- The People's Council at the provincial level prepares the state budget estimate for health insurance premiums for National Assembly Deputies belonging to the Provincial People's Council Delegation. The People's Council at each level prepares the state budget estimate for health insurance premiums for People's Council Deputies of their respective levels;

- The People's Committee at the commune level prepares the state budget estimate for health insurance premiums for the groups specified in Point c Clause 1 and Clause 7 of Article 1 of this Circular.

Chapter II

SUBJECTS, CONTRIBUTION LEVELS AND METHODS OF PAYMENT FOR VOLUNTARY PARTICIPATION IN HEALTH INSURANCE

VOLUNTARY PARTICIPANTS IN HEALTH INSURANCE

Article 5. Subjects

1. The subjects voluntarily participating in the Health Insurance Program under Article 51 of the Health Insurance Law and Clause 2, Article 2 of Decree No. 62/2009/NĐ-CP include:

a) Persons working part-time at communes, wards, and towns as stipulated by laws on civil servants and public officials;

b) Workers who have stopped work and are currently receiving sickness benefits under laws on social insurance due to diseases listed in the Ministry of Health's directory of diseases requiring long-term treatment;

c) Students enrolled in educational institutions, except those participating in the Health Insurance Program under other categories;

d) Members of households engaged in agriculture, forestry, fisheries, and salt production;

đ) Relatives of employees with salaries as stipulated by laws on wages and remuneration; cooperative members and individual business households.

2. The subjects specified in Points a, d, and đ of Clause 1 of this Article shall implement according to administrative boundaries; the subjects specified in Points b and c of Clause 1 of this Article shall implement according to organizational units and schools.

3. The Vietnam Social Security shall provide specific guidance on issuing health insurance cards for these subjects, ensuring continuity when transitioning from voluntary participation to implementation under the Health Insurance Law.

Article 6. Contribution Levels and Reductions in Health Insurance Contributions

1. The contribution levels for the subjects specified in Clause 1 of Article 5 of this Circular:

a) Contribution level for three months from October 1, 2009 to December 31, 2009:

- For the subjects specified in Point c of Clause 1 of this Circular, 30,000 VND per person in urban areas and 25,000 VND per person in rural and mountainous areas;

- For the subjects specified in Points a, b, d, and đ of Clause 1 of this Circular, 80,000 VND per person in urban areas and 60,000 VND per person in rural and mountainous areas.

- For population, family, and children officers at communes, wards, and towns: implemented according to Decision No. 240/2006/QĐ-TTg dated October 25, 2006 of the Prime Minister regarding the implementation of voluntary health insurance for population, family, and children officers at communes, wards, and towns.

b) Monthly contribution level for subjects continuing to voluntarily participate in health insurance from January 1, 2010, is 4.5% of the current minimum wage.

2. The reduction in health insurance contributions for cases participating in health insurance through household registration shall be implemented according to Clauses 3 and 4 of Article 2 of this Circular.

3. The amount of health insurance contributions of voluntary participants in health insurance shall be uniformly managed and utilized according to regulations on the management and use of the health insurance fund under the Health Insurance Law and Articles 10, 11, 12, and 13 of Decree No. 62/2009/NĐ-CP and Article 20 of this Circular.

Chapter III

LEVEL OF HEALTH INSURANCE BENEFITS

Article 7. Level of Health Insurance Benefits

1. The level of health insurance benefits for participants in health insurance shall be implemented according to Article 22 of the Health Insurance Law and Article 7 of Decree No. 62/2009/NĐ-CP.

2. The cost of a single medical examination and treatment not subject to co-payment as stipulated in Point c, Clause 1 of Article 7 of Decree No. 62/2009/NĐ-CP shall be lower than 15% of the current minimum wage. When the state changes the minimum wage, this cost will be adjusted from the date the new minimum wage takes effect.

3. Costs for medicines, medical supplies, high-cost technical services, and rehabilitation services will be covered by the health insurance fund according to the list prescribed by the Minister of Health.

4. The health insurance fund will cover 50% of the costs of cancer treatment drugs and anti-rejection drugs outside the list prescribed by the Ministry of Health but already approved for circulation in Vietnam according to the prescription of healthcare facilities (hereinafter referred to as medical facilities) as stipulated in Clause 1 of Article 7 of Decree No. 62/2009/NĐ-CP and Article 9 of this Circular for the following cases:

a) Patients who have continuously participated in health insurance for at least 36 months.

b) Children under six years old.

c) Subjects under the management of the Ministry of Defense, Ministry of Public Security, and the Government Office Administration who are entitled to free medical examination and treatment according to regulations and now have retired or transferred to another profession while participating in health insurance.

Article 8. Level of health insurance benefits in certain cases

1. The scope, beneficiaries, and level of benefits for early diagnosis screening of certain diseases as prescribed in point b, Clause 1, Article 21 of the Health Insurance Law shall be implemented according to the guidelines of the Ministry of Health.

2. Payment for transportation costs of patients from district-level hospitals and above for the subjects specified in Clauses 9, 13, 14, 17, and 20 of Article 12 of the Health Insurance Law in emergency situations or during inpatient treatment when the medical facility's expertise is exceeded shall be carried out as follows:

a) The Health Insurance Fund will pay the transportation costs, both ways, to the medical facility transferring the patient at a rate of 0.2 liters of gasoline per kilometer based on the administrative distance and the gasoline price at the time of use. If more than one patient is transported on the same vehicle, the payment amount will only be calculated as if transporting one patient;

b) In cases where the patient does not use the medical facility's transportation means, the payment amount will be 0.2 liters of gasoline per kilometer for one way based on the administrative distance and the gasoline price at the time of use. The hospital designating the transfer will pay the transportation costs to the patient and then settle with the Health Insurance Fund.

3. For traffic accident cases:

a) In cases where it has been determined that there was no violation of the law, the Health Insurance Fund will pay according to regulations;

b) In cases where it has not been determined whether there was a violation of traffic laws or not, the person involved in the traffic accident will pay the treatment costs directly to the medical facility. When there is confirmation from the competent authority that there was no violation of traffic laws, the patient will bring the receipts to the Social Insurance for reimbursement according to regulations. The procedures and deadlines for reimbursement shall be carried out according to the provisions of Article 19 of this Circular;

c) The Health Insurance Fund will not pay for traffic accidents caused by violations of traffic laws and cases where the person involved in the traffic accident falls within the scope of payment under labor accident laws.

4. The Health Insurance Fund will not pay for treatment costs for work-related accidents falling within the scope of payment by the employer as stipulated in the Labor Code.

5. In cases where healthcare facilities must organize outpatient and inpatient services outside regular working hours due to overload; on holidays and public holidays, holders of health insurance cards will be reimbursed for medical examination and treatment costs within the scope of their health insurance benefits as prescribed for regular working days. The Ministry of Health will direct implementation for healthcare facilities under its jurisdiction; the Department of Health will take the lead and coordinate with the Provincial Social Insurance to uniformly direct implementation for healthcare facilities in the locality, adapting to the actual conditions of each unit.

Article 9. Payment levels in cases of medical examination and treatment at non-designated healthcare facilities; not following the specialized technical level and medical examination and treatment abroad

1. In cases of medical examination and treatment at non-designated healthcare facilities; not following the specialized technical level: the Health Insurance Fund will pay according to the provisions of Clause 3, Article 7 of Decree No. 62/2009/ND-CP. The determination of out-of-network status, exceeding the specialized technical level, and hospital classification, including both public and private healthcare facilities, to decide on the payment level, shall be carried out according to the regulations of the Minister of Health.

2. In cases of medical examination and treatment at healthcare facilities without a health insurance contract; going to healthcare facilities with a health insurance contract but lacking the required medical examination and treatment procedures as prescribed in Article 28 of the Health Insurance Law: the patient will pay the medical examination and treatment costs directly to the healthcare facility, then bring the receipts to the Social Insurance for reimbursement. Based on the technical services provided, the specialized technical level of the healthcare facility, and valid receipts, the Social Insurance will reimburse the patient according to the actual costs but the maximum level will not exceed the amount prescribed in Point 1 of Appendix 2 issued together with this Circular.

3. In cases of medical examination and treatment abroad: the patient will pay the medical examination and treatment costs directly, then bring the receipts to the Social Insurance for reimbursement according to the actual costs but the maximum level will not exceed the amount prescribed in Point 2 of Appendix 2 issued together with this Circular.

4. The procedures for reimbursement for the cases stipulated in Clauses 2 and 3 of this Article shall be carried out according to the provisions of Article 19 of this Circular.

Article 10. Benefit level for voluntary health insurance participants

1. The time when voluntary health insurance (BHYT) participants enjoy benefits shall be from the date they pay BHYT according to the provisions at point a and b, Clause 3, Article 16 of the Health Insurance Law. For those who participated in voluntary BHYT before the Health Insurance Law took effect, their previous participation period will be counted as continuous payment from the second time onwards and they will enjoy benefits as prescribed.

2. The scope of benefit, BHYT benefit level, medical examination and treatment organizations, and methods of paying medical examination and treatment costs for voluntary BHYT participants shall be implemented uniformly like those responsible for participating in BHYT.

Chapter IV

ORGANIZATION OF HEALTH INSURANCE MEDICAL EXAMINATION AND TREATMENT

Article 11. Medical examination and treatment facilities under health insurance, registration of initial medical examination and treatment facilities, and transfer for treatment of insured patients

1. Medical examination and treatment facilities under BHYT shall be carried out according to the provisions of Article 24 of the Health Insurance Law.

2. Conditions for participating in medical examination and treatment under BHYT for non-public healthcare facilities:

a) Having a registered office and legal personality;

b) Having a business registration certificate or investment permit in accordance with the law;

c) Having a license to operate or a certificate of qualification for practice issued by competent state agencies on health care in accordance with the regulations;

d) Having sufficient conditions regarding human resources, infrastructure, and equipment to ensure requirements for medical examination and treatment as stipulated by the Minister of Health;

đ) Accepting payment levels and payment methods similar to public healthcare facilities at the same level of professional technical skills or classification as prescribed by the Ministry of Health.

3. The Department of Health shall, based on specific local circumstances, specify the conditions regarding human resources, infrastructure, and equipment for commune health stations, urban district health stations, town health stations (hereinafter referred to collectively as commune health stations) to conduct medical examinations and treatments, while also specifying the scope of professional activities, drug lists, and technical service lists that can be performed by commune health stations, health departments of agencies, and schools within the area to organize medical examinations and treatments under BHYT.

4. Registration of initial medical examination and treatment facilities and transfer for treatment of insured patients shall be carried out according to the regulations of the Minister of Health.

Article 12. Medical examination and treatment contracts under health insurance

1. Social Insurance shall be responsible for signing contracts with healthcare facilities. Medical examination and treatment contracts under BHYT shall be established according to the model specified in Appendix 03 attached to this Circular. Based on the scope, nature of specialization, and payment methods applied, both parties shall agree to supplement and complete specific clauses in the contract. Annually, both parties shall organize the termination of the contract and review, adjust, and supplement the terms of the contract for the following year.

2. Medical examination and treatment contracts under BHYT at commune health stations and equivalent facilities:

a) For commune health stations:

- Social Insurance shall sign a contract with the District General Hospital or Regional General Hospital (in areas without a District General Hospital) or the District Health Center (where the District General Hospital has not been separated) to organize the implementation of initial medical examination and treatment under BHYT at commune health stations.

- Within the allocated fund for medical examination and treatment under BHYT, the District General Hospital or District Health Center shall be responsible for supplying drugs, chemicals, and medical consumables to the commune health station and paying the cost of bed usage (if any), and technical services conducted by the commune health station within the specified scope of professional activities; simultaneously monitoring and summarizing to settle accounts with Social Insurance. The retention of patients for observation and treatment at the commune health station shall be carried out according to the regulations of the Minister of Health but the number of days for observation shall not exceed 3 (three) days. Specifically, for commune health stations located in difficult areas as determined by Decision No. 30/2007/QĐ-TTg dated March 5, 2007 of the Government on the List of Administrative Units in Difficult Areas, the Director of the Department of Health shall, based on the provisions of Clause 3, Article 11 of this Circular, specify the organization of inpatient treatment at commune health stations but the number of treatment days shall not exceed 5 (five) days. The total fund to ensure medical examination and treatment at commune health stations shall not be less than 10% of the medical examination and treatment fund under BHYT based on the number of cards registered for medical examination and treatment at commune health stations.

- Based on the healthcare organizational system at the local level and commune health stations meeting the conditions for medical examination and treatment as stipulated by the Department of Health, the Department of Health shall take the lead and coordinate with Social Insurance to direct the signing of contracts with the District General Hospital or Regional General Hospital or District Health Center to organize medical examination and treatment under BHYT at commune health stations.

b) For healthcare facilities of agencies, units, and schools:

Social Insurance shall directly sign contracts with the management agencies of healthcare facilities. Management agencies of healthcare facilities shall be responsible for supplying drugs, chemicals, and medical consumables to ensure the requirements for medical examination and treatment at healthcare facilities.

3. For regional multi-disciplinary clinics directly under the District General Hospital or District Health Center: they shall be treated similarly to departments of the District General Hospital or District Health Center. Based on the regulations regarding specialization and the approved fee schedule for technical services at the clinic, Social Insurance and the District General Hospital or District Health Center shall unify the contract regarding medical examination and treatment at regional multi-disciplinary clinics.

Article 13. Procedures for health examination and treatment under health insurance

1. Participants in health insurance must present their health insurance card with photograph when seeking medical examination and treatment; in cases where the health insurance card does not yet have a photograph, they must present the health insurance card and another type of identification document with photograph.

2. Children under six years old must present their health insurance card when seeking medical examination and treatment; in cases where they do not have a health insurance card, they must present their birth certificate or birth certificate; in cases where immediate treatment is required after birth and there is no birth certificate, the head of the healthcare facility and the father (or mother) or guardian of the child must sign to confirm in the medical record for settlement with the Social Insurance and bear responsibility for this confirmation.

3. In emergency situations, participants in health insurance may seek medical examination and treatment at any healthcare facility that has a contract for health insurance medical examination and treatment and must present the documents specified in Clause 1 or Clause 2 of this Article before being discharged from the hospital to enjoy health insurance benefits.

In cases of emergency treatment at a healthcare facility that has not signed a contract for medical examination and treatment with Social Insurance, the healthcare facility is responsible for providing complete documents confirming the patient's condition and valid receipts for medical examination and treatment costs for the patient to settle with Social Insurance.

4. In cases of transfer for treatment, participants in health insurance must present the documents specified in Clause 1 or Clause 2 of this Article and the hospital transfer file according to the regulations of the Ministry of Health.

5. In cases of returning for examination based on the treatment requirements of a higher-level healthcare facility without going through the initial registered healthcare facility, they must present the documents specified in Clause 1 or Clause 2 of this Article and must have a re-examination appointment letter from the healthcare facility. Each appointment letter is only valid once within the time period stated in the letter. Healthcare facilities can only schedule patients for re-examinations based on treatment requirements when the lower-level facility exceeds its professional capacity.

6. Individuals holding a health insurance card who seek medical examination and treatment while on business trips, working outside their home base, or temporarily residing in another locality shall be entitled to initial medical examination and treatment at a healthcare facility equivalent to the initial registered healthcare facility indicated on the card and, in addition to presenting the documents specified in Clause 1 or Clause 2 of this Article, must also present a work trip certificate or temporary residence registration certificate to enjoy benefits as prescribed.

Article 14. Health Insurance Appraisal

1. The Social Insurance implements health insurance appraisal and is responsible for the results of the appraisal in accordance with the laws on health insurance.

2. Contents of health insurance appraisal include:

a) Checking procedures for health insurance medical examination and treatment:

- Cooperating with healthcare facilities to check the procedures for health insurance medical examination and treatment as prescribed;

- Cooperating with healthcare staff at healthcare facilities to resolve issues related to medical examination and treatment procedures; regarding the rights and responsibilities of health insurance participants and healthcare facilities;

- Proposing administrative reform in medical examination and treatment procedures to ensure convenience and reduce inconvenience for individuals with health insurance cards.

b) Checking and evaluating the prescription of treatment, use of medicines, chemicals, medical supplies, and medical technical services for patients:

- Checking and comparing the actual days of hospitalization, medical services, medicines, and medical supplies used for patients;

- Checking the prescription of treatment, use of medicines, chemicals, medical equipment, and medical technical services appropriate to the patient's condition and the prescribed list;

- Directly contacting patients in treatment departments to monitor and evaluate the quality of treatment for patients with health insurance cards.

c) Checking and determining the cost of health insurance medical examination and treatment:

- Ensuring the creation of payment vouchers for patients and outpatient and inpatient medical examination and treatment expense lists accurately reflecting all expenses and prepared according to the prescribed forms;

- Determining the advance funding;

- Checking the proposed settlement costs of healthcare facilities.

3. Health insurance appraisal is conducted simultaneously or after the patient is discharged, ensuring accuracy, transparency, and clarity. The appraisal results are documented and reported to the healthcare facility.

4. Healthcare facilities are responsible for implementing the appraisal results agreed upon between the healthcare facility and Social Insurance. In cases where there is no agreement, both parties' opinions must be clearly recorded and reported to the superior authority for resolution.

5. The Vietnam Social Insurance provides detailed guidance on the contents and procedures for health insurance appraisal at healthcare facilities.

Chapter V

PAYMENT OF MEDICAL EXAMINATION AND TREATMENT COSTS BETWEEN SOCIAL INSURANCE AND HEALTHCARE FACILITIES

UNDER HEALTH INSURANCE

Article 15. Payment according to fixed rate

1. General principles:

a) Payment according to fixed rate is payment based on the average cost of medical examination and treatment per health insurance card for each group of subjects (hereinafter referred to as fee rate) during registration at healthcare facilities.

b) The total fixed rate fund to be paid is the amount calculated based on the number of registered health insurance cards and the determined fee rate.

c) When implementing payment according to fixed rate, healthcare facilities are entitled to proactively utilize the annual budget that has been confirmed. Healthcare facilities are responsible for providing medical services to patients with health insurance cards and shall not collect any additional fees within the scope of benefits of patients with health insurance cards. Social Insurance is responsible for monitoring and ensuring the rights of patients with health insurance cards.

2. Determination of fixed rate fund:

a) The fixed rate fund allocated to healthcare facilities is the total fixed rate fund of six groups of subjects as follows:

- Group 1: includes subjects specified in Clauses 1, 2, 8 and 12 of Article 1 of this Circular;

- Group 2: includes subjects specified in Clauses 3, 4, 5, 6, 7, 9, 10, 11, 13, 15, 16, 18 and 25 of Article 1 of this Circular;

- Group 3: includes subjects specified in Clauses 14 and 20 of Article 1 of this Circular;

- Group 4: includes subjects specified in Clause 17 of Article 1 of this Circular;

- Group 5: includes subjects specified in Clauses 19 and 21 of Article 1 of this Circular;

- Group 6: includes subjects specified in Clauses 22, 23 and 24 of Article 1 of this Circular.

b) The fixed rate fund of each group of subjects is determined as follows:

- The total cost of medical examination and treatment of each group of subjects in the previous year in the province includes: costs of medical examination and treatment at the initial healthcare facility, costs of medical examination and treatment at other levels, and direct payment costs of the group of subjects (excluding costs specified in Point c Clause of this Article).

- k: adjustment factor due to changes in medical examination and treatment costs and related factors from the following year compared to the previous year.

c) Transportation costs, dialysis costs, organ transplantation costs, heart surgery costs, cancer treatment costs, hemophilia treatment costs, and the co-payment portion of patients are not included in the total fixed rate fund.

d) The total fixed rate fund allocated to healthcare facilities implementing fixed rates in the province shall not exceed the total examination and treatment fund of these facilities. In special cases, the Provincial Social Insurance reports to the National Social Insurance for consideration and adjustment, but the adjusted fee rate shall not exceed the national average cost per group of subjects as determined and announced annually by the National Social Insurance.

đ) The temporary application coefficient k is 1.10. The Ministry of Health and the Ministry of Finance will review and adjust the coefficient k appropriately in case of changes related to medical examination and treatment costs and the scope of health insurance benefits. In special cases, the National Social Insurance reports to the Ministries for consideration and resolution.

3. Monitoring and adjusting the fixed rate fund:

Quarterly, Social Insurance is responsible for informing healthcare facilities of the number of health insurance cards and the total fixed rate fund used when there are changes.

4. Using the fixed rate fund:

a) The fixed rate fund is used to pay for medical examination and treatment costs under health insurance for people with health insurance cards who have registered for medical examination and treatment at that facility, including costs at village health stations, other healthcare facilities, and direct payments as stipulated. Social Insurance is responsible for promptly informing healthcare facilities of any expenses incurred at other healthcare facilities.

b) If the fixed rate fund has surplus, the healthcare facility may use it as income for the unit, but not exceeding 20% of the fixed rate fund; the remaining amount is counted towards the examination and treatment fund for the next year of the unit. If the fixed rate fund includes costs at the village level, the unit assigned to sign contracts for medical examination and treatment at village health stations is responsible for allocating part of the surplus to village health stations according to the number of registered cards at the village health station.

c) In case of shortage in the fixed rate fund:

- Due to objective reasons such as increased frequency of medical examinations and treatments, application of new techniques with high costs, Social Insurance will consider and pay at least 60% of the excess costs over the fund;

- Due to unforeseen circumstances such as outbreaks of epidemics, high rates of severe illness with costs much higher than initially expected, the Provincial Social Insurance will coordinate with the Department of Health to consider and provide supplementary payments to healthcare facilities.

If the provincial examination and treatment fund is insufficient to supplement, it will report to the National Social Insurance for consideration and resolution.

5. Healthcare facilities are responsible for monitoring and summarizing the costs of medical examination and treatment for cases with health insurance cards who did not initially register at the facility for medical examination and treatment; costs outside the fixed rate as stipulated in Point c Clause 2 of this Article to settle with Social Insurance.

Article 16. Payment based on service prices

1. Payment based on service prices is a payment method based on the costs of medical technical services, medicines, chemicals, medical supplies used for patients at healthcare facilities.

2. Payment based on service prices shall be applied in the following cases:

a) Healthcare facilities that have not yet implemented payment based on fixed rates;

b) Patients with health insurance cards who have not registered for initial outpatient and inpatient care at such healthcare facilities;

c) Certain diseases, disease groups, or services not included in the fixed rate fund of healthcare facilities implementing payment based on fixed rates as stipulated in point c, Clause 2, Article 15 of this Circular.

3. Basis of payment: The cost of medical technical services is calculated according to the list of service prices approved by competent authorities in accordance with the law on hospital fees; the cost of medicines, chemicals, medical supplies is calculated according to the purchase price of the healthcare facility; the cost of blood and blood products is paid according to the price prescribed by the Ministry of Health.

4. Determining the outpatient and inpatient care fund for healthcare facilities registering for initial outpatient and inpatient care:

a) For healthcare facilities providing both outpatient and inpatient care, they may use 90% of the outpatient and inpatient care fund based on the total number of registered health insurance cards at the facility for:

- Outpatient and inpatient care at the facility;

- Outpatient and inpatient care at other facilities for patients referred to higher-level hospitals, emergency cases, and out-of-pocket expenses for transportation if applicable.

The remaining 10% of the outpatient and inpatient care fund is reserved for adjustment and supplementation as provided for in Clause 5 of this Article.

b) For healthcare facilities providing only outpatient care, they may use 45% of the outpatient and inpatient care fund based on the total number of registered health insurance cards at the facility for:

- Outpatient care at the facility;

- Outpatient care and specialized outpatient care at other healthcare facilities.

5% of the outpatient and inpatient care fund is reserved for adjustment and supplementation for the facility as provided for in Clause 5 of this Article. The remaining 50% of the outpatient and inpatient care fund is used by the Social Insurance Fund to pay for inpatient care costs.

c) The Social Insurance Fund is responsible for paying the costs of outpatient and inpatient care for patients with health insurance cards at other healthcare facilities and deducting these costs from the funds available for use by the initial outpatient and inpatient care facility where the patient has registered.

5. In the event that the costs of outpatient and inpatient care exceed the total outpatient and inpatient care fund available for use, the Social Insurance Fund shall adjust as follows:

a) Adjust and supplement from the remaining 10% of the outpatient and inpatient care fund for facilities providing both outpatient and inpatient care;

b) Adjust and supplement from the remaining 5% of the outpatient and inpatient care fund for facilities providing only outpatient care.

c) If the adjustment and supplementation still result in a shortfall, the provincial Social Insurance Fund shall be responsible for reviewing and assessing to provide additional payments within the scope of the outpatient and inpatient care fund at the local level. If the local fund is insufficient to cover the shortfall, it shall report to the Vietnam Social Insurance Fund for review and resolution.

6. Starting from 2010, the total payment amount for healthcare facilities (at provincial level and above) for transferred treatment cases shall not exceed the actual average cost per episode of inpatient care and one round of outpatient care per specialty of cases transferred in the previous year multiplied by the number of outpatient and inpatient care visits in the year, adjusted annually by a cost fluctuation factor of 1.10. In cases where there is significant variation in healthcare costs due to changes in hospital fee policies, disease structure, new medical technologies, or changes in the functions and tasks of healthcare facilities, the Vietnam Social Insurance Fund shall be responsible for reporting to the relevant ministries for review and adjustment of the factor as appropriate.

Article 17. Payment based on medical cases

1. Payment based on medical cases or groups of diseases is a package payment form to ensure medical examination and treatment for diagnosed medical cases.

2. The classification and diagnosis criteria for each medical case or group of diseases shall be implemented in accordance with the regulations of the Ministry of Health on disease statistics and classification.

3. The full-package cost for each medical case or group of diseases is based on the current legal provisions regarding hospital fee collection.

4. The Ministry of Health shall guide the pilot implementation of payment based on medical cases or groups of diseases.

Article 18. Advance payment and settlement

Social Insurance implements advance payment, payment, and settlement of medical examination and treatment costs under the Health Insurance Law according to Clause 1 and Clause 2 of Article 32 of the Health Insurance Law, and such details are clearly recorded in the medical examination and treatment contracts under the applicable payment methods.

Chapter VI

DIRECT PAYMENT OF MEDICAL EXAMINATION AND TREATMENT COSTS BETWEEN SOCIAL INSURANCE AND HEALTH INSURANCE PARTICIPANTS

BETWEEN SOCIAL INSURANCE AND BHYT PARTICIPANTS

Article 19. Procedures for direct payment of medical examination and treatment costs for persons holding health insurance cards as stipulated in Clause 2 of Article 31 of the Health Insurance Law

1. Application for payment documents:

a) A payment request form of the insured patient (issued according to the model issued by the Vietnam Social Security);

b) Health Insurance Card (copy);

c) Discharge certificate or medical record (original or copy);

d) Valid receipts (prescription, medical record book, drug purchase invoice, hospital fee invoice, and other related receipts);

đ) In cases of seeking medical examination and treatment abroad, in addition to the documents specified in points a, b, c, and d of Clause 1 of this Article, there must be confirmation from a provincial or central-level healthcare facility regarding the condition of the illness and treatment direction;

e) In cases where individuals are dispatched to work or study abroad, in addition to the documents specified in points a, b, c, and d of Clause 1 of this Article, there must be a dispatch decision from the competent authority for work or study abroad;

Documents and certificates written in foreign languages must be translated into Vietnamese and notarized.

2. Payment deadline:

Within forty days from the date of receipt of complete application documents for medical examination and treatment at healthcare facilities within the province or city; within sixty days from the date of receipt of complete application documents for medical examination and treatment at healthcare facilities in other provinces and abroad, the Social Insurance has the responsibility to review and pay the patient.

Chapter VII

MANAGEMENT AND USE OF THE MEDICAL EXAMINATION AND TREATMENT FUNDS FOR HEALTH INSURANCE

Article 20. Management and use of the amount of funds specified in Point b Clause 1 of Decree No. 62/2009/ND-CP

1. The medical examination and treatment fund for students is determined based on the total number of students participating in health insurance at the school (including the number of students participating in health insurance under other categories) and the health insurance contribution rate prescribed in Point đ Clause 2 of Article 3 and Point a Clause 1 of Article 6 of Decree No. 62/2009/ND-CP.

2. Based on the medical examination and treatment fund determined in Clause 1 of this Article, the Social Insurance will allocate 12% to the school to implement primary health care for students at the school and consolidate these funds into the settlement of medical examination and treatment costs under health insurance of the province.

3. The school is responsible for managing and using these funds to implement primary health care for students in accordance with Circular No. 14/2007/TT-BTC dated March 8, 2007, of the Ministry of Finance guiding the use of funds for health work in schools.

Article 21. Management and use of the funds specified in point a, Clause 2, Article 11 of Decree No. 62/2009/NĐ-CP

1. Content of use:

a) Purchase and maintenance of necessary medical equipment for healthcare facilities at the local level; prioritizing health stations in communes and healthcare facilities in economically disadvantaged areas.

b) Training to improve professional skills for healthcare staff and relevant personnel involved in implementing the health insurance policy at the local level;

c) Supporting inter-departmental inspection and supervision work, rewarding collectives and individuals who effectively implement the health insurance policy for medical examination and treatment at the local level.

2. Based on the annual surplus funds reported by the Social Insurance Department of the province, the Department of Health shall take the lead and coordinate with the Department of Finance and the Social Insurance Department to develop a plan for use, which will be submitted for approval by the Provincial People's Committee.

3. Based on the decision approving the plan, the Social Insurance Department of the province shall transfer funds to the units. The Social Insurance Department of the province shall be responsible for inspecting and supervising the use of funds by the units to ensure compliance with the intended purpose, transparency, and public disclosure.

4. Units allocated funds shall be responsible for managing and using them according to current regulations and settling accounts with the Social Insurance Department of the province for consolidation into the settlement of expenditures from the provincial health insurance fund. By no later than June 30 of the following year, if the funds are not fully utilized, they shall be transferred to the provincial health insurance fund for medical examination and treatment in the following year.

Chapter VIII

IMPLEMENTING PROVISIONS

Article 22. Implementation during the transitional period as stipulated in Clauses 1 and 2 of Article 50 of the Health Insurance Law

1. For cases participating in health insurance, including mandatory and voluntary health insurance before the Health Insurance Law takes effect:

a) Health insurance cards issued before October 1, 2009, with validity until December 31, 2009, shall have their scope of benefits implemented according to the provisions of Decree No. 63/2005/NĐ-CP dated May 16, 2005, and related Circulars.

b) Health insurance cards issued before October 1, 2009, with validity beyond December 31, 2009, shall continue to have their scope of benefits implemented according to the provisions of Decree No. 63/2005/NĐ-CP and related Circulars until December 31, 2009; from January 1, 2010, implementation shall follow the provisions of the Health Insurance Law and related documents. In cases where voluntary health insurance participants have paid premiums for the entire year (including the period after January 1, 2010) at the old rate, there shall be no back payment and the allocation and use of the fund shall be carried out according to the provisions of Decree No. 63/2005/NĐ-CP dated May 16, 2005, and related Circulars; in cases where the premium has not been fully paid, it shall be paid for the remaining period according to the prescribed rate from January 1, 2010.

2. For children under six years old:

a) As of September 30, 2009, healthcare facilities shall terminate the reimbursement of costs for medical examinations and treatments for children under six years old as stipulated in Joint Circular No. 15/2008/TTLT-BTC-BYT dated February 5, 2008, of the Ministry of Finance and the Ministry of Health guiding the implementation of medical examinations, treatments, management, and settlement of costs for medical examinations and treatments for children under six years old without payment at public healthcare facilities, to switch to the reimbursement of costs for medical examinations and treatments under the Health Insurance Law and related documents.

b) The Social Insurance Department shall be responsible for temporarily advancing and reimbursing costs for medical examinations and treatments for children under six years old occurring from October 1, 2009 (including costs for cases admitted to hospitals before October 1, 2009, but still hospitalized and not yet settled by the healthcare facility) according to the regulations on the reimbursement of costs for medical examinations and treatments under the Health Insurance Law.

c) Healthcare facilities shall be responsible for preparing reports on the settlement of state budget funds for medical examinations and treatments for children under six years old in 2009 according to the guidance documents of the Ministry of Finance.

d) The Department of Finance shall take the lead and coordinate with the Department of Health and the Department of Labor, Invalids, and Social Affairs based on forecasts of the number of children under six years old in the locality as of October 1, 2009, to determine the total state budget funds required to pay for health insurance for three months in 2009 for children under six years old at a rate of 3% of the minimum wage (58,500 VND per child), and submit this to the Chairman of the Provincial People's Committee for decision. The Department of Finance shall transfer these funds into the health insurance fund managed by the Social Insurance Department of the province.

đ) The health insurance fund shall reimburse costs for medicines included in the list prescribed by the Minister of Health, including those in convenient forms suitable for children such as syrup, aromatic powder, granules...

Article 23. Effectiveness of Implementation

1. This Circular shall take effect from October 1, 2009.

2. The following documents shall cease to be effective upon expiration of the application period for cases during the transitional period as stipulated in Clauses 1 and 2 of Article 50 of the Health Insurance Law and Clause 2 of Article 16 of Decree No. 62/2009/NĐ-CP:

a) Joint Circular No. 14/2002/TTLT-BYT-BTC dated December 16, 2002, of the Ministry of Health and the Ministry of Finance guiding the organization of medical examinations and treatments and the establishment, management, use, and settlement of the fund for medical examinations and treatments for the poor as stipulated in Decision No. 139/2002/QĐ-TTg dated October 15, 2002, of the Prime Minister;

b) Joint Circular No. 21/2005/TTLT-BYT-BTC dated July 27, 2005, of the Ministry of Health and the Ministry of Finance guiding the implementation of mandatory health insurance;

c) Joint Circular No. 16/2006/TTLT-BYT-BTC dated December 6, 2006, of the Ministry of Health and the Ministry of Finance guiding amendments and supplements to certain points of Joint Circular No. 21/2005/TTLT-BYT-BTC dated July 27, 2005, of the Ministry of Health and the Ministry of Finance guiding the implementation of mandatory health insurance;

d) Joint Circular No. 06/2007/TTLT-BYT-BTC dated March 30, 2007, of the Ministry of Health and the Ministry of Finance guiding the implementation of voluntary health insurance;

đ) Joint Circular No. 14/2007/TTLT-BYT-BTC dated December 10, 2007, of the Ministry of Health and the Ministry of Finance guiding amendments and supplements to certain articles of Joint Circular No. 06/2007/TTLT-BYT-BTC dated March 30, 2007, of the Ministry of Health and the Ministry of Finance guiding the implementation of voluntary health insurance;

e) Joint Circular No. 15/2008/TTLT-BTC-BYT dated February 5, 2008, of the Ministry of Finance and the Ministry of Health guiding the implementation of medical examinations and treatments, management, use, and settlement of costs for medical examinations and treatments for children under six years old without payment at public healthcare facilities;

g) Joint Circular No. 10/2008/TTLT-BYT-BTC dated September 24, 2008, of the Ministry of Health and the Ministry of Finance guiding the implementation of health insurance for people in near-poor households.

Article 24. Implementation Organization

1. The Social Insurance of Vietnam shall be responsible for guiding the procedures and formalities for issuing, reissuing, and replacing health insurance cards. The minimum issuance period for the card is one year. For children under six years old, each month, the People's Committee of communes, wards, and towns shall be responsible for compiling lists of newborns to transfer to the Social Insurance for issuance of health insurance cards. In cases where children under six years old have not been issued health insurance cards, they shall continue to use free medical examination and treatment cards that are still valid until they receive health insurance cards.

2. The costs of implementing the work of collecting health insurance premiums for certain groups shall be carried out according to the regulations of the Prime Minister on financial management for the Social Insurance of Vietnam.

3. The criteria for determining individuals belonging to poor households, near-poor households, agricultural, forestry, fishery, and salt-producing households with a moderate standard of living shall be implemented according to the decision of the Prime Minister and the guidance of the Ministry of Labor, Invalids, and Social Affairs.

4. The Department of Health shall be responsible for:

a) Taking the lead and coordinating with the provincial Social Insurance to disseminate and direct healthcare facilities to organize the implementation of medical examinations and treatments for health insurance participants at the local level in accordance with this Circular.

b) Directing and implementing the establishment of service fee schedules, organizing the supply of medicines and medical supplies, and managing drug prices and medical supply prices in accordance with regulations. For new services or services not included in the framework of medical service fees issued by the Ministry of Health and the Ministry of Finance, the Department of Health shall take the lead and coordinate with relevant sectors to establish prices to be submitted to the Provincial People's Committee for approval in a timely manner, serving as the basis for health insurance payments.

5. Healthcare facilities shall be responsible for:

a) Organizing reception and implementing administrative procedures in accordance with regulations for patients holding health insurance cards;

b) Providing sufficient medicines, chemicals, and medical supplies to serve health insurance medical examinations and treatments;

c) Prescribing the use of medicines, medical supplies, and technical services safely and reasonably in accordance with the professional technical regulations of the Ministry of Health and taking measures to prevent the abuse of services, medicines, infusions, or unnecessary and inappropriate services based on the patient's condition;

d) Actively and proactively applying information technology to manage health insurance medical examinations and treatments. Healthcare facilities that already have or are building management software shall cooperate with the Social Insurance to unify statistical indicators according to the requirements for managing health insurance medical examinations and treatments; those without management software shall study and apply statistical software deployed by the Social Insurance of Vietnam, moving towards unifying a common management program;

đ) Being responsible for establishing and submitting to the competent authority for approval the service fee schedule applicable at their facility. For new services or services not included in the framework of medical service fees issued by the Ministry of Health and the Ministry of Finance, healthcare facilities must explain the pricing structure when submitting to the competent authority for approval.

e) Taking the lead and coordinating with the Social Insurance agency to develop and implement management programs for medical examinations and treatments and cost control.

6. The timeline for implementing payment based on service packages:

a) The Department of Health shall take the lead and coordinate with the provincial Social Insurance to direct the application of payment based on service packages according to a suitable timeline, with at least 30% by 2011, at least 60% by 2013, and all primary healthcare facilities registered in the locality shall implement this method by 2015.

b) Healthcare facilities currently piloting payment based on service packages and other payment methods approved in projects shall continue to implement according to the project plan. Upon completion of the project, if deemed appropriate, the Department of Health and the provincial Social Insurance shall agree to continue implementation on the principle of adjustment to align with the scope of benefits stipulated, while reporting to the Ministry of Health, the Ministry of Finance, and the Social Insurance of Vietnam for guidance.

7. The Department of Health, the provincial Social Insurance, and healthcare facilities shall implement reporting systems in accordance with the regulations of the Ministry of Health and the Social Insurance of Vietnam.

8. In cases where children under six years old are being treated at healthcare facilities but their health insurance cards have expired, the health insurance fund shall cover the full cost of medical examinations and treatments until the child is discharged from the hospital.

9. The Ministry of National Defense, the Ministry of Public Security, and the Government Office of Coding shall take the lead and coordinate with the Ministry of Health and the Ministry of Finance to guide the implementation of health insurance for individuals managed by the Ministry of National Defense, the Ministry of Public Security, and the Government Office of Coding as specified in Clauses 1, 2, and 16 of Article 1 of this Circular.

During the implementation process, if there are any difficulties, please promptly reflect them to the Ministry of Health and the Ministry of Finance for research and resolution./.