Decree No. 102/2011/ND-CP on medical liability insurance in medical examination and treatment

DECREE

On medical examination and treatment liability insurance

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THE GOVERNMENT

Pursuant to the Law on Organization of the Government dated December 25, 2001;

Pursuant to the Law on Insurance Business dated December 9, 2000 and the Law Amending and Supplementing Certain Provisions of the Law on Insurance Business dated November 24, 2010;

Pursuant to the Law on Medical Examination and Treatment dated November 23, 2009;

Considering the proposal of the Minister of Finance,

DECREE:

PART I

GENERAL PROVISIONS

Article 1. Scope of Regulation

This Decree stipulates medical examination and treatment liability insurance for medical examination and treatment facilities.

Article 2. Applicability

1. Medical examination and treatment facilities that have been granted permission to operate in Vietnam and provide medical examination and treatment services.

2. Insurance enterprises permitted to implement liability insurance in accordance with Vietnamese laws.

1. The Reporting Information System of the Ministry of Culture, Sports and Tourism (hereinafter referred to as the Reporting Information System) is an information system collecting, summarizing, and analyzing reporting data and providing data to serve the guidance and management work of the Ministry of Culture, Sports and Tourism and to provide data upon request of competent authorities.

Article 3. Explanation of Terms

1. “Practitioner of medical examination and treatment” refers to individuals who have been issued a practice certificate and perform medical examinations and treatments, including:

a) Doctors, medical technicians.

b) Nursing assistants.

c) Midwives.

d) Technical personnel.

đ) Traditional medicine practitioners.

e) Individuals possessing hereditary prescriptions or traditional healing methods.

2. “Practitioners at medical examination and treatment facilities” refers to practitioners within the staff roster, those under labor contracts, and those invited by medical examination and treatment facilities from other such facilities for specialized support.

Chapter II

MEDICAL EXAMINATION AND TREATMENT LIABILITY INSURANCE

Article 4. Scope of Insurance

Insurance coverage for medical examination and treatment accidents caused by negligence or carelessness of practitioners at medical examination and treatment facilities resulting in harm to patients due to professional technical errors. Other cases shall be agreed upon by the medical examination and treatment facility and the insurance enterprise.

Article 5. Limit of Liability Insurance

1. The limit of liability insurance for each claim within the scope of insurance is the maximum amount the insurance enterprise must pay but not exceeding the total limit of liability insurance for the medical examination and treatment facility as agreed in the insurance contract. The limit of liability insurance includes legal costs that the medical examination and treatment facility must pay according to the law.

2. The total limit of liability insurance for the medical examination and treatment facility is the total maximum amount the insurance enterprise must pay as agreed in the insurance contract.

3. The insurance enterprise and the medical examination and treatment facility may independently negotiate insurance premiums and limits of liability insurance based on the risk assessment of the medical examination and treatment facility and related factors.

Article 6. Principles of Compensation

1. The insurance enterprise has the responsibility to compensate the medical examination and treatment facility based on:

a) A complaint form submitted by the patient or their lawful representative to the medical examination and treatment facility.

b) Medical examination and treatment accidents occurring to the patient within the scope of insurance and the limit of liability insurance as stipulated in Articles 4 and 5 of this Decree.

c) Medical examination and treatment accidents occurring during the validity period of the insurance contract. Other cases shall be agreed upon in the insurance contract between the medical examination and treatment facility and the insurance enterprise.

2. The insurance enterprise is not responsible for compensating claims arising from causes occurring before the validity period of the insurance contract or being resolved by another insurance enterprise unless otherwise agreed in the insurance contract between the medical examination and treatment facility and the insurance enterprise.

3. The insurance enterprise has the right to refuse to compensate all or part of the liability insurance in cases where the medical examination and treatment facility arbitrarily negotiates compensation for each claim under the insurance contract without the written approval of the insurance enterprise, except as provided in point d, Clause 2, Article 9 of this Decree.

4. The medical examination and treatment facility is responsible for paying compensation to the patient or their lawful representative. In cases where the medical examination and treatment facility is suspended or its operating permit revoked, or there is a different written agreement between the medical examination and treatment facility and the insurance enterprise, the insurance enterprise will directly compensate the patient or their lawful representative.

Article 7. Compensation File

The medical examination and treatment facility shall provide the insurance company with one set of files including the following documents:

1. Notification of adverse events and compensation request from the medical examination and treatment facility.

2. Patient's complaint or legal representative's complaint submitted to the medical examination and treatment facility.

3. Conclusion of the specialized council. In case there is no conclusion of the specialized council, there must be medical records and documents proving the cause of the adverse event.

4. Copy of the patient's medical record and related documents serving as the basis for payment of compensation.

Article 8. Rights and Obligations of Medical Examination and Treatment Facilities

1. Rights of medical examination and treatment facilities:

a) To choose an insurance company to participate in liability insurance for medical examination and treatment.

b) To request the insurance company to explain and provide information related to the insurance contract.

c) To request the insurance company to reduce the premium for the remaining period of the insurance contract when there is a change in factors that serve as the basis for calculating premiums leading to a reduction in insured risks.

d) To request the insurance company to compensate promptly, fully, and timely according to the insurance contract.

đ) To negotiate compensation agreements with patients in accordance with point d, Clause 2, Article 9 of this Decree.

e) Other rights as prescribed by law.

2. Obligations of medical examination and treatment facilities:

a) To provide complete and truthful information as required by the insurance company when purchasing liability insurance for medical examination and treatment.

b) To create favorable conditions for the insurance company to inspect the status of the medical examination and treatment facility and equipment before signing the insurance contract.

c) To pay the insurance premium fully and on time as agreed in the contract.

d) In case there is a change in factors that serve as the basis for calculating premiums leading to an increase or decrease in insured risks, the medical examination and treatment facility must promptly notify the insurance company to apply appropriate premiums for the remaining period of the insurance contract.

đ) To provide the compensation file in accordance with Article 7 of this Decree.

e) Other obligations as prescribed by law.

Article 9. Rights and Obligations of Insurance Companies

1. Rights of insurance companies:

a) To request the medical examination and treatment facility to provide complete and truthful information related to the insured object as stipulated in the insurance contract; to examine the status of the medical examination and treatment facility before signing the insurance contract.

b) To request the medical examination and treatment facility to pay additional insurance premiums for the remaining period of the insurance contract when there is a change in factors that serve as the basis for calculating premiums leading to an increase in insured risks.

c) To request the medical examination and treatment facility to provide complete compensation files in accordance with Article 7 of this Decree.

d) To refuse to process compensation for cases not covered by the insurance liability as stipulated in this Decree and agreed in the insurance contract.

đ) Other rights as prescribed by law.

2. Obligations of insurance companies:

a) To advise and provide complete information related to the insurance contract and clearly explain the Rules, terms, and premium rates for liability insurance in medical examination and treatment for the medical examination and treatment facility.

b) When the insurance company receives notification from the medical examination and treatment facility about changes in factors that serve as the basis for calculating premiums leading to a reduction in insured risks, the insurance company shall determine the reduction in premiums for the remaining period of the insurance contract and refund the difference to the medical examination and treatment facility.

c) To compensate fully and promptly according to the insurance contract for the medical examination and treatment facility.

d) Within seven days from the date of receiving the complete compensation file as stipulated in Article 7 of this Decree, the insurance company must issue a document approving or disapproving the negotiation and agreement on compensation between the medical examination and treatment facility and the patient. If the insurance company does not provide feedback within seven days, the medical examination and treatment facility has the right to negotiate and agree on compensation with the patient.

đ) Within fifteen days from the date of receiving the complete compensation file, the insurance company must pay the insurance money to the medical examination and treatment facility, except in cases where the medical examination and treatment facility and the insurance company have other agreements.

e) The insurance company is responsible for allocating a portion of the actual revenue from the original liability insurance premium for medical examination and treatment to build a database on liability insurance for medical examination and treatment. The Ministry of Finance will guide the level of allocation, management mechanism, use, settlement, and finalization of funds for building the database on liability insurance for medical examination and treatment.

g) To implement business reporting systems in accordance with the guidelines of the Ministry of Finance.

h) Other obligations as prescribed by law.

Article 10. Sources of funds for purchasing liability insurance in medical examination and treatment.

Clause 1. For non-public medical examination and treatment facilities, the funds for purchasing liability insurance in medical examination and treatment shall be borne by the facility itself.

Clause 2. For public service units that are medical examination and treatment facilities, where the revenue from public services fully or partially covers regular expenses, the funds for purchasing liability insurance in medical examination and treatment shall be sourced from the revenue of the medical examination and treatment facility.

Clause 3. For medical examination and treatment facilities that are public service units with low public service revenue and those without public service revenue, where regular expenses are fully covered by the state budget, the funds for purchasing liability insurance in medical examination and treatment shall be sourced from the state budget.

Chapter III

RESPONSIBILITIES OF MINISTRIES, SECTORS AND PROVINCIAL AND CITY PEOPLE'S COMMITTEES UNDER THE CENTRAL GOVERNMENT

Article 11. Responsibilities of the Ministry of Finance

Clause 1. Inspect and supervise insurance companies in implementing liability insurance in medical examination and treatment according to this Decree and other relevant laws.

Clause 2. Take the lead and coordinate with the Ministry of Health to establish a database on liability insurance in medical examination and treatment.

Clause 3. Coordinate with the Ministry of Health, related ministries and sectors, and provincial and city people's committees under the central government to organize propaganda and dissemination of liability insurance in medical examination and treatment.

Article 12. Responsibilities of the Ministry of Health

Clause 1. Organize propaganda and dissemination of the implementation of liability insurance purchase in medical examination and treatment by medical examination and treatment facilities.

Clause 2. Coordinate to resolve specialized issues related to complaints and disputes regarding liability insurance in medical examination and treatment upon request of the Court.

Clause 3. Coordinate with the Ministry of Finance to establish a database on liability insurance in medical examination and treatment.

Clause 4. Guide preventive and mitigating measures against errors in medical examination and treatment.

Clause 5. Prescribe reporting procedures for medical examination and treatment facilities participating in liability insurance in medical examination and treatment.

Clause 6. Inspect and supervise participation and implementation of liability insurance in medical examination and treatment by medical examination and treatment facilities according to this Decree and other relevant laws.

Article 13. Responsibilities of Ministries, Other Ministries Equivalent to Ministries, and Government Agencies

Clause 1. Implement, guide, and inspect participation and implementation of liability insurance in medical examination and treatment by subordinate medical examination and treatment facilities according to this Decree.

Clause 2. Perform other tasks within their authority as prescribed by law.

Article 14. Responsibilities of People's Committees of provinces and centrally governed cities

Clause 1. Implement, guide this Decree, and coordinate with the Ministry of Health to direct the application of preventive and mitigating measures against errors in medical examination and treatment.

Clause 2. Direct the Department of Health to inspect and guide participation and implementation of liability insurance in medical examination and treatment by subordinate medical examination and treatment facilities according to this Decree; annually compile and report to the Ministry of Health and the Ministry of Finance.

Chapter IV

IMPLEMENTING PROVISIONS

Article 15. Effective Date

This Decree takes effect from January 1, 2012.

Article 16. Timeline for participating in medical examination and treatment liability insurance

1. By no later than December 31, 2015, all medical examination and treatment facilities operating under the organizational form of hospitals, including general hospitals, specialized hospitals, and traditional medicine hospitals, shall purchase medical examination and treatment liability insurance.

2. By no later than December 31, 2017, all other medical examination and treatment facilities operating under different organizational forms shall purchase medical examination and treatment liability insurance.

Article 17. Implementation Organization

1. The Ministry of Finance and the Ministry of Health shall coordinate with relevant agencies to provide guidance on the implementation of this Decree.

2. Ministers, Heads of ministerial-level agencies, Heads of government-affiliated agencies, Chairpersons of provincial People's Committees directly under the central government shall be responsible for enforcing this Decree./.