This amended document provides guidance on collecting a portion of hospital fees to alleviate difficulties for patients and ensure the payment capacity of the Health Insurance Fund. Individuals with health insurance cards are eligible for reimbursement of medical examination and treatment costs according to prescribed prices, except in special cases.
要点
- Patients holding health insurance cards shall be reimbursed by the health insurance agency at hospitals for medical examination and treatment costs according to partial hospital fee rates as stipulated in Point 1 of this Circular, excluding diseases and cases specified in Article 16 and Article 17 of the Health Insurance Regulations - Article 2.
- For certain medications and high-tech medical services, patients with health insurance cards shall be reimbursed by the health insurance agency at hospitals for a portion of costs according to partial hospital fee rates; the remaining amount must be paid directly by the patient to the hospital - Point 1
- Patients (including those with health insurance cards) who receive treatment based on individual requests must pay the full actual cost to the hospital - Point 1
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JOINT CIRCULAR
NO. 11/TTLB DATED SEPTEMBER 19, 1997 OF THE JOINT MINISTRIES OF HEALTH - FINANCE - LABOR - SOCIAL AFFAIRS AND WAR INVALIDS - GOVERNMENT PRICE CONTROL BOARD AMENDING CERTAIN POINTS OF JOINT CIRCULAR NO. 14/TTLB DATED SEPTEMBER 30, 1995 OF THE JOINT MINISTRIES OF HEALTH - FINANCE - LABOR - SOCIAL AFFAIRS AND WAR INVALIDS - GOVERNMENT PRICE CONTROL BOARD
Pursuant to Decree No. 95/CP dated August 27, 1994 of the Government on collecting a portion of hospital fees and in accordance with the directive of the Prime Minister as stated in Notification No. 62-TB dated June 9, 1997 of the Office of the Government. To align with current circumstances and the actual payment capacity of the health insurance fund, the Joint Ministries of Health - Finance - Labor - Social Affairs and War Invalids - Government Price Control Board amend certain points of Joint Circular No. 14/TTLB dated September 30, 1995 guiding the implementation of collecting a portion of hospital fees as follows:
1. Paragraph B, Section IV - Methods for Collecting a Portion of Hospital Fees is amended as follows:
To alleviate difficulties for patients with severe illnesses requiring high actual costs and to ensure the payment capacity of the Health Insurance Fund (HIF), the total amount from two charges: bed day fees and direct actual cost usage shall not exceed the total amount calculated according to the maximum price table in Part B2: "Maximum Price Table for One Day of Inpatient Treatment" (the price per type of treatment day in this table multiplied by the number of inpatient days). For patients, including those with health insurance cards, who receive treatment based on personal requirements, they must fully cover all actual costs to the hospital.
2. Subparagraph d, Section IV - Methods for Collecting a Portion of Hospital Fees is amended as follows:
Patients holding health insurance cards are reimbursed by the health insurance agency with hospitals for medical services according to the partial hospital fee prices stipulated in Point 1 of this Circular, except for diseases and cases specified in Article 16 and Article 17 of the Health Insurance Regulations.
For certain medications and high-tech medical services as detailed in the annex attached hereto, patients with health insurance cards are reimbursed by the health insurance agency with hospitals a portion of the costs according to partial hospital fee prices; the remainder is paid directly by the patient to the hospital. This provision does not apply to retired individuals, those disabled due to work-related injuries or illnesses, and persons who have contributed significantly to the Revolution.
Implementation Provisions
This Circular takes effect from the date of issuance; previous regulations inconsistent with this Circular are hereby abolished.
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