JOINT CIRCULAR No. 15/1998/TTLT-BYT-BTC-BLDTBXH GUIDING THE IMPLEMENTATION OF COMPULSORY HEALTH INSURANCE AS PROVIDED FOR IN THE HEALTH INSURANCE REGULATION ISSUED PURSUANT TO DECREE No. 58/1998/ND-CP OF AUGUST 13, 1998 OF THE GOVERNMENT

CIRCULAR

JOINT CIRCULAR NO. 15/1998/TTLT-BYT-BTC-BLDTBXH OF DECEMBER 5, 1998 GUIDING THE IMPLEMENTATION OF COMPULSORY HEALTH INSURANCE AS PROVIDED FOR IN THE REGULATION ON HEALTH INSURANCE ISSUED PURSUANT TO DECREE NO. 58/1998/NĐ-CP OF AUGUST 13, 1998 OF THE GOVERNMENT

To unify the implementation of the Regulation on Health Insurance issued pursuant to Decree No. 58/1998/NĐ-CP dated August 13, 1998 of the Government, the Joint Ministries of Health, Finance, Labor, War Invalids and Social Affairs guide the implementation of compulsory health insurance (BHYT) for the following groups subject to compulsory BHYT:

I. OBJECTS, CONTRIBUTION LEVELS, AND RESPONSIBILITIES FOR PAYING HEALTH INSURANCE:

1. Employers and Vietnamese workers listed in the regular staff roster, working under contracts of three months or longer in:

a) State-owned enterprises, including those belonging to the armed forces.

b) Economic organizations under administrative agencies, public institutions, Party organs, and political-social organizations.

c) Non-state economic units with ten or more employees.

d) Foreign-invested enterprises, export processing zones, centralized industrial parks; foreign agencies and international organizations in Vietnam, except where international treaties to which the Socialist Republic of Vietnam is a party provide otherwise.

The contribution level for these objects is 3% of the salary grades, positions, and retention coefficient differences (if applicable), wages, and contractual remuneration, along with regional, hardship, position, and seniority allowances, with employers responsible for contributing 2% and workers contributing 1%.

2. Civil servants and workers employed in administrative agencies, public institutions, Party organs, political-social organizations, and mass organizations receiving salaries from the state budget, including those in their probationary period and those under regular contracts of three months or longer. For civil servants in communes, current regulations of the state shall apply.

The contribution level for these objects is 3% of the salary grades, positions, retention coefficient differences (if applicable), and allowances for positions, regions, hardships, and seniority as stipulated by the state. The employing agency or employer is responsible for contributing 2%, while civil servants, civil employees, and workers contribute 1%.

3. Cadres receiving monthly living expenses working at communes, wards, towns as prescribed in Decree No. 09/1998/NĐ-CP dated January 23, 1998 of the Government, including:

- Secretary and Deputy Secretaries of the Commune Party Committee (Secretary and Deputy Secretary of the Village Branch Party Committee in places without a Commune Party Committee);

- Chairperson of the Commune People's Council, Chairperson of the Commune People's Committee;

- Deputy Chairpersons of the Commune People's Council, Deputy Chairpersons of the Commune People's Committee, Chairperson of the People's Front, Heads of various people's organizations in the commune (Women's Union, Farmers' Association, Veterans' Association, Communist Youth League). Military Commander of the Commune Military Command, Head of the Commune Police Station;

- Members of the Commune People's Committee;

- Four specialized positions within the Commune People's Committee: Judiciary - Household Registration; Land Administration; Finance - Accounting; Office of the Commune People's Committee - Statistics.

The total number of cadres in these positions must not exceed the number specified for each type of commune.

The contribution level for these objects is 3% of the monthly living allowance and any additional allowances (if applicable). The agency providing the living allowance contributes 2%, while the recipient contributes 1%.

4. Current representatives of the People's Council at all levels who are not part of the state's personnel establishment or do not receive social insurance benefits monthly.

The contribution level for these objects is 3% of the current minimum wage as stipulated by the state. The agency providing the living allowance pays the full 3%.

5. Individuals currently receiving long-term social insurance benefits (retirement, disability, work injury, rubber plantation workers receiving monthly social insurance benefits) as provided for in Decree No. 12/CP dated January 26, 1995 of the Government promulgating the Social Insurance Regulation.

The contribution level for these objects is 3% of the retirement pension or monthly social insurance benefit paid directly by the social insurance agency.

6. Persons with meritorious service to the Revolution as provided for in Decree No. 28/CP dated April 29, 1995 of the Government, including:

a) Those engaged in revolutionary activities before the August 1945 Revolution and currently receiving monthly allowances;

b) Wives (or husbands), parents, children of martyrs, persons who have raised martyrs and are currently receiving monthly allowances;

c) Heroes of the Armed Forces, Labor Heroes, Mothers of Vietnam's Heroic Generation;

d) War invalids, persons treated equally to war invalids due to disabilities resulting from injuries of 21% or more;

e) Those engaged in revolutionary or anti-war activities who were captured and imprisoned by the enemy and have certificates as prescribed;

g) War invalids due to illness resulting in disabilities of 61% or more;

h) Persons who have contributed to the Revolution and are currently receiving monthly allowances;

i) Persons receiving allowances for service and the first two children under 18 years old of war invalids and war invalids due to illness with disabilities of 81% or more;

The contribution level for these objects is 3% of the current minimum wage as stipulated by the state, paid directly by the managing agency.

7. Social assistance recipients shall be implemented according to current regulations.

Objects prescribed in Items 1, 2, 3, and 4 of Part I of this Circular remain subject to compulsory health insurance during short-term or long-term domestic study periods. The agency or unit paying salaries or living allowances to the object shall pay health insurance contributions as prescribed.

II. METHODS OF PAYING HEALTH INSURANCE:

Heads of agencies, units, and employers are responsible for compiling lists of civil servants, workers, or managed objects, clearly indicating the salaries, wages, living allowances, monthly allowances, and any additional allowances (if applicable) for each individual, and submitting health insurance contributions as follows:

1. Employers prescribed in Item 1 of Part I of this Circular deduct the advance payment for health insurance contributions and collect the employee's share of health insurance contributions according to the prescribed ratio, depositing them into the health insurance fund at least once every three months.

The portion of health insurance contributions (2%) that falls under the responsibility of the employer shall be accounted for as part of production costs or circulation expenses. The portion of health insurance contributions (1%) that falls under the responsibility of employees shall be deducted from each individual's salary or wages.

2. The head of the agency or unit managing the subjects specified in Sections 2 and 3, Part I of this Circular shall periodically deduct health insurance contributions at least once every three months and submit them to the health insurance agency.

The portion of health insurance contributions (2%) that falls under the responsibility of agencies and units receiving salaries from the state budget shall be allocated in the quarterly and annual budget estimates and accounted for in the corresponding Chapters, Types, Clauses, and Sections of the State Budget Classification. The portion of health insurance contributions (1%) that falls under the responsibility of civil servants, public officials, and employees shall be deducted from each individual's salary or living expenses.

3. Agencies managing the subjects specified in Sections 4 and 6, Part I of this Circular shall periodically submit health insurance contributions to the health insurance agency at least once every three months. The funding for health insurance contributions shall be budgeted by units paying living expenses or allowances to cover 3% of the current minimum wage as stipulated by the state.

4. The social insurance agency shall transfer the health insurance contributions of the subjects specified in Section 5, Part I of this Circular to the health insurance agency on a periodic basis of at least once every three months.

III - REGIME FOR HEALTH INSURANCE MEDICAL SERVICES:

1. Medical services for individuals with health insurance cards

Individuals with health insurance cards who fall ill may be admitted for outpatient and inpatient treatment at healthcare facilities listed on their health insurance cards.

At healthcare facilities, individuals with health insurance cards are provided with the following services:

a) Diagnosis and treatment;

b) Laboratory tests, X-ray imaging, and functional examinations;

c) Medications within the prescribed list as set forth by the Ministry of Health;

d) Blood and transfusion fluids;

e) Surgical procedures and operations.

g) Use of medical supplies, equipment, and hospital beds;

In cases where the illness exceeds the medical expertise of the healthcare facility, individuals with health insurance cards may be transferred to higher-level technical facilities.

2. Individuals with health insurance cards must comply with the following regulations when seeking medical services:

- Receiving medical services at healthcare facilities registered on their health insurance cards.

- Receiving medical services at other healthcare facilities based on referral letters.

- Receiving emergency medical services at any state-owned healthcare facility.

The health insurance agency will reimburse the cost of medical services (KCB) for individuals with health insurance cards who seek medical services according to the above regulations as follows:

a) For individuals entitled to social benefits as stipulated in Decree No. 28/CP dated September 24, 1995, issued by the Government, 100% of the medical service costs according to the current hospital fee schedule will be covered.

b) For other individuals, 80% of the medical service costs according to the current government-prescribed prices will be covered, while the remaining 20% will be self-paid by the individual with the health insurance card to the healthcare facility. If the self-payment amount exceeds six times the current minimum wage in a year, subsequent medical service costs within the year will be fully reimbursed by the health insurance agency.

3. In cases of medical services requested by the patient: choosing their own doctor, selecting their own ward, choosing their own healthcare facility, and selecting their own medical services; medical services exceeding the technical level as prescribed by the Ministry of Health; medical services at healthcare facilities without a contract with the health insurance agency (except in emergencies), the individual with the health insurance card must prepay the hospital fees to the healthcare facility; the health insurance agency will only reimburse the costs according to the hospital fee schedule at the appropriate technical level as prescribed by the Ministry of Health and as stipulated in Points a and b, Section 2, Part III of this Circular. Any additional costs (if any) will be self-paid by the individual with the health insurance card to the healthcare facility.

4. Methods of Reimbursement for Medical Service Costs Under Health Insurance:

The health insurance agency will reimburse medical service costs through two methods:

- The health insurance agency enters into a medical service agreement, makes advance payments, and settles accounts with healthcare facilities for the costs of individuals with health insurance cards according to the Health Insurance Regulations and the medical service agreement.

- The health insurance agency directly reimburses individuals with health insurance cards according to the regulations when they have to pay the medical service costs themselves to the healthcare facility.

IV - RIGHTS AND OBLIGATIONS OF THE PARTIES INVOLVED IN HEALTH INSURANCE:

The rights and obligations of the parties involved in health insurance (individuals with health insurance cards; agencies, units, and employers; health insurance agencies; healthcare facilities) are fully stipulated in Articles 14, 15, 16, and 17, Chapter IV of the Health Insurance Regulations.

1. Rights and Obligations of Individuals with Health Insurance Cards:

a) Entitled to receive medical services under the health insurance regime; introduced and guided by the health insurance agency to choose one of several convenient initial healthcare facilities in their place of residence or work for health management and medical services; allowed to change their initial medical service registration at the end of each quarter; guaranteed their rights according to the regulations by the health insurance agency; entitled to lodge complaints with competent state authorities when employers, health insurance agencies, or healthcare facilities violate the Health Insurance Regulations.

b) Individuals with health insurance cards are responsible for: making full and timely health insurance contributions, presenting their health insurance cards when seeking medical services; preserving their health insurance cards and not lending them to others.

2. Rights and Obligations of Agencies, Units, and Employers:

a) Refusing to comply with requests from the health insurance agency and healthcare facilities that do not conform to the Health Insurance Regulations; entitled to lodge complaints with competent state authorities when the health insurance agency or healthcare facilities violate the Health Insurance Regulations. During the complaint period, they must still fulfill their obligation to make health insurance contributions as prescribed.

b) Making health insurance contributions according to the regulations; providing the health insurance agency with relevant labor, salary, wage, and allowance documents related to health insurance contributions and implementation; complying with inspections and audits regarding health insurance implementation by competent state authorities.

c) Agencies, units, and employers failing to fully fulfill their obligation to make health insurance contributions will be subject to recovery of unpaid health insurance contributions during the non-payment period and must bear the costs of medical services for their beneficiaries during that time.

3. Rights and Obligations of the Health Insurance Agency:

a) Request the agency, unit, or employer to pay and implement the health insurance (BHYT) regime; sign contracts with legitimate healthcare facilities for BHYT treatment; request healthcare facilities to provide medical records, files, and related documents for BHYT cost reimbursement; refuse to reimburse costs that do not comply with the BHYT Regulations or the terms of the signed contract; propose to competent authorities to handle units or individuals violating the BHYT Regulations.

b) Collect BHYT fees, issue cards, and guide card management; provide information on healthcare facilities and guide participants in selecting facilities to register; manage funds, reimburse healthcare costs in accordance with regulations and promptly; inspect and appraise the implementation of the BHYT regime; organize information dissemination and resolve complaints regarding the BHYT regime.

4. Rights and responsibilities of healthcare facilities:

a) Request the BHYT agency to temporarily advance funds and settle healthcare costs according to regulations and the signed healthcare contract; provide healthcare services in accordance with professional principles; request the BHYT agency to provide data on registered BHYT cards at the facility; refuse to perform requests outside the scope of the BHYT Regulations and the signed contract with the BHYT agency.

b) Implement the healthcare contract in accordance with the BHYT Regulations; record and provide relevant documents for BHYT patients as a basis for reimbursement and resolving disputes; prescribe medications, biological products, procedures, tests, and other medical services safely and reasonably in compliance with Ministry of Health technical standards; facilitate conditions for BHYT agency staff stationed at the facility to carry out promotional and explanatory work on BHYT; check the protection of patient rights and resolve complaints related to BHYT treatment; cooperate with the BHYT agency to verify BHYT cards, identify and report violations and abuse of the BHYT regime.

V- ISSUANCE AND USE OF THE HEALTH INSURANCE CARD:

1. The health insurance card serves as the basis for BHYT participants to receive medical care and benefit from the BHYT regime when ill. Each BHYT participant shall have only one health insurance card.

2. The Ministry of Health stipulates the model of the health insurance card used nationwide. Vietnam Health Insurance uniformly manages printing, issuance, and implements measures to prevent counterfeiting of health insurance cards. The BHYT agency shall issue the card only after receiving full payment for BHYT contributions, except in cases where there is a contract for long-term issuance of BHYT cards. Issuance of supplementary health insurance cards for new individuals listed by participating agencies and units must be based on valid documentation to confirm their eligibility for mandatory BHYT participation. Employers have the responsibility to promptly hand over the health insurance card to the recipient.

3. Socially privileged subjects as defined in Decree No. 28/CP dated April 29, 1995 of the Government shall be issued a special marked health insurance card to enjoy benefits under the BHYT Regulations.

Labor, War Invalids, and Social Affairs departments at all levels are responsible for coordinating with BHYT agencies to accurately identify revolutionary merit holders to ensure smooth conversion of health insurance cards without causing inconvenience to BHYT participants.

4. Cardholders are responsible for preserving the card and not lending it to others. In case of loss, they should immediately report to the issuing BHYT agency to apply for a replacement if there is a valid reason. Cards that are erased, torn, or damaged are invalid.

5. To avoid multiple annual renewals causing inconvenience to agencies, units, and employers, they may enter into contracts with the BHYT agency to receive cards with usage periods exceeding three months up to two years, and make payments in installments to the BHYT agency's account.

Vietnam Health Insurance provides detailed guidance on the issuance of cards to BHYT participants.

VI- IMPLEMENTATION PROVISIONS:

This Circular takes effect from January 1, 1999. Previous provisions contrary to this Circular are abolished. If health insurance cards already issued remain valid beyond the effective date of this Circular, cardholders will continue to enjoy the BHYT regime as stipulated in this Circular until the expiration date of the card.

Any difficulties encountered during the implementation of this Circular should be reported to the relevant ministries for consideration and resolution./.