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

JOINT CIRCULAR

JOINT CIRCULAR NO. 15/1998/TTLT-BYT-BTC-BLDTBXH OF DECEMBER 5, 1998 ISSUED BY THE MINISTRY OF HEALTH - MINISTRY OF FINANCE - MINISTRY OF LABOR, WAR INVALIDS AND SOCIAL AFFAIRS GUIDING THE IMPLEMENTATION OF COMPULSORY HEALTH INSURANCE AS PROVIDED FOR IN THE HEALTH INSURANCE REGULATION ISSUED PURSUANT TO DECREE NO. 58/1998/NĐ-CP OF AUGUST 13, 1998 OF THE GOVERNMENT

To unify the implementation of the Health Insurance Regulation 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 health insurance for individuals subject to compulsory health insurance as follows:

I. SUBJECTS, CONTRIBUTION LEVELS, 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, concentrated industrial parks; foreign organizations 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 health insurance for these subjects shall be 3% of the salary grades, positions, differential retention coefficients (if any), salaries, wages recorded in labor contracts, and regional, hardship, position, and seniority allowances, with employers responsible for contributing 2% and employees contributing 1%.

2. Civil servants and workers employed in administrative agencies, public institutions, party organs, political-social organizations, mass organizations enjoying salaries from the state budget, including those in their probationary period and those with regular labor contracts lasting three months or more. For civil servants in commune-level public institutions, current state regulations shall apply.

The contribution level for health insurance for these subjects shall be 3% of the salary grades, positions, differential retention coefficients (if any), and allowances for positions, regions, hardships, and seniority as stipulated by the state. Employing agencies and employers are responsible for contributing 2%, while civil servants 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 Commune People's Councils, Deputy Chairpersons of Commune People's Committees, Chairpersons of People's Councils, Heads of communal mass organizations (Women's Union, Farmers' Association, Veterans' Association, Ho Chi Minh Communist Youth Union); Chief of the Militia Self-Defense Force, 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 health insurance for these subjects shall be 3% of living expenses and any allowances (if any). Agencies providing living expenses are responsible for contributing 2%, while recipients of living expenses contribute 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 health insurance for these subjects shall be 3% of the current minimum wage as stipulated by the state. The agency providing living expenses for the subject shall be responsible for contributing 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 stipulated in Decree No. 12/CP dated January 26, 1995 of the Government on the Social Insurance Regulation.

The contribution level for health insurance for these subjects shall be 3% of the 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 health insurance for these subjects shall be 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.

Subjects specified in Items 1, 2, 3, and 4 of Part I of this Circular, during short-term or long-term domestic study periods, still fall within the scope of mandatory health insurance participation. The agency or unit paying salaries or living expenses to the subject shall pay health insurance contributions as prescribed.

II. METHODS OF PAYING HEALTH INSURANCE:

Heads of agencies and units, and employers have the responsibility to prepare lists of civil servants, workers, or subjects under their management, clearly indicating each person's salary, wages, living expenses, monthly allowances, and any additional allowances (if any) to be submitted for health insurance contributions as prescribed.

1. Employers specified in Item 1 of Part I of this Circular shall deduct the health insurance contribution in advance and collect the employee's health insurance contribution at the prescribed ratio, depositing it 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 the employee 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 at least once every three months the amount due for health insurance contributions from the salaries of such individuals and submit it 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 Chapter, Category, Clause, and Item of the State Budget Manual. The portion of health insurance contributions (1%) that falls under the responsibility of civil servants, employees, and workers shall be deducted from their salaries or living expenses.

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

4. The social security 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 AND TREATMENTS :

1. Medical services for persons holding health insurance cards

Persons holding health insurance cards who fall ill may be admitted for outpatient and inpatient medical services at healthcare facilities listed on their health insurance cards.

At healthcare facilities, persons holding health insurance cards are entitled to 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 professional capacity of the healthcare facility, persons holding health insurance cards may be transferred to higher-level technical facilities.

2- Persons holding 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 (medical examination and treatment) for persons holding health insurance cards who seek medical services in accordance with the above regulations as follows:

a) For subjects falling within the scope of social preferential benefits as stipulated in Decree No. 28/CP dated September 24, 1995 of the Government, 100% of the cost of medical examination and treatment according to the current hospital fee rates set by the State will be covered.

b) For other subjects, 80% of the cost of medical examination and treatment according to the current rates set by the State will be covered, while the remaining 20% shall be borne by the person holding the health insurance card to the healthcare facility. If the self-payment amount exceeds six months of the current minimum wage in a year, the subsequent costs of medical examination and treatment in accordance with the health insurance regime during the year will be fully reimbursed by the health insurance agency.

3. In cases of medical services requested by the patient individually: choosing doctors, choosing wards, choosing healthcare facilities, choosing medical services; medical services exceeding the professional technical level as prescribed by the Ministry of Health; medical services at healthcare facilities without contracts with the health insurance agency (except in emergency cases), the person holding the health insurance card must pay the hospital fees upfront to the healthcare facility; the health insurance agency will only reimburse the cost of medical services according to the hospital fee rates 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 increase (if any) shall be paid by the person holding the health insurance card to the healthcare facility.

4. Methods of reimbursement for health insurance medical services:

The health insurance agency will reimburse the cost of medical services according to the following two methods:

- The health insurance agency signs a health insurance medical service contract, makes advance payments, and settles accounts with healthcare facilities for the costs of persons holding health insurance cards in accordance with the Health Insurance Regulations and the health insurance medical service contract.

- The health insurance agency directly reimburses the costs of medical services to persons holding health insurance cards in accordance with the regulations when they have to pay the costs of medical services to healthcare facilities themselves.

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

The rights and responsibilities of the parties participating in health insurance (persons holding health insurance cards; agencies, units, and employers; health insurance agencies; healthcare facilities) are fully provided for in Articles 14, 15, 16, and 17 of Chapter IV of the Health Insurance Regulations.

1. Rights and responsibilities of persons holding health insurance cards:

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

b) Persons holding health insurance cards are responsible for: paying health insurance contributions fully and on time, presenting the health insurance card when seeking medical services; preserving the card and not lending it 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 are not in accordance with the Health Insurance Regulations; lodging complaints with competent state authorities when the health insurance agency and healthcare facilities violate the Health Insurance Regulations. During the complaint period, they still must fulfill the obligation to pay health insurance contributions as prescribed.

b) Paying health insurance contributions in accordance with the regulations; providing the health insurance agency with documents related to labor, wages, allowances, and other matters related to health insurance contributions and the implementation of the health insurance regime; complying with inspections and audits regarding the implementation of the health insurance regime by competent state authorities.

c) Agencies, units, and employers failing to fully fulfill their obligations to pay health insurance contributions will be subject to recovery of unpaid health insurance contributions and will have to bear the costs of medical services for their subjects if they seek medical services during the period of non-payment.

3. Rights and responsibilities of the health insurance agency:

a) Request agencies, units, and employers to pay and implement the health insurance regime; sign contracts with legitimate healthcare facilities to provide medical services for insured individuals; request healthcare facilities to provide medical records, case files, and related documents for health insurance payment; refuse to pay for medical expenses that do not comply with the Health Insurance Regulations or the terms of the signed contract; propose to competent authorities to handle units and individuals violating the Health Insurance Regulations.

b) Collect health insurance premiums, issue cards, and guide card management; provide information on healthcare facilities and guide insured individuals to choose and register; manage funds, pay medical expenses according to regulations and promptly; inspect and appraise the implementation of the health insurance regime; organize information dissemination and resolve complaints regarding the implementation of the health insurance regime.

4. Rights and responsibilities of healthcare facilities:

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

b) Implement the health insurance medical service contract correctly; record and provide relevant documents for medical services for insured individuals as a basis for payment and resolution of disputes regarding health insurance; prescribe the use of medicines, biological products, procedures, tests, and other healthcare services safely and reasonably in accordance with the Ministry of Health's technical regulations; facilitate conditions for health insurance agency staff stationed at the facility to carry out health insurance information dissemination and explanation work; inspect the protection of rights and resolve complaints related to medical services for individuals with health insurance cards; cooperate with the health insurance agency to check health insurance cards, identify and report to the health insurance agency cases of violation and abuse of the health insurance regime.

V- ISSUANCE AND USE OF HEALTH INSURANCE CARDS:

1. The health insurance card serves as the basis for insured individuals to seek medical treatment and enjoy health insurance benefits when ill. Each insured individual shall have only one health insurance card.

2. The Ministry of Health stipulates the model of the health insurance card used nationwide. The Vietnam Health Insurance uniformly manages printing, issuance, and implements measures to prevent counterfeit health insurance cards. The health insurance agency issues the card only after receiving full health insurance payments, except in cases where there is a long-term contract for payment and issuance of health insurance cards. Issuance of additional health insurance cards for new individuals listed by participating agencies and units must be supported by valid documentation to confirm they are eligible for mandatory health insurance. Agencies, units, and employers have the responsibility to promptly hand over health insurance cards to those who have been issued them.

3. Socially privileged subjects as defined in Decree No. 28/CP dated April 29, 1995 of the Government shall be issued health insurance cards with special markings to enjoy benefits as prescribed by the Health Insurance Regulations.

Labor - Invalids and Social Affairs Departments at all levels are responsible for coordinating with health insurance agencies to accurately determine subjects who are contributors to the Revolution so that the conversion of health insurance cards can be carried out smoothly without causing inconvenience to insured individuals.

Individuals holding health insurance cards are responsible for preserving their cards and not lending them to others. In the event of losing a health insurance card, they must immediately report it to the issuing health insurance agency to apply for a replacement if there is a valid reason. Cards that are erased, torn, or damaged are invalid.

5. To avoid inconvenience for agencies, units, and employers having to renew cards multiple times within a year, agencies, units, and employers may enter into contracts with health insurance agencies to receive cards with usage periods exceeding three months up to two years and transfer funds in installments to the health insurance agency's account.

The Vietnam Health Insurance provides detailed guidance on the issuance of health insurance cards to participating subjects.

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 date this Circular becomes effective, holders of such cards will continue to enjoy health insurance benefits according to 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.