Joint Circular No. 16/2006/TTLT/BYT-BTC amends and supplements certain points of Joint Circular No. 21/2005/TTLT/BYT-BTC on mandatory health insurance. This document stipulates the contribution levels for health insurance, the settlement procedures for medical examination and treatment costs, and the responsibilities of the Social Insurance Authority.
适用范围
Medical examination and treatment facilities, provincial-level Social Insurance Authorities, and individuals participating in mandatory health insurance.
要点
- Participation in health insurance → no longer has a temporary contribution level of 50,000 VND/person/year; the annual contribution level according to the state budget is approved by the competent authority.
- Medical examination and treatment facilities → quarterly compile costs and submit to the Social Insurance Authority for settlement, with a payment period of 25 days from the end of the quarter; advance funding is at least 80% of the costs that have been reviewed.
- Provincial-level Social Insurance Authorities → quarterly compile the situation of using the medical examination and treatment fund to regulate and settle promptly, reporting when the fund is in deficit.
- In case the medical examination and treatment fund is in deficit → the Social Insurance Authority will adjust from the fund within the province's scope; if insufficient, report to the Vietnam Social Insurance for overall adjustment.
- The settlement period and advance funding → quarterly, before the 10th day of the first month of each quarter, medical examination and treatment facilities must compile costs and submit to the Social Insurance Authority; the latest payment time is 25 days from the end of the quarter.
🌐 本文件的社会影响
- Positive impact: Reduces difficulties in the settlement process, ensuring benefits for patients and medical examination and treatment facilities.
- Negative impact: May increase financial burden on the state budget if the health insurance contribution level according to the state budget is insufficient to cover expenses.
- Participants in health insurance may be financially affected due to the non-fixed contribution level for health insurance.
❓ 常见问题
What is the mandatory health insurance contribution level?
The annual health insurance contribution level according to the state budget, approved by the competent authority. Specific amounts are not stated in this document.
How long is the settlement period for medical examination and treatment costs?
Medical examination and treatment facilities must compile and submit to the Social Insurance Authority before the 10th day of the first month of each quarter, with the latest payment time being 25 days from the end of the quarter.
If the medical examination and treatment fund is in deficit, how will the Social Insurance Authority handle it?
The Social Insurance Authority will adjust from the fund within the province's scope; if insufficient, report to the Vietnam Social Insurance for overall adjustment.
What percentage of the reviewed costs can medical examination and treatment facilities receive as advance funding?
Medical examination and treatment facilities can receive at least 80% of the reviewed costs as advance funding.
When does this circular take effect?
This circular takes effect 15 days after its publication in the Official Gazette. All previous regulations contrary to this circular are abolished.
全文
JOINT CIRCULAR
||| Guidance for amending and supplementing certain points of Circular 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.
||| Pursuant to the Health Insurance Charter issued together with Decree No. 63/2005/NĐ-CP dated May 16, 2005 of the Government;
_________________________
||| In order to promote the achieved results and promptly address any difficulties encountered during the process of settling medical expenses under health insurance, the Ministry of Health and the Ministry of Finance hereby issue guidance for amending and supplementing certain points of Circular 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 as follows:
||| I. CONTENTS OF AMENDMENTS AND SUPPLEMENTS
||| 1. Abolish the content
||| "The temporary contribution rate for health insurance is 50,000 VND/person/year" of Point 11 and 12, Section I, Part I. ||| 2. Supplement Point 15 into Section I, Part I as follows:
||| "15. The health insurance contribution rate for the subjects specified in Points 11 and 12 shall be set at the level approved annually by the competent authority based on the budget allocated for medical examination and treatment services."
||| 3. Amend and supplement Subpoint a, Point 3, Section II, Part III as follows:
||| "a. Quarterly, the provincial Social Insurance Office is responsible for compiling the situation of the Medical Examination and Treatment Fund usage in the previous quarter of healthcare facilities within its jurisdiction to adjust and settle medical examination and treatment costs for healthcare facilities promptly. In case of a deficit in the Medical Examination and Treatment Fund, report to the Vietnam Social Security for resolution."
||| 4. Abolish the content
||| "- The Social Insurance Office is responsible for pre-funding healthcare facilities with a minimum amount equal to 80% of the medical examination and treatment costs settled in the previous quarter. At the end of the year, in November, the Social Insurance Office is responsible for pre-funding the facilities with sufficient funds to purchase medicines and consumable medical supplies for patients in the following year" (the last part of Subpoint b, Point 1.1, Section II, Part IV). ||| 5. Supplement Subpoint c into Point 1.1, Section II, Part IV as follows:
||| "c) Time limit for settlement and payment of health insurance medical examination and treatment costs:
||| - Quarterly, before the 10th day of the first month of each quarter, healthcare facilities must compile actual medical examination and treatment costs for insured patients in the previous quarter, which have been verified by the Social Insurance Office, and submit them to the Social Insurance Office for settlement and payment.
||| - Based on the compiled actual medical examination and treatment costs of healthcare facilities and the costs of patients in emergency cases and transfers, etc., which have been verified, the Social Insurance Office is responsible for settling and paying the medical examination and treatment costs to healthcare facilities within 25 days from the end of the quarter. Simultaneously, based on the settlement figures between both parties, the Social Insurance Office will pre-fund healthcare facilities with a minimum amount equal to 80% of the actual medical examination and treatment costs verified by the Social Insurance Office in the previous quarter.
||| - In case the actual settlement exceeds the allocated Medical Examination and Treatment Fund, the provincial Social Insurance Office will reallocate from the available fund within the province to settle the excess costs for healthcare facilities within 35 days from the end of the quarter. If the provincial Medical Examination and Treatment Fund is insufficient, the provincial Social Insurance Office will report to the Vietnam Social Security for unified reallocation.
||| - Semi-annually, the Vietnam Social Security will timely reallocate the Health Insurance Fund to localities to settle healthcare facilities' costs. In case the reserve fund cannot cover the reallocation, it will temporarily follow the provisions of Subpoint d, Point 1, Section II, Part III of Circular Joint Circular No. 21/2005/TTLT-BYT-BTC dated July 27, 2005, while reporting to the joint ministries for resolution."
||| The entire process is illustrated in the example below:
||| Assuming in Quarter I/2007, Hospital X in Province Y received outpatient and inpatient medical examination and treatment with a temporarily allocated Medical Examination and Treatment Fund of 100 million VND (A). The actual medical examination and treatment costs for insured patients at the hospital, verified and agreed upon by both parties, were 70 million VND (B), and the costs for emergency cases and transfers at other healthcare facilities outside Hospital X were 40 million VND (C). The remaining allocated Medical Examination and Treatment Fund for Hospital X would be A - C = 100 million VND - 40 million VND = 60 million VND (D). In this case, the costs at Hospital X (B = 70 million VND) exceed the remaining allocated Medical Examination and Treatment Fund (D = 60 million VND) after deducting costs at other levels, thus: The excess cost over the Fund is B - D = 70 million VND - 60 million VND = 10 million VND (E) will be supplemented by the Social Insurance Office after balancing the Medical Examination and Treatment Fund within the province. If the provincial Medical Examination and Treatment Fund is insufficient, the provincial Social Insurance Office will report to the Vietnam Social Security for unified reallocation (if applicable).
||| The amount that the provincial Social Insurance Office will pre-fund for Hospital X to ensure medical examination and treatment in Quarter II/2007 will be: B x 80% = 70 million VND x 80% = 56 million VND.
||| (Similarly, to determine, settle, and pre-fund for hospitals in subsequent quarters)
||| II. EFFECTIVE DATE
||| This Circular takes effect 15 days after its publication in the Official Gazette. Any previous regulations contrary to those in this Circular are hereby abolished.
||| During the implementation, if there are difficulties or obstacles, please reflect them to the joint ministries for consideration and resolution./.
During implementation, if there are difficulties or obstacles, they are requested to reflect them to the relevant ministries for consideration and resolution./.
关系图
点击文件即可打开。红色边框＝改变效力的关系。
译本
本文件提供以下语言版本：