✦ 智能摘要
This Circular stipulates the management and implementation of health insurance (HIS) for workers in the armed forces and dependents of active-duty military personnel. The HIS contribution rate is 4.5% of salary, with the unit contributing 2/3 and the individual contributing 1/3. Participants enjoy benefits for medical examination and treatment as prescribed by the Health Insurance Law.
适用范围
Workers in the armed forces (civil servants, public officials, national defense workers, contractual laborers), and dependents of active-duty military personnel.
要点
- Workers and employing units contribute 4.5% of salary for HIS, with the employing unit contributing 2/3 and the worker contributing 1/3.
- Dependents of active-duty military personnel contribute 4.5% of the general minimum wage for HIS.
- Workers are entitled to 100% of the cost of medical examination and treatment at the commune level or costs lower than 15% of the general minimum wage; 80% of the cost for each medical examination and treatment if it exceeds 15% of the general minimum wage.
- The HIS card is issued according to a list and has a validity period of 6 to 24 months, depending on the category.
- The HIS Fund is managed by the Vietnam Social Security, with 90% of revenue used to pay for medical examination and treatment costs for participants.
🌐 本文件的社会影响
- Reducing financial burdens for workers in the armed forces and dependents of military personnel through participation in HIS.
- Improving the quality of healthcare for insured individuals, contributing to maintaining the health of the military force.
❓ 常见问题
What is the HIS contribution rate?
Workers in the armed forces contribute 4.5% of their salary, with the employing unit contributing 2/3 and the worker contributing 1/3. Dependents of active-duty military personnel contribute 4.5% of the general minimum wage.
What benefits do HIS participants enjoy?
HIS participants are entitled to 100% of the cost of medical examination and treatment at the commune level or costs lower than 15% of the general minimum wage; 80% of the cost for each medical examination and treatment if it exceeds 15% of the general minimum wage.
How long is the validity period of the HIS card?
The HIS card has a validity period of 6 to 24 months, depending on the category. Workers in the armed forces have cards with a validity period of 12 or 24 months, while dependents of active-duty military personnel have cards with a validity period of 24 months.
How is the HIS Fund managed?
The HIS Fund is uniformly managed by the Vietnam Social Security. The total HIS revenue of the Social Security of the Ministry of National Defense is used to pay for expenses as prescribed, with 90% of revenue allocated for payment of medical examination and treatment costs.
Is there an impact on workers' HIS contributions when they are on leave?
During the period when workers are on maternity leave for childbirth or caring for adopted children under four months old, workers and employing units do not need to contribute to HIS but are still counted towards continuous HIS participation to enjoy HIS benefits.
全文
JOINT CIRCULAR
Guidelines for managing and organizing the implementation of health insurance for workers in the military and dependents of active-duty military personnel
Pursuant to the Health Insurance Law dated November 14, 2008;
Pursuant to Decree No. 62/2009/NĐ-CP dated July 27, 2009 of the Government detailing and guiding the implementation of certain provisions of the Health Insurance Law;
Pursuant to Decree No. 60/2003/NĐ-CP dated June 6, 2003, promulgated by the Government detailing and guiding the implementation of the Law on State Budget;
The Ministry of National Defense, the Ministry of Health, and the Ministry of Finance issue guidelines for managing and organizing the implementation of health insurance (hereinafter referred to as BHYT) for workers in the military and dependents of active-duty military personnel as follows:
PART I
OBJECTS, CONTRIBUTION LEVELS, RESPONSIBILITIES AND METHODS OF CONTRIBUTION, BENEFIT LEVELS FOR HEALTH INSURANCE
Article 1. Objects and scope of regulation
1. Workers currently employed in agencies, units, enterprises, public service organizations with self-management over tasks, staffing, and finance (hereinafter collectively referred to as employing units) under the Ministry of National Defense participating in BHYT, including:
1. Group contributed by employees and employers:
b) Contracted labor with quota;
c) Other contracted labor working under employment contracts or indefinite-term work contracts, or employment contracts with a term of three months or more as stipulated by laws on labor.
2. Workers specified in Clause 1 of this Article who have ceased work and are currently receiving sickness benefits under laws on social insurance due to diseases listed in the Directory of Diseases Requiring Long-Term Treatment issued by the Ministry of Health.
3. Dependents of active-duty military personnel (excluding those eligible to participate in BHYT under other categories of objects) specified in Point a, Clause 16, Article 12 of the Health Insurance Law (hereinafter collectively referred to as dependents of military personnel), including:
a) Biological father, biological mother; father-in-law, mother-in-law, or father-in-law, mother-in-law of spouse; legally adopted person of oneself, spouse, including elderly persons under social welfare support;
b) Spouse;
c) Biological children, legally adopted children under 18 years old, including children under six years old; biological children, legally adopted children over 18 years old but disabled and unable to work according to the law.
Article 2. Contribution levels and responsibility for health insurance contributions
1. Equal to 4.5% of the monthly salary and wages according to rank and grade and various allowances for position, seniority beyond the ceiling, and occupational seniority (if applicable) for the objects specified in Clause 1 of Article 1 of this Circular; in which, the employing unit contributes two-thirds and the worker contributes one-third.
During the period when the worker is on maternity leave or caring for a child under four months old according to laws on social insurance, the worker and the employing unit are not required to contribute to BHYT but are still counted towards continuous participation in BHYT to enjoy BHYT benefits.
2. Equal to 4.5% of the general minimum wage for the objects specified in Clause 2 of Article 1 of this Circular, guaranteed by the Vietnam Social Security from state budget sources, transferred annually to the Social Security Department of the Ministry of National Defense.
3. Equal to 4.5% of the general minimum wage for the objects specified in Clause 3 of Article 1 of this Circular, guaranteed by the national defense budget, provided annually by the Financial Department of the Ministry of National Defense to subordinate units of the Ministry of National Defense for contribution to the Social Security Department of the Ministry of National Defense.
Article 3. Methods and deadlines for health insurance contributions
1. For the objects specified in Clause 1 of Article 1 of this Circular: monthly, the employing unit makes BHYT contributions for the worker and deducts the contribution amount from the worker's salary and wages to pay together at once, no later than the last day of the month to the Social Security Department of the Ministry of National Defense.
2. For the objects specified in Clause 2 of Article 1 of this Circular: based on the list of applications for BHYT cards submitted by units, the Social Security Department of the Ministry of National Defense compiles and reports to the Vietnam Social Security to transfer funds to the Social Security Department of the Ministry of National Defense.
3. For the objects specified in Clause 3 of Article 1 of this Circular: based on the list of applications for BHYT cards for these objects, the personnel management agency of subordinate units of the Ministry of National Defense compiles and coordinates with the financial agency at the same level to report to the head of the unit, transferring funds to the Social Security Department of the Ministry of National Defense. These BHYT contribution funds are transferred at the beginning of each year, at least equal to 85% of the annual contribution amount. By no later than October 31 each year, the personnel management agency of subordinate units of the Ministry of National Defense compiles the number of valid BHYT cards for the year and the BHYT purchase funds (including increases or decreases in the number of objects; or adjustments to the general minimum wage; or adjustments to the BHYT contribution rate) and sends them to the financial agency of the military unit at the same level to transfer the remaining funds to the Social Security Department of the Ministry of National Defense and to complete settlement and finalization according to regulations.
4. Monthly, the Social Security Department of the Ministry of National Defense transfers the entire BHYT revenue to the Vietnam Social Security for unified management.
Article 4. Level of Health Insurance Benefit
1. The person participating in Health Insurance (BHYT) as prescribed in Article 1 of this Circular when going for medical examination and treatment in accordance with Articles 26, 27, and 28 of the Health Insurance Law shall enjoy the BHYT benefit as stipulated in Article 22 of the Health Insurance Law, Article 7 of Decree No. 62/2009/ND-CP dated July 27, 2009 of the Government detailing and guiding the implementation of certain provisions of the Health Insurance Law (hereinafter referred to as Decree No. 62/2009/ND-CP) and Article 7 of Circular Joint Circular No. 09/2009/TTLT-BYT-BTC dated August 14, 2009 of the Ministry of Health and Ministry of Finance guiding the implementation of Health Insurance (hereinafter referred to as Joint Circular No. 09/2009/TTLT-BYT-BTC), specifically as follows:
a) Enjoy 100% of the cost of medical examination and treatment at commune level, primary military health facilities, or costs for each visit that are lower than 15% of the national minimum wage at all levels of healthcare;
b) Enjoy 80% of the cost for each visit exceeding 15% of the national minimum wage; the remaining part shall be paid by the patient to the medical facility;
c) Enjoy 80% of the cost when using high-tech services and large expenses but not exceeding 40 months of the national minimum wage for each use of such technical service; the remaining part shall be paid by the patient to the medical facility;
d) Enjoy 50% of the cost of cancer treatment drugs and anti-rejection drugs outside the list prescribed by the Ministry of Health but permitted for circulation in Vietnam according to the prescription of the medical facility as stipulated in Clause 4, Article 7 of Joint Circular No. 09/2009/TTLT-BYT-BTC.
2. The person participating in BHYT as prescribed in Article 1 of this Circular when going for medical examination and treatment at a facility other than the registered initial medical examination and treatment facility or without following the specialized technical level as prescribed by the Minister of Health (except in emergency cases) shall have their medical examination and treatment costs covered by the BHYT Fund within the scope of benefits specified in Article 21 of the Health Insurance Law and Clause 3, Article 7 of Decree No. 62/2009/ND-CP, specifically as follows:
a) 70% of the cost for cases where medical examination and treatment take place at a facility meeting the third-class standard and not exceeding 40 months of the national minimum wage for each use of high-tech services and large expenses;
b) 50% of the cost for cases where medical examination and treatment take place at a facility meeting the second-class standard and not exceeding 40 months of the national minimum wage for each use of high-tech services and large expenses;
c) 30% of the cost for cases where medical examination and treatment take place at a facility meeting the first-class or special-class standard and not exceeding 40 months of the national minimum wage for each use of high-tech services and large expenses.
3. When the BHYT participant goes for medical examination and treatment at a non-registered facility or abroad, it shall be implemented in accordance with Articles 8 and 9 of Joint Circular No. 09/2009/TTLT-BYT-BTC. Rehabilitation treatment benefits shall be implemented in accordance with Circular No. 11/2009/TT-BYT dated August 14, 2009 of the Ministry of Health. Early screening diagnosis benefits for certain diseases shall be implemented in accordance with guidelines issued by the Ministry of Health.
4. The subject defined in Article 1 of this Circular when participating in BHYT under a group with multiple levels of BHYT benefits shall enjoy the highest level of BHYT benefits.
5. The BHYT Fund will not cover costs in the following cases:
a) Cases stipulated in Article 23 of the Health Insurance Law;
b) Transportation costs for patients, except for cases stipulated in Clause 2, Article 8 of Joint Circular No. 09/2009/TTLT-BYT-BTC;
c) Treatment costs for work-related accidents that should be covered by the employer according to the Labor Code.
Chapter II
HEALTH INSURANCE CARD
Article 5. Issuing Health Insurance Cards
1. The Social Insurance under the Ministry of National Defense shall issue Health Insurance Cards for:
a) Subjects specified in Clauses 1 and 2 of Article 1 of this Circular;
b) Subjects specified in Clause 3 of Article 1 of this Circular, based on signing contracts to pay health insurance premiums and to issue Health Insurance Cards with units.
2. Time for issuing Health Insurance Cards:
a) At the beginning of the fourth quarter each year: personnel management agencies of subordinate units under the Ministry of National Defense shall guide the declaration, examination, consolidation, and preparation of lists to be sent to the Social Insurance under the Ministry of National Defense; subjects receiving Health Insurance Cards before December 31 of the previous year shall enjoy health insurance benefits from January 1 of the following year;
b) Within the first 15 days of the last month of each quarter: personnel management agencies of subordinate units under the Ministry of National Defense shall guide supplementary declarations, examination, consolidation, and preparation of lists to be sent to the Social Insurance under the Ministry of National Defense; subjects receiving Health Insurance Cards before the end of that month shall enjoy health insurance benefits from the first day of the following month;
c) For relatives of non-commissioned officers and soldiers who are military students (falling within the category of military recruitment): after officially accepting, personnel management agencies of academies, schools, centers (collectively referred to as schools) shall guide military personnel to declare relatives eligible for Health Insurance Cards, examine, and prepare lists to be sent to the Social Insurance under the Ministry of National Defense; relatives shall receive cards and enjoy health insurance benefits from the first day of the following month, after the Social Insurance under the Ministry of National Defense receives complete files as stipulated in Article 8 of this Circular;
d) For relatives of non-commissioned officers and soldiers implementing the Law on Military Service after completing training and returning to new units, personnel management agencies shall guide military personnel to declare, examine, and prepare lists to be sent to the Social Insurance under the Ministry of National Defense; relatives shall receive cards and enjoy health insurance benefits from the first day of the following month, after the Social Insurance under the Ministry of National Defense receives complete files as stipulated in Article 8 of this Circular.
Article 6. Validity Period of Health Insurance Cards
1. A validity period of 12 months for subjects specified in Points b and c of Clause 1 and Clause 2 of Article 1 of this Circular.
2. A validity period of 24 months for subjects specified in Point a of Clause 1 of Article 1 of this Circular.
3. A validity period of 24 months for subjects being relatives of officers and professional military personnel and relatives of non-commissioned officers and soldiers who are military students.
4. A validity period of 18 months for relatives of soldiers serving under the Law on Military Service, the validity period of the card may be extended for relatives of non-commissioned officers and soldiers serving 24 months or having a decision to extend the service period of the Minister of National Defense.
Article 7. Recovery and Temporary Detention of Health Insurance Cards
1. Recovery of Health Insurance Cards of subjects managed by the Ministry of National Defense and relatives of military personnel in the following cases:
a) Workers specified in Clause 1 of Article 1 of this Circular terminate labor contracts for any reason.
b) Labor contracts still have remaining terms but the employing unit or workers do not pay health insurance premiums as prescribed in Articles 2 and 3 of this Circular.
c) When workers switch to other service systems not covered by the Health Insurance Law but continue to serve in the Military.
d) When officers and professional military personnel no longer serve on active duty (retirement, transfer to another profession, demobilization, discharge).
đ) Duplicate issuance or incorrect issuance of Health Insurance Cards.
2. Health Insurance Cards shall be temporarily detained when patients use someone else's Health Insurance Card. The person whose Health Insurance Card is detained shall be responsible for retrieving the card and paying fines as prescribed by law.
Article 8. Documents for Issuing Health Insurance Cards
1. Declaration forms of workers entitled to health insurance benefits, confirmed by personnel management agencies.
2. Declarations of military personnel regarding the situation of relatives eligible for health insurance benefits, confirmed by personnel management agencies.
3. Lists proposing issuance of Health Insurance Cards for workers or for relatives of military personnel; Unit Heads managing workers or military personnel at the regiment level and above shall sign and stamp.
Article 9. Procedure for Issuing Health Insurance Cards
1. Units at the brigade level and equivalent shall submit a request for issuing health insurance cards along with a list and a CD containing data to the personnel management agency of the directly superior unit.
2. The personnel management agencies at the division level and equivalent shall compile a list of individuals proposed for issuance of health insurance cards, report to the personnel management agency under the Ministry of National Defense for management purposes; simultaneously, they shall submit a request for issuing health insurance cards along with a list and a CD containing data from subordinate units to the Social Insurance Department under the Ministry of National Defense.
3. The Social Insurance Department under the Ministry of National Defense shall implement printing and issuing health insurance cards in accordance with Articles 5 and 6 of this Circular.
Article 10. Reissuing and Exchanging Health Insurance Cards
1. Reissuing and exchanging health insurance cards shall be carried out as follows:
a) Reissue a health insurance card in case it is lost;
b) Exchange a health insurance card in the following cases: the card is torn, damaged, or faulty; or there is a change in the initial healthcare facility registered for health insurance; or the information recorded on the card is incorrect.
2. Documents and procedure for reissuing and exchanging health insurance cards:
a) Individuals must submit a request for reissuing or exchanging health insurance cards, confirmed by the Head of the brigade-level unit and equivalent;
b) The procedure for reissuing and exchanging health insurance cards shall be carried out similarly to the first-time issuance:
b.1. Division-level units and equivalent shall submit a request along with a list and the old health insurance card (except in cases of loss) to the Social Insurance Department under the Ministry of National Defense;
b.2. Within seven working days from the date of receiving all documents stipulated in Clause 2 of this Article, the Social Insurance Department under the Ministry of National Defense shall issue a new health insurance card; during the waiting period for issuance or exchange, the holder still enjoys the benefits of health insurance participants.
b.3. Exchanging health insurance cards due to changes in the initial healthcare facility registered for health insurance shall be carried out in the last 15 days of the last month of each quarter. In cases of reissuing due to loss of the health insurance card, the information cannot be changed compared to the first-time issuance.
3. Individuals who have their health insurance cards reissued or exchanged must pay fees as prescribed in Circular No. 19/2010/TT-BTC dated February 3, 2010, of the Ministry of Finance regarding the collection, payment, management, and use of fees for reissuing and exchanging health insurance cards, specifically as follows:
a) A fee of 4,000 VND per card for those participating in health insurance who have lost their card and now receive a new health insurance card;
b) A fee of 2,000 VND per card for those participating in health insurance whose card is torn, damaged, or where military personnel have incorrectly declared information about dependents, now receiving a new health insurance card;
c) No fee shall be collected in cases of exchanging cards due to changes in the initial healthcare facility registered for health insurance or due to errors in the information recorded on the card caused by the organization or unit compiling the list.
4. In cases where the holder of a health insurance card leaves the card at a healthcare facility, the reissuance and collection of fees for reissuing the card shall be guided by the Vietnam Social Insurance.
Article 11. Responsibilities of Individuals in Declaring, Accepting, and Using Health Insurance Cards
1. For workers:
a) Fill out a declaration form about personal conditions eligible for health insurance benefits according to the prescribed model, accurately based on identification cards or other photo-bearing identity documents; choose and register the initial healthcare facility for health insurance according to Article 14 of this Circular and bear responsibility for the truthfulness of the declaration;
b) Upon receiving the card, check and compare the contents recorded on the card; if incorrect, return the card to the unit to transfer back to the Social Insurance Department under the Ministry of National Defense for reissuance according to regulations;
c) Shall fulfill all obligations of health insurance participants as stipulated in Article 37 of the Health Insurance Law; have the right to request social insurance organizations, healthcare facilities providing health insurance services, and related agencies to explain and provide information about health insurance benefits; have the right to lodge complaints and denunciations against violations of health insurance laws.
2. For military personnel:
a) Accurately declare the conditions of dependents eligible for health insurance benefits according to the prescribed model, accurately based on identification cards or other photo-bearing identity documents of dependents; choose and register the initial healthcare facility for health insurance according to Article 14 of this Circular and bear responsibility for the truthfulness of the declaration;
b) In cases where dependents are of two or more military personnel on active duty, declare as follows:
b.1. The dependent residing in the same household as whom shall be responsible for declaring; if not residing in the same household, the person responsible for declaring shall follow the priority order: son, daughter, daughter-in-law, son-in-law, legally adopted child (if in the same generation, the eldest child shall declare);
b.2. If both parents are military personnel, or one is military personnel and the other is a public security officer on active duty or engaged in confidential work, then the mother shall be responsible for declaring for the children;
b.3. In cases not following the above order, the person with favorable conditions for declaring must report the reasons clearly and bear responsibility for the declaration, confirmed by the Head of the brigade-level unit and equivalent or higher;
c) Upon receiving the health insurance card, check and compare the contents recorded on the card; if correct, send the card to the dependent, if incorrect, return the card to the unit to transfer back to the Social Insurance Department under the Ministry of National Defense for reissuance according to regulations;
d) Shall report and reflect to the Unit Head about the results of sending the health insurance card, the movement status of dependents, and the medical examination and treatment situation of dependents at healthcare facilities.
3. For dependents of military personnel:
Shall fulfill all obligations of health insurance participants as stipulated in Article 37 of the Health Insurance Law; have the right to request social insurance organizations, healthcare facilities providing health insurance services, and related agencies to explain and provide information about health insurance benefits; have the right to lodge complaints and denunciations against violations of health insurance laws.
Article 12. Responsibilities of Units Managing Military Personnel and Workers at Regiment Level and Above
1. Implement and organize the provision of health insurance (BHYT) for workers under their management and military personnel's dependents:
a) Guide the declaration and registration of initial healthcare facilities for BHYT to ensure accuracy regarding beneficiaries of BHYT, including factors such as surname, given name, date of birth, gender, unit, place of residence, salary or wage contribution for BHYT, and initial healthcare facility for BHYT registration;
b) Receive and issue BHYT cards to workers and deliver BHYT cards to military personnel to be sent to their dependents. In cases where military personnel stationed in remote areas, border regions, islands far from home do not have conditions to send the card back, the unit shall be responsible for transferring the BHYT card to the local authority to hand over to the dependent.
2. Annually, prepare the budget estimate for implementing BHYT (along with the budget estimate for social insurance revenue and expenditure) for the following year and report it to the higher financial authority up to the Social Insurance Department of the Ministry of National Defense and the Financial Department of the Ministry of National Defense.
3. Implement BHYT contributions according to Articles 2 and 3 of this Circular for workers and military personnel's dependents based on signing a contract with the Social Insurance Department of the Ministry of National Defense regarding the issuance of BHYT cards for military personnel's dependents.
4. Promote and disseminate policies and laws related to BHYT to the managed subjects.
Chapter III
ORGANIZATION OF HEALTH INSURANCE MEDICAL EXAMINATION AND TREATMENT
Article 13. Military Medical Facilities Participating in Health Insurance Examination and Treatment
1. Military medical facilities within the military treatment system may register for BHYT examination and treatment with the Social Insurance Department of the Ministry of National Defense or with the Social Insurance Departments of provinces and cities, including:
a) Primary-level military medical facilities:
a.1. Regimental infirmaries and equivalent, divisional infirmaries and equivalent;
a.2. Treatment teams.
b) Military hospital level:
b.1. Institutes (centers) with beds;
b.2. General hospitals, specialized hospitals with outpatient departments.
2. The Military Medicine Bureau shall define the scope of expertise and decide which military medical facilities can register for BHYT examination and treatment in accordance with the special operational conditions of the military and ensuring compliance with legal requirements for BHYT; implement BHYT examination and treatment based on the unit's capacity without affecting assigned military medical tasks; notify the Social Insurance Department of the Ministry of National Defense of the list of military medical facilities qualified for BHYT examination and treatment.
3. Based on guidelines from the Vietnam Social Security, the Social Insurance Department of the Ministry of National Defense shall be responsible for issuing management codes for military medical facilities eligible to participate in BHYT examination and treatment as reported by the Military Medicine Bureau.
Article 14. Registration for Initial Health Insurance Examination and Treatment
1. Subjects specified in Article 1 of this Circular have the right to register for BHYT examination and treatment at one of the military or civilian medical facilities registered for initial BHYT examination and treatment as stipulated in Article 13 of this Circular and in Circular No. 10/2009/TT-BYT dated August 14, 2009 of the Ministry of Health guiding the registration for initial BHYT examination and treatment and referral for BHYT examination and treatment (hereinafter referred to as Circular No. 10/2009/TT-BYT), ensuring the greatest convenience for the subject.
2. Based on the need for BHYT examination and treatment of subjects managed by the Ministry of National Defense and military personnel's dependents, and the capacity and conditions of BHYT examination and treatment facilities both within and outside the military, the Social Insurance Department of the Ministry of National Defense shall be responsible for guiding the registration of initial BHYT examination and treatment facilities appropriately.
Article 15. Health Insurance Examination and Treatment Contracts
1. The Social Insurance under the Ministry of National Defense shall enter into contracts with military medical facilities in accordance with Article 25 of the Health Insurance Law and Clause 12 of Circular Jointly Issued No. 09/2009/TTLT-BYT-BTC to organize health insurance examination and treatment for persons holding health insurance cards issued by the Social Insurance under the Ministry of National Defense.
2. For primary-level military medical facilities:
a) The Social Insurance under the Ministry of National Defense shall enter into a contract directly with the higher-level military hospital of the primary-level military medical facility or enter into a contract with the unit managing the primary-level military medical facility to organize health insurance examination and treatment for persons holding health insurance cards issued by the Social Insurance under the Ministry of National Defense who have registered for initial health insurance examination and treatment at that military medical facility;
b) Within the budget for examination and treatment from the health insurance fund allocated by the Social Insurance under the Ministry of National Defense, the military hospital or the management unit shall be responsible for supplying medicines, chemicals, and consumable medical supplies to the primary-level military medical facility and settling bed usage costs (if applicable); settling technical service fees performed by the primary-level military medical facility within the scope of their expertise; simultaneously, monitoring, compiling, and settling with the Social Insurance under the Ministry of National Defense. The retention of patients for observation and treatment at the primary-level military medical facility shall not exceed five days;
c) The total budget to ensure health insurance examination and treatment at the primary-level military medical facility shall not be less than ten percent of the health insurance examination and treatment fund based on the number of health insurance examination and treatment registration cards at the primary-level military medical facility.
3. Based on specific conditions of each unit, the Social Insurance under the Ministry of National Defense shall take the lead and coordinate with the Military Medical Service to guide the implementation of Clause 2 of this Article appropriately.
Article 16. Referral for Health Insurance Examination and Treatment
1. In cases where the professional and technical capabilities are exceeded, the health insurance examination and treatment facility shall promptly refer the patient to another health insurance examination and treatment facility, either military or civilian, according to the regulations on professional and technical referral.
2. The referral for health insurance examination and treatment shall be carried out in accordance with Circular No. 10/2009/TT-BYT.
Article 17. Health Insurance Appraisal for Military Medical Facilities
1. The Social Insurance under the Ministry of National Defense shall conduct health insurance appraisals and bear responsibility for the appraisal results in accordance with the laws on health insurance for cases holding health insurance cards issued by the Social Insurance under the Ministry of National Defense who have registered for health insurance examination and treatment at military medical facilities.
2. The Social Insurance under the Ministry of National Defense shall take the lead and coordinate with the Military Medical Service to guide military hospitals or units directly managing primary-level military medical facilities that have registered for health insurance examination and treatment to implement health insurance appraisals in accordance with Article 29 of the Health Insurance Law and Clause 14 of Circular Jointly Issued No. 09/2009/TTLT-BYT-BTC.
3. For cases where individuals holding health insurance cards issued by the Social Insurance under the Ministry of National Defense have registered for initial health insurance examination and treatment at civilian medical facilities guided by the Social Insurance of Vietnam.
Chapter IV
MANAGEMENT AND USE OF HEALTH INSURANCE FUNDS IN THE MILITARY
Article 18. Management and Use of Health Insurance Funds
1. The health insurance fund shall be uniformly managed by the Social Insurance of Vietnam.
2. The total health insurance revenue of the Social Insurance under the Ministry of National Defense shall be allocated and managed as follows:
a) Ninety percent of the health insurance revenue (hereinafter referred to as the health insurance examination and treatment fund): The Social Insurance under the Ministry of National Defense shall use it to settle expenses as stipulated in Article 21 of the Health Insurance Law for persons holding health insurance cards issued by the Social Insurance under the Ministry of National Defense.
b) Ten percent of the health insurance revenue shall be transferred to the management of the Social Insurance of Vietnam to establish a health insurance examination and treatment reserve fund and health insurance management costs.
Article 19. Payment methods, advance payments, and final settlement of medical examination and treatment costs under health insurance between the Social Insurance of the Ministry of National Defense and military medical facilities.
1. The Social Insurance of the Ministry of National Defense shall implement the payment of medical examination and treatment costs under health insurance for military medical facilities according to the payment method based on fixed rates, based on determining the fixed rate fund for each group of subjects as stipulated in Article 15 of Circular Joint No. 09/2009/TTLT-BYT-BTC.
2. Determining the medical examination and treatment fund based on fixed rates:
a) The fixed rate fund allocated to military medical facilities is the total fixed rate fund of two groups of subjects:
a.1. Group 1: Subjects specified in Clause 1 of Article 1 of this Circular;
a.2. Group 2: Subjects specified in Clauses 2 and 3 of Article 1 of this Circular.
b) The fixed rate fund for each group of subjects is determined as follows:
|
Fixed rate fund for each group of subjects
|
=
|
Total medical examination and treatment costs under health insurance of the group of subjects in the previous year within the province/city
|
x
|
Total number of health insurance cards of the group of subjects registered this year
|
x
|
k
|
|
Total number of health insurance cards of the group of subjects in the previous year within the province/city
|
Where:
b.1. The total medical examination and treatment costs under health insurance of each group of subjects in the previous year within the province/city directly under the Central Government includes: costs for medical examination and treatment at primary health insurance medical facilities; costs for medical examination and treatment at other levels and direct payment costs of the group of subjects (if any);
b.2. k: is the adjustment factor due to changes in medical examination and treatment costs and related factors from the following year compared to the previous year, adjusted by the Ministry of Health and the Ministry of Finance; the temporary application factor is 1.10;
b.3. In case the fee rate of the following year is lower than that of the previous year, it will be calculated based on the fee rate of the previous year to determine the fixed rate fund of the military medical facility;
b.4. Transportation costs, artificial kidney dialysis, organ transplantation, heart surgery, cancer treatment, Hemophilia treatment, and the co-payment portion of the patient's costs are not included in the total fixed rate fund of this group of subjects;
b.5. The total fixed rate fund allocated to the military medical facility shall not exceed the total budget for medical examination and treatment under health insurance of that facility. In special cases, the Social Insurance of the Ministry of National Defense shall report to the Vietnam Social Security for consideration and adjustment, but the adjusted fee rate shall not exceed the average cost nationwide for the group of subjects as determined and announced annually by the Vietnam Social Security;
c) In necessary cases, the Social Insurance of the Ministry of National Defense may apply the fee rate determined by the provincial social insurance for civilian medical facilities in the area to determine the fixed rate fund for military medical facilities located in that area.
3. Using the fixed rate fund in military medical facilities:
a) Medical examination and treatment costs under health insurance for individuals holding health insurance cards issued by the Social Insurance of the Ministry of National Defense at military medical facilities;
b) Payment to other medical facilities when patients are referred for specialized technical procedures.
4. In case the medical examination and treatment fund under health insurance managed by the Social Insurance of the Ministry of National Defense in a year is not fully utilized:
a) This surplus shall be implemented according to Clause 2 of Article 11 of Decree No. 62/2009/NĐ-CP and Clause 1 of Article 21 of Circular Joint No. 09/2009/TTLT-BYT-BTC. The Social Insurance of the Ministry of National Defense shall take the lead and coordinate with the Military Medicine Department and the Financial Department to develop a plan for using the surplus, to be submitted for approval by the leadership of the Ministry of National Defense;
b) The Social Insurance of the Ministry of National Defense is responsible for transferring the surplus funds to military medical facilities according to the approved plan; supervising and inspecting the proper use of funds and reporting to the Vietnam Social Security.
5. In case the fixed rate fund is insufficient due to objective reasons such as increased frequency of medical examinations and treatments; application of new techniques with high costs; outbreaks of epidemics with higher than expected severe illness rates and costs, the Social Insurance of the Ministry of National Defense shall consider and make additional payments at least equal to 60% of the excess costs. If the medical examination and treatment fund under health insurance of the Social Insurance of the Ministry of National Defense is insufficient to make additional payments, it shall report to the Vietnam Social Security for consideration and handling according to Article 12 of Decree No. 62/2009/NĐ-CP.
6. In case of direct payment:
a) The Social Insurance of the Ministry of National Defense shall guide the implementation of direct payment for individuals holding health insurance cards issued by the Social Insurance of the Ministry of National Defense who have registered for initial medical examination and treatment under health insurance at military medical facilities. Direct payment expenses are included in the medical examination and treatment fund of the military medical facility;
b) The documentation and procedures for direct payment shall be carried out according to Article 19 of Circular Joint No. 09/2009/TTLT-BYT-BTC;
c) Direct payment to patients holding health insurance cards issued by the Social Insurance of the Ministry of National Defense who have registered for medical examination and treatment at civilian medical facilities shall be handled by the social insurances of the provinces/cities.
7. Quarterly, the Social Insurance of the Ministry of National Defense shall be responsible for providing advance payments to military medical facilities for medical examination and treatment under health insurance, at a minimum of 80% of the actual medical examination and treatment costs under health insurance of the previous quarter, which have been settled, but not exceeding the average fixed rate fund per quarter of the facility. For military medical facilities signing their first contract for medical examination and treatment under health insurance, the initial advance payment shall be at a minimum of 80% of the medical examination and treatment budget for one quarter according to the signed contract.
8. The Social Insurance of the Ministry of National Defense shall pay medical examination and treatment costs under health insurance for military medical facilities based on service fees for technical services according to the approved medical fee regulations by the competent authority, but not exceeding the applicable price for equivalent civilian medical facilities at the same level on the same territory; drug and medical consumable prices in the prescribed list based on bidding by the military medical facility, but not higher than the market price in the province at the same time.
Chapter V
IMPLEMENTATION
Article 20. Responsibilities of agencies under the Ministry of National Defense
1. The Military Medical Service shall be responsible for:
a) Taking the lead and coordinating with relevant agencies to study, advise, and propose health insurance policies for subjects managed by the Ministry of National Defense and their dependents; reporting on the implementation of health insurance medical examinations and treatments to the Ministry of National Defense and the Ministry of Health;
b) Organizing the military medical system, building technical lines suitable for the organizational requirements of the Military Forces, meeting the health care needs of soldiers and implementing health insurance medical examinations and treatments for other subjects as prescribed in this Circular;
c) Developing programs and plans for health insurance development within the Military Forces;
d) Propagating and disseminating health insurance policies and laws;
đ) Inspecting, supervising, handling violations, and resolving complaints and denunciations regarding health insurance within the Military Forces according to the provisions of the law.
2. The Financial Service shall be responsible for:
a) Coordinating with the Military Medical Service and relevant agencies to advise and propose financial policies for health insurance that are appropriate to the organizational characteristics and activities of the Military Forces;
b) Ensuring timely and adequate funding from the state budget for health insurance for subjects managed by the Ministry of National Defense and their dependents; directing financial departments of units to collect, settle, and finalize financial accounts for health insurance according to regulations;
c) Supervising and inspecting the implementation of legal provisions on financial management of health insurance within the Military Forces.
3. The Cadre Service and the Military Service, within their respective duties and authorities, shall coordinate with the Social Insurance Department of the Ministry of National Defense to direct and guide their sectors in the registration, listing, and management of subjects entitled to health insurance benefits.
4. The Social Insurance Department of the Ministry of National Defense shall be responsible for:
a) Taking the lead, guiding, and implementing all health insurance activities within the Military Forces according to the law on health insurance; summarizing and evaluating the management and implementation of health insurance work, developing long-term, medium-term, and short-term plans for health insurance development within the Military Forces for approval by the leadership of the Ministry of National Defense;
b) Applying information technology in managing all health insurance activities within the Military Forces; guiding the implementation of standardized forms according to the regulations of the Vietnam Social Security and suitable to the characteristics of the Military Forces;
c) Signing contracts with heads of units within the Ministry of National Defense regarding health insurance contributions and issuance of health insurance cards for subjects who are dependents of military personnel; managing and utilizing the allocated fund for health insurance medical examinations and treatments;
d) Signing contracts with military medical facilities or with units managing primary-level military medical facilities to implement health insurance medical examinations and treatments for subjects;
đ) Implementing settlement of health insurance contributions and costs for health insurance medical examinations and treatments according to regulations;
e) Taking the lead and coordinating with the Military Medical Service to guide military medical facilities registered for health insurance medical examinations and treatments to fully, promptly, and properly implement health insurance laws for subjects managed by the Ministry of National Defense and their dependents;
g) Inspecting the implementation of health insurance; promptly resolving issues arising in the organization and implementation of health insurance within the Military Forces;
h) Coordinating with relevant agencies both within and outside the Military Forces to research and propose the establishment, amendment, and supplementation of health insurance systems, policies, and laws; management and utilization of health insurance funds; and handling of violations of health insurance laws;
i) Researching and developing subjects participating in health insurance within the Military Forces;
k) Regularly or urgently reporting to the Ministry of National Defense and the Vietnam Social Security on the implementation of health insurance policies, management and utilization of health insurance funds, and issuance of health insurance cards within the Military Forces;
l) Propagating and disseminating health insurance policies and laws within the Military Forces;
m) Organizing training for staff involved in health insurance work within the Military Forces.
Article 21. Responsibilities of the Vietnam Social Security
1. Directing and guiding the implementation of health insurance for subjects managed by the Ministry of National Defense and their dependents, in accordance with the organizational characteristics of the Military Forces.
2. Providing card blanks for the Social Insurance Department of the Ministry of National Defense to print health insurance cards for subjects specified in Article 1 of this Circular.
3. Ensuring funding for health insurance contributions for subjects specified in Clause 2, Article 1 of this Circular and management costs for health insurance for the Social Insurance Department of the Ministry of National Defense, consistent with the characteristics, scope of operations, and requirements of the management and organization of health insurance implementation within the Military Forces.
4. Directing the Social Insurance Departments of provinces and cities:
a) To provide information on drug prices and consumable medical supplies, service fees, and cost rates applicable to corresponding groups of subjects managed by the Social Insurance Department of the Ministry of National Defense at each level of medical facility on their territory; providing lists of medical facilities with contracts for health insurance medical examinations and treatments with provincial and municipal Social Insurance Departments so that the Social Insurance Department of the Ministry of National Defense has a basis for notification and guidance to ensure uniform implementation on their territory and throughout the Military Forces;
b) To ensure the rights of subjects holding health insurance cards issued by the Social Insurance Department of the Ministry of National Defense when registering for initial health insurance medical examinations and treatments at civilian medical facilities;
c) To conduct health insurance claims processing and compile settlements of costs for health insurance medical examinations and treatments for those holding health insurance cards issued by the Social Insurance Department of the Ministry of National Defense who have registered for initial health insurance medical examinations and treatments at civilian medical facilities with the Social Insurance Department of the Ministry of National Defense.
Article 22. Responsibilities of Military and Civil Medical Facilities for Health Insurance Examination and Treatment
1. Timely and properly receive, examine, and treat health insurance patients in accordance with the laws on health insurance for subjects holding health insurance cards issued by the Social Insurance under the Ministry of National Defense for initial examination and treatment at the facility.
2. Coordinate and ensure necessary conditions for the Social Insurance under the Ministry of National Defense and the Social Insurance of provinces and cities to conduct health insurance reviews in accordance with Article 43 of the Health Insurance Law.
Article 23. Implementation Provisions
1. This Circular takes effect from April 20, 2010. Provisions regarding health insurance contribution rates, health insurance payment responsibilities, issuance of health insurance cards, registration for health insurance examination and treatment, health insurance benefit levels, and reimbursement of health insurance examination and treatment costs shall be implemented from January 1, 2010.
2. From the date this Circular takes effect, the following documents and regulations shall cease to be effective:
a) Circular No. 154/2007/TT-BQP dated October 1, 2007, issued by the Minister of National Defense guiding the implementation of mandatory health insurance for relatives of officers and professional soldiers on active duty;
b) Clause 3, Part II of Joint Circular No. 181/2007/TTLT-BQP-BTC dated December 4, 2007, issued jointly by the Ministry of National Defense and the Ministry of Finance guiding the implementation of Decree No. 106/2007/NĐ-CP dated June 22, 2007, of the Government on the system of policies for families of non-commissioned officers and soldiers on active duty;
c) Point b, Clause 1, Article 1 of Decision No. 105/2008/QĐ-BQP dated July 11, 2008, issued by the Minister of National Defense concerning the reimbursement of examination and treatment costs for military personnel and civil servants when receiving medical services at civilian medical facilities.
Any difficulties encountered during the implementation process should be reported to the relevant ministries for consideration and resolution./.
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25/2010/TTLT-BQP-BYT-BTC
JOINT CIRCULAR No. 25/2010/TTLT-BQP-BYT-BTC GUIDING THE MANAGEMENT AND IMPLEMENTATION OF HEALTH INSURANCE FOR WORKERS IN THE ARMED FORCES AND DEPENDENTS OF ACTIVE-DUTY MILITARY PERSONNEL
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引用 3
09/2009/TTLT-BYT-BTC
Thông tư liên tịch số 09/2009/TTLT-BYT-BTC Hướng dẫn thực hiện bảo hiểm y tế
已失效
43/2005/QH11
Luật Sửa đổi bổ sung một số điều của Luật Nghĩa vụ quân sự số 43/2005/QH11
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10/2009/TT-BYT
Thông tư số 10/2009/TT-BYT Hướng dẫn ký khám bệnh, chữa bệnh ban đầu và chuyển tuyến khám bệnh, chữa bệnh bảo hiểm y tế
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通知联合第25/2010/TTLT-BQP-BYT-BTC号关于军队职工和现役军人家属医疗保险管理与组织实施的指导意见