Circular No. 25/2016/TT-BLDTBXH provides guidance on determining and managing subjects participating in health insurance as stipulated in Clause 4, Article 1 of the Law Amending and Supplementing Certain Provisions of the Health Insurance Law.

CIRCULAR

GUIDELINES FOR DETERMINING AND MANAGING PARTICIPANTS IN HEALTH INSURANCE AS PROVIDED FOR IN CLAUSE 4, ARTICLE 1 OF THE LAW AMENDING AND SUPPLEMENTING CERTAIN PROVISIONS OF THE HEALTH INSURANCE LAW

Pursuant to the Health Insurance Law dated November 14, 2008 and the Law Amending and Supplementing Certain Provisions of the Health Insurance Law dated June 13, 2014;

Pursuant to Decree No. 105/2014/NĐ-CP dated November 15, 2014 of the Government detailing and guiding the implementation of certain provisions of the Health Insurance Law;4/CP Decree of November 15, 2014 of the Government detailing and guiding the implementation of certain provisions of the Health Insurance Law; to determine and manage subjects participating in health insurance as prescribed in Clause 4, Article 1 of the Law amending some articles of the Health Insurance Law;

Pursuant to Decree No. 106/2012/NĐ-CP dated December 20, 2012 of the Government stipulating functions, tasks, powers, and organizational structure of the Vietnam Television Station; Decree No.Pursuant to Decree No. 61/2015/NĐ-CP dated July 9, 2015 of the Government on employment support policies and the National Employment Fund

At the request of the Director of the Legal Department,

The Minister of Labor, Invalids and Social Affairs issues this Circular on guidelines for determining and managing participants in health insurance as provided for in Clause 4, Article 1 of the Law Amending and Supplementing Certain Provisions of the Health Insurance Law, which is funded by the State and supported by the State's contribution to health insurance.5. Implement ad hoc reports upon the request of competent authorities. 1. This Circular takes effect from September 9, 2016. In cases where referenced documents in this Circular are replaced or amended, they shall be implemented according to the replacing or amending documents.Provincial public libraries perform tasks and powers as prescribed in Clause 2, Article 11, Article 38, and Article 39 of the Library Law and the following tasks and powers: 2. Circular No. 05/2013/TT-BLDTBXH dated May 15, 2013 of the Minister of Labor, Invalids, and Social Affairs guiding procedures for establishing files, managing files, and implementing preferential policies for persons with meritorious service in the revolution and their dependents ceases to be effective from the date this Circular takes effect.3. During the implementation process, if there are difficulties, agencies and organizations are requested to report to the Ministry of Labor, Invalids, and Social Affairs for study and appropriate amendment and supplementation./.

Article 1. Scope of Regulation

This Circular provides guidance on the determination and management of participants in health insurance as provided for in Clause 4, Article 1 of the Law Amending and Supplementing Certain Provisions of the Health Insurance Law, which is funded by the State and supported by the State's contribution to health insurance.

Article 2. Applicability

1. Persons who have rendered meritorious service to the revolution as stipulated in the Ordinance on Preferential Treatment for Persons who have Rendered Meritorious Service to the Revolution;

2. Relatives of persons who have rendered meritorious service to the revolution include:

a) Father, mother, spouse, children aged over six but under eighteen years old, or those who have reached eighteen years old and continue their studies or suffer from severe disabilities or extremely severe disabilities, and children of persons participating in the resistance war affected by toxic chemicals and currently receiving monthly allowances.

b) Children of martyrs, persons raising martyrs;

c) Father, mother, spouse, children aged six but under eighteen years old, or those who have reached eighteen years old and continue their studies or suffer from severe disabilities or extremely severe disabilities of: National Hero of Armed Forces, National Hero of Labor during the Resistance War; wounded veterans, disabled veterans, persons participating in the resistance war affected by toxic chemicals with a rate of work capacity reduction of sixty-one percent or more.

3. Persons serving those who have rendered meritorious service to the revolution, including:

a) Persons serving the Mother Vietnam Heroine living in her family;

b) Persons serving wounded veterans, disabled veterans with a rate of work capacity reduction of eighty-one percent or more living in families;

c) Persons serving persons participating in the resistance war affected by toxic chemicals with a rate of work capacity reduction of eighty-one percent or more living in families.

4. Veterans, including:

a) Veterans who participated in the resistance war before April 30, 1975, as stipulated in Clause 6, Article 5 of Decree No. 150/2006/NĐ-CP dated December 12, 2006 of the Government detailing and guiding the implementation of certain provisions of the Ordinance on Veterans;

b) Persons benefiting from policies pursuant to Decision No. 290/2005/QĐ-TTg dated November 8, 2005 of the Prime Minister on the regime and policies for some individuals directly participating in the resistance war against the United States to save the country but not yet enjoying the policies of the Party and the State, and Decision No. 188/2007/QĐ-TTg dated December 6, 2007 of the Prime Minister on amending and supplementing Decision No. 290/2005/QĐ-TTg;

c) Officers and soldiers of the People's Public Security Force benefiting from the regime pursuant to Decision No. 53/2010/QĐ-TTg dated August 20, 2010 of the Prime Minister on the regime for officers and soldiers of the People's Public Security Force participating in the resistance war against the United States with less than twenty years of service in the Public Security Force and have retired, been discharged to localities;

d) Military personnel benefiting from the regime pursuant to Decision No. 142/2008/QĐ-TTg dated October 27, 2008 of the Prime Minister on implementing the regime for military personnel participating in the resistance war against the United States with less than twenty years of service in the military, have been discharged, retired to localities, and Decision No. 38/2010/QĐ-TTg dated May 6, 2010 of the Prime Minister on amending and supplementing Decision No. 142/2008/QĐ-TTg;

đ) Persons benefiting from policies and support pursuant to Decision No. 62/2011/QĐ-TTg dated November 9, 2011 of the Prime Minister on the regime and policies for individuals participating in the war to protect the country, performing international duties in Cambodia, helping Laos after April 30, 1975, have been discharged, retired, or left their jobs;

e) Youth volunteers benefiting from the regime pursuant to Decision No. 170/2008/QĐ-TTg dated December 18, 2008 of the Prime Minister on the health insurance regime and funeral allowance for youth volunteers during the resistance war against France and Decision No. 40/2011/QĐ-TTg dated July 27, 2011 of the Prime Minister on the regime for youth volunteers who have completed their tasks in the resistance war;

g) Civilian fireline workers participating in the resistance war against France, the United States, protecting the country, and performing international duties as stipulated in Decision No. 49/2015/QĐ-TTg dated October 14, 2015 of the Prime Minister on certain regimes and policies for civilian fireline workers participating in the resistance war against France, the United States, and performing international duties.

5. Children under six years old.

6. Individuals eligible for health insurance cards according to Decree No. 136/2013/NĐ-CP dated October 21, 2013 of the Government on social assistance policies for social welfare beneficiaries.

7. Individuals belonging to poor households as defined in Decision No. 59/2015/QĐ-TTg dated November 19, 2015 of the Prime Minister on issuing multidimensional poverty standards applicable for the period 2016-2020; individuals residing in areas with particularly difficult economic and social conditions as decided by the Prime Minister.

8. Individuals belonging to near-poor households as defined in Decision No. 59/2015/QĐ-TTg dated November 19, 2015 of the Prime Minister on issuing multidimensional poverty standards applicable for the period 2016-2020.

9. Students enrolled at vocational education institutions managed by the Ministry of Labor, Invalids, and Social Affairs.

10. Individuals belonging to households engaged in agriculture, forestry, fisheries, and salt production with average income levels as specified in Circular No. 02/2016/TT-BLĐTBXH dated March 25, 2016 of the Minister of Labor, Invalids, and Social Affairs guiding the procedures for identifying households engaged in agriculture, forestry, fisheries, and salt production with average income levels for the period 2016-2020.

Article 3. Principles for determining and managing insurance beneficiariesparticipating in health insurance

1. A person participating in health insurance according to the provisions of Article 2 of this Circular shall be determined based on the category they belong to.

2. If a person belongs to multiple categories of health insurance participants, they shall only be determined under one category as prescribed by the Health Insurance Law.

3. When determining the category of health insurance participants, sufficient grounds must be ensured, specifically as follows:

a) Decision recognizing and settling benefits issued by the Director of the Department of Labor, War Invalids and Social Affairs for persons who have rendered meritorious service to the revolution, veterans; relatives of persons who have rendered meritorious service to the revolution; persons who have raised martyrs; persons serving those who have rendered meritorious service to the revolution;

b) Annual list confirmed by the Chairman of the People's Committee of communes, towns, wards (hereinafter referred to as the People's Committee at the commune level) for persons belonging to poor households; persons belonging to near-poor households; persons belonging to households engaged in agriculture, forestry, fisheries, and salt production with average living standards; persons currently residing in areas with extremely difficult socio-economic conditions;

c) Monthly social assistance decision issued by the Chairman of the People's Committee at the district level for persons eligible for monthly social assistance;

d) Birth registration certificate or birth certificate for children under six years old. In cases where children do not have these certificates, the basis shall be the confirmation by the People's Committee at the commune level regarding the non-provision of health insurance cards or temporary residence certificates or temporary residence books;

đ) List determined by vocational education institutions under the Ministry of Labor, War Invalids and Social Affairs for students studying at such institutions;

e) List determined by social welfare institutions, care facilities, and convalescent homes for war invalids and persons who have rendered meritorious service (hereinafter referred to as care facilities) for persons who have rendered meritorious service to the revolution and social welfare recipients cared for in such facilities.

4. The People's Committee at the commune level, care facilities, and vocational education institutions under the labor, war invalids, and social affairs sector are responsible for determining and managing health insurance participants as stipulated in this Circular.

Article 4. Procedures for determining and managing participantsparticipating in health insuranceenergy

1. For health insurance participants residing in the community:

a) Persons working in labor, war invalids, and social affairs at the commune level or those assigned shall, based on Clause 3, Article 3, compile a list of health insurance participants using the model provided by the Vietnam Social Security and submit it to the Chairman of the People's Committee at the commune level for approval, then send it to the labor, war invalids, and social affairs authority at the district level and the social security authority at the district level;

b) Within three (03) working days from the date of receipt of the list of health insurance participants sent by the Chairman of the People's Committee at the commune level, the labor, war invalids, and social affairs authority at the district level shall take the lead in coordinating with the social security authority at the district level to review and cross-check the list of health insurance participants.

If the list is correct, within ten (10) working days from the date of receipt of the list, the social security authority at the district level shall issue health insurance cards to the participants and transfer them to the People's Committee at the commune level for distribution.

If the list is incorrect or lacks information, within three (03) working days from the date of receipt, the labor, war invalids, and social affairs authority at the district level shall return the list to the People's Committee at the commune level for completion in accordance with regulations.

2. For persons who have rendered meritorious service to the revolution and social welfare recipients cared for in care facilities, the care facilities shall compile a list using the model provided by the Vietnam Social Security and send it to the social security authority at the district level to issue health insurance cards.

3. For students studying at vocational education institutions under the labor, war invalids, and social affairs sector, the vocational education institutions shall compile a list using the model provided by the Vietnam Social Security and send it to the social security authority at the district level to issue health insurance cards.

4. For the categories specified in Clause 2 and Clause 3 of this Article, within three (03) days, the care facilities and vocational education institutions shall take the lead in coordinating with the social security authority at the district level where their headquarters are located to review the list of health insurance participants to issue health insurance cards.

Article 5. Methods and responsibility for paying health insurance premiums

The methods and responsibilities for paying health insurance premiums shall be implemented in accordance with the Circular Jointly Issued No. 41/2014/TTLT-BYT-BTC dated November 24, 2014, of the Ministry of Health and the Ministry of Finance on guiding the implementation of health insurance.

Article 6. Responsibilities of the People's Committees of provinces, centrally governed cities1. Direct the Department of Labor, Invalids, and Social Affairs to review and transfer the list of persons who have rendered meritorious service to the revolution and their dependents to the County-level Departments of Labor, Invalids, and Social Affairs as the basis for determining the subjects participating in health insurance.

2. Direct and guide the People's Committees at the county level and commune level to implement this Circular, ensuring that the identification of subjects participating in health insurance is carried out consistently and uniformly within the jurisdiction.

3. Inspect the implementation; resolve difficulties and obstacles arising during the implementation process.

Article 7. Responsibilities of the People's Committees of districts, towns under provincial governance

1. Direct the County-level Departments of Labor, Invalids, and Social Affairs to provide lists of persons who have rendered meritorious service to the revolution and their dependents to the Commune-level People's Committees as the basis for compiling lists of participants in health insurance and implementing the identification of subjects participating in health insurance within the jurisdiction, cross-referencing with the County-level Social Insurance Authority.

2. Inspect, examine, and resolve difficulties and obstacles arising during the implementation process. In cases exceeding authority, promptly report to the Provincial People's Committee for examination and resolution.

Article 8. Responsibilities of the People's Committees of communes, wards, towns

1. Implement this Circular. Identify and manage subjects participating in health insurance within the commune, ward, or town, sending the information to the County-level Departments of Labor, Invalids, and Social Affairs and the County-level Social Insurance Authority for consideration and issuance of health insurance cards.2. Assign personnel engaged in labor, invalids, and social affairs or those designated to receive and process files and issue confirmation certificates for subjects participating in health insurance.

3. Regularly review increases and decreases in the number of subjects participating in health insurance within the jurisdiction and send the information to the County-level Departments of Labor, Invalids, and Social Affairs and the County-level Social Insurance Authority.

4. Annually, based on the tasks assigned in this Circular, the Commune-level People's Committee will develop a budget for implementation, which will be submitted to the financial authority for consolidation and allocation by the competent authority.

Article 9. Responsibilities of Care Facilities, Vocational Education Institutions

1. Compile lists of subjects participating in health insurance according to the model provided by the Vietnam Social Security.

2. Regularly review increases and decreases in the number of subjects participating in health insurance at care facilities and vocational education institutions and send the information to the County-level Departments of Labor, Invalids, and Social Affairs and the County-level Social Insurance Authority. Article 10. Responsibilities of the Vietnam Social Security 1. Direct the implementation and guide business operations within the Social Security system. At the same time, take the lead or coordinate with relevant agencies to promptly resolve difficulties and obstacles arising during the implementation process.

2. Direct the Social Security of provinces and centrally governed cities to cooperate with the Departments of Labor, Invalids, and Social Affairs in organizing the implementation and management of subjects participating in health insurance at the local level.

3. Coordinate to conduct joint inspections on the issuance of health insurance cards for subjects, serving as the basis for proposing measures to address difficulties and obstacles arising.

4. Coordinate with the Ministry of Labor, Invalids, and Social Affairs to organize training for cadres engaged in labor, invalids, and social affairs at the commune and district levels and those designated to implement this Circular.

5. Carry out ad hoc reports as required by the competent authority.

1. This Circular takes effect from September 9, 2016. In case the referenced documents in this Circular are replaced or amended, they shall be implemented according to the replacing or amending documents.

2. Article 41 of Circular No. 05/2013/TT-BLDTBXH dated May 15, 2013, of the Minister of Labor, Invalids, and Social Affairs, guiding procedures for establishing and managing files, implementing preferential policies for persons who have rendered meritorious service to the revolution and their dependents, becomes ineffective from the date this Circular takes effect.

3. During the implementation process, if there are any difficulties, please reflect them to the Ministry of Labor, Invalids, and Social Affairs for study and appropriate amendment or supplementation./.

5. Implement ad hoc reports as required by the competent authority.

Article 11. Effective Date

1. This Circular takes effect from September 9, 2016. In cases where the referenced documents in this Circular are replaced or amended, implementation shall be carried out according to the replacing or amending documents.

2. Article 41 of Circular No. 05/2013/TT-BLDTBXH dated May 15, 2013, issued by the Minister of Labor, War Invalids and Social Affairs, guiding procedures for establishing files, managing files, and implementing preferential policies for persons who have rendered meritorious service to the revolution and their dependents, shall cease to be effective from the date this Circular takes effect.

3. During the implementation process, if there are any difficulties, agencies and organizations are requested to report to the Ministry of Labor, War Invalids and Social Affairs for study, amendment, and supplementation to ensure appropriateness./.