Circular No. 30/2020/TT-BYT provides detailed regulations and guidelines for implementing certain provisions of Decree No. 146/2018/NĐ-CP dated October 17, 2018, of the Government detailing and guiding measures to implement certain provisions of the Health Insurance Law.

CIRCULAR

Detailed regulations and guidance on implementing certain provisions

of Decree No. 146/2018/NĐ-CP dated October 17, 2018 of the Government detailing and guiding measures to implement certain provisions of the Health Insurance Law

The Minister of Health issues this Circular detailing and guiding measures to implement certain provisions of Decree No. 146/2018/NĐ-CP dated October 17, 2018 of the Government detailing and guiding measures to implement certain provisions of the Health Insurance Law.

1. Payment for health insurance, reduction in health insurance payment for some subjects.

Pursuant to the Health Insurance Law No. 25/2008/QH12 dated November 14, 2008, as amended and supplemented by Law No. 46/2014/QH13 dated June 13, 2014;

Pursuant to the Government Decree No. 146/2018/NĐ-CP dated October 17, 2018 detailing and guiding the implementation of certain provisions of the Health Insurance Law;

Pursuant to the Government's Decree No. 75/2017/NĐ-CP dated June 20, 2017 stipulating the functions, tasks, powers, and organizational structure of the Ministry of Health;

At the proposal of the Director of the Health Insurance Department, Ministry of Health,

2. Conversion of health insurance benefit levels, payment of health insurance costs for medical examination and treatment for some subjects.

PART I

GENERAL PROVISIONS

Article 1. Scope of Regulation

This Circular stipulates:

3. Implementation of information technology applications in management and appraisal, payment of health insurance costs for medical examination and treatment for some cases.

In this Circular, border communes of border provinces are those communes of the province that have administrative boundaries directly adjacent (share borders) with communes of another province.

Example: Province A borders Province B, Province A has Communes 1, 2, 3, and Province B has Communes 4, 5, 6. Among them, Commune 1 of Province A has an administrative boundary directly adjacent to Commune 4 of Province B, at which point Commune 1 of Province A and Commune 4 of Province B are determined to be two border communes of border provinces. Therefore, a person holding a health insurance card registered for initial medical examination and treatment at the Health Station of Commune 1 in Province A when seeking health insurance medical examination and treatment at the Health Station of Commune 4 in Province B (or vice versa) will still enjoy 100% of medical examination and treatment costs within the scope and level of benefits prescribed in Clause 1, Article 14 of Decree No. 146/2018/NĐ-CP dated October 17, 2018 of the Government detailing and guiding measures to implement certain provisions of the Health Insurance Law (hereinafter referred to as Decree No. 146/2018/NĐ-CP). Commune 1 of Province A does not have an administrative boundary directly adjacent to Communes 5 and 6 of Province B, so a person holding a health insurance card registered for initial medical examination and treatment at the Health Station of Commune 1 in Province A seeking medical examination and treatment at Commune 5 or Commune 6 in Province B (or vice versa) shall not apply the regulation for medical examination and treatment at border communes of border provinces.

Article 2. Interpretation of Terms

PAYMENT FOR HEALTH INSURANCE AND REDUCTION IN HEALTH INSURANCE PAYMENT

FOR SOME SUBJECTS

Chapter II

Article 3. Payment for health insurance for newborns requiring immediate treatment upon birth who die

In the case where newborns require immediate treatment upon birth and subsequently die, the medical examination and treatment facility sends a notification letter accompanied by a summary of the patient's medical record to the social insurance agency where the health insurance medical examination and treatment contract was signed for the social insurance agency to compile a list of these cases and send it to the Department of Finance where the mother resides or the Department of Finance where the medical examination and treatment facility is located (in the case of newborns without a guardian or abandoned at the medical examination and treatment facility) for the Department of Finance to transfer funds according to Clause 5, Article 15 of the Health Insurance Law.

Article 4. Determination of subjects for payment, payment levels, and reduction in payment levels for health insurance under household registration form

1. The determination of subjects as stipulated in Clause 3, Article 5 of Decree No. 146/2018/NĐ-CP is based on one of the following documents:

a) For religious officials, religious workers, and monks/nuns: household registration book or temporary residence certificate or list stamped by the religious organization directly managing the religious officials, religious workers, and monks/nuns;

b) For people living in social welfare institutions: household registration book or temporary residence certificate or list stamped by the social welfare institution where they reside.

2. Reduction in health insurance payment levels for the subjects specified in Article 5 of Decree No. 146/2018/NĐ-CP shall be implemented starting from the second person listed in the household registration book or temporary residence certificate or in the list stamped by the religious organization or social welfare institution as stipulated in Clause 1 of this Article participating in household health insurance.

CONVERSION OF HEALTH INSURANCE BENEFIT LEVELS,

PAYMENT OF HEALTH INSURANCE COSTS FOR MEDICAL EXAMINATION AND TREATMENT

Chapter III

FOR SOME SUBJECTS

PAYMENT OF MEDICAL EXAMINATION AND TREATMENT COSTS UNDER HEALTH INSURANCE

FOR CERTAIN ELIGIBLE PERSONS

Article 5. Conversion of health insurance benefit levels for certain subjects

1. In cases where a person belongs to multiple health insurance subjects but the code character indicating the benefit level recorded on the health insurance card does not reflect the subject with the highest benefit level, such person shall be converted to the highest benefit level when they have one of the documents specified in Clauses 2, 3, and 4 of this Article.

2. Documents determining that a health insurance participant belongs to the subject of persons who have rendered meritorious service to the revolution, except for former soldiers as stipulated in Clause 3 of this Article; relatives of persons who have rendered meritorious service to the revolution; persons who have raised martyrs:

Implement according to the provisions of Article 5 of Circular No. 30/2019/TT-BLDTBXH dated December 26, 2019 of the Ministry of Labor, Invalids and Social Affairs regarding guidelines for compiling lists of subjects participating in health insurance managed by the Ministry of Labor, Invalids and Social Affairs, specifically as follows:

a) Persons who have rendered meritorious service to the revolution: based on the Decision recognizing the status issued by the competent authority or the Decision resolving benefits issued by the Director of the Department of Labor, Invalids and Social Affairs of the province or centrally-administered city.

b) Relatives of persons who have rendered meritorious service to the revolution, persons who have raised martyrs: based on the Decision resolving benefits issued by the Director of the Department of Labor, Invalids and Social Affairs of the province or centrally-administered city; in cases where there is no decision resolving benefits, based on the list of payments for persons who have rendered meritorious service to the revolution and their relatives.

a) Former soldiers discharged from military service or demobilized shall base on one of the following documents:

- Discharge or demobilization Decision (resignation);

- Officer's resume or Summary Form 63 for officers;

- Military personnel resume;

- Military identification card;

- Military personnel form;

- Party member resume established before the date of discharge or demobilization (resignation) of the former soldier;

- Decision granting benefits under one of the following documents:

+ Decree No. 500-NĐ/LB dated November 12, 1958 of the Joint Ministries of National Defense, Finance, and Social Relief specifying the terms for long-term allowances for military personnel who were discharged due to illness and unable to work;

+ Decree No. 111-NĐ dated June 22, 1957 of the Ministry of National Defense detailing specific allowances for military personnel being discharged;

+ Decision No. 47/2002/QĐ-TTg dated April 11, 2002 of the Prime Minister concerning the treatment of military personnel, defense workers who participated in the anti-French resistance war and were discharged (demobilized, resigned) before December 31, 1960;

+ Decision No. 290/2005/QĐ-TTg dated November 8, 2005 of the Prime Minister concerning policies for some subjects directly participating in the resistance war against the United States to save the country but not yet enjoying the policies of the Party and State;

+ Decision No. 188/2007/TTg dated December 6, 2007 of the Prime Minister amending and supplementing Decision No. 290/2005/QĐ-TTg dated November 8, 2005 of the Prime Minister;

+ Decision No. 142/2008/QĐ-TTg dated October 27, 2008 of the Prime Minister implementing policies for military personnel who participated in the resistance war against the United States with less than 20 years of service in the military and were discharged, demobilized back to localities;

+ Decision No. 38/2010/QĐ-TTg dated May 6, 2010 of the Prime Minister amending and supplementing Decision No. 142/2008/QĐ-TTg dated October 27, 2008 of the Prime Minister;

+ Decision No. 62/2011/QĐ-TTg dated November 9, 2011 of the Prime Minister concerning policies for subjects participating in the war to protect the country, performing international duties in Cambodia, assisting Laos after April 30, 1975 who were discharged, demobilized, resigned.

b) Former soldiers retired and receiving monthly social insurance benefits: based on the Decision granting pension benefits or the Decision granting social insurance benefits issued by the competent authority.

c) Former soldiers transferred to civilian jobs shall base on one of the following documents:

- Discharge, demobilization (resignation), transfer Decision;

- Officer's resume or Summary Form 63 for officers;

- Military personnel resume;

- Military identification card;

- Military personnel form;

- Defense worker resume;

- Party member resume established before the date of discharge, demobilization, transfer of the former soldier.

d) In cases where former soldiers have lost their files and papers:

- Former soldiers who have lost files and papers showing they are former soldiers but have one of the following documents:

+ Induction Decision;

+ Recruitment Decision;

+ Promotion and rank advancement Decision, salary increase Decision;

+ Transfer, appointment Decision; assignment;

+ Papers recognizing achievements during the resistance war, commendations for combat;

+ Confirmation document as a former soldier issued by the People's Committee of the commune where the subject resides according to Point b, Clause 7, Article 2 of Decree No. 150/2006/NĐ-CP dated December 12, 2006 of the Government detailing and guiding the implementation of some articles of the Ordinance on Former Soldiers (Applicable to subjects with documents, materials established before December 29, 2006 containing content proving they are former soldiers).

- Former soldiers who were conscripted after April 30, 1975 and have direct combat experience or direct combat support but have lost files and papers showing they are former soldiers: Certificate of the work process of the subject participating in the war to protect the country issued by the head of the unit where the subject worked according to Article 6 of Circular Joint No. 01/2012/TTLT-BQP-BLDTBXH-BTC dated January 5, 2012 of the Joint Circular of the Ministry of National Defense, Ministry of Labor, Invalids and Social Affairs, Ministry of Finance guiding the implementation of Decision No. 62/2011/QĐ-TTg dated November 9, 2011 of the Prime Minister concerning policies for subjects participating in the war to protect the country, performing international duties in Cambodia, assisting Laos after April 30, 1975 who were discharged, demobilized, resigned as the basis for confirming former soldiers.

- Veterans who were conscripted after April 30, 1975, with direct combat service or direct combat support service recorded in their files but without specific time, unit, or location details: The abstract of decoded unit, time, and location of combat incidents during the war to protect the Fatherland shall be issued by the Head of the Military Command Board of the district where the veteran resides, following the Guidance No. 3386/LC-CTC-CCS dated November 15, 2012, of the Joint Operations Directorate and the Policy Directorate on implementing Decision No. 2084/QĐ-BBTM dated November 9, 2012, of the General Staff regarding the issuance of the List of Locations, Time Periods, and Units Directly Participating in Combat to Protect the Fatherland and International Missions After April 30, 1975.

4. Other subjects:

Based on documents proving that they are subjects entitled to higher benefits than those currently enjoyed, as certified by the managing authority.

Example: Mr. Nguyen Van A, a military personnel participating in the war to protect the Fatherland at the northern border, discharged in 1980, subsequently signed a labor contract with Company B and participated in health insurance under the category of workers (the benefit level on his health insurance card was 80%).

After providing his discharge decision, Mr. A was identified as a veteran. Therefore, the social insurance agency reissued his health insurance card, increasing his benefit level from 80% to 100%, subject to the limit on payment ratios for certain medications, chemicals, medical supplies, and medical services as stipulated by the Minister of Health.

5. The new health insurance benefit levels for the subjects specified in Clauses 2, 3, and 4 of this Article shall be calculated from the date when the new health insurance card becomes effective in the information technology system of the social insurance agency. The social insurance agency shall notify the person whose benefit level has been changed immediately upon its effectiveness in the information technology system.

Cases of examination and treatment under health insurance in-person include:

1. Health insurance participants examining and treating at the primary healthcare facility listed on their health insurance card.

2. Health insurance participants registering for primary examination and treatment at a commune health center or multi-purpose clinic or district hospital may seek examination and treatment under health insurance at another commune health center or multi-purpose clinic or district hospital within the same province. In cases where children have not yet obtained a health insurance card due to incomplete birth registration procedures, they may use their birth certificate for examination and treatment at the facilities specified herein.

3. Health insurance participants in emergency situations may be treated at any healthcare facility nationwide.

Doctors or medical officers shall assess and determine the emergency status of patients, record it in the medical file, and bear responsibility for their decisions.

4. Health insurance participants may transfer to another level for examination and treatment under health insurance as prescribed, including:

a) Transferring according to Articles 10 and 11 of Circular No. 40/2015/TT-BYT dated November 16, 2015, of the Minister of Health on Registration for Primary Examination and Treatment Under Health Insurance and Transfer for Examination and Treatment Under Health Insurance. The transfer file includes the transfer form according to Form No. 6 issued together with Decree No. 146/2018/NĐ-CP and other relevant documents (if any);

b) Transferring according to Clause 3 of Article 14 of Decree No. 146/2018/NĐ-CP, which includes: emergency cases; patients undergoing inpatient treatment who are diagnosed with diseases outside the scope of expertise of the healthcare facility; and patients whose condition exceeds the expertise of the healthcare facility while being treated either inpatient or outpatient;

c) Transferring according to Clause 2 of Article 6 of Circular No. 04/2016/TT-BYT dated February 26, 2016, of the Minister of Health on Examination and Treatment and Payment of Costs for Examination and Treatment Under Health Insurance Related to Tuberculosis Examination and Treatment.

5. Health insurance participants holding documents proving they are residing in another locality due to work assignments, temporary job transfers, concentrated training programs, or temporary residence, and seeking primary examination and treatment at a healthcare facility of the same or equivalent level to the one registered on their health insurance card, as stipulated in Clause 7 of Article 15 of Decree No. 146/2018/NĐ-CP. Healthcare facilities shall retain copies of such documents in the patient's medical records.

6. Individuals with rescheduled appointments after transferring according to Clause 5 of Article 15 of Decree No. 146/2018/NĐ-CP.

7. Individuals who have donated organs must be treated immediately after donation.

8. Newborn infants requiring immediate treatment after birth.

Article 7. Payment for medical examination and treatment expenses for individuals who have donated human organs or tissues

1. The health insurance fund shall pay for medical examination and treatment expenses for individuals who have donated their organs or tissues according to the provisions of the law on donation, collection, and transplantation of human tissues and organs and donation and collection of corpses, in cases where immediate treatment is required following the completion of the procedure by the surgeon to remove the donated organ or tissue.

2. The health insurance fund shall not cover medical examination and treatment costs that have already been included in the cost of the procedure to remove the organ or tissue from the donor or have been paid by other financial sources.

3. The medical facility performing the procedure to remove the organ or tissue from the donor shall be responsible for:

a) Compiling a list of donors and their medical examination and treatment expenses and submitting it to the social insurance agency for payment in accordance with Clause 4, Article 15 of Decree No. 146/2018/NĐ-CP;

b) Implementing the electronic data extraction and transfer process as stipulated in Clause 2, Article 10 of this Circular.

Article 8. Guidelines for implementing health insurance medical examination and treatment in primary healthcare services

1. Medical practitioners, except laboratory technicians, radiology technicians, physiotherapy technicians, and midwives, may provide primary healthcare services at educational institutions, vocational training centers, agencies, organizations, or enterprises (hereinafter referred to as agencies or units) as specified in Point a, Clause 1, Article 34 of Decree No. 146/2018/NĐ-CP when they possess one of the following documents:

a) A work assignment document for medical practitioners who are civil servants or employees of the agency or unit;

b) An agreement document for medical practitioners who do not fall under the circumstances specified in Point a of this Clause.

2. The agreement document specified in Point b, Clause 1 of this Article must include the following main information and contents:

a) The party hiring the practitioner to concurrently perform medical examination and treatment in primary healthcare services (hereinafter referred to as the hiring party): Name, address of the agency or unit; name and position of the head of the agency or unit; contact phone number;

b) The party accepting to concurrently perform medical examination and treatment in primary healthcare services (hereinafter referred to as the accepting party): Name, date of birth, gender, residential address, identification card number or other valid identification; contact phone number for individual practitioners or the name, address, and name of the head of the medical facility for agreements signed with medical facilities;

c) Content of the job, workplace, and working hours, wherein the working hours are agreed upon between the hiring and accepting parties;

d) Duration of the agreement (by fiscal year or academic year);

đ) Commitment of both the hiring and accepting parties to bear legal responsibility for the content of the agreement and the results of its implementation.

a) The medical facility has its headquarters in the same commune as the agency or unit or in a neighboring commune to the commune where the agency or unit's headquarters is located;

b) The medical practitioner has registered to practice during regular office hours in the commune where the agency or unit's headquarters is located or in a neighboring commune to the commune where the agency or unit's headquarters is located.

Article 9. Transfer to perform ancillary medical services

a) Ancillary medical services within the list of medical technology services approved by competent state agencies for healthcare facilities and currently being performed at such facilities but at the time of prescribing for patients, those facilities cannot perform them;

b) Ancillary medical services not within the list of medical technology services approved by competent state agencies for healthcare facilities but actually necessary for professional activities as prescribed by the Minister of Health on management, diagnosis, and treatment in diagnosis and treatment shall be covered by the health insurance fund for inpatient treatments from district level hospitals upwards.

The head of health insurance healthcare facilities shall base on their functions, tasks, and scope of professional activities approved by competent authorities to compile a list of ancillary medical services that need to be transferred and send it to the social insurance agency where the health insurance diagnosis and treatment contract is signed for both parties to sign a supplementary appendix to the health insurance diagnosis and treatment contract before implementation.

2. Healthcare facilities shall only transfer patients or patient samples to receiving facilities that have been approved by competent authorities to meet the conditions for performing ancillary medical services and must sign a general agreement with the facility providing ancillary medical services (the contract includes the content of unified inspection by the social insurance agency where the health insurance diagnosis and treatment contract is signed regarding the ancillary medical services received and performed at the ancillary medical service provision facility).

3. The receiving facility for patients or patient samples to perform ancillary medical services shall not further transfer patients or patient samples to a third party (different facility).

4. Coding of ancillary medical services: The healthcare facility transferring patients or patient samples (hereinafter referred to as the transferring facility) shall code as follows: XX.YYYY.ZZZZ.K.WWWWW, wherein:

a) XX.YYYY.ZZZZ is the code for ancillary medical services;

b) K is a character indicating that the ancillary medical service is performed at another facility;

c) WWWWW is a character indicating the code number of the ancillary medical service provision facility issued by the Ministry of Health.

5. Payment of costs:

a) The payment of costs for performing ancillary medical services shall be implemented in accordance with Clause 6, Article 27 of Decree No. 146/2018/ND-CP and according to the price of the receiving facility for patients or patient samples but shall not exceed the price of diagnosis and treatment services prescribed in Circular No. 13/2019/TT-BYT dated July 5, 2019, of the Minister of Health amending and supplementing some articles of Circular No. 39/2018/TT-BYT dated November 30, 2018, of the Minister of Health on uniform prices for diagnosis and treatment services under health insurance between hospitals of the same category nationwide and guiding the application of prices and payment of costs for diagnosis and treatment under health insurance in certain cases.

In the case of an ancillary medical service being performed at multiple receiving facilities in the same prescription, the health insurance fund shall only pay for one performance of that ancillary medical service.

b) The receiving facility providing ancillary medical services shall not charge additional fees for diagnosis and ancillary medical services for patients.

Article 10. Implementing information technology applications to serve management and appraisal, payment of medical examination and treatment costs under health insurance for certain cases.

1. Children after birth enjoy health insurance benefits as prescribed by the Health Insurance Law, but have not been issued a health insurance card by the social insurance agency due to not having completed the registration of birth procedures shall be handled by medical examination and treatment facilities as follows:

a) Record a temporary health insurance card code, including the following contents:

- Object code: marked with the symbol TE;

- Health insurance benefit level code: marked with the number 1;

- Province or centrally governed city code: recorded according to Decision No. 124/2004/QĐ-TTg dated July 8, 2004 of the Prime Minister on issuing the List and Code Number of Administrative Units in Vietnam (hereinafter referred to as Decision No. 124/2004/QĐ-TTg), where the mother or the legal guardian resides or where the medical examination and treatment facility is located in the case of newborns without a recipient or abandoned at the medical examination and treatment facility;

- Medical identification code: recorded according to Decision No. 2153/QĐ-BYT dated May 25, 2020 of the Minister of Health on issuing the Regulation on Establishing, Using and Managing Medical Identification Codes (hereinafter referred to as Decision No. 2153/QĐ-BYT).

Example: The temporary card code for children's medical examination and treatment, with the mother residing in Hanoi, would be coded as follows: TE101, followed by the medical identification code (ten digits).

b) Recording the name in the medical record for medical examination and treatment and transferring electronic data for management and appraisal, payment of medical examination and treatment costs under health insurance for newborns without a surname and given name shall be carried out as follows:

- If the newborn has a mother or father: record according to the mother's or father's surname and given name;

- If the newborn does not have a mother or father but has a legal guardian: record according to the legal guardian's surname and given name;

- If the newborn has no recipient or is abandoned at the medical examination and treatment facility: record the name of the medical examination and treatment facility where the treatment is being conducted.

2. Individuals who have donated body parts but have not been issued a health insurance card by the social insurance agency shall have their medical examination and treatment facilities record a temporary health insurance card code to ensure that electronic data can be extracted and transferred for management and appraisal, payment of medical examination and treatment costs under health insurance for this individual, which shall be carried out as follows:

a) Object code: marked with the symbol HG;

b) Benefit level code: marked with the number 4;

c) Province or centrally governed city code: recorded according to Decision No. 124/2004/QĐ-TTg where the organ or body part donor resides;

d) Medical identification code: recorded according to Decision No. 2153/QĐ-BYT.

Example: An organ or body part donor residing in Hanoi would be coded as follows: HG401, followed by the medical identification code (ten digits).

3. Medical examination and treatment facilities temporarily submit data for appraisal and payment of medical examination and treatment costs under health insurance for individuals under the management of the Politburo and Secretariat by paper until new regulations and guidelines on transferring electronic data are issued; the consolidated data on medical examination and treatment costs under health insurance for these individuals shall be implemented according to Model C79-HD issued together with Circular No. 102/2018/TT-BTC dated November 14, 2018 of the Ministry of Finance on guiding accounting for social insurance.

Article 11. Suspension and immediate termination of the validity of health insurance cards

1. The social insurance agency shall immediately suspend and terminate the validity of health insurance cards for persons who have died through the social insurance agency's information technology system as follows:

a) In cases where insured persons die at medical examination and treatment facilities, the social insurance agency shall immediately suspend and terminate the validity of their health insurance cards upon receiving electronic data with value equal to 5 in field number 22 (KET_QUA_DTRI) of Table 1 issued together with Decision No. 4210/QD-BYT dated September 20, 2017 of the Minister of Health on the format and standard data output for management and review, payment of medical examination and treatment costs under health insurance, transferred from the medical examination and treatment facility to the Data Reception Portal within the social insurance agency’s information technology system;

b) In cases where insured persons die outside medical examination and treatment facilities, the social insurance agency shall immediately suspend and terminate the validity of their health insurance cards upon receiving death information from the People's Committee of the commune where the insured person died, which has been transferred to the social insurance agency’s information technology system.

2. When the medical examination and treatment facility has extracted and transferred electronic data to the Data Reception Portal within the social insurance agency’s information technology system as stipulated in point a, Clause 1 of this Article or the People's Committee of the commune where the insured person died has issued a death certificate and transferred it to the social insurance agency’s information technology system as stipulated in point b, Clause 1 of this Article, but medical examination and treatment costs under health insurance still occur and a payment request is made, the following actions shall be taken:

a) The health insurance fund shall directly pay the medical examination and treatment costs under health insurance according to Article 4 of Circular No. 09/2019/TT-BYT dated June 10, 2019 of the Minister of Health guiding the verification of conditions for signing initial medical examination and treatment contracts under health insurance, transferring the implementation of clinical services and some cases of direct payment of costs in medical examination and treatment under health insurance if due to card data errors or incorrect information updates by the medical examination and treatment facility or the commune People's Committee;

b) The health insurance fund shall not pay medical examination and treatment costs under health insurance that arise when relatives of the deceased insured person or others use the health insurance card of a deceased person; simultaneously, the social insurance agency shall compile and recommend to competent state authorities to consider handling units and individuals in violation according to the provisions of the law.

Chapter IV

IMPLEMENTING PROVISIONS

Article 12. Effective Date

1. This Circular takes effect from March 1, 2021.

2. Article 3 of Circular No. 09/2019/TT-BYT dated June 10, 2019 of the Minister of Health guiding the verification of conditions for signing initial medical examination and treatment contracts under health insurance, transferring the implementation of clinical services and some cases of direct payment of costs in medical examination and treatment under health insurance shall cease to be effective from the date this Circular takes effect.

Article 13. Reference Provisions

In cases where referenced documents in this Circular are replaced or amended, they shall be implemented according to the replaced or amended documents.

1. The Minister, Heads of Ministries equivalent to ministries, Heads of government agencies, Chairmen of provincial People's Committees under the central government, and related agencies, units, and individuals are responsible for implementing this Circular.

1. Responsibilities of the Provincial People's Committee:

a) Promptly guide and resolve difficulties and obstacles within their duties during the implementation of this Circular;

b) Direct the People's Committee of the commune managing the deceased insured person to issue a death certificate and immediately register it on the social insurance agency’s information technology system according to regulations.

2. Responsibilities of the Vietnam Social Security:

a) Guide the issuance of new cards due to changes in health insurance benefits as stipulated in Article 5 of this Circular and the issuance of health insurance cards for persons who have donated organs or tissues;

b) Upgrade and improve the information technology system to ensure compliance with the full and correct implementation of Decree No. 146/2018/NĐ-CP, Circular No. 48/2017/TT-BYT dated December 28, 2017 of the Minister of Health on the extraction and transfer of electronic data in the management and payment of medical examination and treatment costs under health insurance, and other regulations of the Minister of Health;

- Implement the management and automatic issuance of healthcare identification codes as prescribed in Decision No. 2153/QĐ-BYT;

- Maintain the reception, management, utilization, and timely feedback to medical examination and treatment facilities and insured persons of information related to determining insured persons who have participated in health insurance for five consecutive years or more and whose total out-of-pocket expenses for medical examination and treatment in the same year exceed six months' basic salary as stipulated in Clause 3, Article 27 of Decree No. 146/2018/NĐ-CP.

3. Responsibilities of the Departments of Health of provinces and centrally-administered cities and health management agencies of ministries and sectors:

a) Take the lead and coordinate with the provincial social insurance agency to disseminate and instruct medical examination and treatment facilities under their jurisdiction to implement medical examinations and treatments for insured persons according to laws on medical examinations and treatments, the Health Insurance Law, Decree No. 146/2018/NĐ-CP, and the provisions of this Circular;

b) Take the lead and coordinate with the Department of Health of the neighboring province or centrally-administered city to unify the determination and implementation of medical examinations and treatments under health insurance at border communes as stipulated in Clause 4, Article 14 of Decree No. 146/2018/NĐ-CP.

4. Responsibilities of medical examination and treatment facilities under health insurance:

Cooperate with the social insurance agency where the medical examination and treatment contract under health insurance was signed to strictly comply with all legal provisions on medical examinations and treatments, the Health Insurance Law, Decree No. 146/2018/NĐ-CP, and the provisions of this Circular. During implementation, if there are any difficulties or issues, they should promptly report them to the Ministry of Health for consideration and resolution.

Coordinate with the social insurance agency that signed the medical examination and treatment health insurance contract to comply fully and properly with the laws on medical examination and treatment, the Health Insurance Law, Decree No. 146/2018/NĐ-CP, and the provisions of this Circular. Any difficulties or issues encountered during implementation should be promptly reported to the Ministry of Health for consideration and resolution.

During the implementation process, if there are any difficulties or issues, it is recommended that agencies, units, organizations, and individuals promptly reflect them to the Ministry of Health for consideration and resolution./.