Joint Circular No. 40/1998/TTLT-BGDĐT-BYT on guiding health insurance for students

JOINT CIRCULAR

Regarding guidance on student health insurance

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Health insurance generally, and student health insurance specifically, is a social policy of the Party and State, characterized by humanitarianism and community spirit, not for profit purposes. After more than three years implementing Circular No. 14/TT-LB dated September 19, 1994 of the Ministry of Education and Training and the Ministry of Health, student health insurance (SHI) has achieved some initial results, affirming the correct direction and necessity of SHI in protecting, caring for, and educating students' health, implementing the Party and State's directions on socializing education and healthcare work. Based on Decree No. 299/HĐBT dated August 15, 1992 of the Government promulgating the Health Insurance Charter and Resolution No. 37/CP dated June 20, 1996 of the Government on strategic orientation for health care and protection work, to address issues that are no longer appropriate, after receiving the agreement of the Ministry of Finance at Document No. 2607/TC-HCSN dated July 17, 1998, the Ministry of Education and Training and the Ministry of Health guide the implementation of student health insurance nationwide as follows:

I. SUBJECTS PARTICIPATING IN STUDENT HEALTH INSURANCE:

All students from primary school level upwards studying at state-owned, semi-public, private schools, and regular education centers can participate in student health insurance. Excluded are those who are beneficiaries of preferential policies of the State and have been issued health insurance cards by the State.

II. SCOPE OF STUDENT HEALTH INSURANCE, RIGHTS AND OBLIGATIONS OF STUDENTS PARTICIPATING IN STUDENT HEALTH INSURANCE:

1. The contents of student health insurance include: primary health care (PHC) at school health facilities, medical examination and treatment, and death benefits.

a. Contents of PHC at school health facilities:

- Students are managed and guided to prevent school diseases, specifically:

+ Maintaining personal hygiene, nutritional hygiene, environmental hygiene;

+ Preventing epidemics;

+ Measures to prevent and treat common illnesses and symptoms (diarrhea, abdominal pain, eye pain, headache);

+ Preventing spinal deformities;

+ Oral hygiene, vision protection (preventing myopia);

+ Preventing social diseases and social evils (school drug abuse, HIV/AIDS, etc.);

+ Preventing traffic accidents and occupational injuries;

+ Regular health check-ups at the beginning of grade 1, end of each general education level, and start of each academic year at universities and vocational schools.

- Implementing first aid for accidents and sudden illnesses;

- Ensuring food hygiene at school for students and trainees.

b. Medical examination and treatment: Students can be examined and treated at healthcare facilities (collectively referred to as hospitals) registered on their health insurance examination and treatment card. In emergency cases, they can be examined and treated at any hospital.

- Outpatient medical examination and treatment: In cases of emergency and accidents but not requiring hospitalization.

- Outpatient medical examination and treatment includes the following:

+ Examination, diagnosis, and treatment.

+ Laboratory tests, X-ray imaging, functional examinations.

+ Medicines listed according to regulations of the Ministry of Health.

+ Blood and fluid transfusions.

+ Surgical procedures and operations.

+ Use of medical supplies and equipment, and hospital beds.

c. In cases where illness or accidents lead to death, funeral expenses will be compensated.

2. Rights of students participating in health insurance:

a. Receiving health insurance cards and examination and treatment cards according to the model prescribed by the Ministry of Health.

b. Receiving health care, protection, and health education at school.

c. Being reimbursed by the health insurance agency for outpatient and inpatient examination and treatment costs as stipulated in Point b, Section 1, Part II of this Circular when seeking examination and treatment at:

- Hospitals registered on the student's health insurance examination and treatment card.

- Hospitals according to transfer certificates consistent with the specialized technical levels defined by the Ministry of Health.

- Any state hospital in case of emergency.

d. In cases of examination and treatment not complying with the provisions in Point c, Section 2, Part II of this Circular, the health insurance agency will reimburse examination and treatment costs according to the hospital fee prices at the appropriate specialized technical level.

e. Receiving funeral expense compensation from the health insurance agency in case of accidental death.

g. The health insurance agency will not reimburse in the following cases:

- Diseases covered by the State budget: leprosy treatment; special drugs for tuberculosis, malaria, schizophrenia, epilepsy treatment; family planning services;

- Rabies prevention and treatment; HIV/AIDS testing, diagnosis, and treatment; gonorrhea, syphilis;

- Vaccination, convalescence, and recuperation;

- Plastic surgery, cosmetic surgery, prosthetic limbs, artificial eyes, dentures, glasses, hearing aids, artificial lenses, artificial joints, artificial heart valves;

- Congenital diseases and congenital malformations;

- War and natural disaster accidents;

- Suicide, intentional injury, drug addiction, violation of laws.

3. Obligations of students participating in health insurance:

a. Paying health insurance premiums fully and on time as prescribed.

b. Strictly adhering to the instructions of school health staff.

c. When ill or injured and hospitalized, must present the health insurance card or valid identification with photo and the health insurance examination and treatment card within 48 hours of admission.

III. RIGHTS AND OBLIGATIONS OF ORGANIZATIONS IMPLEMENTING STUDENT HEALTH INSURANCE:

1. Schools:

a. The main responsibility for protecting, caring for, and educating students' health during school hours lies with the school leadership.

b. Each school or cluster of schools must arrange school health facilities according to regulations and ensure conditions for school health facilities to operate according to their functions and responsibilities as defined by the Ministry of Education and Training and the Ministry of Health regarding school health work.

c. Schools are responsible for organizing publicity, registration, declaration, collection of student health insurance payments, and using the remaining health insurance funds at the school effectively and for the intended purpose as stipulated in this Circular.

2. Hospitals:

a. Conducting medical examinations and treatments in accordance with contracts with the health insurance agency for students participating in health insurance, ensuring reasonable and safe treatment according to the regulations of the Ministry of Health.

b. Recording and providing relevant documents related to student health insurance medical examinations and treatments to serve as a basis for financial settlement and finalization.

c. Check health insurance cards and medical examination and treatment vouchers, identify cases of violation and abuse of card and voucher usage, and promptly report to the health insurance agency for resolution.

d. Hospitals and health insurance agencies shall enter into responsibility contracts, advance funding, and periodically settle medical examination and treatment costs according to regulations and signed medical examination and treatment contracts. Hospitals are responsible for managing and using this revenue in accordance with current state regulations.

3. Health Insurance Agency:

a. Enter into responsibility contracts with schools to organize the collection of health insurance premiums from students.

b. Enter into medical examination and treatment contracts with hospitals to ensure convenient and reasonable reception and examination and treatment for students participating in health insurance.

c. Organize the issuance of health insurance cards and medical examination and treatment vouchers for students. The cost of printing and issuing these cards and vouchers is covered by the management funds of the health insurance agency.

d. Inspect and appraise the reception and implementation of student health insurance benefits at hospitals, protect the legitimate rights of students participating in health insurance; refuse to pay health insurance subsidies for cases that do not comply with the provisions of this Circular.

e. The health insurance agency that issues health insurance cards and medical examination and treatment vouchers for students is responsible for advancing funds and settling costs according to regulations. Settlement is carried out through the following methods:

- Payment to healthcare facilities according to signed contracts.

- Payment through multi-line settlements outside the assigned management area.

- Direct payment to insured patients in other cases.

IV. LEVELS OF STUDENT HEALTH INSURANCE CONTRIBUTIONS AND CONTENT OF USE OF THE STUDENT HEALTH INSURANCE FUND:

1. The fee levels for health insurance contributions are determined based on educational level as follows:

Based on the economic and social conditions of the locality, the Chairman of the Provincial People's Committee or the City People's Committee under the Central Government decides on specific contribution levels within the framework of the above-defined fee levels, ensuring the principle of sufficient revenue and expenditure, fund safety, and development of the health insurance cause.

2. Health insurance fees: collected once or twice a year (12 months) at appropriate times as stipulated by local authorities.

For elementary school and junior high school students, parents are responsible for submitting health insurance fees to the school's health insurance collection organization.

For high school, university, college, vocational high school, and technical secondary students, students themselves submit health insurance fees to the school's health insurance collection organization.

3. The student health insurance fund is established at the provincial or city health insurance agency and distributed and used as follows:

a. 65% of the collected health insurance fees retained in the provincial or city health insurance fund will be used as follows:

- 60% for medical examination and treatment expenses and funeral assistance of 1,000,000 VND per case.

- 4% for the management of the provincial or city health insurance agency.

- 1% submitted to the National Health Insurance Fund. Of which:

+ 0.8% to establish a reserve fund.

+ 0.2% for the management of the National Health Insurance Fund.

b. 35% of the collected health insurance fees managed and used by the school as follows:

- 30%: for paying allowances to school health staff, purchasing common medicines and medical equipment for initial first aid and health care for students at the school clinic.

- 5%: for individuals and units involved in promoting and organizing the collection of health insurance fees (including education and training departments at district, county, town levels and equivalent).

Schools are responsible for managing, using, and settling this portion of the funds with higher-level state management agencies as a budget expense. After approval of the settlement, one copy should be sent to the health insurance agency that issued the card.

c. The student medical examination and treatment fund is accounted for separately. If there is a surplus after one year of operation, 80% will be allocated to the reserve fund, and 20% will be used to purchase health insurance for students in extremely difficult circumstances.

In cases where income does not cover expenses and the reserve fund has been exhausted, the health insurance agency reports to the relevant Departments of Education and Training, Health, and Finance for review and conclusion, then submits to the Provincial or City People's Committee for consideration and resolution, to prevent the loss of the ability to pay for the student health insurance fund, while planning to adjust the student health insurance contribution level to ensure fund safety.

V. PRINTING AND ISSUANCE OF STUDENT HEALTH INSURANCE CARDS AND MEDICAL EXAMINATION AND TREATMENT VOUCHERS:

- Student health insurance cards and medical examination and treatment vouchers are issued uniformly nationwide as specified in Article 2 of Decision No. 810/BYT-QĐ dated September 20, 1994, by the Minister of Health.

- Medical examination and treatment vouchers have a validity period indicated on the voucher corresponding to the amount of health insurance paid.

- Health insurance cards help identify eligible insured persons with a maximum validity period of five years. In cases where students already hold valid identity cards with photos, it is not necessary to issue health insurance cards.

VI. IMPLEMENTATION ORGANIZATION:

1. Health insurance agencies at all levels cooperate with education and training agencies to intensify publicity and explanation about health insurance in general and student health insurance in particular in schools, especially to parents of students.

2. Education and training agencies, health agencies at the same level, and health insurance agencies work together to build, maintain, and develop school health services, effectively implementing the activities of school health services.

3. Provincial or city health insurance agencies develop student health insurance plans, report to the Department of Health Director, Department of Education and Training Director for review, and submit to the Chairman of the Provincial or City People's Committee for approval and implementation when the plan is approved.

4. Health Departments direct hospitals under their jurisdiction to provide good service to patients with student health insurance cards when they seek outpatient and inpatient care.

5. Schools are responsible for monitoring and settling the portion of the student health insurance fund remaining at the school, reporting to the Finance Department at the same level for approval.

6. The Education and Training Authority, Health Authority, and the same-level Health Insurance Agency shall coordinate to organize inter-sectoral conferences to implement student health insurance, conduct comprehensive evaluations, and propose measures to enhance student health insurance work for each phase.

This Circular takes effect from the date of signature and replaces Circular No. 14/TTLB dated September 19, 1994, issued jointly by the Ministry of Education and Training and the Ministry of Health. All previous regulations that conflict with this Circular are hereby abolished. During the implementation process, if there are any difficulties, localities and units shall promptly report them to the Ministry of Education and Training and the Ministry of Health for study and resolution.