Joint Circular No. 41/2014/TTLT-BYT-BTC guides the implementation of health insurance

JOINT CIRCULAR

Hguiding the implementation of health insurancepolicies

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Pursuant to the Health Insurance Law on December 14, the 11 year 2008 and the Law Amending and Supplementing Certain Provisions of the Health Insurance Law on June 13, 2014;

Pursuant to Decree No. 105/2014/ND-CP dated November 15, 2014 of the Government detailing and guiding the implementation of certain provisions of the Law Bhealth insurance;

Pursuant to Decree No. 63/2012/ND-CP dated September the 8 year 2012 of the Government stipulates the functions, tasks, powers, and organizational structure of the Ministry of Health;

Pursuant to Decree No. 215/2013/NĐ-CP dated December 23, 2013, promulgated by the Government stipulating the functions, tasks, powers, and organizational structure of the Ministry of Finance;

The Minister of Health and the Minister of Finance issue this Joint Circular guiding the implementation of health insurance.

PART I

PARTICIPANTS, CONTRIBUTION METHODS, AND

 LIABILITY FOR HEALTH INSURANCE CONTRIBUTIONS

METHODS OF CONTRIBUTION AND BENEFIT LEVELS UNDER HEALTH INSURANCE

In accordance with Article 12 amended and supplemented by the Health Insurance Law; Articles 15, 21, 25, and Article 26 amended and supplemented by the Ordinance on Preferential Treatment for Persons Contributing to the Revolution and Article 1 of Decree No. 105/2014/ND-CP, the participants in health insurance (hereinafter referred to as health insurance) include:

1. Group whose contributions are made by employees and employers, including:

a) Employees working under indefinite-term labor contracts, labor contracts with a term of at least three months; managers of non-state-owned enterprises and units, cooperative managers receiving salaries; civil servants, public officials, and employees (hereinafter collectively referred to as employees) working in the following organizations:

- State agencies, people's armed forces units;

- Political organizations, political-social organizations, social-professional organizations, social organizations, social-professional organizations, other social organizations;

- Public and private non-public service units;

- Enterprises belonging to various economic sectors established and operating under the Enterprise Law and Investment Law;

- Foreign agencies and international organizations operating within the territory of Vietnam;

- Cooperatives, cooperative unions established and operating under the Cooperative Law;

- Individual households, cooperatives, other organizations, and individuals who hire workers under labor contracts.

b) People engaged in part-time work at communes, wards, towns as prescribed by law.

2. Group whose contributions are made by the Social Insurance Organization, including:

a) Persons receiving monthly pensions or disability benefits;

b) Persons currently receiving monthly social insurance benefits due to workplace accidents, occupational diseases, or long-term illnesses listed in the directory; persons aged 80 years or older currently receiving monthly survivor benefits;

c) Commune-level civil servants who have retired and are currently receiving monthly social insurance benefits;

d) Persons currently receiving unemployment benefits;

đ) Rubber plantation workers currently receiving monthly benefits pursuant to Decision No. 206/CP dated May 30, 1979 of the Council of Ministers (now the Government) regarding policies for newly liberated workers engaged in heavy and harmful jobs who are now too old to continue working.

3. Group whose contributions are made by the state budget, including:

a) Officers, professional military personnel, non-commissioned officers, soldiers in active service in the army; officers, non-commissioned officers in specialized positions, and officers, non-commissioned officers in technical and professional positions in the police force, police academy students, non-commissioned officers, and police recruits serving on a fixed-term basis in the police force; personnel in confidential services receiving salaries equivalent to those of military personnel; confidential service students receiving benefits and policies according to the policies for students at military and police academies;

b) Village, ward, town cadres who have retired and are currently receiving monthly benefits from the state budget;

c) Persons who have ceased receiving disability benefits and are currently receiving monthly benefits from the state budget;

d) Persons contributing to the revolution, former soldiers, including:

- Persons contributing to the revolution as stipulated in the Ordinance on Preferential Treatment for Persons Contributing to the Revolution;

- Former soldiers who participated in the resistance war before April 30, 1975 as provided for in Clause 6, Article 5 of Decree No. 150/2006/ND-CP dated December 12, 2006 of the Government detailing and guiding the implementation of certain provisions of the Ordinance on Former Soldiers;

- Persons 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 as provided for in Decision No. 290/2005/QD-TTg dated November 8, 2005 of the Prime Minister on the system and 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 the State and Decision No. 188/2007/QD-TTg dated December 6, 2007 of the Prime Minister amending and supplementing Decision No. 290/2005/QD-TTg;

- Police officers participating in the resistance war against the United States with less than 20 years of service in the police force who have retired and left their posts according to Decision No. 53/2010/QD-TTg dated August 20, 2010 of the Prime Minister on the system for police officers participating in the resistance war against the United States with less than 20 years of service in the police force who have retired and left their posts;

- Military personnel participating in the resistance war against the United States with less than 20 years of service in the military who have been discharged and left their posts according to Decision No. 142/2008/QD-TTg dated October 27, 2008 of the Prime Minister on implementing the system for military personnel participating in the resistance war against the United States with less than 20 years of service in the military who have been discharged and left their posts and Decision No. 38/2010/QD-TTg dated May 6, 2010 of the Prime Minister amending and supplementing Decision No. 142/2008/QD-TTg;

- Persons participating in the war to protect the homeland and performing international duties in Cambodia and assisting Laos after April 30, 1975 who have been discharged and left their posts according to Decision No. 62/2011/QD-TTg dated November 9, 2011 of the Prime Minister on the system and policies for persons participating in the war to protect the homeland and performing international duties in Cambodia and assisting Laos after April 30, 1975 who have been discharged and left their posts;

- Youth volunteers according to Decision No. 170/2008/QD-TTg dated December 18, 2008 of the Prime Minister on the health insurance system and funeral allowance for youth volunteers during the anti-French resistance period and Decision No. 40/2011/QD-TTg dated July 27, 2011 of the Prime Minister on the system for youth volunteers who have completed their tasks during the resistance period;

đ) Current members of the National Assembly and People's Councils at all levels;

e) Children under six years old (including all children residing in the area, regardless of whether they are relatives of the subjects specified in Point a of this Clause, without regard to permanent residence registration).

g) Persons entitled to monthly social assistance benefits in accordance with the provisions of Government Decree No. 136/2013/ND-CP dated October 21, 2013 on social assistance policies for beneficiaries, Government Decree No. 06/2011/ND-CP dated January 14, 2011 detailing and guiding the implementation of certain articles of the Law on Elderly People, and Government Decree No. 28/2012/ND-CP dated April 10, 2012 detailing and guiding the implementation of certain articles of the Law on Persons with Disabilities;

h) Members of poor households; ethnic minority people residing in areas with difficult socio-economic conditions; people residing in areas with particularly difficult socio-economic conditions; people residing in island communes and island districts according to Government Resolutions, Prime Minister's Decisions, and Decisions of the Minister, Chairman of the National Ethnic Minorities Committee;

i) Relatives of those who have rendered meritorious service to the revolution, including fathers, mothers, wives, husbands, children over six years old but under eighteen years old, or those aged eighteen or older if they continue their education or suffer from severe disabilities or extremely severe disabilities of martyrs; persons who have raised martyrs;

k) Relatives of those who have rendered meritorious service to the revolution, except for the subjects specified in Point i of this Clause, including:

- Fathers, mothers, wives, husbands, children aged over six but under eighteen years old, or those aged eighteen or older if they continue their education or suffer from severe disabilities or extremely severe disabilities of the following subjects: persons who were engaged in revolutionary activities before January 1, 1945; persons who were engaged in revolutionary activities from January 1, 1945 to August 1945; Heroes of the People's Armed Forces, Labor Heroes during the resistance war; war invalids and disabled veterans with a reduction in work capacity of 61% or more; persons affected by toxic chemicals during the anti-war resistance with a reduction in work capacity of 61% or more;

- Children born to persons affected by toxic chemicals during the anti-war resistance who suffer from deformities or disabilities due to the effects of toxic chemicals and cannot live independently or have reduced self-sufficiency in living;

l) Relatives of the subjects specified in Point a Clause 3 of this Article (excluding children under six years old);

m) Persons who have donated organs as prescribed by law;

n) Foreign students studying in Vietnam and receiving scholarships funded by the Vietnamese state budget;

o) Persons serving those who have rendered meritorious service to the revolution, including:

- Persons serving Heroic Mothers living in families;

- Persons serving war invalids and disabled veterans with a reduction in work capacity of 81% or more living in families;

- Persons serving persons affected by toxic chemicals during the anti-war resistance with a reduction in work capacity of 81% or more living in families.

4. Group supported by the state budget for contribution levels, including:

a) Members of near-poor households;

b) Students enrolled at educational institutions within the national education system;

c) Members of households engaged in agriculture, forestry, fisheries, and salt production with average income levels;

5. Group participating in health insurance under household registration, b) Explanation and calculation of cost components and profit of Electricity Corporation i, including:

a) All individuals listed in the household registration book, excluding the subjects specified in Clauses 1, 2, 3, and Clause 4 of this Article and those who have declared temporary absence;

b) All individuals listed in the temporary residence registration book, excluding the subjects specified in Clauses 1, 2, 3, and Clause 4 of this Article;

Example 1: Mr. B's family has five people listed in the household registration book, including one person receiving pension, and one civil servant; additionally, there is one person from another locality registered for temporary residence. The number of people participating in health insurance under Mr. B's household registration is four people.

Article 2. Methods for paying health insurance premiums for certain subjects

1. For individuals receiving pension benefits, disability allowances, and monthly social insurance benefits guaranteed by the state budget as stipulated in Clause 2 and Point c, Clause 3, Article 1 of this Circular: Monthly, the Social Insurance Organization shall pay the health insurance premium for these subjects from the funds allocated for pension and social insurance benefits guaranteed by the state budget.

2. For revolutionary meritorious persons as specified in Point d, relatives of revolutionary meritorious persons as specified in Points i and k, servants of revolutionary meritorious persons as specified in Point o, and persons entitled to monthly social assistance benefits as specified in Point g, Clause 3, Article 1 of this Circular:

a) Quarterly, the Social Insurance Organization shall compile the number of issued health insurance cards and the amount paid for health insurance premiums for these subjects (Appendix 01 model), and submit it to the Labor, War Invalids, and Social Affairs authority at the same level for transferring corresponding funds from the sources implementing preferential policies for revolutionary meritorious persons and social welfare policies into the health insurance fund;

b) By no later than December 31 each year, the Social Insurance Organization, in collaboration with the Labor, War Invalids, and Social Affairs authority at the same level, must complete the payment and transfer of funds into the health insurance fund for that year.

3. For subjects specified in Points b, d (excluding revolutionary meritorious persons), e, h, and Point m, Clause 3, Article 1 of this Circular, and members of households classified as near-poor as specified in Point a, Clause 4, Article 1 of this Circular who are supported by the state budget at 100% of the prescribed contribution rate as stipulated in Points a and b, Clause 1, Article 3 of Decree No. 105/2014/NĐ-CP:

Quarterly, the Social Insurance Organization shall compile the number of issued health insurance cards and the amount paid and supported (Appendix 02 model), and submit it to the Finance Department for transferring funds into the health insurance fund according to Clause 7 of this Article.

4. For subjects who are members of households classified as near-poor as specified in Point a, Clause 4 (excluding those supported at 100% of the health insurance premium contribution rate) and members of households engaged in agriculture, forestry, fisheries, and salt production with average living standards as specified in Point c, Clause 4, Article 1 of this Circular:

a) Periodically every three months, six months, or twelve months, the representative of the household directly pays the portion of the health insurance premium due to the Social Insurance Organization or the health insurance premium collection agent at the commune level;

b) Periodically every three months, six months, or twelve months, the Social Insurance Organization shall compile the number of issued health insurance cards, the amount collected from the subjects, and the amount supported by the state budget (Appendix 02 model), and submit it to the Finance Department for transferring funds into the health insurance fund according to Clause 7 of this Article.

5. For students and trainees currently studying at educational institutions within the national education system as specified in Point b, Clause 4, Article 1 of this Circular:

a) Educational institutions collect the portion of the health insurance premium due from students and trainees once every six months or annually and deposit it into the health insurance fund;

b) The portion of the health insurance premium supported by the state budget is implemented as follows:

- For students and trainees studying at educational institutions managed by local authorities, the local budget supports them regardless of their permanent residence registration: Every six months, the Social Insurance Organization shall compile the number of issued health insurance cards, the amount collected from students and trainees, and the amount supported by the state budget (Appendix 02 model), and submit it to the Finance Department for transferring funds into the health insurance fund according to Clause 7 of this Article;

- For students and trainees studying at educational institutions managed by central ministries and agencies, the central budget supports them: Every six months, the Social Insurance Organization shall compile the number of issued health insurance cards, the amount collected from students and trainees, and the amount supported by the state budget (Appendix 02 model), and submit it to the Vietnam Social Insurance for consolidation, then to the Ministry of Finance for transferring funds into the health insurance fund.

c) For students and trainees belonging to multiple categories as specified in Clause 3 and Point a, Clause 4, Article 1 of this Circular studying at educational institutions managed by central ministries and agencies, they participate in health insurance according to Clause 8 of this Article and present their health insurance card to the educational institution when compiling the list of participants to avoid duplicate issuance of health insurance cards.

6. For groups participating in health insurance under household registration as specified in Clause 5, Article 1 of this Circular: Periodically every three months, six months, or twelve months, the representative of the household directly pays the health insurance premium to the Social Insurance Organization or the health insurance premium collection agent at the commune level.

7. The Finance Authority, based on the regulations on the分级管理预算的地方和由社会保险机构转交的参加对象、国家预算支付和资助健康保险费的汇总表，负责每季度一次将资金转入健康保险基金；最迟于每年12月31日前完成当年的资金转入健康保险基金。

8 ||| In cases where an individual simultaneously belongs to multiple categories of health insurance participants as specified in Article 1 of this Circular, they shall pay the health insurance premium according to the first category they are determined to belong to in the order of the categories specified in Article 1 of this Circular.

Article 3. Determination of the amount to be paid and supported for certain subjects when the State adjusts the health insurance contribution rate and the minimum wage level.

1. For the group of subjects specified in Clause 3, Article 1 of this Circular and the subject who belongs to a near-poor household as stipulated at Point a, Clause 4, Article 1 of this Circular shall be supported by the state budget at 100% of the contribution rate:

The amount of the state budget contribution and support at 100% of the contribution rate shall be determined based on the health insurance contribution rate and the minimum wage level corresponding to the period of use recorded on the health insurance card. When the State adjusts the health insurance contribution rate and the minimum wage level, the amount of the state budget contribution and support shall be adjusted from the date the new health insurance contribution rate and minimum wage level take effect.

2. For the group of subjects supported by the state budget at a portion of the health insurance contribution rate as stipulated in Clause 4, Article 1 of this Circular:

Health insurance participants pay contributions periodically every three months, six months, or twelve months. The amount of contribution by the participant and the state budget support shall be determined based on the health insurance contribution rate and the minimum wage level at the time of paying health insurance contributions. When the State adjusts the health insurance contribution rate and the minimum wage level, the participant and the state budget shall not have to make additional payments for the difference caused by the adjustment of the health insurance contribution rate and the minimum wage level for the remaining time that the participant has already paid health insurance contributions.

Example 2: Mr. M, belonging to a near-poor household, pays health insurance contributions for the year 2015. At the time of January 2015, the contribution rate was 4.5%, and the minimum wage was 1,150,000 VND; assuming from May 2015, the State adjusts the minimum wage to 1,200,000 VND; the amount of contribution by Mr. M and the state budget support shall be determined as follows:

- In case Mr. M makes contributions every six months in January and July, the amount of contribution and support for the first six months of the year shall be calculated based on the contribution rate of 4.5% and the minimum wage of 1,150,000 VND/month (Mr. M and the state budget do not need to make additional payments for the difference caused by the adjustment of the minimum wage for the two months of May and June). The amount of contribution and support for the last six months of the year shall be calculated based on the contribution rate of 4.5% and the minimum wage of 1,200,000 VND/month.

- In case Mr. M makes a single payment for the entire year in January, the amount of contribution and support shall be calculated based on the health insurance contribution rate of 4.5% and the minimum wage of 1,150,000 VND/month (Mr. M and the state budget do not need to make additional payments for the difference caused by the adjustment of the minimum wage from May to December 2015).

3. For the group of subjects participating in health insurance under household registration as stipulated in Clause 5, Article 1 of this Circular:

Health insurance participants pay contributions periodically every three months, six months, or twelve months. The amount of contribution shall be determined based on the gradually decreasing contribution rate from the second member onwards as stipulated in Point g, Clause 1, Article 2 of Decree No. 105/2014/ND-CP and the minimum wage level at the time of paying health insurance contributions. When the State adjusts the health insurance contribution rate and the minimum wage level, the participant shall not have to make additional payments for the difference caused by the adjustment of the health insurance contribution rate and the minimum wage level for the remaining time that the participant has already paid health insurance contributions.

Example 3: In the case of four members of Mr. B's family in Example 1 of Clause 5, Article 1 of this Circular, who wish to make a single payment for the entire year for health insurance contributions, the amount of health insurance contributions shall be determined as follows (in case the State adjusts the minimum wage level, apply as in Example 2 of Clause 2 of this Article):

- First person: 1,150,000 VND x 4.5% x 12 months = 621,000 VND.

- Second person: 621,000 VND x 70% = 434,700 VND.

- Third person: 621,000 VND x 60% = 372,600 VND.

- Fourth person: 621,000 VND x 50% = 310,500 VND.

Chapter II

ESTABLISH LIST OF PARTICIPANTS,

 ISSUE HEALTH INSURANCE CARDS

Article 4. Responsibility for compiling the list of participants in health insurance

1. Employers shall compile the list of participants in health insurance (BHYT) for the subjects specified in Clause 1, Article 1 of this Circular and submit it to the Social Insurance Organization.

2. The People's Committee at the commune level shall compile the list of participants in BHYT for the subjects specified in Clauses 2, 3, 4, and Clause 5, Article 1 of this Circular, by household, except for the subjects specified in Points a, l, and Point n, Clause 3, and Point b, Clause 4, Article 1 of this Circular, and submit it to the Social Insurance Office at the district level, specifically as follows:

a) In 2015, the People's Committee at the commune level shall compile the list of participants in BHYT within its jurisdiction and submit one copy of the list to the Social Insurance Office at the district level no later than October 1, 2015.

b) From 2016 onwards, each month, the People's Committee at the commune level shall compile the list of increases and decreases in the number of participants in BHYT within its jurisdiction and submit one copy of the list to the Social Insurance Office at the district level to adjust the issuance of BHYT cards within its jurisdiction.

3. Educational and training institutions, vocational training centers shall be responsible for compiling the list of participants in BHYT for the subjects managed by the Ministry of Education and Training and the Ministry of Labor, Invalids and Social Affairs as stipulated in Point n and Point o, Clause 3, and Point b, Clause 4, Article 1 of this Circular, and submit it to the Social Insurance Organization no later than October 31 each year.

4. The Social Insurance Organization, upon receiving the list of participants in BHYT as prescribed in Clause 2 and Clause 3 of this Article, shall be responsible for taking the lead and coordinating with relevant agencies and units managing the subjects to review before issuing BHYT cards.

5. The compilation of the list of participants in BHYT for the subjects managed by the Ministry of Defense and the Ministry of Public Security as stipulated in Point a, Clause 1, Article 1; Point a, Point l (excluding children under six years old), and Point n, Clause 3, Article 1; and Point b, Clause 4, Article 1 of this Circular shall be carried out according to separate regulations.

Example 4: Child Q under six years old, who is the child of a military officer, falls under the subject specified in Point e, Clause 3, Article 1 of this Circular. According to the provisions of Point b, Clause 1, Article 17, amended and supplemented in the Health Insurance Law, Child Q shall be included in the list of participants in BHYT compiled by the People's Committee at the commune level where he resides and submitted to the Social Insurance Office at the district level for the issuance of a BHYT card, with local government budget ensuring the funding for BHYT contributions.

6. The list of participants in BHYT shall be compiled according to the model issued by the Vietnam Social Insurance.

Article 5. Health Insurance Cards

1. The model of the BHYT card shall be issued by the Vietnam Social Insurance after obtaining the unified opinion of the Ministry of Health. The BHYT card reflects the following information:

a) BHYT card number: The BHYT card number must be consistent with the individual identification number issued by the competent state agency. In cases where the competent state agency has not yet issued an individual identification number, the Vietnam Social Insurance shall assign a BHYT card number for the participant to ensure that each participant has a unique BHYT card number.

b) The BHYT benefit level code of the participant according to the provisions of Article 22, amended and supplemented in the Health Insurance Law and Article 4 of Decree No. 105/2014/ND-CP.

c) The validity period recorded on the card shall be implemented according to the provisions of Clause 3, Article 16, amended and supplemented in the Health Insurance Law; the validity period recorded on the BHYT card for certain subjects is as follows:

- For those receiving unemployment benefits, the validity period recorded on the BHYT card corresponds to the duration of unemployment benefits recorded in the decision on unemployment benefits issued by the competent state agency.

- For children under six years old, the validity period recorded on the BHYT card starts from the date of birth until the child reaches seventy-two months of age. If the child reaches seventy-two months of age but has not yet reached the school enrollment period, the validity period recorded on the BHYT card will end on September 30 of that year.

- For ethnic minority people living in areas with difficult economic and social conditions; people living in areas with extremely difficult economic and social conditions; people living in island communes and island districts: The validity period recorded on the BHYT card runs from January 1 to December 31 of the year or December 31 of the last year recorded on the BHYT card (in cases where the BHYT card is valid for multiple years).

- For households classified as poor and near-poor households supported by the state budget at 100% of the contribution rate: The validity period recorded on the BHYT card runs from January 1 to December 31 of the year. In cases where the Social Insurance Organization receives the list of participants in BHYT along with the Decision approving the list of poor and near-poor households from the competent state agency after January 1, the validity period recorded on the BHYT card will start from the effective date of this Decision.

- For near-poor households supported by the state budget at a portion of the contribution rate and households engaged in agriculture, forestry, fisheries, and salt production with average income levels: The validity period recorded on the BHYT card starts from the date the participant pays the BHYT contribution corresponding to the duration of the policy approved by the competent state agency; in cases of first-time participation, the validity period recorded on the BHYT card will start thirty days after the participant pays the BHYT contribution.

- For students and university students, the validity period recorded on the BHYT card runs from January 1 to December 31 of the year; for first-grade primary students and first-year university students, the validity period recorded on the BHYT card starts from the date of enrollment or the expiration date of the previously issued BHYT card to December 31 of the following year; for twelfth-grade high school students and final-year university students, the validity period recorded on the BHYT card starts from January 1 to the end of the month marking the end of the academic year.

- For other participants in BHYT, the validity period recorded on the BHYT card shall be determined by the Vietnam Social Insurance.

d) Starting from January 1, 2016, the BHYT card issued to participants must indicate the continuous participation period prior to that date, up to a maximum of sixty months, excluding the subjects specified in Points a, d, e, g, h, and Point i, Clause 3, Article 1 of this Circular. The continuous BHYT participation period is the time recorded on the subsequent BHYT card that directly follows the expiration date of the previous card; in cases of interruption, the maximum duration shall not exceed three months.

An employee sent to study or work abroad shall have continuous health insurance participation time including the period of studying or working abroad until the date of the decision to return to work issued by the dispatching agency or organization.

An employee working abroad, within 60 days from the date of entry back into the country, if participating in health insurance, the continuous health insurance participation time includes the entire period of working abroad and the period from returning to the country to the date of health insurance participation.

An employee during the period of processing to enjoy unemployment benefits according to the Law on Employment, if not participating in health insurance under other groups, the continuous health insurance participation time includes the period of processing to enjoy unemployment benefits according to the Law on Employment.

Example 5: Mr. M has continuous health insurance participation time from December 21, 2013 to December 31, 2015; the continuous health insurance participation time recorded on the health insurance card with usage period from January 1, 2016 is as follows: "Continuous participation time up to December 31, 2015: 24 months and 10 days".

Example 6: Mr. V's continuous health insurance participation time up to December 31, 2015 is 70 months; the continuous health insurance participation time recorded on the health insurance card with usage period from January 1, 2016 is as follows: "Continuous participation time up to December 31, 2015: over 60 months".

Example 7: Ms. K worked at a business enterprise and continuously paid health insurance from January 1, 2013 until January 5, 2015 when she terminated her labor contract. Ms. K submitted the application for unemployment benefit on April 4, 2015 (within three months); the competent authority issued the decision on unemployment benefit on April 20, 2015 (within twenty days); the Social Insurance Organization received the decision on April 26, 2015 and implemented the payment of unemployment benefit to the employee from May 1, 2015 (within three months). In this case, the continuous health insurance participation time up to April 30, 2015 is 28 months.

Article 6. Issuance of Health Insurance Cards for individuals who have donated body parts in accordance with the law shall be carried out as follows:

a) The medical facility where the body part was taken must clearly record "donated body part" on the discharge certificate;

b) The Social Insurance Organization shall issue a Health Insurance Card to the individual who has donated a body part based on the discharge certificate specified in Point a Clause 7 and notify the People's Committee of the commune where the individual resides;

c) The validity period recorded on the Health Insurance Card starts from the date the individual who has donated a body part is discharged from the hospital.

Chapter III

ORGANIZATION OF HEALTH INSURANCE MEDICAL EXAMINATION AND TREATMENT

Article 6. Medical facilities for registration and referral for health insurance examination and treatment

1. Health insurance medical facilities are healthcare facilities as defined by the Law on Examination and Treatment that have signed contracts for health insurance examination and treatment with the Social Insurance Organization.

2. Initial registration for health insurance examination and treatment and referral for health insurance examination and treatment shall be carried out in accordance with the regulations of the Minister of Health.

Article 7. Contracts for health insurance examination and treatment

1. General principles:

a) The Social Insurance Organization is responsible for signing contracts with healthcare facilities. The health insurance examination and treatment contract is established according to the model prescribed in Appendix 03 attached to this Circular. Depending on the conditions of the healthcare facility, the Social Insurance Organization and the healthcare facility may agree to supplement the contents of the contract without contravening the laws on health insurance;

b) The duration of the contract is for the fiscal year, from January 1 to December 31 of that year; for the first signed contract, it is calculated from the signing date to December 31 of that year;

c) The costs for examination and treatment for cases where the insured person examines and treats before January 1 but is discharged after January 1 shall be handled as follows:

- If the healthcare facility continues to sign the examination and treatment contract, it will be included in the examination and treatment costs of the following year;

- If the healthcare facility does not continue to sign the examination and treatment contract, it will be included in the examination and treatment costs of the previous year.

2. Documents for signing health insurance examination and treatment contracts:

a) For healthcare facilities signing the contract for the first time:

- A letter requesting to sign the contract from the healthcare facility;

- The operating permit of the healthcare facility;

- The decision on hospital classification by the competent authority (if applicable); for non-public healthcare facilities, there must be a decision on the level of specialized technical services by the competent authority.

b) For healthcare facilities signing annual contracts:

Supplement the functions, tasks, scope of specialized services, and hospital classification approved by the competent authority (if applicable).

3. Procedures for signing health insurance examination and treatment contracts:

a) For healthcare facilities signing the contract for the first time:

- The healthcare facility sends one set of documents stipulated in Point a Clause 2 of this Article to the Social Insurance Organization according to the分级任务如下：

- Within thirty days from the date of receiving complete and valid files (as recorded on the receipt stamp), the Social Insurance organization must complete the examination of the files and sign the contract; in case of disagreement with signing the medical examination and treatment contract, it must provide a written response stating the reasons.

b) For healthcare facilities signing annual medical examination and treatment contracts: Healthcare facilities and the Social Insurance organization shall complete the signing of the next year's health insurance contract before December 31.

4. Medical examination and treatment health insurance contracts at village health stations and healthcare facilities of agencies, units, and schools:

a) For village health stations:

- The Social Insurance organization signs a contract with the district hospital or the district health center where the district hospital has not been separated, or another healthcare facility approved by the Department of Health to provide initial medical examinations and treatments at the village health station for health insurance participants.

- Within the allocated fund for medical examinations and treatments, the district hospital or the district health center or another healthcare facility approved by the Department of Health is responsible for supplying medicines, chemicals, and medical supplies to the village health station, paying bed usage fees (if any), and medical technical service fees carried out within the scope of expertise by the village health station; simultaneously monitoring, supervising, and compiling to settle accounts with the Social Insurance organization.

- The total budget for medical examinations and treatments at the village health station must be a minimum of 10% and a maximum not exceeding 20% of the outpatient medical examination and treatment fund calculated based on the number of health insurance cards registered for initial medical examinations and treatments at the village health station as stipulated in Point b Clause 4 Article 11 of this Circular.

- The period for retaining patients for observation and treatment at commune health stations shall not exceed three days; for commune health stations located in areas with difficult socio-economic conditions, extremely difficult conditions, island communes, and island districts, it shall not exceed five days.

b) For medical facilities of agencies, units, and schools (excluding agencies, units, and schools provided primary healthcare funding according to Points b and c Clause 1 Article 6 Decree No. 105/2014/NĐ-CP):

Agencies, units, and schools managing medical facilities must directly sign contracts with social insurance organizations and are responsible for supplying medicines, chemicals, medical supplies, and medical technical services to meet the requirements for diagnosis and treatment. In cases where agencies, units, and schools managing medical facilities equivalent to commune health stations cannot provide medicines, chemicals, medical supplies, and medical technical services to meet the requirements for diagnosis and treatment, the social insurance organization will sign contracts through district hospitals or district health centers.

5. For multi-purpose clinics under district hospitals or district health centers: they shall operate similarly to departments of district hospitals or district health centers. Based on professional regulations, service fee schedules for diagnosis and treatment approved by competent authorities, social insurance organizations and district hospitals or district health centers shall agree upon terms in their contracts for diagnosis and treatment at multi-purpose clinics.

Article 8. Procedures for Diagnosis and Treatment under Health Insurance

1. Participants in health insurance must present their health insurance cards with photographs when seeking diagnosis and treatment; if the health insurance card does not have a photograph, they must present one type of identification document proving their identity.

2. Children under six years old seeking diagnosis and treatment only need to present their health insurance cards. If they do not present their health insurance cards but still enjoy health insurance benefits, they must present birth certificates or birth registration certificates; in cases requiring immediate treatment after birth without a birth certificate, the head of the medical facility and the child's parent or guardian must sign confirmation on the medical record as the basis for payment according to Clause 2 Article 13 of this Circular and bear responsibility for such confirmation.

3. Participants in health insurance who are waiting for a new or replacement health insurance card must present the appointment letter for issuing or replacing the health insurance card issued by the social insurance organization that received the application and one type of identification document proving their identity when seeking diagnosis and treatment.

4. Individuals who have donated body parts and seek diagnosis and treatment must present the documents specified in Clause 1, Clause 2, or Clause 3 of this Article. In cases requiring immediate treatment after donation without a health insurance card, they still enjoy health insurance benefits; the head of the medical facility where the body part was taken and the patient or the patient’s relative must sign confirmation on the medical record as the basis for payment according to Clause 3 Article 13 of this Circular and bear responsibility for such confirmation.

5. In cases of referral for diagnosis and treatment, participants in health insurance must present the documents specified in Clause 1, Clause 2, or Clause 3 of this Article and the referral letter according to the regulations of the Minister of Health.

6. In emergency cases, participants in health insurance may seek diagnosis and treatment at any medical facility and must present the documents specified in Clause 1, Clause 2, or Clause 3 of this Article before being discharged. After the emergency phase ends, the medical facility will process the transfer of the patient to another department or ward within the facility for continued monitoring and treatment or refer them for diagnosis and treatment according to the regulations for correct-line diagnosis and treatment.

For medical facilities without contracts for diagnosis and treatment under health insurance, when patients are discharged, the medical facility is responsible for providing patients with documents confirming their medical condition and valid receipts related to diagnosis and treatment costs for patients to settle with the social insurance organization according to Articles 14, 15, and Article 16 of this Circular.

7. Participants in health insurance returning for follow-up visits based on doctors' appointments from higher-level medical facilities without going through the initial registered medical facility must present the documents specified in Clause 1, Clause 2, or Clause 3 of this Article and the follow-up appointment letter. Each follow-up appointment letter is only valid once within the time frame indicated on the letter. Based on the patient's condition and professional requirements, the doctor will decide whether to schedule further follow-up appointments.

8. Participants in health insurance seeking diagnosis and treatment during work trips, mobile work, concentrated study sessions according to training programs, or temporary residence, and not in emergency situations, can receive initial diagnosis and treatment at medical facilities of the same level of professional skills or equivalent to the initial registered medical facility on their health insurance card and must present the documents specified in Clause 1, Clause 2, or Clause 3 of this Article and one of the following documents (original or copy): work assignment letter, decision to send for study, proof of temporary residence registration.

9. Medical facilities and social insurance organizations are not allowed to stipulate additional administrative procedures for diagnosis and treatment under health insurance beyond those specified in this Article. In cases where medical facilities or social insurance organizations need copies of health insurance cards, hospital transfer letters, or other documents related to diagnosis and treatment for management purposes, they must make their own copies and not request patients to pay for these copies.

Article 9. Health Insurance Appraisal

1. The Social Insurance Organization shall conduct health insurance appraisals and be responsible for the appraisal results in accordance with the laws on health insurance.

2. The contents of health insurance appraisals include:

a) Checking the procedures for health insurance medical examinations and treatments as stipulated in Article 8 of this Circular;

b) Inspecting and evaluating the prescription of treatment, use of medicines, chemicals, medical supplies, and medical technical services within the scope of benefits for health insurance participants and the actual hospitalization days of patients;

c) Inspecting and evaluating to determine the costs of health insurance medical examinations and treatments:

- Preparing payment vouchers for patients and itemized bills for outpatient and inpatient medical examination and treatment costs, ensuring accurate reflection of all expenses and filling out according to the prescribed forms;

- Inspecting the settlement costs proposed by healthcare facilities.

d) Cooperating with healthcare staff at healthcare facilities to resolve issues related to health insurance medical examination and treatment procedures, rights, and responsibilities of health insurance participants; directly contacting patients in treatment departments to provide answers and disseminate policies and laws on health insurance.

3. Health insurance appraisals shall be conducted simultaneously or after discharge and must ensure accuracy, transparency, and fairness. The appraisal results shall be documented and notified to healthcare facilities.

4. The contents of health insurance appraisals must ensure consistency between healthcare facilities and the Social Insurance Organization. In cases where there is no agreement, the opinions of both parties must be clearly recorded and reported to higher authorities for resolution.

5. The Vietnam Social Security shall provide detailed guidance on the contents and procedures for health insurance appraisals after obtaining unified opinions from the Ministry of Health.

Chapter IV

HEALTH INSURANCE MEDICAL EXAMINATION AND TREATMENT COST REIMBURSEMENT BETWEEN THE SOCIAL INSURANCE AGENCY AND HEALTHCARE FACILITIES

 HEALTH INSURANCE SOCIAL SECURITY ORGANIZATION AND HEALTHCARE FACILITY CONTRACTS

Article 10. Reimbursement Based on Fixed Rates

1. General principles:

a) Reimbursement based on fixed rates refers to reimbursement according to predetermined fees for a registered card at a healthcare service provider within a specific period (hereinafter referred to as the fixed rate fee).

b) The total fixed rate fund to be reimbursed is calculated based on the number of health insurance cards registered multiplied by the fixed rate fee that has been determined.

c) Healthcare facilities may proactively use the determined funding for the year to provide medical services to patients with health insurance cards without charging additional fees within the scope of patient benefits. The Social Insurance Organization is responsible for monitoring and ensuring patient benefits.

2. Determining the Fixed Rate Fund:

a) The annual fixed rate fund allocated to healthcare facilities is calculated by multiplying the fixed rate fee by the total number of health insurance cards initially registered for medical examination and treatment in the year, adjusted according to the coefficient k specified in Point d of this Clause;

b) The fixed rate fee is determined based on the level of specialized technical expertise, calculated as the total cost of health insurance medical examinations and treatments in the previous year divided by the total number of health insurance cards initially registered for medical examination and treatment at the same level of specialized technical expertise in the previous year;

c) The total cost of health insurance medical examinations and treatments in the previous year at the level of specialized technical expertise includes the costs of medical examinations and treatments for individuals with health insurance cards issued by local social insurance organizations, who have registered for initial medical examinations and treatments at healthcare facilities within that level, including costs at healthcare facilities within and outside the province at the same level of specialized technical expertise, costs of medical examinations and treatments at other healthcare facilities outside the initial registration location, excluding costs specified in Point đ of this Clause;

d) Coefficient k is an adjustment factor due to changes in medical examination and treatment costs and other related factors from the following year compared to the previous year. The coefficient k applied in 2015 was 1.10; from 2016, it is adjusted according to the price index of drug and medical service groups of the preceding year published by the General Statistics Office;

đ) Transportation costs, artificial kidney dialysis, organ transplantation, heart surgery, cardiovascular interventions, cancer treatment, hemophilia treatment, and co-payment portions of patients are not included in the total fixed rate fund;

e) The fixed rate fund allocated to healthcare facilities shall not exceed the medical examination and treatment fund of such facility as stipulated in Points a or b of Clause 4, Article 11 of this Circular, minus any excess costs incurred during the year. In special cases, the provincial Social Insurance reports to the Vietnam Social Security for review and adjustment, but the adjusted fixed rate fee shall not exceed the average expenditure nationwide for the level of specialized technical expertise as determined and announced annually by the Vietnam Social Security.

3. Monitoring and Adjusting the Fixed Rate Fund:

When there are changes in the number of health insurance cards registered at healthcare facilities, the provincial Social Insurance is responsible for notifying the healthcare facility of the number of health insurance cards and the total fixed rate fund available for use. If medical examination and treatment costs change due to changes in the structure of medical service prices, new medical applications, new drugs, and other related factors, or changes in the functions and tasks of healthcare facilities, both parties will agree to re-determine the fixed rate fee and adjust the fixed rate fund accordingly.

4. Using the Fixed Rate Fund:

a) The fixed rate fund is used to reimburse the costs of medical examinations and treatments under the regulations for patients with health insurance cards registered for medical examinations and treatments at that facility, including costs at village health stations and other healthcare facilities, and direct payments as stipulated in Articles 14, 15, and 16 of this Circular. The Social Insurance Organization is responsible for promptly informing healthcare facilities about any additional costs incurred at other healthcare facilities and deducting them from the fixed rate fund allocated to that facility.

b) In cases where the fixed rate fund has surplus, the healthcare facility may record the surplus portion into its revenue. The maximum surplus retained cannot exceed 20% of the fixed rate fund, with the remainder transferred into the common medical examination and treatment fund of the province for management and use. If the fixed rate fund includes costs at the village level, the entity responsible for signing contracts for medical examinations and treatments at village health stations must allocate a portion of the surplus to each village health station based on the number of registered cards at each station.

c) In cases where the fixed rate fund is insufficient:

c) In cases of insufficient fixed quota funds:

- Due to objective reasons such as increasing the frequency of medical examinations and treatments, applying new techniques with high costs, the Social Insurance Organization shall examine and pay at least 60% of the excess costs.

- Due to force majeure reasons such as the outbreak of epidemics, a higher than expected rate of severe cases with high costs, the provincial Social Insurance Organization shall coordinate with the Department of Health to examine and supplement payments to healthcare facilities. In cases where the provincial medical examination and treatment fund is insufficient for supplementation, it shall report to the Vietnam Social Insurance Organization for examination and resolution.

5. Healthcare facilities are responsible for monitoring and compiling the costs of medical examinations and treatments for cases with health insurance cards that have not registered for initial medical examinations and treatments at their facility; costs outside the defined rates stipulated in Point c Clause 2 Article 10 of this Circular for settlement with the Social Insurance Organization.

Article 11. Payment according to service prices

1. Payment according to service prices is a payment method based on the costs of medicines, chemicals, medical supplies, medical equipment, and medical technical services used for patients at healthcare facilities.

2. Payment according to service prices shall be applied in the following cases:

a) Healthcare facilities that have not yet implemented the payment method according to defined rates;

b) Patients with health insurance cards who have not registered for initial medical examinations and treatments at the healthcare facility;

c) Certain diseases, disease groups, and medical technical services not included in the defined rate fund of healthcare facilities implementing the payment method according to defined rates as stipulated in Point c Clause 2 Article 10 of this Circular.

3. Basis for payment: The cost of medical technical services is calculated according to the service price for medical examinations and treatments approved by the competent authority; the cost of medicines, chemicals, and medical supplies is calculated according to the purchase price but not exceeding the winning bid price; the cost of blood and blood products is paid according to the price prescribed by the Ministry of Health.

4. The health insurance medical examination and treatment fund used at healthcare facilities registered for initial medical examinations and treatments is determined according to Clause 1 Article 17 of this Circular, with the scope of use as follows:

a) For healthcare facilities conducting outpatient and inpatient medical examinations and treatments:

- 90% for expenditures on medical examinations and treatments at the facility; expenditures on medical examinations and treatments for patients who seek medical examinations and treatments at other healthcare facilities and transportation costs (if applicable);

- The remaining 10% is adjusted and supplemented according to Clause 5 of this Article.

b) For healthcare facilities only conducting outpatient medical examinations and treatments:

- 45% for expenditures on outpatient medical examinations and treatments at the facility; expenditures on medical examinations and treatments for patients who seek outpatient medical examinations and treatments at other healthcare facilities and transportation costs (if applicable);

- 5% for adjustments and supplements to the healthcare facility according to Clause 5 of this Article;

- The remaining 50%, the Social Insurance Organization uses to pay for inpatient medical examination and treatment costs.

The Social Insurance Organization is responsible for paying the costs of medical examinations and treatments for individuals with health insurance cards at other healthcare facilities and deducting from the funding source available for the healthcare facility indicated on the individual's health insurance card.

5. In cases where the costs of medical examinations and treatments exceed the total medical examination and treatment fund available, the Social Insurance Organization shall adjust as follows:

a) Adjust and supplement from 10% of the remaining medical examination and treatment fund for facilities conducting both outpatient and inpatient medical examinations and treatments;

b) Adjust and supplement from 5% of the remaining medical examination and treatment fund for facilities only conducting outpatient medical examinations and treatments;

c) If the adjustment still results in a shortfall, the provincial Social Insurance Organization shall be responsible for examining and supplementing payments within the medical examination and treatment fund at the local level; if the local fund is insufficient for adjustment, it shall report to the Vietnam Social Insurance Organization for examination and resolution.

6. The total payment amount for cases seeking medical examinations and treatments (excluding initial registration for medical examinations and treatments) shall not exceed the actual average cost based on the scope of benefits for one inpatient treatment cycle and one outpatient medical examination and treatment session per specialty of transferred cases multiplied by the number of medical examination and treatment sessions in the year and multiplied by factor k.

Annually, based on the price index of the medicine and healthcare service group of the previous year published by the General Statistics Office, the Social Insurance Organization shall announce and adjust the total payment amount for healthcare facilities.

In cases where costs arise due to changes in the structure of medical examination and treatment service prices, application of new healthcare services, new medicines, and other related factors, or changes in the functions and tasks of healthcare facilities according to the decision of the competent authority, these additional costs shall be settled by the Social Insurance Organization and included in the total expenditure for the year as the basis for determining the average cost for the next year.

In cases where healthcare facilities exceed the total budget payment amount, the health insurance fund will not cover the additional costs.

Article 12. Payment according to medical cases

1. Payment according to medical cases or groups of diseases is a lump-sum payment based on pre-determined costs for diagnosis and treatment for each case according to the diagnosis.

2. The classification and determination of diagnoses for each medical case or group of diseases shall be carried out in accordance with the regulations of the Ministry of Health.

3. The lump-sum cost for each medical case or group of diseases is based on the current regulations regarding service prices for diagnosis and treatment.

4. The Ministry of Health shall guide the pilot implementation of payment according to medical cases or groups of diseases.

Article 13. Health Insurance Payment in Certain Cases

1. Payment for transportation costs of patients from district level to higher levels for the subjects specified in Points d, e, g, h, and Point i Clause 3 Article 1 of this Circular in emergency situations or when they need to be transferred during inpatient treatment shall be as follows:

a) In the case where patients use the transportation means of healthcare facilities, the health insurance fund shall pay the transportation costs, both ways, to that healthcare facility at a rate of 0.2 liters of gasoline per kilometer based on the actual distance between two healthcare facilities and the gasoline price at the time of use. If there are more than one patient being transported on the same vehicle, the payment will only be calculated as if transporting one patient. The receiving healthcare facility must sign confirmation on the dispatch form of the transferring healthcare facility; in off-hours, the signature of the receiving physician is also required.

b) In the case where patients do not use the transportation means of healthcare facilities, the health insurance fund shall pay the one-way transportation cost (the outbound trip) for the patient at a rate of 0.2 liters of gasoline per kilometer based on the actual distance between two healthcare facilities and the gasoline price at the time of transfer to a higher level. The healthcare facility responsible for transferring the patient must advance the payment directly to the patient and then claim it from the health insurance fund.

2. Payment for diagnosis and treatment costs for children under six years old who seek medical care without presenting a health insurance card:

a) Healthcare facilities are responsible for compiling a list of children under six years old who have received diagnosis and treatment, along with copies of birth certificates or birth registration certificates; in cases where immediate treatment is necessary after birth and before obtaining a birth certificate, the head of the healthcare facility and the child's father, mother, or guardian must sign confirmation on the medical record as the basis for payment according to Clause 2, Article 8 of this Circular.

b) Social Insurance organizations, based on the list of children who have received diagnosis and treatment provided by healthcare facilities, are responsible for verifying and checking the issuance of health insurance cards for these children. If the card has not been issued, they shall guide the issuance and subsequently deduct the diagnosis and treatment costs from the budget of the healthcare facility recorded on the child's health insurance card. If the child has already been issued a card, the deduction will be made from the budget of the initial healthcare facility registered for diagnosis and treatment.

3. Payment for diagnosis and treatment costs for individuals who have donated body parts and require post-donation treatment but do not have a health insurance card:

a) Healthcare facilities where the body part was taken are responsible for compiling a list of donors and detailed diagnosis and treatment costs for each individual in the month, and sending it to the social insurance organization with which the healthcare facility has a contract for health insurance diagnosis and treatment payments.

b) Social Insurance organizations, based on the list of individuals who have donated body parts and received diagnosis and treatment provided by healthcare facilities, are responsible for issuing health insurance cards according to regulations and deducting the costs from the budget of the healthcare facility recorded on the donor's health insurance card.

4. Payment for diagnosis and treatment costs for medical technical services performed by staff from higher-level healthcare facilities under the guidance program, support projects, and capacity enhancement programs for lower-level facilities as stipulated by the Minister of Health:

a) In cases where medical technical services have been approved for pricing by competent authorities, the health insurance fund shall pay according to the approved price.

b) In cases where medical technical services have not been approved for pricing, the health insurance fund shall pay according to the service price of the technology transfer facility approved by competent authorities. The receiving healthcare facility is responsible for notifying the provincial social insurance organization about the medical technical services performed under the program and project, and submitting the technical directory and service prices for approval by competent authorities to serve as the basis for implementing the technology and health insurance payment.

5. In cases where healthcare facilities are overloaded and organize health insurance diagnosis and treatment on holidays, they must notify the social insurance organization to supplement the diagnosis and treatment contract before implementation. Patients with health insurance cards who seek medical care will have their costs covered within the scope of health insurance benefits. Healthcare facilities are responsible for ensuring manpower and professional conditions, publicly disclosing any additional costs that patients must pay outside the scope of health insurance benefits, and informing patients in advance; patients must pay any costs outside the scope of health insurance benefits (if applicable).

Chapter V

DIRECT PAYMENT OF DIAGNOSIS AND TREATMENT COSTS BETWEEN SOCIAL INSURANCE AND HEALTH INSURANCE PARTICIPANTS

Article 14. Direct payment for medical examination and treatment costs

The cases of direct payment for medical examination and treatment costs according to Clause 2, Article 31 amended and supplemented by the Health Insurance Law include:

1. Medical examination and treatment at healthcare facilities without health insurance medical examination and treatment contracts.

2. Medical examination and treatment not in accordance with the procedures for health insurance medical examination and treatment as stipulated in Article 8 of this Circular.

Article 15. Documents for requesting payment

1. A request for payment of health insurance medical examination and treatment costs established in the form issued by the Vietnam Social Security.

2. Procedures and documents as prescribed in Article 8 of this Circular.

3. Discharge certificate.

4. Original valid vouchers (prescription drug invoices, hospital fee invoices, and related vouchers).

Article 16. Direct Payment

1. Patients or their relatives are responsible for submitting the documents specified in Article 15 of this Circular to the Social Security Office of the district where they reside.

2. The Social Security Office of the district shall be responsible for:

a) Receiving the payment request documents from patients or their relatives and issuing a receipt for the documents. Incomplete documents must be supplemented to meet the requirements;

b) Within 40 days from the date of receiving complete payment request documents, it must complete the health insurance review and directly pay the medical examination and treatment costs to the patient. If payment is not made, a written response with the reasons must be provided;

c) Summarize the amount paid for medical examination and treatment costs to the patient and deduct it from the budget allocated to the healthcare facility where the health insurance card holder has registered for initial medical examination and treatment.

3. Health insurance payment level:

a) For patients who seek medical examination and treatment at healthcare facilities with health insurance medical examination and treatment contracts: payment within the scope of health insurance benefits and entitlements as prescribed;

b) For patients who seek medical examination and treatment at healthcare facilities without health insurance medical examination and treatment contracts: payment based on actual costs within the scope of health insurance benefits and entitlements but not exceeding the maximum limit set out in Appendix 04 attached to this Circular.

Chapter VI

MANAGEMENT AND USE OF THE HEALTH INSURANCE FUND

Article 17. Use of the health insurance medical examination and treatment fund as prescribed in Clause 1, Article 6 of Decree No. 105/2014/ND-CP

1. Allocation of the health insurance medical examination and treatment fund to healthcare facilities registered for initial medical examination and treatment:

Based on the total health insurance medical examination and treatment fund in the province determined according to Clause 1, Article 6 of Decree No. 105/2014/ND-CP, the provincial Social Security is responsible for allocating the fund to healthcare facilities registered for initial medical examination and treatment, calculated as follows:

Where:

- The total health insurance medical examination and treatment fund in the province is determined according to Clause 1, Article 6 of Decree No. 105/2014/ND-CP (equal to 90% of the health insurance premium income in the province for medical examination and treatment).

- The total primary healthcare expenditure fund in the province is determined according to Clause 2 of this Article.

2. Transfer funds to educational institutions under the national education system and organizations, agencies, enterprises that have the necessary conditions for providing primary healthcare as prescribed in Article 18 of this Circular:

a) For preschool educational institutions:

- The amount retained for preschool educational institutions includes two parts: equal to 5% of the total health insurance fund revenue calculated based on the total number of children under six years old currently enrolled at the institution and 1% of the total monthly health insurance premiums paid by the institution to the Social Security organization as stipulated in Point c of this Clause.

In the first month of the school year or course, the Social Security organization is responsible for transferring the aforementioned amount to preschool educational institutions.

Example 8: Preschool educational institution B meets the conditions for providing primary healthcare for children; in 2015, there were 100 children under six years old enrolled. Assuming the health insurance contribution rate is 4.5%, the basic salary is 1,150,000 VND, the amount transferred by the Social Security organization to the institution is 3,105,000 VND:

5% x (100 children x 4.5% x 1,150,000 VND/month x 12 months)

Additionally, the Social Security organization must also retain 1% of the total monthly health insurance premiums paid by the institution to the Social Security organization as per Example 10 in Point c of this Clause.

b) For other educational institutions:

- The amount retained for educational institutions includes two parts: equal to 7% of the total health insurance fund revenue calculated based on the total number of students and trainees currently enrolled at the educational institution who participate in health insurance (including students and trainees participating in health insurance under different groups) and 1% of the total monthly health insurance premiums paid by the institution to the Social Security organization as stipulated in Point c of this Clause.

- In the first month of the school year or course, the Social Security organization is responsible for transferring the aforementioned amount to educational institutions.

Example 9: University K meets the conditions for providing primary healthcare for students; in the 2015-2016 academic year, there were 5,000 students enrolled, including: 100 from poor households, 100 from military families, 100 from families of those who have contributed to the revolution, and 4,700 from other categories. Assuming the health insurance contribution rate for all categories is 4.5%, the basic salary is 1,150,000 VND; the amount transferred by the Social Security organization to the university is 217,350,000 VND:

7% x (5,000 students x 4.5% x 1,150,000 VND/month x 12 months)

Additionally, the Social Security organization must also retain 1% of the total monthly health insurance premiums paid by the university to the Social Security organization as per Example 10 in Point c of this Clause.

c) For primary healthcare funds for groups managed by agencies, organizations, and enterprises:

- The retention rate for agencies, organizations, and enterprises with in-house healthcare facilities is 1% of the total health insurance premiums (excluding late payment interest) paid by the agency, organization, or enterprise to the Social Security organization.

- Monthly, after receiving the health insurance contributions from agencies, organizations, enterprises, the social insurance organization shall be responsible for retaining the aforementioned amount for those agencies, organizations, and enterprises.

Example 10: Enterprise A has an organizational healthcare unit (without a health insurance medical examination and treatment contract), which implements the payment of contributions into the health insurance fund, totaling 105 million VND, including: 100 million VND is the amount to be paid according to the prescribed contribution rate, and 5 million VND is the late payment fine. After receiving this amount, the social insurance organization shall be responsible for issuing a document to retain 1,000,000 VND (1% x 100,000,000 VND) for Enterprise A.

Article 18. Conditions, scale of organization; content of expenditure; management and settlement of primary health care funding at educational institutions, agencies, organizations, and enterprises

1. Educational institutions, agencies, organizations, and enterprises (excluding educational institutions, agencies, organizations, and enterprises with organizational healthcare units having health insurance medical examination and treatment contracts) shall be allocated funding from the health insurance medical examination and treatment fund to provide primary health care for the subjects managed by such educational institutions, agencies, organizations, and enterprises when they meet the following conditions:

a) Having at least one full-time or part-time staff member or a labor contract lasting three months or more, with a minimum qualification of a secondary-level medical education.

b) Having a medical room or separate workspace to perform initial emergency care and preliminary treatment for the subjects managed by educational institutions, agencies, organizations, and enterprises who suffer from accidents, injuries, and common illnesses during their study or work at these institutions.

2. Content of expenditure for primary health care:

a) Expenditure on purchasing medicines and medical supplies for initial emergency care and preliminary treatment for children, students, and employees when they suffer from accidents and common illnesses during their study or work at educational institutions, agencies, organizations, and enterprises;

b) Expenditure on purchasing and repairing ordinary medical equipment for primary health care at educational institutions, agencies, organizations, and enterprises;

c) Expenditure on purchasing office supplies and filing cabinets for managing health records of children, students, and employees;

d) Expenditure on purchasing books, materials, and tools for conducting promotional activities, teaching, and extracurricular education on health care, health counseling, reproductive health, and family planning at educational institutions, agencies, organizations, and enterprises;

đ) Other expenditures necessary to implement primary health care activities at educational institutions, agencies, organizations, and enterprises.

3. Management and settlement of funding:

a) Educational institutions, agencies, organizations, and enterprises that are allocated funding from the health insurance medical examination and treatment fund shall be responsible for using it for primary health care for the subjects managed by them, and shall not use it for other purposes.

b) The expenditures for primary health care as stipulated in Clause 2 of this Article shall be accounted for and settled as follows:

- For public educational institutions, they shall account for the expenditures for primary health care within the costs of implementing medical services at the institution and settle accounts with the higher-level management unit according to current regulations;

- For non-public educational institutions, they shall account for the expenditures for primary health care within the costs of the non-public educational institution and settle accounts with the higher-level unit (if applicable);

- For enterprises and economic organizations, they shall maintain a separate accounting ledger to reflect the receipt and use of funds, without consolidating it into the enterprise's cost settlement;

- For other agencies and units, they shall account for the expenditures for primary health care within the costs of implementing medical services at the agency or unit and settle accounts with the higher-level management agency or unit (if applicable) or the financial authority according to current regulations.

c) Educational institutions, agencies, organizations, and enterprises that are allocated primary health care funding according to this Article do not need to settle accounts with the social insurance organization but shall be responsible for reporting on the use of funds when requested by the social insurance organization or competent state authorities.

d) Any remaining funding allocated up to the end of the year that has not been fully utilized may be carried over to the next year for continued use.

Article 19. Financial support for People's Communes to establish health insurance participation lists

1. The financial support funds for People's Communes to establish health insurance participation lists on their territory shall be allocated from the annual budget for managing the machinery of the Vietnam Social Security.

2. The amount of financial support shall be based on the number of people in the health insurance participation list established by the People's Commune (for increased and decreased participants, the increase and decrease in numbers shall be calculated separately) and the expenditure level announced annually by the Vietnam Social Security based on the approved budget estimate by the Prime Minister; specifically, the expenditure level for 2015 is VND 1,500 per person.

3. Transfer of financial support funds for People's Communes to establish health insurance participation lists on their territory:

a) For 2015: By the end of March at the latest, the County Social Insurance shall be responsible for temporarily providing funds equivalent to 50% of the support funds calculated according to the expenditure level specified in Clause 2 of this Article and the total population of the commune at the time of support. The remaining amount will be provided after receiving the health insurance participation list in accordance with Point a, Clause 4, Article 4 of this Circular.

b) From 2016 onwards, the County Social Insurance shall transfer the support funds to the People's Commune after receiving the increased and decreased participant lists in accordance with Point b, Clause 4, Article 4 of this Circular.

Example 11:

- In 2015: The commune N has a population of 6,000 people, the temporary advance payment made by the County Social Insurance to the commune is VND 4,500,000 (50% x VND 1,500 x 6,000 people). The remaining amount will be provided after receiving the health insurance participation list in accordance with Point a, Clause 4, Article 4 of this Circular.

- In 2016: Commune N submits a report on the increase and decrease in participants, including an increase of 30 people and a decrease of 10 people. Assuming the expenditure level for establishing the health insurance participation list in 2016 is VND 2,000 per person; the support amount for the commune is VND 80,000:

(30 people increased + 10 people decreased) x VND 2,000

c) The transfer of financial support funds shall be carried out through bank transfers or direct cash payments.

4. The People's Commune receiving funds to establish health insurance participation lists does not need to settle accounts with the commune budget but must maintain separate accounting records to reflect the receipt and use of funds.

Chapter VII

IMPLEMENTING PROVISIONS

Article 20. Transitional Provisions

1. In 2015, the Social Insurance organization shall issue health insurance cards for various groups of participants based on the participant lists transferred by the management agencies, organizations, and units. Upon receiving the 2015 health insurance participation list from the People's Commune, the Social Insurance organization shall be responsible for reviewing and ensuring that the cards are issued correctly according to the participants.

2. For health insurance participants involved in traffic accidents:

a) Cases admitted to hospital for treatment before January 1, 2015 but discharged from January 1, 2015 and cases involving traffic accidents admitted to hospital for treatment from January 1, 2015 shall have their medical examination and treatment costs covered by the health insurance fund within the scope of benefits as prescribed.

b) If the traffic accident was caused by the participant's violation of traffic laws, and the health insurance fund had already covered the medical examination and treatment costs according to the prescribed regulations and the participant was discharged before January 1, 2015, there is no need to refund these expenses to the health insurance fund.

3. In cases where patients are required to use high-tech medical services as stipulated in Decision No. 36/2005/QĐ-BYT dated October 31, 2005 of the Minister of Health regarding the issuance of the List of High-Tech Medical Services, the health insurance fund shall cover the costs within the scope of benefits but not exceeding 40 months of the base salary for each use of such service until the Ministry of Health issues the list, ratio, and conditions for reimbursement for medical services within the scope of benefits for health insurance participants (except for cases stipulated in Point b, Clause 1, Article 4 of Decree No. 105/2014/NĐ-CP).

4. For health insurance medical examination and treatment contracts signed before the effective date of this Circular, the Social Insurance organization and healthcare facilities shall agree to amend and supplement the contracts to comply with the provisions of this Circular.

Article 21. Effective Date

1. This Circular takes effect from February 1, 2015; the provisions of this Circular shall be implemented from January 1, 2015.

2. The following documents and regulations shall cease to be effective from the date this Circular takes effect:

a) Joint Circular No. 09/2009/TTLT-BYT-BTC dated August 14, 2009 of the Ministry of Health and the Ministry of Finance guiding the implementation of health insurance and Joint Circular No. 24/2014/TTLT-BYT-BTC dated July 14, 2014 of the Ministry of Health and the Ministry of Finance amending and supplementing certain articles of Joint Circular No. 09/2009/TTLT-BYT-BTC dated August 14, 2009 of the Ministry of Health and the Ministry of Finance guiding the implementation of health insurance;

b) Joint Circular No. 39/2011/TTLT-BYT-BTC dated November 11, 2011 of the Ministry of Health and the Ministry of Finance guiding the procedures for reimbursing medical examination and treatment costs for health insurance participants involved in traffic accidents;

c) The following provision in Clause 2, Part II of Circular No. 14/2007/TT-BTC dated March 8, 2007 of the Ministry of Finance guiding the use of funds for health work in schools: "For funds retained from the voluntary health insurance medical examination and treatment fund of students and trainees: Educational institutions shall be responsible for managing, using, and settling accounts with the social insurance agency according to current regulations."

Article 22. Implementation organization

1. The Vietnam Social Security shall be responsible for:

a) Issuing health insurance card models, appointment card models for reissuance, replacement, and the process for issuing new cards, reissuance, recovery, temporary retention, and replacement of health insurance cards after obtaining the agreement of the Ministry of Health;

b) Issuing the application form for first-time health insurance participants and guiding participants to fill out the application form when issuing health insurance cards;

c) Based on the price index of medicines and medical services of the previous year published by the General Statistics Office, promptly informing the provincial social insurances to adjust costs related to health insurance medical examinations and treatments for healthcare facilities;

d) Directing provincial social insurances to cooperate with the Department of Health, the Department of Finance, health insurance medical examination and treatment facilities in their jurisdiction, adjacent jurisdictions, and relevant agencies to resolve issues within their authority or to recommend higher authorities to handle arising issues promptly.

đ) Direct the Social Insurance at all levels to provide forms, software (if available) to the People's Committees at the commune level for the purpose of compiling and managing lists of participation in health insurance by households within their jurisdiction;

e) Guide the Social Insurance of provinces and cities to base on payment receipts for shared costs paid by patients to determine the cumulative amount of shared costs for the year to issue certificates exempting from shared costs for the year for individuals who have continuously participated in health insurance for five years or more and whose cumulative shared costs for medical examination and treatment expenses in the year exceed six times the minimum wage, except in cases where they seek medical examination and treatment outside the designated network as stipulated in Point c Clause 1 Article 22 of the amended Health Insurance Law;

Example 12: As of May 1, 2015, Mr. A had continuously participated in health insurance for 60 months and his cumulative shared costs for medical examination and treatment expenses from January 1, 2015 to May 1, 2015 was 7 million VND (greater than six times the minimum wage). From May 1, 2015 to December 31, 2015, Mr. A would be eligible for full reimbursement of medical examination and treatment costs within the scope of health insurance benefits by the health insurance fund;

2. The Department of Health shall be responsible for:

a) Take the lead and coordinate with the provincial Social Insurance to disseminate and direct healthcare facilities to organize medical examinations and treatments for health insurance participants in accordance with the Health Insurance Law, the Law Amending and Supplementing Certain Provisions of the Health Insurance Law, Decree No. 105/2014/ND-CP, and this Circular;

b) Take the lead and coordinate with the Department of Health and the provincial Social Insurance related to border areas to organize medical examinations and treatments and transfer specialized technical services to facilitate health insurance participants;

3. Healthcare facilities providing health insurance services shall be responsible for:

a) Promoting the application of information technology in managing medical examinations and treatments. Medical facilities that already have or are developing management software shall cooperate with the Social Insurance organization to unify statistical indicators according to the requirements for managing medical examinations and treatments; those without management software shall study and apply software deployed by the Vietnam Social Insurance, moving towards unifying a common management program;

b) Take the lead and coordinate with the Social Insurance organization to develop and implement programs for managing and controlling medical examination and treatment costs.

Any difficulties encountered during implementation should be promptly reported to the Ministry of Health and the Ministry of Finance for study and resolution./.