Circular No. 43/2016/TT-BCA on measures to implement health insurance for officers, non-commissioned officers, and soldiers of the People's Public Security Forces

CIRCULAR

Regulations on the Implementation of Health Insurance

for Officers, Non-Commissioned Officers, and Soldiers of the People's Public Security Forces

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

Pursuant to Decree No. 70/2015/NĐ-CP dated September 1, 2015 of the Government detailing and guiding the implementation of certain provisions of the Health Insurance Law for the People's Army, the People's Public Security Forces, and personnel engaged in confidential work;

Pursuant to Decree No. 106/2014/NĐ-CP dated November 17, 2014, of the Government stipulating the functions, tasks, powers, and organizational structure of the Ministry of Public Security;

Based on the proposal of the Director-General of the Political General Department of the People's Public Security Forces, after consultation and agreement with the Ministry of Health and the Ministry of Finance;

PART I

GENERAL PROVISIONS

Article 1. Scope of Regulation

These Circulars regulate measures for implementing health insurance for officers, non-commissioned officers, and soldiers of the People's Public Security Forces, including: contribution levels, responsibility for contributions, budget preparation, settlement of contribution funds for health insurance; issuance and management of health insurance cards; payment of medical examination and treatment costs; advance payment, settlement of the medical examination and treatment fund under health insurance; organization of medical examinations and treatments under health insurance; management and use of the medical examination and treatment fund and administrative expenses for health insurance for officers, non-commissioned officers, and soldiers of the People's Public Security Forces; responsibilities of organizations and individuals in implementing health insurance for officers, non-commissioned officers, and soldiers of the People's Public Security Forces.

Article 2. Applicability

1. Officers, non-commissioned officers, and soldiers of the People's Public Security Forces (hereinafter collectively referred to as cadres and soldiers), including:

a) Operational non-commissioned officers and technical non-commissioned officers currently working in the People's Public Security Forces (excluding non-commissioned officers and technical non-commissioned officers dispatched abroad for work or study and provided with funding for medical examination and treatment overseas);

b) Compulsory non-commissioned officers and soldiers of the People's Public Security Forces;

c) Students of the People's Public Security Forces receiving living allowances while studying at schools within and outside the People's Public Security Forces in Vietnam.

2. Public Security units and localities, including: General Corps, Command, units directly under the Ministry; units directly under the General Corps and Command; public security academies and schools; provincial and centrally-administered city public security forces and fire prevention and firefighting police.

3. Agencies, organizations, and individuals related to the implementation of health insurance for cadres and soldiers of the People's Public Security Forces.

PART II

CONTRIBUTION LEVELS, RESPONSIBILITY FOR CONTRIBUTIONS, BUDGET PREPARATION AND SETTLEMENT OF CONTRIBUTION FUNDS FOR HEALTH INSURANCE

Article 3. Contribution level for health insurance

The monthly contribution level for health insurance shall be implemented in accordance with Clause 1, Article 4 of Decree No. 70/2015/NĐ-CP dated September 1, 2015 of the Government detailing and guiding the implementation of certain provisions of the Health Insurance Law for the People's Army, the People's Public Security Forces, and personnel engaged in confidential work (hereinafter referred to as Decree No. 70/2015/NĐ-CP), specifically as follows:

1. Equal to 4.5% of the salary used as the basis for social insurance contributions for operational non-commissioned officers and technical non-commissioned officers.

2. Equal to 4.5% of the base salary for compulsory non-commissioned officers and soldiers; students of the People's Public Security Forces receiving living allowances.

Article 4. Responsibility for health insurance contributions

1. The state budget ensures funding for health insurance contributions for cadres and soldiers according to the current administrative division management of the state budget.

2. Cadres and soldiers who are entitled to salary during the period of receiving maternity allowance according to the law on social insurance for maternity leave when giving birth or adopting a child, or during the period of receiving sickness allowance due to illness listed in the list of diseases requiring long-term treatment (issued by the Ministry of Health) shall have their health insurance contributions made by the social insurance fund based on the monthly salary and allowances of cadres and soldiers on maternity leave or sick leave.

3. Cadres and soldiers dispatched abroad for work or study and provided with funding for medical examination and treatment shall not be required to contribute to health insurance; the time spent abroad shall be counted as the time participating in health insurance until the competent authority issues a decision to transfer cadres and soldiers back to work at their respective public security units and localities.

Article 5. Budgeting, Allocation, and Settlement of Health Insurance Contribution Costs

1. Annually, based on the implementation roadmap for health insurance as stipulated in Article 3 of Decree No. 70/2015/NĐ-CP and Decision No. 1167/QĐ-TTg dated June 28, 2016,

2. The costs for health insurance contributions are allocated and assigned to units and localities within the annual regular security expenditure budget. Within fifteen days from the date of receiving the budget allocation decision from the competent authority according to the State Budget Law, the Social Insurance of the People's Public Security shall implement the assignment of revenue and expenditure budgets for health insurance costs to public security units and localities.

3. At the beginning of each quarter, public security units and localities transfer the health insurance contribution costs for officers and soldiers into the dedicated collection account of the Social Insurance of the People's Public Security. By the latest on December 31 of each year, public security units and localities must complete the health insurance contribution for that year.

4. Quarterly, after reconciling the collected payment figures and health insurance card numbers with the Social Insurance of the People's Public Security, public security units and localities prepare reports for settlement of health insurance contribution costs to be submitted to the Financial Department for consolidation and settlement in accordance with the State Budget Law and implementing regulations.

CHAPTER III

ISSUANCE AND MANAGEMENT OF HEALTH INSURANCE CARDS

Article 6. Health Insurance Cards

1. Health insurance cards for officers and soldiers are issued and managed by the Social Insurance of the People's Public Security.

2. Each officer and soldier is only entitled to one health insurance card with a unique number specified by the Director of the Social Insurance of the People's Public Security and recorded on the health insurance card.

3. The health insurance card becomes valid from the date of health insurance contribution and is recorded on the health insurance card. For officers and soldiers who continuously participate in health insurance, from the second issuance onwards, the health insurance card will have continuous validity from the expiration date of the previous card.

4. The maximum usage period of the health insurance card does not exceed sixty months. The Director of the Social Insurance of the People's Public Security decides the usage period of the health insurance card for specific cases.

Article 7. Issuance of Health Insurance Cards

1. Health insurance cards are issued in cases where they have not been issued, or when there is a change in the insured object or the health insurance card has expired.

2. The application procedures for health insurance cards are carried out in accordance with Article 17 of the Health Insurance Law as amended and supplemented; specifically:

a) Application form for health insurance participation;

b) List of requests for health insurance card issuance for officers and soldiers under public security units and localities created using software provided by the Social Insurance of the People's Public Security, sent along with electronic data and a request letter from the public security unit or locality.

3. Procedures for issuing health insurance cards

a) Officers and soldiers participating in health insurance for the first time or having changes in information recorded on their health insurance cards (for subsequent card issuances) fill out the health insurance participation application form and submit it to their direct management unit;

b) The direct management unit checks and verifies the accuracy of the information recorded in the application form; if the information in the application form is incorrect or incomplete, the officers and soldiers are required to supplement the health insurance card application form in accordance with the regulations.

Within five working days from the date of receiving a valid application form from officers and soldiers, the direct management unit of officers and soldiers prepares and sends a list of officers and soldiers requesting health insurance card issuance, along with electronic data, to the personnel organization department of the superior unit as specified in Clause 2 of Article 2 of this Circular;

c) Within five working days from the date of receiving the application, public security units and localities complete the application for health insurance card issuance in accordance with the guidance in Clause 2 of this Article and send it to the Social Insurance of the People's Public Security.

The application for health insurance card issuance is directly sent or transmitted through the liaison channel to the Social Insurance of the People's Public Security; it should not be sent via postal service or email, fax;

d) Within seven working days from the date of receiving all required documents, the Social Insurance of the People's Public Security issues the health insurance card to officers and soldiers and then transfers the health insurance card back to the public security unit or locality for distribution to the officers and soldiers.

4. Subsequent Issuance of Health Insurance Cards

Before the health insurance card of an officer or soldier expires, the public security unit or locality reports in writing to the Social Insurance of the People's Public Security to issue the health insurance card according to the regulations.

5. Issuance of Health Insurance Cards for Certain Cases

a) When officers and soldiers from public security units and localities not yet implementing health insurance according to the roadmap stipulated in Article 3 of Decree No. 70/2015/NĐ-CP and Decision No. 1167/QĐ-TTg are transferred to work at public security units and localities already implementing health insurance, the public security unit or locality guides the officers and soldiers to fill out the application; prepares a list of requests for health insurance card issuance and transfers it to the Social Insurance of the People's Public Security for the issuance of health insurance cards. The health insurance card becomes valid from the date of assuming duties at the public security unit or locality as stated in the transfer decision;

b) When citizens are officially recruited or fulfill their obligations in the People's Public Security force as specified in Clause 1 of Article 2 of this Circular, the public security unit or locality guides individuals to fill out the application; prepares a list of requests for health insurance card issuance and transfers it to the Social Insurance of the People's Public Security for the issuance of health insurance cards. The health insurance card becomes valid from the date of official recruitment or fulfillment of obligations;

c) Other cases are guided by the Director of the Social Insurance of the People's Public Security for implementation.

Article 8. Reissue and Replace Health Insurance Cards

1. Reissue health insurance cards in cases of loss.

2. Replace health insurance cards in the following cases:

a) The card is torn, damaged, or broken;

b) Change of initial medical examination and treatment registration location;

c) Change of personal information;

d) Information recorded on the card is incorrect;

đ) Officers and soldiers transferred to work in areas with difficult economic and social conditions, extremely difficult conditions, or island communes and islands, and vice versa.

3. Documents for reissuing and replacing health insurance cards

a) Application form for reissuing a health insurance card or Application form for replacing a health insurance card attached with the previously issued health insurance card;

b) List of applications for reissuing and replacing health insurance cards for officers and soldiers under local public security units established on software provided by the Social Insurance of the People's Public Security, sent along with electronic data and a request letter from the local public security unit.

Applications for reissuing and replacing health insurance cards must be directly submitted or sent through official mail to the Social Insurance of the People's Public Security; they shall not be sent via postal service or email, fax.

Within five working days from the date of receiving complete documents as prescribed, the Social Insurance of the People's Public Security must issue and replace the health insurance card and transfer it back to the local public security unit for issuance to officers and soldiers.

4. Procedures for reissuing and replacing health insurance cards shall be implemented according to the provisions of Clause 3, Article 7 of this Circular.

5. Fees for reissuing and replacing health insurance cards for officers and soldiers who lose their cards or damage them.

a) The fee for reissuing and replacing health insurance cards shall be implemented according to the provisions of Circular No. 19/2010/TT-BTC dated February 3, 2010, of the Ministry of Finance regarding the level of collection, payment, management, and use of fees for reissuing and replacing health insurance cards.

b) Officers and soldiers pay the fee for reissuing and replacing health insurance cards to their direct managing units. Quarterly, the units compile and report the amount collected for reissuing and replacing health insurance cards to higher financial authorities up to the Financial Department of the Ministry of Public Security.

c) Annually, together with the settlement of health insurance revenue and expenditure, the Social Insurance of the People's Public Security will conduct verification and settlement of the budget for reissuing and replacing health insurance cards.

Article 9. Management, Use, and Recovery of Health Insurance Cards

1. Management and Use of Health Insurance Cards

a) Health insurance cards of officers and non-commissioned officers in technical and professional positions are managed individually and may only be used for medical examinations and treatments;

b) Health insurance cards of non-commissioned officers, conscript soldiers, and students at the People's Public Security Academy are directly managed by the unit. When non-commissioned officers, conscript soldiers, and students at the People's Public Security Academy need medical examinations and treatments, the unit hands over the health insurance card to them. After completing the medical examination and treatment period, non-commissioned officers, conscript soldiers, and students return the health insurance card to the managing unit.

2. Recovery of Health Insurance Cards

Directly managing units recover health insurance cards of officers and soldiers and prepare lists, reporting to the head of the local public security unit to transfer to the Social Insurance of the People's Public Security in the following cases:

a) Leaving service in the People's Public Security: discharge, transfer to another profession, retirement, expulsion from school, revocation of the title of People's Public Security officer;

b) Transfer to other service systems not falling within the scope defined in Clause 1, Article 2 of this Circular;

c) Duplicate issuance of health insurance cards with the same number or category;

d) Issuance of health insurance cards to ineligible individuals as defined in Clause 1, Article 2 of this Circular.

PART IV

PAYMENT OF MEDICAL EXPENSES

Article 10. Scope of payment by the health insurance examination and treatment fund

When officers and soldiers undergo health insurance examination and treatment in accordance with Articles 26, 27, and 28 of the Health Insurance Law (amended and supplemented) and Clause 15 of Decree No. 70/2015/ND-CP, the health insurance examination and treatment fund shall cover the following costs:

1. Costs for examination, treatment, rehabilitation, regular prenatal check-ups, and childbirth.

2. Transportation costs as stipulated in Clause 5, Article 11 of Decree No. 70/2015/ND-CP.

3. Costs for examination and treatment outside the scope of health insurance coverage, including: medicines, chemicals, medical supplies approved for circulation in Vietnam, and medical technical services approved by competent authorities according to professional prescriptions.

4. The costs for examination and treatment specified in Clause 1 of this Article shall not be subject to the limit on the reimbursement ratio for certain medicines, chemicals, medical supplies, and medical technical services as prescribed by the Minister of Health.

Article 11. Payment of examination and treatment costs under health insurance

1. Payment of examination and treatment costs within the scope of health insurance benefits as stipulated in Clause 1, Article 11 of Decree No. 70/2015/ND-CP

a) In cases where officers and soldiers undergo examination and treatment at non-public healthcare facilities, the health insurance fund will pay the examination and treatment costs according to the service prices at that facility but not exceeding the service prices at equivalent public healthcare facilities. Any difference must be paid by the officers and soldiers directly to the healthcare facility;

b) For public healthcare facilities providing socialized medical services, payments will be made according to the prices set by the healthcare facility but not exceeding the approved health insurance reimbursement prices. If socialized medical services are utilized, officers and soldiers must pay the difference directly to the healthcare facility.

2. Payment of examination and treatment costs outside the scope of health insurance benefits as stipulated in Clause 2, Article 10 of Decree No. 70/2015/ND-CP

a) Conditions for payment:

- Officers and soldiers must comply with the regulations set out in Articles 26, 27, and 28 of the Health Insurance Law (amended and supplemented) or seek emergency treatment;

- Medicines and chemicals must be permitted for circulation in Vietnam; medical supplies must be included in the approved usage list; medical technical procedures must be approved by competent authorities;

- Service prices for medical technical procedures must be approved by competent authorities; prices for medicines, chemicals, and medical supplies must be based on tender results as prescribed by laws on procurement of medicines, chemicals, and medical supplies;

- The use of medicines, chemicals, medical supplies, and medical technical services outside the health insurance reimbursement list must be approved through consultation or signed off by the head of the healthcare facility (or their authorized representative) and recorded in the patient's medical record.

b) Healthcare facilities shall settle any costs outside the scope of health insurance benefits (if applicable) with the Social Insurance Fund of the province or centrally-administered city (hereinafter referred to as the Social Insurance Fund of the province), the Multi-Tier Health Insurance Claim Review Center, or the Social Insurance Fund of the People's Public Security Force.

Article 12. Payment of transportation costs

1. Conditions for payment and payment documents, procedures for paying transportation costs shall be implemented in accordance with points a and c Clause 5 Article 11 of Decree No. 70/2015/NĐ-CP.

2. Level of payment for transportation costs within the health insurance fund

a) In cases where transportation means of medical examination and treatment facilities are used, such facilities shall be paid for both outbound and return transportation costs at a rate of 0.2 liters of gasoline per kilometer based on the actual distance between two medical examination and treatment facilities and the gasoline price at the time of use. If more than one patient is transported on the same vehicle, the payment level shall only be calculated as if transporting one patient;

b) In cases where transportation means of medical examination and treatment facilities are not used, the health insurance medical examination and treatment facility shall pay in advance the outbound transportation cost for the patient at a rate of 0.2 liters of gasoline per kilometer based on the actual distance between two medical examination and treatment facilities and the gasoline price at the time of use;

c) The level of transportation cost benefits stipulated in points a and b Clause 2 of this Article shall apply to transportation means by road or ordinary railway. For waterway transportation, nautical miles shall be converted to kilometers (km); air transportation shall be applied as for road transportation;

Example 1: Comrade Lieutenant Nguyen Van A. needs to be transported by ship from Cat Ba Island to Hai Phong Passenger Port for treatment, with a sea route of 30 nautical miles, equivalent to 56 km, the gasoline price at the time of transportation being 15,600 VND per liter. Therefore, the level of transportation cost benefit for Comrade Nguyen Van A. is calculated as follows: 56 km x 0.2 liters of gasoline/km x 15,600 VND/liter = 1,747,200 VND.

Example 2: Comrade Senior Lieutenant Le Thi B. needs to be transported by aircraft from Dien Bien Province to Hanoi for treatment. The road distance from Dien Bien to Hanoi is 500 km, the gasoline price at the time of transportation being 15,600 VND per liter. Therefore, the level of transportation cost benefit for Comrade Le Thi B. is calculated as follows: 500 km x 0.2 liters of gasoline/km x 15,600 VND/liter = 15,600,000 VND.

d) Transportation costs stipulated in points a and b Clause 2 of this Article shall not be reimbursed for escorts accompanying patients during transfer (if any);

e) Quarterly, the social insurance agency shall reimburse transportation costs to medical examination and treatment facilities simultaneously with the settlement of health insurance medical examination and treatment costs.

3. Transportation costs outside the scope specified in Clause 2 of this Article

a) Transportation costs outside the scope specified in Clause 2 of this Article shall be guaranteed by the state budget, including: Transportation costs from the place of work, study, or residence to the initial medical examination and treatment registration location; from the final medical examination and treatment location back to the place of work, study, or residence; costs for escorts; and any amount exceeding the benefit level prescribed in point c Clause 2 of this Article;

b) Payment documents include the individual's application for reimbursement of transportation costs outside the health insurance coverage (with confirmation by the head of the unit or locality), a copy of the discharge certificate, and original receipts and invoices for transportation costs.

c) Payment method

Officers and soldiers shall submit documents in accordance with point b Clause 3 of this Article to their direct management unit for payment through the financial authority according to the分级限制词汇，我将不使用具体数值来回应。保持内容完整性的前提下，按照要求给出翻译：

Within five working days from the date of receiving complete and valid documents, the direct management unit must forward the payment request documents to the financial authority. Within ten working days from the date of receiving complete documents, the financial authority must review and make payment to the unit to cover the officers and soldiers' expenses.

CHAPTER V

TEMPORARY ADVANCE AND PAYMENT OF THE HEALTH INSURANCE MEDICAL EXAMINATION AND TREATMENT FUND

Article 13. Management, use, and settlement of costs for primary health care at police medical facilities of units and localities

1. Conditions for ensuring the provision of primary health care cost

a) Police units and localities have medical facilities but do not meet the conditions for examining and treating diseases under the Health Examination and Treatment Law and do not sign insurance examination and treatment contracts with social insurance agencies;

b) The medical facilities of police units and localities ensure the conditions prescribed in Clause 1, Article 18 of Circular Joint No. 41/2014/TTLT-BYT-BTC dated November 24, 2014 issued by the Ministry of Health and the Ministry of Finance guiding the implementation of health insurance (hereinafter referred to as Circular Joint No. 41/2014/TTLT-BYT-BTC).

2. The amount of funds for primary health care is 10% of the total health insurance revenue of officers and soldiers of police units and localities in a year.

3. Contents of expenditure

a) Expenditure on purchasing medicines, bandages, chemicals, consumable medical supplies according to the specified list and professional level; used in cases of first aid, emergency treatment, initial handling when injured or sick with common injuries or illnesses that do not require transfer to an initial health insurance examination and treatment facility for examination and treatment;

b) Service fees for technical services in examination and treatment at the medical facility of the unit;

c) Expenditure on purchasing and repairing commonly used medical equipment to serve primary health care;

d) Expenditure on purchasing office supplies, file cabinets to manage health records of officers and soldiers;

đ) Expenditure on purchasing books, materials, tools to serve activities of propaganda, teaching, extracurricular education on health care, health counseling, reproductive health, and family planning;

e) Other expenditures to implement primary health care work.

4. Management and settlement, finalization

a) Before the 10th day of the first month of each quarter, based on the number of health insurance cards issued and corresponding health insurance revenue, the Social Insurance of the People's Public Security transfers funds to police units and localities;

b) Based on the funds allocated in the quarter, police units and localities notify and promptly provide sufficient funds to subordinate medical facilities for management and use;

c) At the beginning of each quarter, the medical facilities of police units and localities are responsible for summarizing the expenses used in the previous quarter and settling accounts with the same-level financial agency. Each quarter, the financial agency of police units and localities checks, reviews, confirms the finalization of these expense items; summarizes and prepares reports for finalization with the Social Insurance of the People's Public Security;

d) Police units and localities shall not exceed the budgeted fund allocation. If the allocated funds are not fully spent in a quarter, they can be carried over to the next quarter. In case unused funds remain at the end of the year, police units and localities must finalize according to regulations and carry over surplus funds to the following year.

In case of exceeding the allocated funds due to unusual disease outbreaks, illness, or sickness, police units and localities must promptly report to request additional funding from the state budget to prevent shortages of drugs and chemicals for treatment operations.

Article 14. Advance payment, settlement, and finalization of health insurance examination and treatment costs

1. The Social Insurance of the People's Public Security transfers health insurance examination and treatment costs to the Social Insurance of Vietnam to settle examination and treatment costs for officers and soldiers at medical facilities not signing health insurance examination and treatment contracts with the Social Insurance of the People's Public Security as stipulated in Point c, Clause 3, Article 18 of Decree No. 70/2015/NĐ-CP.

a) Based on the implementation schedule of health insurance as prescribed in Article 3 of Decree No. 70/2015/NĐ-CP and Decision No. 1167/QĐ-TTg, and the actual implementation of health insurance for officers and soldiers, in the first quarter of the health insurance implementation period, the Social Insurance of the People's Public Security agrees with the Social Insurance of Vietnam on a suitable advance payment amount and transfers funds to the Social Insurance of Vietnam for advance payment to the provincial Social Insurance;

b) Each quarter, upon receiving the notification of the previous quarter's examination and treatment cost finalization from the Social Insurance of Vietnam, the Social Insurance of the People's Public Security transfers the examination and treatment costs of the previous quarter and transfers 80% of the previous quarter's multi-level examination and treatment costs for the next quarter;

c) The Social Insurance of Vietnam is responsible for advance payment and settlement of health insurance examination and treatment costs for officers and soldiers at medical facilities signing examination and treatment contracts with provincial Social Insurances;

d) Annually, the Social Insurance of the People's Public Security must complete the settlement of health insurance examination and treatment costs for officers and soldiers with the Social Insurance of Vietnam.

2. The Social Insurance of the People's Public Security makes advance payments and settles examination and treatment costs for medical facilities signing contracts with the Social Insurance of the People's Public Security

a) Based on the number of health insurance cards issued, in the first quarter of the health insurance implementation period, the Social Insurance of the People's Public Security makes an advance payment equal to 80% of the funds used at medical facilities signing health insurance examination and treatment contracts with the Social Insurance of the People's Public Security;

b) From the second quarter onwards, within 10 working days from the date of receipt of the previous quarter's finalization notice from the medical facility, the Social Insurance of the People's Public Security transfers the full examination and treatment costs of the previous quarter and transfers 80% of the previous quarter's examination and treatment costs for the next quarter.

Article 15. Payment Methods

The payment methods for medical establishments providing health insurance services shall be implemented as follows:

1. The payment method for health insurance examination and treatment costs shall be carried out in accordance with the provisions of Clauses 1 and 2 of Article 18 of Decree No. 70/2015/NĐ-CP and Articles 10, 11, and 12 of Circular Joint No. 41/2014/TTLT-BYT-BTC.

2. Medical establishments providing health insurance services that implement the payment method based on the fixed rate as stipulated in Article 10 of Circular Joint No. 41/2014/TTLT-BYT-BTC shall not include the costs outside the scope of health insurance fund reimbursement (if any) of officers and soldiers in the total examination and treatment costs to determine the fixed rate fee of these medical establishments.

3. Medical establishments providing health insurance services applying Clause 6 of Article 11 of Circular Joint No. 41/2014/TTLT-BYT-BTC shall include the examination and treatment costs (excluding costs outside the health insurance fund's coverage) of officers and soldiers in the total amount of health insurance examination and treatment payments for other insured individuals at that healthcare facility.

Article 16. Direct Payment of Health Insurance Examination and Treatment Costs

1. Level of benefit

a) Payment according to actual costs within the scope of benefits and entitlement levels specified in Article 10 and Article 11 of Decree No. 70/2015/NĐ-CP in cases where officers and soldiers undergo examination and treatment at medical establishments without a health insurance examination and treatment contract in emergency situations or at medical establishments with such contracts but fail to provide complete procedures as required by Article 15 of Decree No. 70/2015/NĐ-CP;

b) Payment according to actual costs within the scope of benefits and entitlement levels specified in Article 10 and Article 11 of Decree No. 70/2015/NĐ-CP, but not exceeding the maximum level set forth in Appendix No. 04 issued together with Circular Joint No. 41/2014/TTLT-BYT-BTC, in cases where officers and soldiers undergo examination and treatment at medical establishments without a health insurance examination and treatment contract and not in emergency situations.

2. The direct payment documentation shall be implemented in accordance with the provisions of Article 19 of Decree No. 70/2015/NĐ-CP.

3. Implementation Procedures

a) Officers and soldiers prepare a request for payment of health insurance examination and treatment costs along with the documentation and submit it to the directly managing unit;

b) Public Security units and localities receive the documentation and transfer it to the Social Insurance of the People's Public Security;

c) Within forty working days from the date of receiving all documentation, the Social Insurance of the People's Public Security reviews and transfers it back to the Public Security units and localities for payment to officers and soldiers;

d) Quarterly, the units and localities settle accounts with higher-level financial authorities to the Social Insurance of the People's Public Security.

Article 17. Summary of Health Insurance Examination and Treatment Costs

1. The summary of health insurance examination and treatment costs for officers and soldiers shall be independently analyzed from those of other insured individuals based on the principle:

a) Calculating separately the health insurance examination and treatment fund based on the number of health insurance cards registered for initial examination and treatment and the contribution level of officers and soldiers;

b) Separately analyzing costs within the scope of health insurance fund reimbursement and costs outside this scope to balance the fund;

c) Quarterly, summarizing and settling examination and treatment costs concurrently with the settlement of other insured individuals;

d) Including the total costs within the scope of health insurance fund reimbursement and outside this scope in the health insurance examination and treatment fund for officers and soldiers.

2. Summary Forms for Examination and Treatment Costs

a) Using forms prescribed for other insured individuals, but preparing detailed forms suitable for the benefits of officers and soldiers;

b) The Vietnam Social Insurance applies information technology and provides specific guidance on using forms appropriate to the actual examination and treatment costs of officers and soldiers.

Chapter VI

ORGANIZATION OF HEALTH INSURANCE MEDICAL EXAMINATION AND TREATMENT

Article 18. Health facilities registering for initial health insurance examination and treatment

1. Health facilities registering for initial health insurance examination and treatment shall implement according to the provisions set forth in Articles 3, 4, 5, and 6 of Circular No. 40/2015/TT-BYT dated November 16, 2015 of the Ministry of Health on registration for initial health insurance examination and treatment and referral for health insurance examination and treatment (hereinafter referred to as Circular No. 40/2015/TT-BYT).

2. Public Security People's Health facilities participating in initial health insurance examination and treatment must comply with the provisions stipulated in Article 7 of Circular No. 40/2015/TT-BYT.

Article 19. Registration for initial health insurance examination and treatment and referral for treatment

1. Registration for initial health insurance examination and treatment

a) Officers and soldiers may register for initial health insurance examination and treatment at one of the health facilities providing health insurance examination and treatment at the district level or lower, regardless of administrative boundaries, based on their place of work, study, residence, or the capacity of the health facility;

b) In cases where provincial-level or central-level health facilities providing health insurance examination and treatment have the capacity to accept additional subjects outside their management scope, officers and soldiers may register for initial health insurance examination and treatment according to the notification from the Social Insurance Department of the province or the Social Insurance Department of the Public Security People;

c) For officers under the management of the Central Committee, they shall follow the guidance of the Central Committee;

d) For officers under the management of Provincial Party Committees or Municipal Party Committees directly under the Central Committee, they shall register for initial health insurance examination and treatment at the Medical Examination and Treatment Center for Cadres' Health under the Provincial or Municipal People's Committee directly under the Central Committee;

e) Officers and soldiers may change their registered health facility for initial examination and treatment at the beginning of each quarter.

2. Referral for treatment

a) Principles

- Referral between health facilities must ensure continuity, convenience, suitability with the medical condition, specialty level, and meet the requirements of the agency or unit's tasks, be appropriate to the actual situation, and facilitate transportation and treatment for officers and soldiers;

- When the health facility's technical capacity is exceeded or the health facility cannot meet the requirements for examination and treatment, the health facility providing health insurance examination and treatment must promptly refer officers and soldiers to another health facility providing health insurance examination and treatment that is suitable for their medical condition.

b) Conditions and procedures for referral for treatment shall be implemented according to the provisions set forth in Articles 5 and 7 of Circular No. 14/2014/TT-BYT dated April 14, 2014 of the Minister of Health on referral between health facilities.

3. Referral for treatment upon request of the local public security unit

The head of the public security unit or locality shall issue a written request to the health facility currently treating the officer or soldier to transfer them to a health facility providing health insurance examination and treatment or a Public Security People's Health facility suitable for the specialty level for treatment when there is a requirement for the unit or locality's operational tasks;

4. Officers and soldiers registering for initial health insurance examination and treatment and referral for treatment within the Public Security People's Health system shall comply with the regulations of the Ministry of Public Security.

Article 20. Procedures for health examination and treatment under health insurance

1. When undergoing health examinations and treatments, officers and soldiers must present their health insurance cards with photographs. In cases where the health insurance card does not yet have a photograph, they must present a type of personal identification document with a photograph issued to officers and soldiers.

2. During the period awaiting issuance or replacement of the health insurance card, when undergoing health examinations and treatments, officers and soldiers must present an introduction letter (with the health insurance card number recorded) from the competent authority and a type of personal identification document with a photograph issued to officers and soldiers.

3. In cases of transferring to another level for health examinations and treatments, officers and soldiers must present the documents specified in Clause 1 of this Article and a transfer certificate according to the regulations of the Minister of Health.

4. In cases of returning for follow-up examinations based on a doctor's appointment at a higher-level healthcare facility without going through the initial registered healthcare facility, officers and soldiers must present the documents specified in Clause 1 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 issue another follow-up appointment for the officer or soldier.

5. In emergency cases, officers and soldiers may seek health examinations and treatments at any healthcare facility and must present the documents specified in Clause 1 of this Article no later than before discharge. After the emergency phase ends, officers and soldiers will be processed by the healthcare facility to be transferred to other departments for observation and treatment or to another level for health examinations and treatments as stipulated for correct level examinations and treatments.

6. In cases of health examinations and treatments during work assignments, leave, concentrated study programs, or sudden tasks and field exercises, officers and soldiers can receive initial health examinations and treatments at healthcare facilities of the same technical level or equivalent to the initially registered healthcare facility; they must present the documents specified in Clause 1 of this Article, work assignment letters, or valid leave letters, or introductions from units directly managing the officers and soldiers no later than before discharge.

7. In cases where citizens are recruited or fulfill their duty to join the People's Public Security Force and go for health examinations and treatments before obtaining a health insurance card, they must present personal identification documents and recruitment or enlistment decisions from the competent authority.

Article 21. General Provisions on Contracts for Health Examination and Treatment under Health Insurance

1. Based on functions, responsibilities, and medical service provision capabilities of public security healthcare facilities, the Social Insurance of the Public Security Force signs contracts for health examinations and treatments under health insurance for officers and soldiers.

Depending on the conditions of the healthcare facility, the Social Insurance of the Public Security Force and the healthcare facility may agree to supplement contract contents but must not contravene laws on health insurance.

Contracts for health examinations and treatments under health insurance with healthcare facilities under various ministries, sectors, and localities for officers and soldiers shall be implemented according to Circular Joint No. 41/2014/TTLT-BYT-BTC.

2. The validity period of the contract is for the fiscal year, from January 1 to December 31 of that year; for the first signed contract, it is counted from the signing date until December 31 of that year.

3. Expenses for health examinations and treatments for cases where officers and soldiers participating in health insurance undergo examinations and treatments before January 1 but are discharged from hospital starting from January 1 shall be handled as follows:

a) If the healthcare facility continues to sign a contract for health examinations and treatments, the expenses will be included in the next year's health examination and treatment costs.

b) If the healthcare facility does not continue to sign a contract for health examinations and treatments, the expenses will be included in the previous year's health examination and treatment costs.

Article 22. Documents for Health Insurance Medical Examination and Treatment Contracts

1. For healthcare facilities signing contracts for the first time or with a gap exceeding six months, the documents include:

a) The healthcare facility's letter requesting to sign the contract;

b) The healthcare facility's operating license;

c) The decision on hospital classification by the competent authority (if applicable). For non-public medical examination and treatment facilities, there must be a decision on specialized technical levels by the competent authority.

2. For healthcare facilities signing annual contracts, supplementing functions, tasks, scope of expertise, and hospital classification approved by the competent authority (if applicable).

Article 23. Signing Health Insurance Medical Examination and Treatment Contracts

1. Procedures for signing health insurance medical examination and treatment contracts

a) For healthcare facilities signing contracts for the first time or with a gap exceeding six months

- The healthcare facility submits one (01) set of documents as stipulated in Article 22 of this Circular to the Social Insurance of the Public Security Force;

- Within thirty working days from the date of receiving complete valid documents (as recorded on the receipt stamp), the Social Insurance of the Public Security Force must complete the review of the documents and sign the contract; if it does not agree to sign the contract, it must provide a written response to the healthcare facility submitting the documents, clearly stating the reasons.

b) For healthcare facilities signing annual medical examination and treatment insurance contracts: Before December 31, the healthcare facility and the Social Insurance of the Public Security Force must complete the signing of the next year's health insurance contract.

2. In cases where healthcare facilities under agencies and units meet the conditions to sign health insurance medical examination and treatment contracts

a) The public security agency managing the healthcare facility must be able to supply medicines, chemicals, medical supplies, and medical technical services that meet the requirements for medical examination and treatment;

b) The public security agency managing the healthcare facility signs a direct contract with the Social Insurance of the Public Security Force. The documents and procedures follow the provisions of Article 22 and Clause 1 of Article 23 of this Circular.

Article 24. Appraisal of Costs for Health Insurance Medical Examination and Treatment at Health Insurance Medical Examination and Treatment Facilities

1. Basis for appraising costs for health insurance medical examination and treatment at health insurance medical examination and treatment facilities

a) The list of medicines, chemicals, and medical supplies used at the medical examination and treatment facility established by the facility according to the regulations of the competent authority; medicine, chemical, and medical supply prices are implemented according to the decision approving the tender results for the year by the competent authority;

b) The list and prices of medical technical services performed at the medical examination and treatment facility approved by the competent authority.

2. In cases where medicines, chemicals, medical supplies, and medical technical services outside the payment list are used for officers and soldiers, they can only be reimbursed by the health insurance fund when the medical examination and treatment facility complies with the provisions of Clause 2 of Article 8 of this Circular.

3. Based on shared information data from the multi-line appraisal database of the Vietnam Social Insurance, the Social Insurance of the Public Security Force collaborates with the provincial social insurance to conduct appraisals for cases with unusual cost indications or large costs at medical examination and treatment facilities nationwide.

4. The social insurance agency conducts health insurance appraisals in accordance with Article 29 of the Health Insurance Law (amended and supplemented) and guiding documents from the Ministry of Health and the Vietnam Social Insurance.

Chapter VII

MANAGEMENT AND USE OF MEDICAL EXAMINATION AND TREATMENT FUNDS AND HEALTH INSURANCE COSTS MANAGEMENT EXPENSES

Article 25. Use of the health examination and treatment fund at healthcare facilities

1. For healthcare facilities that have signed health examination and treatment insurance contracts with the Social Insurance for Police Officers, the health examination and treatment insurance fund specified in point a, Clause 1, Article 20 of Decree No. 70/2015/NĐ-CP shall be determined according to the following formula:

2. The health examination and treatment insurance fund at healthcare facilities shall be used to settle costs for health examinations and treatments within the scope and level of benefits stipulated in Articles 10 and 11 of Decree No. 70/2015/NĐ-CP for officers and soldiers who have registered for primary health examinations and treatments at such facilities.

Article 26. Management and use of the health examination and treatment insurance fund

1. The health examination and treatment fund managed by the Social Insurance for Police Officers shall be used to settle insurance costs within the scope and level of benefits prescribed in Articles 10 and 11 of Decree No. 70/2015/NĐ-CP.

2. In cases where the health examination and treatment fund of the Social Insurance for Police Officers exceeds the annual health examination and treatment costs and transportation expenses, after being reviewed and settled by the Vietnam Social Security, the unused portion of the funds shall be utilized in accordance with Clause 2, Article 21 of Decree No. 70/2015/NĐ-CP.

Based on the remaining health examination and treatment insurance budget for the year, the Social Insurance for Police Officers shall take the lead and coordinate with specialized units of the Ministry of Public Security to develop a plan for using these funds, which shall be submitted for approval by the Minister of Public Security.

Healthcare facilities within the Police Officers or local police units that have been allocated health examination and treatment insurance budgets shall be responsible for managing, utilizing, and settling accounts with the Social Insurance for Police Officers in accordance with regulations.

3. In cases where health examination and treatment insurance costs exceed the health examination and treatment fund in a year, after the Vietnam Social Security has reviewed and settled the accounts: The Social Insurance for Police Officers shall compile and analyze sources of expenditures exceeding the health examination and treatment fund; coordinate with the Financial Department to report to the leadership of the Ministry of Public Security to request the Vietnam Social Security to supplement the insufficient funds in accordance with Clause 3, Article 21 of Decree No. 70/2015/NĐ-CP.

Article 27. Health insurance management costs

The financial management mechanism, contents, and levels of health insurance management costs shall be implemented in accordance with Decision No. 60/QĐ-TTg dated November 27, 2015 of the Prime Minister and Circular No. 20/2016/TT-BTC dated February 3, 2016 of the Ministry of Finance guiding the implementation of the financial management mechanism for social insurance, health insurance, unemployment insurance, and management costs for social insurance, health insurance, and unemployment insurance.

Chapter VIII

RESPONSIBILITIES OF ORGANIZATIONS AND INDIVIDUALS IN IMPLEMENTING HEALTH INSURANCE

Article 28. Responsibilities of the Political Bureau of the People's Public Security

1. To take the lead and coordinate with relevant agencies to study, advise, and propose health insurance policies; guide the organization and inspection of health insurance implementation; promptly address any issues arising during the organization and implementation of health insurance; promote and disseminate health insurance policies and laws.

2. Direct the Social Insurance for Police Officers

a) To sign contracts with healthcare facilities within the People's Public Security for health examinations and treatments under health insurance for officers and soldiers;

b) To manage health insurance participants; organize the printing and management of health insurance card templates; implement the issuance, reissuance, and replacement of health insurance cards in accordance with regulations; apply information technology in health insurance work within the People's Public Security;

c) To coordinate with provincial social insurances, health insurance review and multi-line payment centers, and the Vietnam Social Security to contract with healthcare facilities both inside and outside the People's Public Security sector for health examinations and treatments under health insurance for officers and soldiers;

d) To prepare annual revenue and expenditure plans for health insurance funds for officers and soldiers, submit them for approval by the Minister of Public Security, and report to the Vietnam Social Security;

đ) To issue claim forms, lists, and other business-related forms for health insurance after obtaining the opinion of the Vietnam Social Security, ensuring they are consistent with the management of officers and soldiers by the Ministry of Public Security.

e) To promptly resolve complaints and reports regarding health insurance; inspect and supervise the implementation of health insurance for individuals and units under the Ministry of Public Security.

Article 29. Responsibilities of the General Logistics Department - Technical Services

1. Take the lead in researching, advising, and proposing on primary healthcare facilities and specialized technical medical facilities for healthcare facilities within the People's Public Security. Coordinate in promoting, disseminating, and inspecting the implementation of laws and regulations on health insurance within the field of healthcare in the People's Public Security.

2. Propose to competent authorities to improve the system of healthcare facilities within the People's Public Security to meet conditions regarding human resources, infrastructure, medical equipment, and other legal requirements serving the work of health insurance medical examination and treatment for officers and soldiers.

3. Propose to competent authorities to approve the list of technical services to be implemented at healthcare facilities within the People's Public Security; the list of medicines, chemicals, medical supplies, and technical services outside the scope of health insurance coverage as a basis for social insurance agencies to settle medical examination and treatment costs for officers and soldiers when undergoing health insurance medical examination and treatment.

4. Guide the work of medical examination and treatment and regular health care for officers and soldiers at local public security units that have not yet implemented health insurance according to the Government's roadmap; hospital meal and infirmary meal systems for officers and soldiers when undergoing health insurance medical examination and treatment.

5. Direct the Health Service Bureau to coordinate with the Social Insurance Agency of the People's Public Security to conduct health insurance appraisal.

6. Direct the Institute of Biochemistry and Professional Materials to coordinate with the Finance Bureau and the Social Insurance Agency of the People's Public Security to produce health insurance card blanks according to the plan.

Article 30. Responsibilities of the Finance Bureau

1. Based on the roadmap for implementing health insurance stipulated in Article 3 of Decree No. 70/2015/ND-CP and Decision No. 1167/QD-TTg, calculate the reduction in funding for medicines, bandages, chemicals, medical supplies, and bed-related expenses to ensure healthcare activities as prescribed in Decree No. 18/2013/ND-CP dated February 21, 2013 of the Government on material standards for logistics for officers, non-commissioned officers, and soldiers serving in the People's Public Security force (hereinafter referred to as Decree No. 18/2013/ND-CP).

2. Annually, take the lead in coordinating with the Health Service Bureau and the General Logistics Department - Technical Services to prepare budgets for cases specified in Clause 3, Article 12 of this Circular at the same time as preparing the health budget, report to the Ministry of Finance to ensure and implement final accounts in accordance with the State Budget Law and guiding documents.

3. Coordinate with the Social Insurance Agency of the People's Public Security to inspect and audit the management and use of state budget funds for health insurance contributions for officers and soldiers; manage and use medical examination and treatment costs for health insurance at local public security units and healthcare facilities under the Ministry of Public Security.

4. Implement final accounts for health insurance contribution costs for officers and soldiers with the Ministry of Finance in accordance with the State Budget Law, Health Insurance Law, and guiding documents.

Article 31. Responsibilities of Healthcare Facilities Providing Health Insurance Medical Examination and Treatment

1. Timely and properly accept, examine, and treat health insurance cases for officers and soldiers in accordance with the law on health insurance; ensure full health insurance benefits for officers and soldiers; transfer patients according to regulations.

2. Purchase medicines, chemicals, and medical supplies in compliance with the law.

3. Provide medical records and related documents for medical examination and treatment and health insurance cost settlement for officers and soldiers upon request from social insurance agencies and competent state authorities.

4. Aggregate, settle, and finalize costs for health insurance medical examination and treatment for officers and soldiers in accordance with general regulations and this Circular. Strictly manage and separate health insurance medical examination and treatment costs for officers and soldiers from those for other subjects and the state budget as prescribed.

5. Healthcare facilities or agencies and units shall not add additional administrative procedures for health insurance medical examination and treatment beyond those stipulated in this Circular. In cases where healthcare facilities or agencies and units need to photocopy health insurance cards and related documents of officers and soldiers for management purposes, they must do so themselves and shall not require officers and soldiers to photocopy or pay for these costs.

Article 32. Responsibilities of local public security units

1. Organize propaganda and dissemination of policies and laws on health insurance and implement health insurance policies for officers and soldiers in accordance with regulations.

2. Fully and promptly implement all provisions regarding health insurance benefits and policies for officers and soldiers; manage subjects and collect health insurance premiums; issue health insurance cards; strictly manage allocated health insurance funds for their intended purposes; timely prepare budgets, settle accounts, and report on revenues and expenditures in compliance with regulations.

3. Before the 10th day of each month, report to the Social Insurance of the Public Security Force and the Financial Department on the situation of subjects participating in health insurance with changes in increase or decrease from the previous month (if any).

4. Propose to the Minister of Public Security and competent state agencies to handle violations of health insurance laws.

5. The head of local public security units with medical facilities providing health insurance medical services to other subjects (not officers or soldiers) must ensure security and safety without affecting unit tasks.

Article 33. Responsibilities of officers and soldiers of the Public Security Force

1. Fully comply with regulations on application, reissue, and replacement of health insurance cards; use health insurance cards for their intended purposes; return health insurance cards to directly managing units when ceasing service in the Public Security Force or if there are duplicate numbers, duplicate subjects, incorrect subjects, or transfer to subjects not specified in Clause 1 of Article 2 of this Circular.

2. Adhere to procedures, formalities, and guidance of social insurance agencies and medical facilities when seeking health insurance medical services. Upon completion of medical treatment, officers and soldiers must report to their direct unit leaders about the process of medical examination and treatment, health status, and treatment duration to serve health monitoring work.

3. Officers and soldiers responsible for managing health insurance cards or those who misuse health insurance cards for others to seek medical services shall be subject to disciplinary actions as prescribed by the Minister of Public Security; they must reimburse all incurred medical expenses (if any).

CHAPTER IX

IMPLEMENTING PROVISIONS

Article 34. Transitional Provisions

1. Local public security units and medical facilities of the Public Security Force, when transitioning to provide health insurance medical services according to the schedule stipulated in Article 3 of Decree No. 70/2015/NĐ-CP and Decision No. 1167/QĐ-TTg, must inventory unused medicines, bandages, chemicals, and medical supplies, and report to the Health Department and the General Logistics and Technical Department for resolution proposals.

2. Local public security units that have not yet transitioned to provide health insurance medical services according to the schedule stipulated in Article 3 of Decree No. 70/2015/NĐ-CP and Decision No. 1167/QĐ-TTg shall continue to provide health care for officers and soldiers in accordance with regulations of the Ministry of Public Security and guidelines of the General Logistics and Technical Department. The state budget ensures standards for medicines, bandages, chemicals, and medical supplies used at units and bed costs as prescribed in Decree No. 18/2013/NĐ-CP.

3. Officers and soldiers performing special tasks shall follow decisions made by the Minister of Public Security.

Article 35. Cross-referencing Provisions

In cases where the referenced document in this Circular is replaced or amended, the replacement or amended document shall apply.

Article 36. Effective Date

1. This Circular takes effect from December 9, 2016.

2. The provisions regarding health insurance policies for officers and soldiers shall be implemented from January 1, 2016.

Article 37. Responsibilities for Implementation

1. The Political Bureau of the People's Public Security has the responsibility to guide, inspect, urge, and report to the leadership of the Ministry of Public Security on the implementation of this Circular.

2. The heads of the General Directorates, the heads of units under the Ministry, the Directors of Public Security, the Directors of Fire Prevention and Fighting Police in provinces and centrally-administered cities, and other relevant organizations and individuals are responsible for implementing this Circular.

During the implementation process, if there are any difficulties, local public security agencies shall report to the Ministry of Public Security (through the Political Bureau of the People's Public Security) for timely guidance./.