Decree No. 62/2009/NĐ-CP detailing and guiding the implementation of certain provisions of the Health Insurance Law

DECREE

Detailed regulations and guidance on implementing certain provisions of the Health Insurance Law

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THE GOVERNMENT

Based on the Law on the Organization of the Government dated December 25, 2001;

Pursuant to the Health Insurance Law dated November 14, 2008;

Considering the proposal of the Minister of Health,

DECREE:

PART I

SUBJECTS, CONTRIBUTION LEVELS, SUPPORT LEVELS, RESPONSIBILITIES AND METHODS OF HEALTH INSURANCE CONTRIBUTIONS

Article 1. Subjects participating in health insurance as stipulated in Clause 25, Article 12 of the Health Insurance Law

1. Rubber workers currently receiving monthly allowances pursuant to Decision No. 206/CP dated May 30, 1979 of the Council of Ministers (now the Government).

2. Young volunteers during the anti-French resistance period pursuant to Decision No. 170/2008/QĐ-TTg dated December 18, 2008 of the Prime Minister regarding health insurance and funeral assistance for young volunteers during the anti-French resistance period.

3. Workers entitled to sickness benefits under laws on social insurance due to diseases listed in the Catalogue of Diseases Requiring Long-term Treatment issued by the Ministry of Health.

4. Non-professional staff at communes, wards, towns (hereinafter referred to as communes) as stipulated by laws on civil servants and public officials.

Article 2. Implementation timeline for health insurance for subjects specified in Article 1 of this Decree

1. Subjects specified in Clauses 1 and 2 shall implement health insurance from July 1, 2009.

2. Subjects specified in Clauses 3 and 4 shall implement health insurance from January 1, 2010. These subjects may voluntarily join health insurance until December 31, 2009 if they have not yet implemented it according to the regulations.

Article 3. Contribution levels and support for health insurance contributions as stipulated in Article 13 of the Health Insurance Law and for subjects specified in Article 1 of this Decree

1. From July 1, 2009 to December 31, 2009, the monthly contribution levels for these subjects are as follows:

a. Equal to 3% of the monthly salary or wages of workers for subjects specified in Clauses 1 and 2 of Article 12 of the Health Insurance Law;

b. Equal to 3% of the monthly pension or disability allowance for subjects specified in Clause 3 of Article 12 of the Health Insurance Law;

c. Equal to 3% of the minimum wage for subjects specified in Clauses 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, and 20 of Article 12 of the Health Insurance Law and for subjects specified in Clauses 1 and 2 of Article 1 of this Decree.

2. From January 1, 2010, the monthly contribution levels for these subjects are as follows:

a. Equal to 4.5% of the monthly salary or wages of workers for subjects specified in Clauses 1 and 2 of Article 12 of the Health Insurance Law;

b. Equal to 4.5% of the monthly pension or disability allowance for subjects specified in Clause 3 of Article 12 of the Health Insurance Law;

c. Equal to 4.5% of the minimum wage for subjects specified in Clauses 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, and 20 of Article 12 of the Health Insurance Law and for subjects specified in Article 1 of this Decree.

d. Equal to 4.5% of the unemployment benefit for subjects specified in Clause 8 of Article 12 of the Health Insurance Law;

đ. Equal to 3% of the minimum wage for subjects specified in Clause 21 of Article 12 of the Health Insurance Law.

3. From January 1, 2012, the monthly contribution level for subjects specified in Clause 22 of Article 12 of the Health Insurance Law is equal to 4.5% of the minimum wage.

4. From January 1, 2014, the monthly contribution levels for these subjects are as follows:

a. Equal to 3% of the minimum wage for subjects specified in Clause 23 of Article 12 of the Health Insurance Law;

b. Equal to 4.5% of the minimum wage for subjects specified in Clause 24 of Article 12 of the Health Insurance Law.

5. The state budget will provide partial support for contributions for the following subjects:

a. At least 50% of the contribution level for subjects specified in Clause 20 of Article 12 of the Health Insurance Law from July 1, 2009;

b. At least 50% of the contribution level for subjects specified in Clause 21 of Article 12 of the Health Insurance Law who belong to near-poor households and at least 30% of the contribution level for subjects specified in Clause 21 of Article 12 of the Health Insurance Law who do not belong to near-poor households from January 1, 2010;

c. At least 30% of the contribution level for subjects specified in Clause 22 of Article 12 of the Health Insurance Law who have a moderate standard of living from January 1, 2012.

6. In cases where subjects specified in Clauses 20 and 22 of Article 12 of the Health Insurance Law participate in health insurance as a family unit including all individuals named in the household registration book and living together in one house, and subjects specified in Clause 23 of Article 12 of the Health Insurance Law with two or more relatives participating, the contribution levels for members are as follows:

a. The first person contributes at the prescribed level;

b. The second, third, and fourth persons contribute successively at 90%, 80%, and 70% of the contribution level of the first person.

c. The fifth person and subsequent contributors pay at 60% of the contribution level of the first person.

Article 4. Obligation to pay health insurance premiums for the subjects specified in Article 1 of this Decree

1. The subjects specified in Clauses 1, 2, and 3 shall be covered by the state budget.

2. The subjects specified in Clause 4 shall be covered by the People's Committee of the commune and the subject themselves, with the People's Committee of the commune covering two-thirds and the subject covering one-third of the premium amount.

Article 5. Methods of paying health insurance premiums for the subjects specified in Clause 7 of Article 15 of the Health Insurance Law and for the subjects specified in Article 1 of this Decree

1. Every six months, the subjects specified in Clauses 20, 22, and 24 of Article 12 of the Health Insurance Law shall pay their health insurance premiums into the health insurance fund.

2. Every six months or annually, the management organization for the subjects specified in Clause 21 of Article 12 of the Health Insurance Law shall collect the health insurance premiums from the subjects and deposit them into the health insurance fund.

3. Monthly, the workers shall pay health insurance premiums for their dependents specified in Clause 23 of Article 12 of the Health Insurance Law through their employers to be deposited into the health insurance fund.

4. Monthly, the social insurance organization shall pay health insurance premiums for the subjects specified in Clauses 1 and 3 of Article 1 of this Decree into the health insurance fund.

5. Annually, the agencies, organizations, and units managing the subjects specified in Clause 2 of Article 1 of this Decree shall pay health insurance premiums for these subjects into the health insurance fund.

6. Monthly, the People's Committee of the commune shall pay health insurance premiums for the subjects specified in Clause 4 of Article 1 of this Decree and deduct from their monthly allowances to deposit simultaneously into the health insurance fund.

7. Every six months, based on the list of subjects, the total amount of health insurance premiums paid by the subjects supported by the state budget, reported by the social insurance organization, and the state budget support level as prescribed, the financial agency shall transfer funds into the health insurance fund according to the分级限制了每次翻译的内容，我将按照要求继续提供剩余部分的翻译：

Article 6. Contribution levels and methods of paying health insurance premiums for voluntary participants in health insurance as stipulated in Clause 3 of Article 50 of the Health Insurance Law and in Clauses 3 and 4 of Article 1 of this Decree

1. From July 1, 2009 to December 31, 2009, the contribution levels for the subjects are as follows:

a. The six-month contribution level for the subjects specified in Clause 21 of Article 12 of the Health Insurance Law who are currently studying at school is 60,000 VND/person in urban areas and 50,000 VND/person in rural and mountainous areas;

b. The six-month contribution level for the subjects specified in Clauses 22, 23, and 24 of Article 12 of the Health Insurance Law and the subjects specified in Clauses 3 and 4 of Article 1 of this Decree is 160,000 VND/person in urban areas and 120,000 VND/person in rural and mountainous areas.

2. Starting January 1, 2010, the monthly contribution level for voluntary participants in health insurance is 4.5% of the minimum wage, to be paid by the participant. In cases where voluntary participants join health insurance as a family unit, the contribution level shall be implemented according to the provisions of Clause 6 of Article 3 of this Decree.

3. Based on the health insurance contribution level, voluntary participants in health insurance shall pay every six months or once a year into the health insurance fund.

Chapter II

LEVELS OF HEALTH INSURANCE BENEFITS AND METHODS OF PAYING EXPENSES

UNDER HEALTH INSURANCE

Article 7. The level of health insurance benefits for cases prescribed in Clause 1 and Clause 3 of Article 22 of the Health Insurance Law.

1. When participating in health insurance and going for medical examination and treatment as prescribed in Articles 26, 27, and 28 of the Health Insurance Law, the insured person shall be reimbursed by the health insurance fund for medical examination and treatment costs within the scope of benefits as follows:

a. 100% of the cost of medical examination and treatment for subjects prescribed in Clauses 2, 9, and 17 of Article 12 of the Health Insurance Law;

b. 100% of the cost of medical examination and treatment at commune-level facilities;

c. 100% of the cost of medical examination and treatment in cases where the total cost of one medical examination and treatment session is lower than 15% of the minimum wage; the Ministry of Health shall take the lead and coordinate with the Ministry of Finance to specify the specific amount and time of application when adjusting the minimum wage for consistent implementation;

d. 95% of the cost of medical examination and treatment for subjects prescribed in Clauses 3, 13, and 14 of Article 12 of the Health Insurance Law; the remaining portion shall be paid by the patient directly to the medical examination and treatment facility;

đ. 80% of the cost of medical examination and treatment for other subjects; the remaining portion shall be paid by the patient directly to the medical examination and treatment facility;

e. In cases where patients choose their own doctors or hospital rooms, they shall only be reimbursed by the health insurance fund for medical examination and treatment costs according to the current service prices applied by the state to that medical examination and treatment facility and in accordance with the benefit levels prescribed in Article 22 of the Health Insurance Law and Article 7 of this Decree.

2. When participating in health insurance and going for medical examination and treatment as prescribed in Articles 26, 27, and 28 of the Health Insurance Law and using high-tech services with high costs, the health insurance fund shall reimburse the costs within the scope of benefits as follows:

a. 100% of the cost for subjects prescribed in Clause 17 of Article 12 of the Health Insurance Law and subjects who were revolutionary activists before January 1, 1945; revolutionary activists from January 1, 1945 to August 19, 1945; Mothers of Vietnam's Heroes; war invalids, persons receiving policies equivalent to war invalids, Class B war invalids, and disabled veterans with a disability rate of 81% or higher; war invalids, persons receiving policies equivalent to war invalids, Class B war invalids when treating recurrent injuries or illnesses;

b. 100% of the cost for subjects prescribed in Clause 2 of Article 12 of the Health Insurance Law but not exceeding 40 months of the minimum wage for each use of high-tech services; the remaining portion shall be covered by the budget of the agency or unit managing the subject;

c. 100% of the cost for subjects prescribed in Clause 9 of Article 12 of the Health Insurance Law (excluding those entitled under point a of Clause 1 of this Article) but not exceeding 40 months of the minimum wage for each use of high-tech services;

d. 95% of the cost for subjects prescribed in Clauses 3, 13, and 14 of Article 12 of the Health Insurance Law but not exceeding 40 months of the minimum wage for each use of high-tech services;

đ. 80% of the cost for other subjects but not exceeding 40 months of the minimum wage for each use of high-tech services.

3. When participating in health insurance and going for medical examination and treatment at a medical examination and treatment facility other than the initial facility or not following the specialized technical level specified by the Minister of Health (except in emergency cases), the health insurance fund shall reimburse the costs of medical examination and treatment within the scope of benefits prescribed in Article 21 of the Health Insurance Law as follows:

a. 70% of the cost for cases where medical examination and treatment are conducted at a medical examination and treatment facility meeting the criteria of Level III and not exceeding 40 months of the minimum wage for each use of high-tech services with high costs;

b. 50% of the cost for cases where medical examination and treatment are conducted at a medical examination and treatment facility meeting the criteria of Level II and not exceeding 40 months of the minimum wage for each use of high-tech services with high costs;

c. 30% of the cost for cases where medical examination and treatment are conducted at a medical examination and treatment facility meeting the criteria of Level I and Special Level and not exceeding 40 months of the minimum wage for each use of high-tech services with high costs.

4. When participating in health insurance and going for medical examination and treatment at non-public healthcare facilities, the health insurance fund shall reimburse according to the benefit levels prescribed in Article 22 of the Health Insurance Law and Clauses 1, 2, and 3 of this Article based on the service prices applicable to public medical examination and treatment facilities at the corresponding specialized technical level.

Article 8. The scope of benefits and the level of health insurance coverage for voluntary participants in health insurance as stipulated in Clause 3, Article 50 of the Health Insurance Law and Clauses 3 and 4 of Article 1 of this Decree.

The scope of benefits and the level of health insurance coverage for voluntary participants in health insurance shall be implemented according to the provisions of Articles 21, 22, and 23 of the Health Insurance Law and Article 7 of this Decree.

Article 9. Application of methods for settling medical examination and treatment costs as stipulated in Article 30 of the Health Insurance Law.

1. The payment method based on fixed rates shall be applied to primary healthcare facilities in accordance with the regulations of the Ministry of Health.

2. The payment method based on service fees and the payment method based on disease cases shall be applied additionally to settle costs for services outside the fixed rate application at primary healthcare facilities and shall be applied to healthcare facilities that do not implement the fixed rate payment method.

3. The Ministry of Health shall take the lead and coordinate with the Ministry of Finance to provide detailed guidance and specifically apply the payment methods stipulated in Clauses 1 and 2 of this Article to healthcare facilities in accordance with their specific circumstances.

Chapter III

MANAGEMENT AND USE OF THE HEALTH INSURANCE FUND

Article 10. Allocation and management of the health insurance fund.

The total health insurance revenue collected by the Social Insurance of provinces and centrally governed cities (hereinafter referred to as the Social Insurance of provinces) shall be allocated and managed as follows:

1. Ninety percent of the health insurance revenue (hereinafter referred to as the medical examination and treatment fund) shall be retained by the Social Insurance of provinces for management.

2. Ten percent of the health insurance revenue shall be transferred to the Vietnam Social Security for management to establish the medical examination and treatment insurance reserve fund and health insurance management expenses, which are regulated as follows:

a. The total annual health insurance management expenses shall be decided by the General Director of the Vietnam Social Security within the total management expenses of the Vietnam Social Security approved by the Prime Minister.

b. The medical examination and treatment insurance reserve fund is the remaining amount after deducting the health insurance management expenses.

Article 11. Utilization of the medical examination and treatment fund managed by the Social Insurance of provinces.

1. The medical examination and treatment fund managed by the Social Insurance of provinces as stipulated in Clause 1 of Article 10 of this Decree shall be used to settle the costs of persons holding health insurance cards issued by the Social Insurance of provinces, including:

a. Payment of costs as prescribed in Article 21 of the Health Insurance Law;

b. Transfer twelve percent of the medical examination and treatment fund of students and trainees to educational institutions under the national education system for initial health care of students and trainees.

2. In the case where the medical examination and treatment fund managed by the Social Insurance of provinces is not fully utilized in a year, it shall be used as follows:

a. Sixty percent shall be used for purchasing, maintaining medical equipment, training to improve professional skills, and other expenses to serve medical examination and treatment under health insurance at the local level in accordance with the guidelines of the Ministry of Health and the Ministry of Finance;

b. Forty percent shall be transferred to the Vietnam Social Security to supplement the medical examination and treatment insurance reserve fund.

3. In the case where the medical examination and treatment fund managed by the Social Insurance of provinces incurs a deficit in a year, the Social Insurance of provinces shall report to the Vietnam Social Security for handling in accordance with the provisions of Article 12 of this Decree.

Article 12. Use of the medical examination and treatment reserve fund under health insurance

1. The medical examination and treatment reserve fund under health insurance managed by the Vietnam Social Security shall be used to supplement the medical examination and treatment fund managed by the provincial social security in cases where the medical examination and treatment fund managed by the provincial social security incurs an overspending.

The General Director of the Vietnam Social Security shall decide on the supplementation based on reports regarding the overspending of the medical examination and treatment fund managed by the provincial social security and report to the Management Board of the Vietnam Social Security at the nearest meeting. In cases where the reserve fund is insufficient for supplementation, a solution must be reported to the Management Board before reporting to the Ministry of Health and the Ministry of Finance.

2. In cases where the medical examination and treatment reserve fund is smaller than the total expenditure for medical examinations and treatments of the two preceding quarters or larger than the total expenditure for insured medical examinations and treatments of the two preceding years, the Vietnam Social Security shall have the responsibility to report to the Management Board, the Ministry of Health, and the Ministry of Finance.

The Ministry of Health shall take the lead and coordinate with the Ministry of Finance to submit measures for resolution to the Prime Minister.

Article 13. Investment activities and growth of the health insurance fund

1. The Vietnam Social Security shall be responsible for implementing measures to preserve and grow the health insurance fund from temporarily idle funds. Investment activities from the health insurance fund must ensure safety, effectiveness, and recoverability when necessary.

2. The Management Board of the Vietnam Social Security shall decide on investment according to the following forms:

a. Purchasing government bonds, promissory notes, and treasury bills;

b. Lending to state commercial banks, the Vietnam Development Bank, and the Social Policy Bank at market interest rates;

c. Other investment forms decided by the Management Board of the Vietnam Social Security.

3. Annual profits from investments and growth of the health insurance fund shall be supplemented into the medical examination and treatment reserve fund under health insurance.

Article 14. Financial Plan

1. Annually, the Vietnam Social Security shall prepare financial plans concerning revenue and expenditure of the health insurance fund; management costs of health insurance; investment and growth of the health insurance fund, to be submitted to the Management Board of the Vietnam Social Security for approval and reported to the Ministry of Finance and the Ministry of Health.

The Ministry of Finance shall take the lead and coordinate with the Ministry of Health to review and consolidate these plans for submission to the Prime Minister for decision on allocation of financial plans.

2. Based on the financial plan assigned by the Prime Minister, the General Director of the Vietnam Social Security shall decide on the budget for revenue and expenditure to be allocated to units for implementation.

Article 15. Responsibilities for managing the health insurance fund

1. The Vietnam Social Security shall implement the collection, disbursement, management, and settlement of the health insurance fund in accordance with the provisions of the law.

2. The Vietnam Social Security may open deposit accounts for the health insurance fund at the State Treasury system and state commercial banks. The balance on the deposit account shall earn interest rates as prescribed by the State Treasury and state commercial banks.

Chapter IV

IMPLEMENTING PROVISIONS

Article 16. Transitional Provisions

1. Continue to implement the free medical examination and treatment policy for children under six years old in the form of actual reimbursement and expenditure as stipulated in Decree No. 36/2005/NĐ-CP dated March 17, 2005 of the Government detailing the implementation of certain articles of the Law on Protection, Care, and Education of Children until this Decree takes effect.

2. In cases of participating in health insurance from July 1, 2009 until this Decree takes effect, the provisions of Decree No. 63/2005/NĐ-CP dated May 16, 2005 of the Government on the Health Insurance Regulations shall apply until December 31, 2009.

Article 17. Effective Date

1. This Decree shall take effect from October 1, 2009.

2. Abolish Decree No. 63/2005/NĐ-CP dated May 16, 2005 of the Government on the Health Insurance Regulations and Article 18 of Decree No. 36/2005/NĐ-CP dated March 17, 2005 of the Government detailing the implementation of certain articles of the Law on Protection, Care, and Education of Children, and other regulations on health insurance that contradict the provisions of this Decree.

Article 18. Responsibilities for guiding implementation

1. The Ministry of Health shall take the lead and coordinate with the Ministry of Finance to guide the implementation of the provisions assigned in the Health Insurance Law and this Decree; issue guidance documents on specialized technical matters and quality management for health insurance medical facilities.

2. The Ministry of Labor, Invalids and Social Affairs shall study and develop criteria for identifying near-poor households and middle-income families to submit to the Prime Minister for issuance. For the year 2009, the criteria for identifying near-poor households shall be implemented according to Decision 117/2008/QĐ-TTg dated August 27, 2008 of the Prime Minister regarding adjustments to health insurance contributions for social policy beneficiaries.

3. Other relevant ministries and sectors shall have the responsibility to guide the implementation of this Decree within their respective functions, tasks, and authorities.

Article 19. Responsibility for Implementation

The Minister, heads of ministerial-level agencies, heads of government agencies, Chairpersons of People's Committees of provinces and centrally-administered cities are responsible for enforcing this Decree./.