Decree No. 63/2005/NĐ-CP on Issuing the Health Insurance Regulation

DECREE OF THE GOVERNMENT

Issuing the Health Insurance Regulation

THE GOVERNMENT

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

At the proposal of the Minister of Health and the Minister of Finance,

DECREE:

Article 1. The Health Insurance Regulation is hereby issued together with this Decree.

Article 2. This Decree shall take effect from July 1, 2005, and replace Government Decree No. 58/1998/NĐ-CP dated August 13, 1998, on the issuance of the Health Insurance Regulation. All previous regulations that conflict with this Decree are hereby abolished.

 

Article 3. The Ministry of Health shall be responsible for guiding the implementation of this Decree in coordination with the Ministry of Finance and other relevant ministries and agencies.

 

Article 4. Ministers, Heads of ministerial-level agencies, Heads of government-affiliated agencies, Chairpersons of provincial People's Committees under central cities, and the General Director of the Vietnam Social Security are responsible for enforcing this Decree.

 

HEALTH INSURANCE REGULATION

(Issued together with Government Decree No. 63/2005/NĐ-CP
dated May 16, 2005)

PART I
GENERAL PROVISIONS

Article 1. General Objectives

1. Health insurance as defined in this Regulation is a social policy organized and implemented by the State to mobilize contributions from employers, employees, organizations, and individuals to cover medical examination and treatment costs for those holding health insurance cards as stipulated in this Regulation when they fall ill.

2. Health insurance under this Regulation has a social nature, not aimed at profit-making, and aims at fairness and efficiency in medical examinations and treatments, and full participation by all citizens.

Article 2. Definitions

In this Regulation, the following terms are understood as follows:

1. Compulsory health insurance is a form of health insurance carried out based on the compulsory participation of the insured.

2. Voluntary health insurance is a form of health insurance carried out based on the voluntary participation of the insured.

3. A health-insured patient is a patient holding a compulsory or voluntary health insurance card who, upon medical examination and treatment, enjoys benefits and cost reimbursement according to the provisions of the competent authority.

4. Relatives include the following subjects: biological parents; parents of spouse; foster parents or legal guardians of the individual or spouse; spouse; children under 18 years old; children aged 18 or older but disabled and unable to work according to the law.

5. Health insurance card is a type of certificate confirming that the named person has fulfilled their obligations and is entitled to medical examination and treatment benefits as prescribed, issued by the competent authority on health insurance.

6. Health insurance premium is the amount of money that the insured, employer, or state budget must pay to the Health Insurance Fund as prescribed.

7. Health Insurance Fund is a monetary fund formed from health insurance premiums and other lawful sources. The Health Insurance Fund is used to cover medical examination and treatment costs and other lawful expenses as prescribed for the insured.

8. Health insurance medical examination and treatment facility is a state-owned or private medical facility that has contracts with the social insurance agency to provide medical examination and treatment services to those holding health insurance cards.

9. Health insurance benefit scope includes medical examination and treatment benefits, care, rehabilitation, or cash payments that the insured is entitled to according to the provisions of the competent authority.

10. High-tech services are complex and specialized medical techniques that require high skill levels or the use of advanced medical equipment and expensive medical supplies with high costs when performed.

11. Health insurance payment methods are measures and procedures applied as prescribed for the payment of medical examination and treatment costs between the Health Insurance Fund management agency and health insurance medical examination and treatment facilities or the insured.

12. Direct payment is a payment method where the Health Insurance Fund management agency directly pays the insured in cash without going through the health insurance medical examination and treatment facility.

13. Service fee payment is a payment method based on the prescribed service fees for various types of medical services used by the insured patient.

14. Capitation payment is a payment method based on a fixed quota per registered card at a health insurance medical examination and treatment facility within a specified period. When implementing this payment method, the health insurance medical examination and treatment facility may not charge any additional fees.

15. Diagnosis-related group payment is a payment method based on the cost of each specific disease or group of diseases diagnosed.

Article 3. Subjects Implementing Compulsory Health Insurance

Compulsory health insurance applies to the following subjects:

1. Vietnamese workers (hereinafter referred to as workers) working under labor contracts with a term of three months or more and indefinite-term labor contracts in enterprises of all economic sectors, agencies, public institutions, units under armed forces, and the following organizations:

a) Enterprises established and operating under the Law on State-Owned Enterprises;

b) Enterprises established and operating under the Enterprise Law;

c) Enterprises established and operating under the Law on Foreign Investment in Vietnam;

d) Enterprises in agriculture, forestry, fisheries, and salt industry;

đ) Cooperatives established and operating under the Law on Cooperatives;

e) Enterprises of political organizations and political-social organizations;

g) State agencies, public institutions, political organizations, political-social organizations, occupational social organizations, other social organizations, units under armed forces;

h) Commune, ward, and town health stations;

i) Kindergartens;

k) Agencies and organizations of foreign countries or international organizations in Vietnam, except where international treaties, multilateral or bilateral agreements to which Vietnam is a party prescribe otherwise;

l) Semi-public, privately-run, and private establishments in culture, healthcare, education, training, science, sports, and other public services;

m) Other organizations employing workers.

2. Cadres, civil servants, and public officials as prescribed by the Civil Servant Law.

3. Persons receiving retirement benefits or monthly social insurance allowances.

4. Persons who have rendered meritorious service to the revolution as prescribed by law.

5. Persons participating in the resistance war and their biological children affected by chemical toxins used by the United States during the war in Vietnam who are currently receiving monthly allowances.

6. Deputies to the National Assembly who are not on the state payroll or the payrolls of political-social organizations; members of People's Councils at all levels who are not on the state payroll or do not receive monthly social insurance benefits.

7. Village, town, and ward cadres who have retired and are currently receiving monthly social insurance benefits and elderly village cadres who have retired and are currently receiving monthly allowances from the state budget as stipulated in Decision No. 130/CP dated June 20, 1975 of the Council of Ministers and Decision No. 111/HĐBT dated October 13, 1981 of the Council of Ministers.

8. Relatives of active-duty officers of the Vietnam People's Army and relatives of officers working in the Ministry of Public Security.

9. Social welfare beneficiaries who receive monthly assistance.

10. Individuals aged 90 years or older and individuals as defined in Article 6 of Decree No. 30/2002/NĐ-CP dated March 26, 2002 of the Government regarding the definition and guidance for implementing certain provisions of the Elderly Persons Ordinance.

11. Individuals eligible for medical examination and treatment as stipulated in Decision No. 139/2002/QĐ-TTg dated October 15, 2002 of the Prime Minister concerning medical examination and treatment for the poor.

12. Veterans from the anti-French and anti-American periods, excluding those who have participated in mandatory health insurance as provided above.

13. Foreign students studying in Vietnam who are granted scholarships by the Vietnamese government.

14. Workers employed by enterprises, agencies, and organizations specified in Clause 1 of this Article, working under labor contracts with a term of less than three months, when such contracts expire and the workers continue to work or enter into new labor contracts with the same enterprise, organization, or individual, must participate in mandatory health insurance.

Article 4. Subjects for voluntary health insurance

Voluntary health insurance applies to all subjects who voluntarily wish to participate in health insurance, including those who have already participated in mandatory health insurance but wish to join voluntary health insurance to enjoy higher health insurance service levels than those participating in mandatory health insurance. The objectives, principles, organizational forms, and management of voluntary health insurance are regulated in Articles 24, 25, 26, and 27 of this Charter.

Article 5. Health Insurance Fund

1. The health insurance fund is formed from the following sources:

a) Premiums collected from employers and insured persons for health insurance.

b) Contributions made by the State for health insurance for specified subjects and other State support (if any).

c) Profits generated from lawful measures aimed at preserving and growing the Health Insurance Fund.

d) Revenue from donations and grants from domestic and foreign organizations and individuals.

đ) Other lawful revenues.

2. The Health Insurance Fund shall be used to cover the costs of medical examinations, treatments, and rehabilitation services for insured persons within the scope of their health insurance benefits and other expenses as prescribed.

Article 6. Health Insurance Card

1. The Health Insurance Card is issued to insured persons. The card is designed to be easily recognizable, convenient, and suitable for management and use.

2. The Vietnam Social Security issues the model, uniformly manages, and distributes the Health Insurance Card.

3. The Health Insurance Card becomes valid immediately and continuously upon payment of health insurance premiums in accordance with regulations. Issuance, replacement, and exchange of cards must ensure continuity and not affect the rights of insured persons.

4. For voluntary health insurance, the Health Insurance Card becomes valid for use thirty days after payment of health insurance premiums in the following cases:

a) First-time payment of health insurance premiums;

b) Continued payment of health insurance premiums after a period of interruption due to any reason.

5. The Health Insurance Card is invalid in the following cases:

a) The card has expired;

b) The card was not issued by an authorized agency;

c) The named person on the card has died;

d) The card has been altered, erased, etc.

PART II
HEALTH INSURANCE REGIME AND COST REIMBURSEMENT
MEDICAL EXAMINATION AND TREATMENT INSURANCE

Article 7. Scope of benefits for mandatory health insurance participants

Mandatory health insurance cardholders are entitled to health insurance benefits when seeking outpatient and inpatient care at state and private healthcare facilities that have contracts with the social security agency for treating insured patients, including:

1. Diagnosis, treatment, and rehabilitation during treatment at healthcare facilities.

2. Laboratory tests, imaging diagnostics, functional examinations.

3. Medications listed in the Ministry of Health's directory.

4. Blood and fluid transfusions.

5. Procedures and surgeries.

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

7. Costs of prenatal examinations and childbirth.

8. Transportation costs when transferring to specialized technical facilities according to the Ministry of Health's regulations for certain groups such as the poor, social policy beneficiaries, and residents or workers in mountainous, remote, and far-flung areas.

Article 8. Reimbursement of medical examination and treatment costs for mandatory health insurance participants

1. The costs of medical examinations and treatments for mandatory health insurance participants as stipulated in Article 7 of this Charter shall be fully reimbursed by the Health Insurance Fund based on current state hospital fees, except for high-cost advanced medical services which shall be reimbursed according to the provisions of Clause 2 of this Article.

2. High-cost advanced medical services shall be reimbursed by the Health Insurance Fund up to the maximum reimbursement ratio and amount as prescribed. The Ministry of Health will coordinate with the Ministry of Finance to specify the list of high-cost advanced medical services and the maximum amounts reimbursable by the Health Insurance Fund for each service type.

3. Insured patients must self-pay any costs exceeding the maximum amount stipulated in Clause 2 of this Article, except for the subjects specified in Clauses 3, 4, 5, 9, 10, and Clause 11 of Article 3 of this Charter, whose costs will be reimbursed by the Health Insurance Fund according to the limit set by the Ministry of Health and the Ministry of Finance.

Article 9. Health Insurance Medical Examination and Treatment Facilities

1. The Ministry of Health shall stipulate the professional technical standards for healthcare facilities meeting the conditions to provide health insurance medical examination and treatment services, serving as the basis for social insurance organizations to enter into contracts for medical examination and treatment with persons holding health insurance cards.

2. Private healthcare facilities that have contracts with social insurance organizations to participate in providing medical examination and treatment services for persons holding health insurance cards must fully meet the professional and technical standards and comply with regulations on payment regimes for insured patients as prescribed for state-owned healthcare facilities.

Article 10. Registration for health insurance medical examination and treatment

1. Persons holding health insurance cards may choose healthcare facilities to register for initial medical examination and treatment and receive medical examination and treatment at healthcare facilities according to the appropriate professional technical level system based on their health condition.

2. Persons holding mandatory health insurance cards are entitled to health insurance payment benefits as prescribed in Article 8 of this Regulation when:

a) Receiving medical examination and treatment at healthcare facilities specified on their health insurance card for management and health care purposes;

b) Receiving medical examination and treatment at other healthcare facilities upon referral from the registered facility, in accordance with the professional technical level system as prescribed by the Ministry of Health;

c) Receiving medical examination and treatment at healthcare facilities in emergency situations;

d) Receiving medical examination and treatment at healthcare facilities not initially registered or outside the designated treatment level for certain special cases as specifically agreed between the social insurance organization and the employer.

Article 11. Payment in cases where persons holding health insurance cards seek medical examination and treatment on demand; at private healthcare facilities

1. In cases where persons holding health insurance cards seek medical examination and treatment on their own initiative such as: choosing their own doctor, choosing their own ward, choosing their own healthcare facility, choosing their own medical services; receiving medical examination and treatment beyond the designated professional technical level as prescribed by the Ministry of Health; receiving medical examination and treatment at healthcare facilities without contracts with social insurance organizations; receiving medical examination and treatment abroad, the Health Insurance Fund shall only pay the patient's medical examination and treatment costs according to the current hospital fee prices of state-owned healthcare facilities at the appropriate professional technical level as prescribed by the Ministry of Health within the scope of benefits stipulated in Article 7 of this Regulation.

2. In cases where persons holding health insurance cards receive medical examination and treatment at private healthcare facilities in accordance with the designated level as registered, the Health Insurance Fund shall only pay the patient's medical examination and treatment costs according to the hospital fee prices of state-owned healthcare facilities at the equivalent level.

Persons holding health insurance cards are responsible for paying the difference (if any) between the actual medical examination and treatment costs and the payment amount of the Health Insurance Fund as prescribed in Clause 1 and Clause 2 of this Article.

Article 12. Cases where health insurance benefits are not available

The Health Insurance Fund shall not pay for costs in the following cases:

1. Treatment of leprosy, specific drugs for treating diseases such as tuberculosis, malaria, schizophrenia, epilepsy, and other diseases if already covered by the state budget.

2. Diagnosis and treatment of HIV/AIDS (except for HIV tests as prescribed professionally and for individuals specified in Decision No. 265/2003/QĐ-TTg dated December 16, 2003 of the Prime Minister regarding the regime for those exposed to HIV, infected with HIV/AIDS due to occupational accidents and risks); gonorrhea, syphilis.

3. Vaccination, convalescence, recuperation, testing, early pregnancy diagnosis, health check-ups, family planning services, and infertility treatment.

4. Plastic surgery, cosmetic surgery, prosthetic limbs, artificial eyes, false teeth, glasses, hearing aids.

5. Occupational diseases, work-related injuries, war injuries.

6. Costs of treatment in cases of suicide, intentional injury, drug addiction, or due to the commission of criminal acts.

7. Medical examination and forensic medical examinations; forensic psychiatric examinations.

8. Cases of medical examination, treatment, rehabilitation, and childbirth at home.

Article 13. Forms of payment for health insurance medical examination and treatment costs

Health insurance medical examination and treatment costs are paid in two forms:

1. Social insurance organizations pay healthcare facilities providing health insurance medical examination and treatment services according to the contract between both parties.

2. Social insurance organizations directly pay insured patients the costs of medical examination and treatment as prescribed in Clause 1 of Article 11 of this Regulation.

Article 14. Payment between social insurance organizations and healthcare facilities

1. Forms of payment between social insurance organizations and healthcare facilities providing health insurance medical examination and treatment services:

a) Payment based on service fees;

b) Payment based on fixed rates;

c) Payment based on disease groups;

d) Other suitable payment forms.

2. Social insurance organizations implement specific payment forms in accordance with guidelines issued by the Ministry of Health and the Ministry of Finance.

3. Based on ensuring the rights of health insurance participants, the interests of healthcare facilities providing health insurance medical examination and treatment services, and the safety of the Health Insurance Fund, in line with hospital fee policies and convenience for all parties, the Vietnam Social Security will guide the implementation of new payment methods after reaching consensus with the Ministry of Health and the Ministry of Finance.

CHAPTER III
RESPONSIBILITIES, METHODS, AND AMOUNTS OF CONTRIBUTIONS
COMPULSORY HEALTH INSURANCE

Article 15. Health insurance premiums and compulsory health insurance contribution responsibilities

1. For the subjects prescribed in Clauses 1 and 2 of Article 3 of this Regulation: the monthly health insurance premium is 3% of the monthly salary, wages, living allowance, and allowances for leadership positions, seniority in profession, seniority beyond the framework, regional allowances, and retention coefficient (if any), of which the employer contributes 2% and the employee contributes 1%.

2. For subjects who receive pensions or disability benefits: the monthly health insurance premium is 3% of the pension or social insurance benefit, directly paid by the social insurance organization.

3. The subjects entitled to monthly occupational accident allowance and occupational disease allowance; rubber workers who have ceased work and are receiving monthly allowances; persons entitled to allowances under Decision No. 91/2000/QĐ-TTg dated August 4, 2000 of the Government, and the subjects specified in Clauses 4, 5, 6, 7, 8, 9, and Clause 12, Article 3 of this Regulation: the monthly health insurance premium rate shall be 3% of the current minimum wage level.

4. The subjects specified in Clauses 10 and 11, Article 3 of this Regulation: the temporary monthly premium rate shall be VND 50,000 per person per year.

5. The subjects specified in Clause 13, Article 3 of this Regulation (foreign students studying in Vietnam with scholarships): the monthly health insurance premium rate shall be 3% of the monthly scholarship amount, which shall be paid by the scholarship-granting agency.

6. The State budget shall ensure funding for health insurance contributions for subjects entitled to social insurance benefits before October 1, 1995, and the subjects specified in Clauses 4, 5, 6, 7, 8, 9, 10, 11, and Clause 12, Article 3 of this Regulation. The Social Insurance Fund shall ensure funding for health insurance contributions for subjects entitled to social insurance benefits from October 1, 1995.

7. The Government may adjust the mandatory health insurance contribution rate when necessary.

8. Encourage employers in enterprises to pay the full health insurance premium for their employees (in such cases, the health insurance premium will be accounted for at 2% of production costs and 1% from the enterprise's fund).

9. Subjects participating in mandatory health insurance, if they also participate in voluntary health insurance schemes, must pay the voluntary health insurance premium according to the applicable regulations, in addition to the mandatory health insurance premium as stipulated above, based on the level of voluntary health insurance services they receive.

Article 16. Methods of Health Insurance Contributions

1. Agencies, enterprises, organizations, and individuals (hereinafter referred to as employers) managing the subjects specified in Article 3 of this Regulation shall deduct and collect health insurance premiums at the rates or levels prescribed in Article 15 of this Regulation and submit them to the social insurance agency on a monthly basis for those subjects concurrently participating in both social insurance and health insurance, and at least once every three months for other subjects.

2. In special cases, the social insurance organization and the employer may agree through a contract on the payment of health insurance premiums and issuance of long-term health insurance cards outside the provisions of Clause 1 of this Article.

PART IV
RIGHTS AND OBLIGATIONS OF THE PARTIES INVOLVED IN HEALTH INSURANCE
HEALTH INSURANCE

Article 17. Rights and Obligations of Health Insurance Participants

1. Holders of health insurance cards have the right:

a) To receive medical examination and treatment in accordance with the health insurance regime as stipulated in Chapter II of this Regulation;

b) To choose one of the convenient primary healthcare facilities in their place of residence or workplace, as guided by the social insurance organization, for health management, care, and medical examination and treatment;

c) To change their registration for primary healthcare facilities at the end of each quarter;

d) To request the social insurance agency and healthcare facilities to ensure their rights as prescribed in this Regulation;

đ) To lodge complaints or denunciations upon discovering violations of the Health Insurance Regulation.

2. Holders of health insurance cards have the obligation:

a) To pay health insurance premiums fully and on time;

b) To present their health insurance card when seeking medical examination and treatment;

c) To keep and not lend their health insurance card to others;

d) To comply with the regulations and guidance of the social insurance organization and healthcare facilities when seeking medical examination and treatment.

Article 18. Rights and Obligations of Employers

1. Employers have the right:

a) To refuse to implement requests from the social insurance organization and healthcare facilities that do not conform to the Health Insurance Regulation and related directives issued by competent state authorities;

b) To lodge complaints upon discovering violations of the Health Insurance Regulation. During the complaint period, they must still fulfill their obligation to pay health insurance premiums as prescribed.

2. Employers have the obligation:

a) To pay health insurance premiums fully and on time as prescribed in the Health Insurance Regulation;

b) To provide labor-related documents, wages, salaries, and allowances of health insurance contributors when requested by the social insurance organization and to implement the health insurance contribution system as prescribed;

c) To comply with inspections and audits regarding the implementation of health insurance contribution and payment systems for employees conducted by competent state authorities.

Article 19. Rights and Obligations of Social Insurance Organizations

1. Social insurance organizations have the right:

a) To require employers to pay health insurance premiums and implement the health insurance system; to request relevant documents concerning health insurance contributions and implementation;

b) To organize agents to issue health insurance cards;

c) To enter into contracts with healthcare facilities meeting the prescribed standards for medical examination and treatment for holders of health insurance cards;

d) To request healthcare facilities to provide medical records, case files, and related documents for health insurance examination and treatment cost reimbursement;

đ) To refuse to reimburse costs for medical examinations and treatments that do not comply with the Health Insurance Regulation or do not conform to the terms of the contract signed between the social insurance organization and the healthcare facility;

e) To seize counterfeit health insurance cards and documents and transfer them to competent state authorities for handling in accordance with the law;

g) To recommend to competent state authorities the handling of employers and employees who violate the Health Insurance Regulation.

2. Social insurance organizations have the obligation:

a) To organize and implement health insurance programs, expand the scope of mandatory and voluntary health insurance participants as stipulated in this Regulation;

b) To collect health insurance premiums, issue cards, and guide the management and use of health insurance cards;

c) To provide information about healthcare facilities and guide health insurance participants in choosing facilities for registration;

d) To manage funds and promptly and properly settle health insurance examination and treatment costs;

đ) To inspect and appraise the implementation of examination and treatment regimes and the settlement of health insurance examination and treatment costs;

e) To organize information dissemination and promotion of health insurance.

g) Resolve complaints regarding the implementation of health insurance benefits within its jurisdiction;

h) Implement legal provisions and requirements of competent authorities concerning statistical systems, reporting on professional activities, financial reports, inspection, and supervision;

i) Study, develop plans, and submit to competent authorities for issuance measures to expand and develop health insurance to achieve universal health coverage;

k) Study, propose, and submit to competent authorities measures to enhance the benefits of health insurance participants, improve payment methods, ensure balance in health insurance examination and treatment funds, and related issues concerning health insurance;

Article 20. Rights and responsibilities of health insurance examination and treatment facilities

1. Health insurance examination and treatment facilities have the following rights:

a) Request social insurance organizations to temporarily advance and settle examination and treatment costs according to the Health Insurance Regulations and signed contracts;

b) Provide medical examinations, treatments, and healthcare services to insured patients in accordance with professional regulations;

c) Request social insurance organizations to provide data on the number of people registered at health insurance examination and treatment facilities;

d) Refuse to implement requests outside the scope of the Health Insurance Regulations and signed contracts with social insurance organizations or those not in line with hospital professional rules issued by the Ministry of Health;

đ) Utilize funding paid by social insurance organizations according to regulations;

e) Lodge complaints with competent authorities upon discovering violations of the Health Insurance Regulations or initiate lawsuits against social insurance organizations for breaches of health insurance examination and treatment contracts;

2. Health insurance examination and treatment facilities have the following responsibilities:

a) Fulfill health insurance examination and treatment contracts accurately;

b) Record, prepare documentation, and provide materials related to insured patients' examinations and treatments as bases for settlement and resolution of health insurance disputes;

c) Prescribe medications, biological products, procedures, surgeries, tests, transfers, and other healthcare services safely and reasonably for insured patients according to the Ministry of Health's technical regulations;

d) Facilitate conditions for social insurance organization staff stationed at the facility to carry out promotional and explanatory work about health insurance, guide insured individuals about their rights, responsibilities, and resolve complaints related to examination and treatment using health insurance cards;

đ) Check health insurance cards, identify, and report to social insurance organizations cases violating health insurance card usage regulations and abusing health insurance benefits;

e) Manage and utilize funding from social insurance organizations according to regulations;

g) Implement legal provisions concerning statistical systems, reporting on professional activities, financial reports, and inspections and supervisions related to health insurance;

CHAPTER V
MANAGEMENT AND USE OF THE HEALTH INSURANCE FUND

Article 21. Management and utilization of the Health Insurance Fund

1. The Health Insurance Fund is a component of the Social Insurance Fund, managed centrally, uniformly, democratically, and transparently according to financial management regulations for the Vietnam Social Security;

2. The Ministry of Finance and the Ministry of Health provide detailed guidance on managing and utilizing the Health Insurance Fund;

Article 22. Accounting system and financial reporting

Social insurance organizations must implement the accounting system and financial reporting of the Health Insurance Fund according to legal regulations;

Article 23. Financial transparency

After the fiscal year ends, social insurance organizations must publish financial reports on the utilization of the Health Insurance Fund according to legal regulations;

Chapter VI
VOLUNTARY HEALTH INSURANCE

Article 24. Objective

Voluntary health insurance as stipulated in these Regulations aims to implement social policies in medical examinations and treatments, not for business purposes, and does not apply legal provisions on insurance business;

Article 25. Objectives and principles

1. Voluntary health insurance applies to all subjects willing to voluntarily participate in health insurance, including those who have participated in mandatory health insurance but wish to join voluntary health insurance to enjoy higher service levels than mandatory health insurance participants; foreign nationals working, studying, or traveling in Vietnam;

2. Voluntary health insurance is implemented based on administrative boundaries or groups of subjects under organizational management for voluntary participation;

3. Participants in voluntary health insurance are entitled to reimbursement for examination and treatment costs commensurate with their contribution level and chosen type of voluntary health insurance;

4. The State encourages diversification of voluntary health insurance types based on compliance with the objectives set forth in Article 24 of these Regulations. The Ministry of Health and the Ministry of Finance guide registration and implementation of voluntary health insurance according to these Regulations;

5. Provincial People's Committees balance local budgets and mobilize contributions from agencies, organizations, and individuals to support voluntary health insurance contributions for local residents, particularly near-poor individuals, to promote voluntary health insurance participation among residents;

Article 26. Forms, benefits, and insurance premiums for voluntary health insurance

1. Types of voluntary health insurance include:

a) Inpatient and outpatient examination and treatment insurance;

b) Supplementary insurance beyond mandatory health insurance;

c) Community health insurance; family health insurance, and other types of health insurance;

2. The Ministry of Health and the Ministry of Finance define the scope of benefits and premium ranges for voluntary health insurance based on healthcare service prices, benefits received, economic and social conditions, and the number of participants in each group. Based on these regulations, the Vietnam Social Security determines specific contribution levels suitable for each group and the economic and social conditions of each locality.

3. Compulsory health insurance participants may also enroll in voluntary health insurance at various levels and enjoy benefits as prescribed for voluntary health insurance. The Ministry of Health shall coordinate with the Vietnam Social Security to pilot this form of health insurance.

Article 27. Management of the Voluntary Health Insurance Fund

1. Revenue from voluntary health insurance shall be accounted for, allocated, and utilized in accordance with the requirements to cover medical examination and treatment costs for participants and to support the development of voluntary health insurance.

2. Organizations implementing voluntary health insurance may allocate a portion of the total revenue from voluntary health insurance to cover expenses related to fee collection, issuance of voluntary health insurance cards, and supplementary expenses for promotional activities, mobilization, and rewards. The specific ratio of such allocation shall be stipulated by the Ministry of Health and the Ministry of Finance.

3. At the end of each year, if there is surplus in the Voluntary Health Insurance Fund, the entire surplus shall be transferred to the following year to fund medical examination and treatment services for voluntary health insurance participants. If the total revenue of the Voluntary Health Insurance Fund is less than the total expenditure, it is permissible to utilize the surplus from the Compulsory Health Insurance Fund or other sources as prescribed to ensure timely and full payment of benefits to eligible recipients.

4. The Ministry of Finance and the Ministry of Health shall provide detailed guidance on the implementation, management, and utilization of the Voluntary Health Insurance Fund in accordance with the above provisions and in compliance with the financial management regulations of the Vietnam Social Security.

Chapter VII
ORGANIZATION AND MANAGEMENT OF HEALTH INSURANCE

Article 28. Organizational System

1. The Prime Minister shall prescribe the organizational system for implementing health insurance policies under this Charter uniformly and consistently from central to local levels.

2. The Vietnam Social Security is the agency responsible for implementing health insurance policies as prescribed in this Charter.

Article 29. State Management of Health Insurance

1. The Government shall uniformly manage state affairs concerning health insurance throughout the country.

2. The Government shall assign the Ministry of Health to perform state management functions over health insurance, including the following:

a) Leading and coordinating the formulation of health insurance policies and laws to be submitted for higher-level approval or promulgation within its authority;

b) Formulating and promulgating, within its authority, regulations and technical standards for healthcare facilities qualified to provide medical examination and treatment services to health insurance participants;

c) Providing guidance, inspection, audit, and resolution of issues arising from the implementation of health insurance laws to ensure the rights and responsibilities of health insurance participants and healthcare facilities providing health insurance services as prescribed by law.

3. The Ministry of Finance, the Ministry of Labor, Invalids and Social Affairs, and the Ministry of Home Affairs shall fulfill their state management functions over health insurance within their respective mandates and authorities.

4. The Chairperson of the People's Committee of provinces and centrally-administered cities shall be responsible for managing state affairs concerning health insurance within their jurisdictions, including:

a) Directing and organizing the implementation of health insurance policies, including both compulsory and voluntary health insurance, within their jurisdictions;

b) Inspecting and auditing the implementation of health insurance laws and resolving issues related to medical examination and treatment services for health insurance cardholders within their jurisdictions.

Chapter VIII
REWARD, DISCIPLINARY ACTION, COMPLAINT RESOLUTION, REPORTING, AND VIOLATION HANDLING
REPORTING AND HANDLING VIOLATIONS

Article 30. Awards

Organizations and individuals who have achieved notable results in the health insurance cause shall be rewarded according to the law on commendation and reward.

Article 31. Complaint Resolution and Reporting

1. Organizations and individuals have the right to file complaints or reports regarding violations of the Health Insurance Charter.

2. When complaints or reports about health insurance arise, they shall be resolved by the social security organization, competent state management agencies, specialized inspection agencies, or courts depending on the nature of the case, in accordance with the law on complaints and reports.

3. The Ministry of Health shall be responsible for resolving complaints and reports related to health insurance medical examination and treatment. The Ministry of Finance shall handle complaints and reports related to the management and use of the Health Insurance Fund. The Ministry of Home Affairs shall resolve complaints and reports related to personnel management in health insurance work. Provincial and centrally-administered city people's committees shall resolve complaints and reports related to health insurance at the local level in accordance with the law and their authority.

4. The Ministry of Health shall lead the establishment of inter-ministerial working groups to resolve complaints and reports related to health insurance that involve the jurisdiction of multiple ministries, sectors, and agencies.

Article 32. Handling Violations

1. Any person violating the provisions of the Health Insurance Charter shall be subject to disciplinary action, administrative violation handling, or criminal prosecution, depending on the severity of the violation; if damage is caused, compensation must be provided in accordance with the law.

2. The Ministry of Health, the Ministry of Finance, specialized inspection agencies, and provincial and centrally-administered city people's committees shall be responsible for organizing inspections, audits, detection, and handling of violations within their mandates and authorities.

Article 33. Inspection and Audit of Health Insurance

1. Health insurance medical examination and treatment facilities, the Health Insurance Fund, and social security organizations shall be subject to inspection and audit by competent state management agencies and specialized inspection agencies regarding matters related to health insurance.

2. Inspections and audits must be conducted in accordance with their functions, authority, and procedures as prescribed by law. An inspection decision must be issued by an authorized person, and a conclusion record must be prepared upon completion.

CHAPTER IX
IMPLEMENTING PROVISIONS

Article 34. Effectiveness

1. These Bylaws shall take effect concurrently with the effectiveness of the Decree promulgating these Bylaws.

2. All previous regulations on health insurance that conflict with the provisions of these Bylaws are hereby abolished.

Article 35. Implementation guidance

The Ministry of Health shall take the lead and coordinate with relevant ministries and sectors to guide the implementation of these Bylaws.