Nghị định 62/2009/NĐ-CP Hướng dẫn Luật Bảo hiểm y tế

DECREE

DETAILING AND GUIDING A NUMBER OF ARTICLES OF THE LAW ON HEALTH INSURANCE

THE GOVERNMENT

Pursuant to the December 25, 2001 Law on Organization of the Government;
Pursuant to the November 14, 2008 Law on Health Insurance;
At the proposal of the Minister of Health,

DECREES:

Chapter 1

HEALTH INSURANCE PREMIUM PAYERS, PREMIUM AND SUPPORT RATES, PAYMENT RESPONSIBILITY AND METHODS

Article 1. Health insurance participants defined in Clause 25, Article 12 of the Law on Health Insurance

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2. Youth volunteers in the anti-French resistance war period under the Prime Minister's Decision No. 170/2008/QD-TTg of December 18, 2008, on health insurance benefits and burial allowances for youth volunteers in the anti-French resistance war period.

3. Laborers who are entitled to illness allowance under the social insurance law as they suffer from diseases on the Health Ministry-promulgated list of diseases which need long­term treatment.

4. Part-time commune/ward/township (below collectively referred to as commune) officials under the law on cadres and civil servants.

Article 2. Roadmap for health insurance premium payment by the insured defined in Article 1 of this Decree

1. The insured defined in Clauses I and 2 shall pay health insurance premiums from July 1,2009.

2. The insured defined in Clauses 3 and 4 shall pay health insurance premiums from January 1, 2010. Pending participation in health insurance under regulations, they may voluntarily pay health insurance premiums through December 31, 2009.

Article 3. Health insurance premium rates and support rates provided for in Article 13 of the Law on Health Insurance and those applicable to the insured defined in Article 1 of this Decree

1. From July 1, 2009 to December 31, 2009. the insured shall pay monthly health insurance premiums at the following rates:

a/ 3% of their monthly salaries or remuneration, for those defined in Clauses 1 and 2, Article 12 of the Law on Health Insurance;

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c/ 3% of the monthly minimum salary, for those defined in Clauses 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 and 20, Article 12 of the Law on Health Insurance and those defined in Clauses 1 and 2, Article 1 of this Decree.

2. From January 1, 2010, the insured shall pay monthly health insurance premiums at the following rates:

a/ 4,5% of their monthly salaries or remuneration, for those defined in Clauses 1 and 2, Article 12 of the Law on Health Insurance;

b/ 4,5% of the monthly pensions or working capacity loss allowances, for those defined in Clause 3, Article 12 of the Law on Health Insurance;

c/ 4.5% of the monthly minimum salary, for those defined in Clauses 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 and 20, Article 12 of the Law on Health Insurance and those defined in Article 1 of this Decree;

d/ 4.5% of the unemployment allowance, for those defined in Clause 8, Article 12 of the Law on Health Insurance;

e/ 3% of the monthly minimum salary, for those defined in Clause 21. Article 12 of the Law on Health Insurance;

3. From January 1,. 2012, the monthly premium rate applicable to those defined in Clause 22, Article 12 of the Law on Health Insurance will be equal to 4.5% of the monthly minimum salary.

4. From January 1, 2014, the insured shall pay monthly health insurance premiums at the following rates:

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b/ 4,5% of the minimum salary, for those defined in Clause 24, Article 12 of the Law on Health Insurance.

5. The state budget shall provide partial supports to the insured for health insurance premium payment at the following rates:

a/ At least 50% of the premium rate from July 1, 2009, for those defined in Clause 20, Article 12 of the Law on Health Insurance;

b/ At least 50% of the premium rate from January 1, 2010, for those defined in Clause 21, Article 12 of the Law on Health Insurance who are from households living just above the poverty line; and at least 30% of the premium rate, for those defined in Clause 21, Article 12 of the Law on Health Insurance who are not from households living just above the poverty line;

c/ At least 30% of the premium rate from January 1, 2012, for those defined in Clause 22, Article 12 of the Law on Health Insurance who have an average living standard.

6. For the insured defined in Clauses 20 and 22, Article 12 of the Law on Health Insurance who participate in the capacity as households in health insurance with all individuals named in the household registration book and co-living in the same house, and those defined in Clause 23, Article 12 of the Law on Health Insurance who participate in health insurance with two or more of their relatives, the premium rate for each of these members is as follows:

a/ The prescribed rate, for the first person;

b/ 90%. 80% and 70% of the premium rate applicable to the first person, for the second, the third and the fourth persons, respectively;

c/ 60% of the premium rate applicable to the first person, for the fifth person on.

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1. Those defined in Clauses 1, 2 and 3 will have their health insurance premiums paid by the state budget

2. Those defined in Clause 4 will have two thirds of their health insurance premiums paid by commune People's Committees and the remaining third by themselves.

Article 5. Methods of health insurance premium payment by the insured defined in Clause 7, Article 15 of the Law on Health Insurance and those defined in Article 1 of this Decree

1. Once every six months, those defined in Clauses 20, 22 and 24, Article 12 of the Law on Health Insurance shall pay health insurance premiums to the health insurance fund.

2. Once every six months or every year, organizations managing the insured defined in Clause 21. Article 12 of the Law on Health Insurance shall collect health insurance premiums from them for payment to the health insurance fund.

3. Monthly, laborers who pay health insurance premiums for their relatives defined in Clause 23, Article 12 of the Law on Health Insurance shall pay health insurance premiums via their employers to the health insurance fund.

4. Monthly, social insurance organizations shall pay health insurance premiums for those defined in Clauses 1 and 3, Article 1 of this Decree to the health insurance fund.

5. Annually, agencies, organizations and units managing the insured defined in Clause 2, Article 1 of this Decree shall pay health insurance premiums for them to the health insurance fund.

6. Monthly, commune People's Committees shall pay health insurance premiums for those defined in Clause 4. Article 1 of this Decree and simultaneously make deductions from the latter's allowances for payment to the health insurance fund.

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Article 6. Health insurance premium rates and methods of health insurance premium payment for voluntary health insurance participants defined in Clause 3, Article 50 of the Law on Health Insurance and Clauses 3 and 4, Article 1 of this Decree

1. From July 1, 2009, to December 31, 2009, the premium rates set for the insured are as follows:

a/ The six-month rate applicable to those defined in Clause 21, Article 12 of the Law on Health Insurance who are studying at school is VND 60.000/person for urban areas and VND 50.000/person. for rural and mountainous areas;

b/ The six-month rate applicable to those defined in Clauses 22, 23 and 24 of the Law on Health Insurance and those defined in Clauses 3 and 4, Article 1 of this Decree is VND 160,000/ person, for urban areas and VND 120,000/ person, for rural and mountainous areas.

2. From January 1, 2010, voluntary health insurance participants shall themselves pay health insurance premiums at a monthly rate equal to 4,5% of the minimum salary. For voluntary health insurance participants being households, the premium rates are those provided for in Clause 6, Article 3 of this Decree.

3. Based on the health premium rates, voluntary health insurance participants may pay health insurance premiums either once every six months or in lump sum for the whole year to the health insurance fund.

Chapter II

LEVELS OF HEALTH INSURANCE BENEFIT AND METHODS OF PAYMENT OF COSTS OF INSURED HEALTH CARE

Article 7. Levels of health insurance benefits for cases defined in Clauses 1 and 3, Article 22 of the Law on Health Insurance

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a/ 100% of the costs, for those defined in Clauses 2, 9 and 17, Article 12 of the Law on Health Insurance;

b/ 100% of the costs, for medical examination and treatment provided at the commune level;

c/ 100% of the costs, provided that the total cost of one-time medical examination and treatment is lower than 15% of the minimum salary; the Health Ministry shall assume the prime responsibility for and coordinate with the Finance Ministry in specifying money amounts and time of application when the minimum salary is adjusted for uniform implementation:

d/ 95% of the costs, for those defined in Clauses 3, 13 and 14, Article 12 of the Law on Health Insurance; the remainder shall be paid by the patient directly to the medical examination and treatment establishment;

e/ 80% of the costs, for other categories of the insured: the remainder shall be paid by the patient directly to the medical examination and treatment establishment;

f/ If the insured select doctors and hospital rooms for themselves, they will get medical examination and treatment costs paid by the health insurance fund according to current service chargers stipulated by the State and applicable to the concerned medical examination and treatment establishments, and at the levels of benefit specified in Article 22 of the Law on Health Insurance and Article 7 of this Decree.

2. Health insurance participants who seek medical examination and treatment under Articles 26, 27 and 28 of the Law on Health Insurance, involving the use of costly high technology will get medical examination and treatment costs paid by the health insurance fund at the following levels:

a/ 100% of the costs, for those defined in Clause 17, Article 12 of the Law on Health Insurance and those who were revolutionary activists prior to January 1, 1945; revolutionary activists in the period between January I. 1945. and August 19, 1945; Vietnamese hero mothers; war invalids and beneficiaries of policies for war invalids. class-B war invalids, diseased soldiers who lose 81 % or more of their working capacity; war invalids, beneficiaries of policies for war invalids, class-B war invalids, and diseased soldiers when they have their recuring injuries or diseases treated;

b/ 100% of the costs, for those defined in Clause 2, Article 12 of the Law on Health Insurance, which, however, must not exceed 40-month minimum salary for one-time use of the technological service; the remainder shall be covered by the budget of the insured-managing agency or unit:

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d/ 95% of the costs, for those defined in Clauses 3, 13 and 14. Article 12 of the Law on Health Insurance, which, however, must not exceed 40-month minimum salary for one-time use of the technological service;

e/ 80% of the costs, for other insured, which, however, must not exceed 40-month minimum salary for one-time use of the technological service;

3. Health insurance participants who use medical examination and treatment services not at the primary care provider or the technical line prescribed by the Health Minister (except for emergency cases) will get their medical examination and treatment costs paid by the health insurance fund within the scope of their entitlement provided for in Article 21 of the Law on Health Insurance as follows:

a/ 70% of the costs, for medical examination and treatment provided by grade-Ill medical examination and treatment establishments, and not exceeding 40-month minimum salary for each use of costly hi-tech services;

b/ 50% of the costs, for medical examination and treatment provided by grade-II medical examination and treatment establishments, and not exceeding 40-month minimum salary for each use of costly hi-tech services;

c/ 30% of the costs, for medical examination and treatment provided by grade-I or special medical examination and treatment establish­ments, and not exceeding 40-month minimum salary for each use of costly hi-tech services;

4. Health insurance participants using medical examination and treatment services at non-public medical establishments will get paid by the health insurance fund at the levels prescribed in Article 22 of the Law on Health Insurance and Clauses 1, 2 and 3 of this Article and service charges applicable to public medical establishments of equivalent technical line.

Article 8. Scope of entitlement and levels of benefit for voluntary health insurance participants defined in Clause 3, Article 50 of the Law on Health Insurance and Clauses 3 and 4, Article 1 of this Decree

The scope of entitlement and levels of benefit for voluntary health insurance participants comply with Articles 21, 22 and 23 of the Law on Health Insurance and Article 7 of this Decree.

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1. The quota-based payment method applies to primary care providers according to regulations of the Health Ministry.

2. The service charge-based payment and disease-based payment methods are applied additionally to pay for extra-quota services at primary care providers and those medical examination and treatment establishments which do not apply the quota-based payment method.

3. The Health Ministry shall assume the prime responsibility for, and coordinate with the Finance Ministry in. guiding and specifying the application of payment methods prescribed in Clauses 1 and 2 of this Article as appropriate to medical examination and treatment establishments.

Chapter III

MANAGEMENT AND USE OF THE HEALTH INSURANCE FUND

Article 10. Allocation and management of the health insurance fund

Total health insurance collections of Social Insurance of a province or centrally run city (below referred to as provincial Social Insurance) shall be allocated and managed as follows:

1. 90% (below referred to as the medical care fund) shall be retained at and managed by the provincial Social Insurance.

2. 10% shall be transferred to the Vietnam Social Insurance for management and setting up of a provision fund for insured medical care and covering health insurance management costs according to the following provisions:

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b/ The provision fund for insured medical care is the remainder after deduction of the health insurance management cost.

Article 11. Use of the medical care fund managed by the provincial Social Insurance

1. The medical care fund managed by the provincial Social Insurance prescribed in Clause 1, Article 10 of this Decree may be used to cover costs paid by bearers of health insurance cards issued by the provincial Social Insurance, including:

a/ The costs prescribed in Article 21 of the Law on Health Insurance;

b/ A 12% deduction to be transferred to the medical care fund for pupils and students which are managed by educational establishments of the national education system to serve primary health care for pupils and students.

2. If the medical care fund managed by the provincial Social Insurance is not used up in a year, the remainder shall be used as follows:

a/ 60% for procurement and maintenance of medical equipment and training to improve professional skills of health workers and in service of local medical examination and treatment under joint guidance of the Health Ministry and the Finance Ministry;

b/ 40% to be transferred to the Vietnam Social Insurance for addition to the provision fund for insured medical care.

3. In case of deficit of the medical care fund managed by the provincial Social Insurance in a year, the provincial Social Insurance shall report such to the Vietnam Social Insurance for handling according to Article 12 of this Decree.

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1. The provision fund for insured medical care managed by the Vietnam Social Insurance shall be used for addition to the medical care fund managed by the provincial Social Insurance in case of the latter fund is insufficient.

The director general of the Vietnam Social Insurance shall, based on the deficit of the medical care fund managed by the provincial Social Insurance, decide on the supplementation and report such to the management council of the Vietnam Social Fund at the nearest meeting of the council. If the provision fund is insufficient for supplementation, such must be reported to the management council for solution before it is reported to the Healthy Ministry and the Finance Ministry.

2. If the provision fund for insured medical care is smaller than the total insured medical care costs of the two preceding quarters or larger than the total insured medical care costs in the two preceding years, the Vietnam Social Insurance shall report such to the management council, the Health Ministry and the Finance Ministry.

The Health Ministry shall assume the prime responsibility for, and coordinate with the Finance Ministry in, proposing handling measures to the Prime Minister.

Article 13. Investment, growth of the health insurance fund

1. The Vietnam Social Insurance shall take measures to preserve and increase the health insurance fund with the temporarily idle money amount in the fund. The health insurance fund's investment activities must ensure safety, efficiency and recoverability in case of necessity.

2. The management council of the Vietnam Social Insurance shall decide on the investment in the following forms:

a/ Buying treasury bills and bonds of the State;

b/ Lending to state-owned commercial banks. Vietnam Development Bank or Social Policy Bank at market interest rate;

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3. Annual earnings from the investment and growth of the health insurance fund shall be added to the provision fund for insured medical care.

Article 14. Financial plan

1. Annually, the Vietnam Social Insurance shall make a financial plan on revenue and expenditure of the health insurance fund: cost of management, investment and growth of the health insurance fund, to be submitted to the management council of the Vietnam Social Insurance for approval and reporting to the Finance Ministry and the Health Ministry.

The Finance Ministry shall assume the prime responsibility for. and coordinate with the Health Ministry in. considering and making a sum-up to the Prime Minister for decision on assignment of the financial plan.

2. Based on the financial plan assigned by the Prime Minister, the general director of the Vietnam Social Insurance shall decide to allocate revenue and expenditure estimates to concerned units for implementation.

Article 15. Responsibility for management of the health insurance fund

1. The Vietnam Social Insurance shall take charge of collection, spending, management and settlement of the health insurance fund in accordance with law.

2. The Vietnam Social Insurance may open health insurance fund deposit accounts at state treasuries and state-owned commercial banks. Balances on those deposit accounts are eligible for deposit interest rates set by the concerned state treasuries or state-owned commercial banks.

Chapter IV

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Article 16. Transitional provisions

1. The free medical examination and treatment policy continues applying to under-6 children based on actual payment and spending according to the Government's Decree No. 36/2005/ND-CP of March 17. 2005, detailing the implementation of a number of articles of the Law on Protection, Care and Education of Children until this Decree takes effect.

2. Cases of participation in health insurance from July 1, 2009, till the effective date of this Decree will comply with the Government's Decree No. 63/2005/ND-CP of May 16, 2005, promulgating the Health Insurance Regulation till the end of December 31, 2009.

Article 17. Effect

1. This Decree takes effect on October 1, 2009.

2. To annul the Government's Decree No. 63/2005/ND-CP of May 16, 2005, promulgating the Health Insurance Regulation, and Article 18 of the Government's Decree No. 36/2005/ND-CP of March 17, 2005, detailing a number of articles of the Law on Protection. Care and Education of Children and other provisions on health insurance which are contrary to the provisions of this Decree.

Article 18. Implementation guidance responsibility

1. The Health Ministry shall assume the prime responsibility for, and coordinate with the Finance Ministry in. guiding the implementation of articles of the Law on Health Insurance and this Decree as assigned; issue legal documents on professional and technical guidance for and quality management of establishments providing insured medical examination and treatment.

2. The Ministry of Labor. War Invalids and Social Affairs shall study and formulate criteria to identify households living just above the poverty line and those achieving the average living standards, and submit them to the Prime Minister for promulgation. For 2009, criteria for identifying households living just above the poverty line comply with the Prime Minister's Decision No. 117/2008/QD-TTg of August 27, 2008. adjusting health insurance premium rates applicable to social policy beneficiaries.

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Article 19. Implementation responsibility

Ministers, heads of ministerial-level agencies, heads of government-attached agencies and chairmen of provincial-level People's Committees shall implement this Decree.-

ON BEHALF OF THE GOVERNMENT PRIME MINISTER




Nguyen Tan Dung