Chương I Luật bảo hiểm y tế 2008: Những quy định chung

Chapter I

GENERAL PROVISIONS

Article 1. Governing scope and subjects of application

1. This Law provides the health insurance regime and policies, including participants, premium rates, responsibilities and methods of payment of health insurance premiums; health insurance cards; eligible health insurance beneficiaries; medical care for the insured; payment of costs of medical care covered by health insurance; health insurance fund; and rights and responsibilities of parties involved in health insurance.

2. This Law applies to domestic and foreign organizations and individuals in Vietnam that are involved in health insurance.

3. This Law does not apply to commercial health insurance.

Article 2. Interpretation of terms

In this Law, the terms below are construed as follows:

1. Health insurance is a form of insurance applied in the health care sector for non-profit purposes, organized by the State and joined by responsible persons under this Law.

2. All-people health insurance means health insurance joined by all persons prescribed in this Law.

3. Health insurance fund means a financial facility set up from health insurance premium payments and other lawful collections, which is used to cover costs of medical care for the insured, managerial costs of health insurance institutions and other lawful costs related to health insurance.

4. Employers include state agencies, public non-business units, people’s armed forces units, political organizations, socio-political organizations, socio-political-professional organizations, social organizations, socio-professional organizations, enterprises, cooperatives, individual business households and other organizations; foreign organizations; and international organizations operating in the Vietnamese territory, which are responsible for making health insurance contributions.

5. Health insurance-covered primary care provider means the first medical examination and treatment establishment registered by an insured and indicated in the health insurance card.

6. Health insurance assessment means professional activities conducted by a health insurance institution to evaluate the reasonableness of medical care services provided to an insured serving as a basis for the payment of costs of health insurance-covered medical care.

Article 3. Health insurance principles

1. Ensuring the sharing of risks among the insured.

2. Health insurance premiums shall be determined in percentage of wage, remuneration, pension, allowance or minimum salary in the administrative sector (below referred to as the minimum salary).

3. Health insurance benefits shall be based on the seriousness of sickness and category of beneficiaries within the scope of the insured’s benefits.

4. Costs of health insurance-covered medical care shall be jointly paid by the health insurance fund and the insured.

5. The health insurance fund shall be managed in a centralized, unified, public and transparent manner, ensuring the balance between revenue and expenditure, and be protected by the State.

Article 4. State policies on health insurance

1. The State pays, or assists payment of, health insurance premiums for people with meritorious services to the revolution and a number of social beneficiary groups.

2. The State adopts preferential policies for the health insurance fund’s investments in order to preserve and increase the fund. The fund’s revenues and profits from its investments are tax-free.

3. The State creates favorable conditions for organizations and individuals to join health insurance or pays health insurance premiums for several beneficiary groups.

4. The State encourages investment in technological development and advanced technical facilities for health insurance management.

Article 5. State management agencies in charge of health insurance

1. The Government performs the unified state management of health insurance.

2. The Ministry of Health shall take responsibility before the Government for performing the state management of health insurance.

3. Ministries and ministerial-level agencies shall, within the ambit of their tasks and powers, coordinate with the Ministry of Health in performing the state management of health insurance.

4. People’s Committees at all levels shall, within the ambit of their tasks and powers, perform the state management of health insurance in localities.

Article 6. The Ministry of Health’s responsibilities for health insurance

To assume the prime responsibility for, and coordinate with other ministries, ministerial-level agencies and relevant agencies and organizations in. performing the following tasks:

1. Formulating health insurance policies and law, organizing the health care system, professional and technical lines and financial sources for the protection, care and improvement of people’s health, based on all-people health insurance;

2. Formulating strategies, planning and master plans on development of health insurance;

3. Promulgating lists of drugs, medical supplies and technical services which the insured is entitled to, and professional and technical regulations on health insurance-covered medical care;

4. Working out and submitting to the Government solutions to ensure the balance of the health insurance fund;

5. Popularizing and disseminating health insurance policies and law;

6. Directing and guiding the implementation of the health insurance regime;

7. Inspecting, examining and handling violations in, and settling complaints and denunciations about, health insurance;

8. Monitoring, assessing and reviewing activities in the health insurance domain;

9. Organizing scientific research and international cooperation on health insurance.

Article 7. The Finance Ministry’s responsibilities for health insurance

1. To coordinate with the Ministry of Health, concerned agencies and organizations in formulating health insurance-related Financial policies and regulations.

2. To inspect and examine the implementation of legal provisions on financial mechanisms applicable to health insurance and the health insurance fund.

Article 8. Responsibilities of People’s Committees at all levels for health insurance

1. Within the ambit of their tasks and powers, People’s Committees at all levels shall:

a/ Direct and organize the implementation of policies and law on health insurance;

b/ Ensure funding to pay health insurance premiums for persons eligible for premium payment or support from the state budget under this Law;

c/ Popularize and disseminate health insurance policies and law;

d/ Inspect, examine and handle violations of, and settle complaints and denunciations about, health insurance.

2. Apart from the responsibilities defined in Clause 1 of this Article, People’s Committees of provinces and centrally run cities shall also manage and use funding sources under Clause 2, Article 35 of this Law.

Article 9. Health insurance institutions

1. Health insurance institutions function to implement health insurance regimes, policies and law, and manage and use the health insurance fund.

2. The Government shall specify the organization, functions, tasks and powers of health insurance institutions.

Article 10. Audit of the health insurance fund

Once every three years, the State Audit shall audit the health insurance fund and report the results to the National Assembly.

If requested by the National Assembly, the National Assembly Standing Committee or the Government, the State Audit shall conduct extraordinary audit of the health insurance fund.

Article 11. Prohibited acts

1. Failing to pay or fully pay health insurance premiums under this Law.

2. Committing fraud related to or forging health insurance files or cards.

3. Using collected health insurance premiums or the health insurance fund for improper purposes.

4. Obstructing, troubling or causing harms to the insured and parties involved in health insurance in the exercise of their lawful rights and enjoyment of their benefits.

5. Deliberately making false reports or providing false information and data on health insurance.

6. Abusing one’s position, power or professional operations to act in contravention of the health insurance law.