Chapter V
ORGANIZATION OF MEDICAL CARE FOR THE INSURED
Article 24. Health insurance-covered medical care providers
1. A health insurance-covered medical care provider is a health establishment which signs a medical care contract with a health insurance institution.
2. Health insurance-covered medical care providers include:
a/ Commune health stations and the equivalent, maternity houses;
b/ General and specialized clinics;
c/ General and specialized hospitals.
Article 25. Contracts on health insurance-covered medical care
1. A health insurance-covered medical care contract is a written agreement between a health insurance institution and a medical establishment on the provision of health insurance-covered medical care services and payment for these services.
2. A health insurance-covered medical care contract has the following principal details:
a/ Service beneficiaries and quality requirements;
b/ Method of payment of medical care costs;
c/ Rights and duties of the contractual parties;
d/ Term of the contract;
e/ Liabilities for breach of the contract;
f/ Conditions for modification, liquidation and termination of the contract.
3. Any agreement on conditions for modification, liquidation and termination of a contract defined at Point e. Clause 2 of this Article must not interrupt medical care for the concerned insured.
4. The Ministry of Health shall provide a model contract on health insurance-covered medical care.
Article 26. Registration for health insurance-covered medical care services
1. The insured may register for health insurance-covered primary care services at medical establishments of commune and district or equivalent levels, except for cases in which they are entitled to register at provincial or central medical establishments under regulations of the Minister of Health.
If an insured works on a mobile basis or moves in a different locality, he/she may seek primary care services at a medical establishment of corresponding technical line in the locality where he/she works or resides under regulations of the Minister of Health.
2. The insured may change the registered primary care provider at the beginning of every quarter.
3. The name of the primary care provider shall be specified in a health insurance card.
Article 27. Treatment-line transfer
For a case falling beyond the professional and technical capacity of a health insurance-covered medical care provider, such provider may transfer the patient to another provider according to regulations on technical transfer.
Article 28. Procedures for health insurance-covered medical care
1. An insured seeking medical care service shall present his/her health insurance card attached with his/her photo; a card without photo must be produced together with a written proof of persona identity of the card holder; for children under 6 years, only health insurance cards need to be produced.
2. In case of emergency, an insured may seek medical care services at any medical establishment and shall produce his/her health insurance card together with papers defined in Clause 1 of this Article before he/she is discharged from hospital.
3. In case of treatment-line transferal, an insured shall obtain a transferal dossier from the concerned medical establishment.
4. In case of re-examination to meet treatment requirements, an insured shall obtain a note of appointment from the concerned medical establishment.
Article 29. Health insurance assessment
1. Health insurance assessment covers:
a/ Scrutinizing medical care procedures;
b/ Checking and evaluating the order of treatment, prescription, and the use of medicines, chemicals, medical supplies and technical services for patients;
c/ Inspecting and determining costs of health insurance-covered medical care.
2. Health insurance assessment must ensure accuracy, publicity and transparency.
3. Health insurance institutions shall conduct health insurance assessment and take responsibility before law for assessment results.
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