Chương VIII Luật bảo hiểm y tế 2008: Quyền và trách nhiệm của các bên liên quan đến bảo hiểm y tế

Chapter VIII

RIGHTS AND RESPONSIBILITIES OF PARTIES INVOLVED IN HEALTH INSURANCE

Article 36. Rights of the insured

1. To be granted health insurance cards if paying health insurance premiums.

To select a primary care provider under Clause 1, Article 26 of this Law.

3. To be entitled to medical care.

4. To get medical care costs paid by health insurance institutions.

5. To request health insurance institutions, health insurance-covered medical care providers and relevant agencies to explain and provide information on health insurance.

6. To complain about or denounce violations of the health insurance law.

Article 37. Responsibilities of the insured

1. To pay health insurance premiums fully and on time.

2. To use health insurance cards for proper purposes, not to lend their cards to others.

3. To abide by the provisions of Article 28 of this Law when using medical care services.

4. To comply with regulations and guidance of health insurance institutions and medical establishments when using medical care services.

5. To pay medical care costs to medical establishments, in addition to the costs-covered by the health insurance fund.

Article 38. Rights of organizations and individuals paying health insurance premiums

1. To request health insurance institutions and competent state agencies to explain and provide information on health insurance regimes.

2. To complain about and denounce violations of the health insurance law.

Article 39. Responsibilities of organizations and individuals paying health insurance premiums

1. To make dossiers of request for the grant of health insurance cards.

2. To pay health insurance premiums fully and on schedule.

3. To hand health insurance cards to the insured.

4. To provide full and accurate information and documents related to the health insurance duties of employers and their representatives to the insured upon request of health insurance institutions, employees or their representatives.

5. To be subject to examination and inspection of the observance of the health insurance law.

Article 40. Rights of health insurance institutions

1. To request employers, representatives of the insured and the insured to provide full and accurate information and documents related to their health insurance duties.

2. To inspect and evaluate the provision of health insurance-covered medical care services; to revoke or seize health insurance cards, for cases defined in Article 20 of this Law.

3. To request health insurance-covered medical care providers to provide patient files and records and medical care documents for health insurance assessment.

4. To refuse payment of costs of health insurance-covered medical care which violate this Law or the health insurance-covered medical care contracts.

5. To request persons who are liable to pay damages to the insured to refund medical care costs which have been paid by health insurance institutions.

6. To propose competent state agencies to revise health insurance policies or law and handle organizations and individuals that violate the health insurance law.

Article 41. Responsibilities of health insurance institutions

1. To popularize and disseminate health insurance policies and law.

2. To provide dossier and procedural guidance, to organize the implementation of health insurance regimes in a quick, simple and convenient manner for the insured.

3. To collect health insurance premiums and grant health insurance cards.

4. To manage and use the health insurance fund.

5. To sign health insurance-covered medical care contracts with medical establishments.

6. To pay health insurance-covered medical care costs.

7. To provide information on health insurance-covered medical care providers and guide the insured in selecting primary care providers.

8. To check the quality of medical care services; to conduct health insurance assessment.

9. To protect interests of the insured: to settle according to their competence petitions, complaints and denunciations on health insurance regimes.

10. To archive files and data on health insurance according to law; to apply information technology to health insurance management and establish a national database on health insurance.

11. To organize statistics and reporting work, provide professional guidance on health insurance; to make reports on the management and use of the health insurance fund on a periodical basis or upon request.

12. To organize professional training and retraining, scientific research and international cooperation on health insurance.

Article 42. Rights of health insurance-covered medical care providers

1. To request health insurance institutions to provide full and accurate information on the insured and the fund allocated to them for the provision of medical care for the insured.

2. To be entitled to fund advance and payment of medical care costs by health insurance institutions in accordance with the signed health insurance-covered medical care contracts.

3. To propose competent state agencies to handle organizations and individuals that violate the health insurance law.

Article 43. Responsibilities of health insurance-covered medical care providers

1. To provide quality medical care services according to simple and convenient procedures for the insured.

2. To provide patient files and records and documents on medical care and the payment of medical care costs at the request of health insurance institutions and competent state agencies.

3. To ensure necessary conditions for health insurance institutions to conduct assessment; to coordinate with health insurance institutions in propagating and explaining health insurance regimes to the insured.

4. To inspect, detect and inform health insurance institutions of the misuse of health insurance cards; to coordinate with health insurance institutions in revoking and seizing health insurance cards in cases defined in Article 20 of this Law.

5. To manage and use money from the health insurance fund strictly according to law.

6. To make statistics and reports on health insurance in accordance with law.

Article 44. Rights of organizations representing employees and those representing employers

1. To request health insurance institutions, care providers and employers to provide full and accurate information on health insurance for employees.

2. To request competent state agencies to handle violations of the health insurance law which affect the lawful rights and interests of employees and employers.

Article 45. Duties of organizations representing employees and those representing employers

1. To popularize and disseminate health insurance policies and law to employees and employers.

2. To participate in the formulation of health insurance policies and law. and propose amendments or supplements thereto.

3. To join in the supervision of enforcement of the health insurance law.