Chương III Nghị định 105/2014/NĐ-CP: Quản lý và sử dụng quỹ bảo hiểm y tế

Chapter III

MANAGEMENT AND UTILIZATION OF HEALTH INSURANCE FUND

Article 6. Distribution and utilization of health insurance fund

Total revenues from the contribution of health insurance premiums generated in a centrally-affiliated city and province at the contribution rate enshrined in Article 2 hereof shall be distributed and utilized as follows:

1. 90% of health insurance contributions to healthcare services (hereinafter referred to as healthcare fund) that serves the following purposes:

a) Make payment for expenses incurred within the amount of benefits to which the policy-holder is entitled under the regulations laid down in amended and supplemented Article 22 of the Health Insurance Law and Article 4 hereof.

b) Reserve a portion of health insurance contributions at educational institutions that belong to the national education system and conform to the requirements set out by the Ministry of Health with the intent of purchasing medicines, medical consumables, general medical equipment and devices in order to serve the purpose of making arrangements for the practice of primary healthcare services provided for children, learners and students.

The reserved amount of health insurance contributions for educational institutions that belong to the national education system shall make up 7% of total revenues in proportion to the contribution of total number of insured learners or students studying at educational institutions (including learners and students participating in the health insurance in other groups of contributing entities), and the equivalent rate of health insurance contributions for which each contributing entity shall be liable as stipulated in Article 2 hereof; 5% of total revenues in proportion to total children under 6 years of age studying at kindergartens.

In the first month of an academic year or course, social insurance offices shall be responsible to transmit the aforementioned sum to educational institutions and account for such expenditures into a general medical expense statement within their authority. Educational institutions being expenditure receivers shall be responsible for using, accounting for and making financial statements on expenditures, which shall be then reported to superior administrators in accordance with legal regulations.

c) Retain an amount of health insurance contributions in order for agencies, organizations or enterprises that operate their own healthcare facilities to provide primary healthcare services for their staff (except for those that enter into a contract for primary healthcare services covered by health insurance with social insurance organizations). The rate of reserved health insurance contributions shall equal 1% of total sum of health insurance contributions that agencies, organizations or enterprises have paid to social insurance organizations.

The Ministry of Health and the Ministry of Finance shall provide detailed instructions on the implementation of Point b, c Clause 1 of this Article on requirements, scale, spending items, management and financial statements concerning this source of expenditures.

2. 10% of health insurance contributions set aside for the reserve fund and pay expenses incurred by the management of health insurance fund in which at least 5% of health insurance contributions is used for the reserve fund and regulated as follows:

a) Total amount of annual administrative expenditures for the health insurance fund the shall be decided by the General Director of Vietnam Social Security in proportion to total administrative expenditures allocated to Vietnam Social Security after being approved by the Prime Minister;

b) Reserve fund is created by the retained amount of deductions from payments for administrative expenses of the health insurance fund.

3. The management and utilization of revenues gained from the contribution of health insurance premiums shall be regulated as follows:

a) Social Insurance Offices at all administrative levels, affiliated to Vietnam Social Security, shall directly collect health insurance contributions that various contributing entities have paid, and transmit the collected amount to Vietnam Social Security according to the instructions provided by Vietnam Social Security;

b) Vietnam Social Security shall be responsible for timely transferring a full amount of expenditures to meet the demand of Social Insurance Offices at provincial and municipal levels for advances or payments on medical expenses covered by health insurance in accordance with legal regulations.

4. Based on the data available on the financial statement approved by the Management Council of Vietnam Social Security, an amount of expenditures that has not been used up at cities or provinces where revenues gained from the contribution of health insurance premiums used for medical services are greater than medical expenses within an insurance year shall be distributed as follows:

a) With regard to the amount of expenditures used to cover medical expenses that have not been used up in 2014, Vietnam Social Security shall be responsible for accounting for the whole remaining amount into the reserve fund;

b) From January 1, 2015 to December 31, 2020, Vietnam Social Security shall be responsible for accounting for 80% of that amount into the reserve fund, simultaneously report 20% of that amount of expenditures to local social insurance organizations to prepare their spending plan in accordance with regulations laid down at amended and supplemented Point a Clause 3 Article 35 of the Law on Health Insurance.

Based on the amount of expenditures that has not been locally used up, the Department of Health shall direct and cooperate with the Department of Finance and Social Security Office of cities or provinces in preparing the use plan for submission to the provincial People’s Committees to obtain their approval and send a report to the provincial People’s Councils. Based on the approval of provincial People’s Committees, Social Security Office of cities or provinces shall allocate expenditures to relevant entities for their spending plan.

Entities that receive such budget shall be responsible for carrying out management and utilization in accordance with applicable laws, work with the Social Security Office of cities of provinces to make the account settlement for the purpose of recording all of payments into the health insurance fund of cities or provinces, which must ensure the conformity with the given purposes, efficiency, public disclosure and transparency.

c) From January 01, 2021, Vietnam Social Security shall be responsible for bringing forward the entire budget that have not been used up into the reserve fund that serves as the regulator for all operations.

Article 7. Management and utilization of the reserve fund

1. The reserve fund managed by Vietnam Social Security shall be entitle to use to provide supplement to the budget for medical expenses covered by Social Insurance Offices of cities or provinces in case the amount of revenue gained from the contribution of health insurance premiums used to make payment for medical expenses in accordance with regulations laid down in Clause 1 Article 6 hereof remains less than the amount of payments for medical expenses within an insurance year. After completing the report on inspection of annual account settlement, Social Insurance Offices of cities or provinces must send such report to Vietnam Social Security for their verification in order to supplement total differential rate of expenditures with the amount derived from the reserve fund.

2. Where the reserve fund is not sufficient to provide supplementary sums for medical expenditures that arise in cities or provinces under regulations set out in Clause 1 of this Article, Vietnam Social Security is obliged to consult with its Management Council to find solutions before sending a report to the Ministry of Health and the Ministry of Finance.

The Ministry of Health shall direct and cooperate with the Ministry of Finance in sending a report to the Government to seek any possible solution in order to ensure the adequate and timely-distributed amount of budget for medical expenses covered under health insurance policies as prescribed by laws.

Article 8. Expenses for the administration of health insurance fund

1. Recurrent expenditures that conform to legal regulations shall include:

a) Spending on particular works such as:

- Communicative and cooperative activities that work towards the growth of health insurance;

- Activities concerning the task of collecting revenues and paying expenses for the health insurance fund;

- Cooperative activities relating to the inspection, examination and supervision of health insurance operations.

b) Operating expenses for health insurance mechanism that help to manage health insurance funds at all administrative levels.

2. Non-recurring expenses shall include:

a) Spending on the development and modernization of information technology;

b) Spending on scientific researches, training, education and international cooperation in the health insurance sector.

3. Other expenses in accordance with laws.

The Ministry of Finance shall provide detailed instructions on spending accounts and rates enshrined in this Article.

Article 9. Investment activities of health insurance fund

1. Temporarily idle cash available at the health insurance fund shall be used to carry out the investment tasks which conform to the investment types regulated in the Law on Social Insurance.

2. The Management Council of Vietnam Social Security shall decide and be held accountable to the Government for the investment type and structure of the health insurance fund upon the request of Vietnam Social Security.

3. All of annual net income yielded from the investment activities of the health insurance fund shall be set aside to complement the reserve fund that serves as the regulator for entire operations.

Article 10. Financial settlement and plan preparation

1. Vietnam Social Security must complete the report on financial settlement by October 01 of the subsequent year in accordance with the regulations laid down in amended and supplemented Article 32 of the Law on Social Insurance.

2. Every year, Vietnam Social Security shall prepare the financial plan for revenues and expenditures, administrative expenses and investments derived from temporarily idle cash of the health insurance fund, which shall be then submitted to the Management Council of Vietnam Social Security to obtain the approval and make a report to the Ministry of Finance and the Ministry of Health.

The Ministry of Finance shall take charge of cooperating with the Ministry of Health in submitting a summary report to the Prime Minister for the decision on annual financial plan.

3. Within a period of 15 days from the receipt of the Prime Minister’s decision on the budget plan, Vietnam Social Security shall be responsible for allocating the estimated norms of revenues and expenditures to relevant regulatory bodies.