Chapter I
PARTICIPANTS, MANNER AND RESPONSIBILITY FOR PAYMENT OF HEALTH INSURANCE PREMIUMS
Article 1. Participants in health insurance
As defined in Article 12 amending and supplementing the Law on Health Insurance; Articles 15, 21, 25 and 26 amending and supplementing the Ordinance on Incentives for Contributors to the Revolution and Article 1 of the Decree No. 105/2014/NĐ-CP, the participants in health insurance (hereinafter referred to as participants) shall include:
1. Participants as employees and employers, including:
a) Permanent employees or employees with a pre-determined period of employment from three months and over; business entrepreneurs, non-public service providers and paid managers of cooperatives; officials and civil servants (hereinafter referred to as employees) working for agencies, organizations and enterprises as follows:
- Regulatory agencies, the people’s armed forces;
- Political organizations, socio-political organizations, and socio-political and occupational organizations;
- Public and non-public service providers;
- Enterprises of economic sectors established and operated under the Law on Enterprise and the Law on Investment;
- Agencies, foreign organizations, international organizations operating within the territory of Vietnam;
- Cooperatives, cooperative alliance established and operated under the Law on Cooperatives;
- Business households, organizations and individuals hiring workforce with labor contracts.
b) Casual workers in communes, wards and towns according to the provisions of law.
2. Participants paid for by the social insurance organization, including:
a) Persons on a monthly pension, benefit for loss of capacity for work;
b) Persons entitled to monthly social insurance benefit due to occupational accidents, occupational diseases or any illness of long-term treatment; persons from 80 years old and older entitled to a monthly Allowance for the Survivor;
c) Retired public servants in communes, wards and towns entitled to monthly social insurance benefits;
d) Persons on unemployment benefits;
dd) Rubber workers on monthly allowances under the Decision No. 206/CP dated May 30, 1979 enacted by the Cabinet Council (now the Government) about policies on old and weak people who undertook hard and harmful works in rubber plantations right after the Revolution Day (1975) .
3. Participants totally paid for by the State, including:
a) Military officers, soldiers, servicemen, non-commissioned officers on active duty; Professional and technical military officers, non-commissioned officers currently working for the people’s public security force; officer cadets, non-commissioned officers, enlisted members working for a pre-determined period in the people’s public security force;
b) Public servants in communes, wards and towns entitled to monthly social insurance benefits from the State budget;
c) Retired persons on monthly benefits from the State budget;
d) Contributors to the Revolution, veterans, including:
- Persons who contributed to the Revolution as defined in the Ordinance on Incentives for contributors to the Revolution;
- Veterans who joined the war of resistance from 1974 and earlier as defined in Clause 6, Article 5 of the governmental Decree No. 150/2006/NĐ-CP dated December 12, 2006 detailing and guiding the implementation of a number of articles of the Veteran Ordinance;
- Persons who joined the war of resistance against the American as defined in the Prime Minister’s Decision No. 290/2005/QĐ-TTg dated November 08, 2005 about policies on a number of subjects who joined the war of resistance against the American but yet to be entitled to the preferential policies offered by the Communist Party and State, and the Prime Minister’s Decision No. 188/2007/ QĐ-TTg dated December 06, 2007 amending and supplementing the Decision No. 290/2005/QĐ-TTg;
- Retired officers, enlisted members as defined in the Prime Minister’s Decision No. 53/2010/QĐ-TTg dated August 20, 2010 about policies on retired officers and enlisted members who joined the war of resistance against the American and had nearly 20 years of experience working for the People’s public security force;
- Discharged servicemen as defined in the Prime Minister’s Decision No. 142/2008/QĐ-TTg dated October 27, 2008 about policies on discharged servicemen who joined the war of resistance against the American and had nearly 20 years of experience in military, and the Prime Minister’s Decision No. 38/2010/QĐ-TTg dated May 06, 2010 amending and supplementing the Decision 142/2008/QĐ-TTg;
- Discharged servicemen as defined in the Prime Minister’s Decision No.62/2011/QĐ-TTg dated November 09, 2011 about policies on discharged, retired servicemen who joined the war of Fatherland protection, did international duties in Cambodia and Laos after April 30, 1975;
- Youth pioneers as defined in the Prime Minister’s Decision No. 170/2008/QĐ-TTg dated December 18, 2008 about policies of health insurance and funeral benefits on youth pioneers who served in the war of resistance against the French and the Decision No. 40/2011/QĐ-TTg dated July 27, 2011 about policies on youth pioneers who fulfilled duties in the war of resistance;
dd) Incumbent members of the National Assembly, members of People’s Councils at all levels;
e) Children under 6 years old (all children residing in the administrative division including children as relatives of those as defined in Point a of this Clause regardless of permanent residence);
g) Persons entitled to monthly social insurance benefits as defined in the Prime Minister’s Decision No. 136/2013/NĐ-CP dated October 21 about policies of social insurance benefits, the Decree No. 06/2011/NĐ-CP dated January 14, 2011 detailing and guiding the implementation of a number of articles of the Law on old age people and the Decree No. 28/2012/NĐ-CP dated April 10, 2012 detailing and guiding the implementation of a number of articles of the Law on the disabled;
h) Persons from poor households, ethnics currently residing in the areas facing extreme socio-economic difficulties; persons residing in island districts and communes according to the Government’s Resolution, the Prime Minister’s Decision and Minister, and Decision by Chairman/Chairwoman of the Committee for Ethnic Affairs;
i) Relatives of the contributors to the Revolution as fathers, mothers, spouses; children of the revolutionary martyrs; caretakers to martyrs;
k) Relatives of the contributors to the Revolution other than those as defined in Point i of this Clause, including:
- Fathers, mothers, spouses, children from 6 - 18 years old, or from 18 years old and older (in case they still attend school or are seriously disabled) of the following subjects: persons taking part in revolutionary movement before January 01, 1945, from January 01, 1945 to the August Revolution Day in 1945; Heroes of the People’s Armed Forces, heroes of labor in the time of war of resistance; war invalids, soldiers losing from 61 per cent and over of capacity for work; partisans losing from 61 per cent and over of capacity for work as the consequence of chemical agents;
- Children aged from 6 and over of partisans who become disfigured or malformed and unable to perform daily activities as the consequence of chemical agents.
l) Relatives of those as defined in Point a, Clause 3 of this Article (except biological offspring, adopted children under 6 years old);
m) Persons donating their body organs after death;
n) Expatriates who are granted scholarship from the State budget for studying in Vietnam;
o) Caretakers to the contributors to the Revolution, including:
- Caretakers to Vietnamese heroic mothers living in the same family;
- Caretakers to war invalids, wounded soldiers living in the same family;
- Caretakers to partisans living in the same family who lose from 81 per cent and over of capacity for work as the consequence of chemical agents.
4. Participants partly paid for by the State, including:
a) Members of nearly poor households;
b) Students learning at educational institutions that belong to national education system;
c) Members of households relying on agricultural, forestry, fish farming and salt production with average standards of living.
5. Participants as household members, including:
a) All members listed in family register other than the subjects as defined in Clauses 1, 2, 3 and 4 of this Article and members declared as temporary absence;
b) All members listed in temporary residency register other than the subjects as defined in Clause 1, 2, 3 and 4 of this Article;
Example 1: Family B has five household members of which one member is retired on a pension, one member is a public servant and one member registered for temporary residency. Hence, the number of participants in health insurance is four (04).
Article 2. Payment of health insurance premiums (hereinafter referred to as premiums) for a number of participants
1. For any person who is entitled to pension, compensation for loss of capacity for work, social insurance benefits as defined in Clause 2 and Point c, Clause 3, Article 1 hereof, on a monthly basis, the social insurance organization shall pay premiums for these participants from the state budget intended for pension, social insurance benefits.
2. For any contributor to the Revolution as defined in Point d, relative of contributors to the Revolution as defined in Points i and k, caretakers to contributors to the Revolution as defined in Point o, and person enjoying monthly social insurance benefits as defined in Point g, Clause 3, Article 1 hereof:
a) On a quarterly basis, the social insurance organization shall collect and classify the number of issued health insurance cards and the sum of premiums paid for these subjects (See the forms in the Appendix 01) and make submission to the agency of Labor, Invalids and Social Affairs at the same level for transfer to the healthcare fund the respective expenditure from the source used as incentives for contributors to the Revolution and the source for social welfare;
b) Annually, up to December 31 at the latest, the social insurance organization shall preside over and collaborate with the agency of Labor, Invalids and Social Affairs at the same level on completing the payment and transfer of the expenditure of such year to the healthcare fund.
3. For the cases as defined in Points b, d (except contributors to the Revolution), Points e, h and m, Clause 3, Article 1 hereof and members of nearly poor households as defined in Point a, Clause 4, Article 1 hereof that are supported 100 per cent of by State budget as defined in Points a and b, Clause 1, Article of the Decree No. 105/2014/NĐ-CP:
On a quarterly basis, the social insurance organization shall collect and classify the number of issued health insurance cards and the sum of health insurance premiums paid, supported (See the forms in the Appendix 02) and make submission to the agency of Finance for transfer of the expenditure to the healthcare fund as stipulated by Clause 7 of this Article;
4. For members of nearly poor households as defined in Point a, Clause 4 (excepts those supported 100 per cent of the health insurance payment) and members of households relying on agricultural, forestry, fish farming and salt production with average standards of living as defined in Point c, Clause 4, Article 1 hereof:
a) On a three-month, six-month or annual basis, members of households shall pay premiums on their part to the social insurance organization or to the health insurance agencies situated at communes;
b) On a three-month, six-month or annual basis, the social insurance organization shall collect and classify the number of issued health insurance cards, the amount paid by these subjects and the amount supported by the State (See the forms in the Appendix 02) and make submission to the agency of Finance for transfer of the expenditure to the healthcare fund as stipulated by Clause 7 of this Article;
5. For students who are learning at the educational institutions affiliated to national education system as defined in Point b, Clause 4, Article 1 hereof:
a) On a six-month or annual basis, the educational institution shall collect part of the premium rate paid by individual students and transfer such amount to the healthcare fund;
b) Part of the premium rate supported by the State shall be handled as follows:
- For students, the rate of premium supported by the State shall be transferred from the budget of the locality where their educational institution is situated regardless of family register of such students. On a six-month basis, the social insurance organization shall collect and classify the number of issued health insurance cards, the premiums and the amount supported (See the forms in the Appendix 02) by the State to make submission to the agency of Finance for transfer of the expenditure to the healthcare fund as stipulated in Clause 7 of this Article;
- For students who are learning at the educational institution managed by the Ministry and central body, the supported amount shall be paid by the State budget. On a six-month basis, the social insurance organization shall collect and classify the number of issued health insurance cards, the premiums and the amount supported (See the forms in the Appendix 02) to make submission to the Vietnam Social Security for finalization and submission to the Ministry of Finance for the transfer of the expenditure to the healthcare fund;
c) For students of other categories as defined in Clause 3 and Point a, Clause 4, Article 1 hereof who are learning at the educational institution managed by the Ministry and the central body, participation in health insurance shall abide by the provisions as set out in Clause 8 of this Article and the health insurance card should be presented to the educational institution for the establishment of the list of participants and avoidance of coincident issuance of health insurance cards.
6. For participants as household members as defined in Clause 5, Article 1 hereof, on a three-month, six-month or annual basis, members of households shall pay premiums to the social insurance organization or to the health insurance agencies situated at communes;
7. Based on the regulations on decentralized management of local budget, the list of categories of participants, the expenditures paid or supported by the State budget, sent by the health insurance organization, the agency of Finance shall be responsible for transferring such expenditure to the healthcare fund every three months; Annually, up to December 31 at the latest, the transfer of the expenditure of that year to the healthcare fund must be completed.
8. In case one participant of multiple categories as defined in Article 1 hereof, the first category of participants in the order of categories as defined in Article 1 hereof shall be applied.
Article 3. Determination of premiums, supported amount toward a number of participants upon revision of amount of premiums, base pay by the State
1. For category of participants as defined in Clause 3, Article 1 hereof and participants as members of nearly poor households as defined in Point a, Clause 4, Article 1 hereof, the State shall support 100% of the premiums:
The amount supported by the State shall be based on the rate of premiums, base pay in proportion to the time limit stated on the health insurance card. When the State revises level of premium, base pay, the amount supported by the State shall be revised since new rate of premiums and base pay take effect.
2. For category of participants supported part of the premium rate by the State as defined in Clause 4, Article 1 hereof:
Payment of premiums shall be done on a three-month, six-month or annual basis. The premium paid by the participant and the State shall be based on rate of premium and base pay at the date of payment. When the State revises rate of premium and base pay, both the participant and the State shall not pay the difference as the result of revision of premium and base pay for the rest of the term.
Example 2: Mr. A as a member of nearly poor household who is participating in health insurance for 2015. In January 2015, rate of premium is 4.5% and base pay is VND 1,150,000; supposing that from May 2015, the base pay is revised to VND 1,200,000 – , then the amount paid by Mr. M and supported by the State are determined as follows:
- If the payment of premium is made on a six-month basis (in January and July), the premium paid for the first six months shall be based on 4.5% of VND 1,150,000/month as base pay (Mr. M and the State shall not pay the difference from the revision of base pay in May and June) and the premium paid for the remaining six months shall be based on 4.5% of VND 1,200,000/month as base pay.
- If the payment is made in January on an annual basis, the premium shall be based on 4.5% of VND 1,150,000/month as base pay (Mr. M and the State shall not pay the difference from the revision of base pay from May-December, 2015).
3. Participants as household members as defined in Clause 5, Article 1 hereof:
If payment of premium is done on a three-month, six-month or annual basis, the premium shall be paid according to descending rate from the second member and onward as defined in Point g, Clause 1, Article 2 of the Decree No.105/2014/NĐ-CP and base pay at the date of payment. When the State revises rate of premium and base pay, the participant shall not pay the difference from the revision of premium and base pay for the rest of the term.
Example 3: If four (04) members of Mr.B's family as mentioned in Example 1 of Clause 5, Article 1 hereof want to pay premiums once a year, the premium shall be determined as follows (in case base pay is revised by the State, apply Example 2, Clause 2 of this Article):
- The first member: VND 1,150,000 x 4.5% x 12 months = VND 621,000.
- The second member: VND 621,000 x 70% = VND 434,700.
- The third member: VND 621,000 x 60% = VND 372,600.
- The fourth member: VND 621,000 x 50% = VND 310,500.
Tìm kiếm
Thông tư liên tịch 41/2014/TTLT-BYT-BTC (Bản Word)
Thông tư liên tịch 41/2014/TTLT-BYT-BTC (Bản Pdf)