Chương V: Thông tư liên tịch 41/2014/TTLT-BYT-BTC Thanh toán trực tiếp chi phí khám bệnh, chữa bệnh giữa bảo hiểm xã hội và người tham gia bảo hiểm y tế

Chapter V

PAYMENT ON MEDICAL SERVICES MADE BETWEEN THE SOCIAL INSURANCE ORGANIZATION AND PATICIPANTS;

Article 14. Payment on medical services

Payment on medical services made according to the provisions set out in Clause 2, Article 31 on amendments and supplements to the Law on Health Insurance shall comprise:

1. Medical services provided by a non-contracting medical facility

2. Medical services provided outside the procedures for medical examination and treatment as regulated by Article 8 hereof.

Article 15. Documentation for payment request

1. Payment request form for medical services shall be made according to the form issued by the Vietnam Social Security.

2. Procedures and papers as regulated in Article 8 hereof.

3. Hospital discharge note

4. Originals of proper documents (invoices of medicine and hospital fees and related vouchers).

Article 16. Direct payment

1. Insured patients or their relatives must be responsible for making submission of the documentation to the district-level social insurance organization where they reside as regulated in Article 15 hereof.

2. The district-level social insurance organization must be responsible for:

a) Receiving the documentation submitted by the insured patients or their relatives and make a receipt. Any documentation found inadequate must be supplemented;

b) Completing appraisal of health insurance and making payment on medical services direct to the insured  patients within a period of 40 days since receipt of adequate documentation. Making a written notice included with reasons to the patients in case the payment is not facilitated;

c) Totaling all the expenses paid to insured patients and balancing such expenses against the patient’s primary healthcare provider’s permissible fund.

3. Health insurance payment limit:

a) In case insured patients going for medical examination and treatment provided by a contracting medical facility, the payment shall be made within the limit of benefits.

a) In case insured patients going for medical examination and treatment provided by a non-contracting medical facility, the payment shall be made on actual expenses within the limit of benefits but not in excess of the limit as regulated in the Appendix 04 enclosed hereof.