Chương VI: Thông tư liên tịch 41/2014/TTLT-BYT-BTC Quản lý và sử dụng quỹ bảo hiểm y tế

Chapter VI

MANAGEMENT AND USE OF HEALTHCARE FUND

Article 17. Use of the healthcare fund according to the provisions set out in Clause 1, Article 6 of the Decree No. 105/2014/NĐ-CP

1. Allocation of healthcare fund to primary healthcare providers:

Based on the overall healthcare fund at province-level determined according to the provisions set out in Clause 1, Article  6 of the Decree No. 105/2014/ NĐ-CP, the social insurance organization at province-level shall be responsible for allocating healthcare fund to primary healthcare providers. The formula for calculation is below:

where

- Total health insurance revenues are determined according to the provisions set out in Clause 1, Article 6 of the Decree No. 105/2014/CĐ-CP (equal to 90 per cent of the health insurance premiums on a provincial scale).

- Total expenses paid on medical services provided by primary healthcare providers on a provincial scale are determined according to the provisions set out in Clause 2  of this Article.

2. Transfer expenditure to educational institutions that belong to the national education system, agencies, organizations and enterprises that qualify for providing medical services as primary healthcare providers as prescribed in Article 18 hereof:

a) Preschool education institution:

- A portion reserved for preschool education institution comprise two amounts: 5 per cent of total health insurance revenues calculated over the total number of children under six at the institution and 1 per cent of total health insurance premiums paid by the institution to the social insurance organization as stipulated in Point c of this Clause.

In the first month of the school year or academic course, the social insurance organization shall be responsible for transfering the abovementioned amount of money to preschool education institution.

Example 8: Preschool education institution B qualifies for providing medical services as a primary healthcare provider to 100 learners under six years old in 2015. Supposing that the premium rate equals 4.5 per cent of VND 1,150,000 as a base pay, the amount of money transferred to the institution is VND 3,105,000:

5% x (100 children x 4.5% x VND 1,150,000/month x 12 months)

Additionally, the social insurance organization must reserve for the pre-school educational institution a portion equal to 1 per cent of the total health insurance premiums paid by the institution to the social insurance organization as shown in Example 10 in Point C of this Clause.

a) Other educational institutions:

- A portion reserved for other educational institutions comprise two amounts: 7 per cent of total health insurance revenues calculated over the total number of students as policyholders (including students as participants entitled to other categories of health insurance) and 1 per cent of total health insurance premiums paid by the institution to the social insurance organization as stipulated in Point c of this Clause.

- In the first month of the school year or academic course, the social insurance organization shall be responsible for transfering the abovementioned amount of money to the educational institution.

Example 9: University K qualifies for providing medical services as a primary healthcare provider to its students. In 2015-2016 school year, there are 5,000 students attending in this university of which 100 students are from poor households, 100 students are relatives of military forces, 100 students relatives of the contributors to the Revolution and 4,700 students are of other health insurance participants> Supposing that the premium rate for all participants equals 4.5 per cent of VND 1,150,000 as a base pay, the amount of money transferred to the institution is VND 217,350,000:

7% x (5,000 students x 4.5% x VND 1,150,000/month x 12 months)

Additionally, the social insurance organization must reserve for University K a portion equal to 1 per cent of the total health insurance premiums paid by the institution to the social insurance organization as shown in Example 10 in Point C of this Clause.

c) Agencies, organizations and enterprises:

- A portion that equals 1 per cent of the total health insurance premiums paid by such agencies, organizations and enterprises to the social insurance organization:

- On a monthly basis, after receiving the health insurance premiums from agencies, organizations and enterprises, the social insurance organization shall be responsible for reserving a portion to the agencies, organizations and enterprises.

Example 10: Enterprise A that has its own healthcare provider (without entering into a contract for medical services with any other healthcare providers) pays to the healthcare fund an amount of VND 105 million as health insurance premiums of which VND 100 million is the compulsory amount and VND 5 million is a fine imposed for overdue payment. After receiving this amount, the social insurance organization shall be responsible for reserving a portion equal to VND 1 million for Enterprise A (1% x VND 100,000,000).

Article 18. Payment for the provision of medical services at educational institutions, agencies and enterprises; 

1. Educational institutions, agencies, organizations and enterprises (other than those that have their own healthcare providers) shall be granted expenditure from the healthcare fund for providing primary medical services to persons who belong to such educational institutions, agencies and enterprises when the following conditions are met:

a) There must be at least one person in charge or holding several office positions or on a labor contract for at least three months as a medical technician at a minimum.

b) There must be a medical clinic or a separate room for conducting first-aids or primary medical tasks on persons working for such educational institutions, agencies, organizations and enterprises during their period of learning and working at the educational institution, agency or enterprise...

2. Payment for primary medical services:

a) Expenses for medicine, medical materials serving first-aids and primary medical tasks on children, students, and other persons that belong to such educational institutions, agencies, and enterprises during their period of learning and working at the educational institution, agency or enterprise...;

b) Expenses for repair or purchase of medical equipment, facilities serving the provision of primary medical services at educational institutions, agencies and enterprises;

c) Expenses for purchase of stationery, filing cabinets used to keep medical records of children, students and employees;

d) Expenses for purchase of books, materials and tools serving extracurricular propaganda and education about health care consulting, reproductive health and family planning at educational institutions, agencies and enterprises;

dd) Other expenses for conducting primary medical tasks at educational institutions, agencies and enterprises;

3. Management and settlement of expenditure:

a) Educational institutions, agencies, organizations and enterprises granted such expenditure from the healthcare fund shall be responsible for providing primary medical services to persons who belong to educational institutions, agencies and enterprises other than for other purposes.

b) Expenses for primary medical services as defined in Clause 2 of this Article shall be entered into accounts and settled as follows:

- For public educational institutions, the expenses for primary medical services shall be included to the expenses for medical services provided at the medical facility and final settlement with upper-level agency must be made according to the applicable regulations;

- For non-public educational institutions, the expenses for primary medical services shall be included to the non-public education institution’s expenses and final settlement must be made with upper-level agency (if any);

- For enterprises or economic organizations, accounting books should be opened separately to reflect receipt and use of expenses and not include them to the enterprises or economic organizations’ expenses;

- For other agencies or organizations, the expenses for primary medical services shall be included to the expenses for medical tasks conducted at agencies or organizations and final settlement with upper-level agency (if any) or financial agency must be made according to the applicable regulations;

c) Educational institutions, agencies, organizations and enterprises granted expenditure for conducting primary medical services according to the provisions as set out in this Article shall not be required to make final settlement with the social insurance organization but shall be responsible for reporting to upper-level agencies the use of the expenditure at the request of the social insurance organization or competent agencies.

d) The expenses granted to the end of year shall be transferred to the following year if they are not used up.

Article 19. Expenditure as support to the People’s Committees of communes for making a list of participants in the administrative division

1. Supportive budget paid to the People’s Committees of communes for making a list of participants in the administrative division comes from the Vietnam Social Security’s annual expense estimate for management.

2. Supportive budget paid to the People’s Committees of communes shall be based on the number of participants in the list and level of budget to be paid shall be announced annually by the Vietnam Social Security based on the estimated level approved by the Prime Minister; As for 2015, level of budget to be paid is VND 1,500 for a participant.

3. Payment of supportive budget to the People’s Committees of communes for making a list of participants in the administrative division:

a) As for the year 2015, to the end of March at the latest, the social insurance organization at district-level shall provide an advance equal to 50 per cent of the supportive budget according to the level as defined in Clause 2 of this Article and the entire population of the commune at the time of payment. The remainder shall be transferred upon receipt of the list of participants as stipulated in Point a, Clause 4, Article 4 hereof.

b) As of 2016, the social insurance organization at district-level shall transfer the supportive budget to the People’s Committee of communes after receiving the revised list of participants according to the provisions set out in Point b, Clause 4, Article 4 hereof.

Example 11:

- In 2015: Commune N has a population of 6,000 and the amount advanced to the People's Committee of Commune is VND 4,500,000 (50% x VND 1,500 x 6,000 people). The remainder shall be transferred after the list of participants is received as defined in Point a, Clause 4, Article 4 hereof:

- In 2015: Commune N reports an increase of 30 people and a decrease of 10 people. Supposing that the expense for the formation of the list of participants applied in 2015 is VND 2,000/person; the supportive budget granted to the People’s Committee of Commune is VND 80,000:

(30 people (increase) + 10 people (decrease) x VND 2,000 = VND 80,000

c) The transfer of the supportive budget is done via transfer or in cash.

4. The People’s Committee of the commune that is granted the supportive budget for the formation of the list of participants shall not make any financial settlement with the budget of the commune but shall open a separate accounting book to reflect the use of the budget.