Chương VII: Thông tư liên tịch 41/2014/TTLT-BYT-BTC Điều khoản thi hành

Chapter VII

IMPLEMENTARY PROVISIONS

Article 20. Transitional clause

1. In 2015, the social insurance organization shall issue health insurance cards to policyholders based on the list of participants sent by the agency, organization and enterprise where they (participants) are working. Upon receipt of the list of participants in 2015 sent by the People’s Committee of commune, the social insurance organization shall be responsible for checking and ensuring proper issuance of health insurance cards.

2. For policyholders having traffic accidents:

a) Any case hospitalized before January 01, 2015 and discharged since January 01, 2015, or any case hospitalized since January 01, 2015 shall be entitled to the health insurance benefits within the limit as regulated;

b) Any case hospitalized after a traffic accident due to violation of the Law on Traffic and discharged before 01, 2015 shall be entitled to the health insurance benefits within the limit as regulated.

3. In case the patient is chosen for treatment by applying technical services as stipulated in the Ministry of Health’s Decision No. 36/2005/QĐ-BYT dated October 31, 2005 on promulgation of high-cost technical services, the insured patient shall be entitled to the limit of benefits but not in excess of 40 months of base pay per use of such technical service until the Ministry of Health issues the list of technical services, rate and conditions for payment within the limit of benefits for policyholders (except the cases as defined in Point b, Clause 4, Article 4 of the Decree No. 105/2014/CĐ-CP.

4. With respect to any contract for the provision of medical services signed before the effective date of this Circular, the social insurance organization and healthcare provider must agree to make appropriate amendments and supplements to the provisions set out hereof.

Article 21. Effect

1. This Circular shall take effects since February 01, 2015 and the provisions set out hereof shall be executed as of January 01, 2015.

2. The following documents and regulations shall become invalid since the effective date of this Circular:

a) The Ministry of Health – the Ministry of Finance’s Joint Circular No. 09/2009/TTLT-BYT-BTC dated August 14, 2009 providing guidance on the implementation of health insurance and Joint Circular No. 24/2014/TTLT-BYT-BTC amending and supplementing a number of articles of the Joint Circular 09/2009/TTLT-BTY-BTC;

b) The Ministry of Health – the Ministry of Finance’s Joint Circular No. 39/2011/TTLT-BYT-BTC dated November 11, 2011 providing guidance on payment for medical services provided to traffic-related patients insured:

c) The following provision set out in Clause 2, Section II of the Ministry of Finance’s Circular No. 14/2007/TT-BTC dated March 08, 2007 providing guidance on medical tasks performed in schools "With respect to the expenditures provided by the healthcare fund volunteered by students, the educational institutions shall be responsible for managing, using and making financial settlement with the social insurance organization according to applicable regulations”.

Article 22. Implementation

1. The Vietnam Social Security shall be responsible for:

a) Issuing specimen health insurance card, appointment note for replacement of health insurance card, procedures for issuance, replacement, revocation of health insurance cards after approved by the Ministry of Health;

b) Issuing specimen declaration form for first-time participants and providing guidance to participants on making the declaration for issuance of health insurance cards;

c) Making timely notice to the social insurance organizations at provincial and municipal level for revising expenses for medical services provided to insured patients at medical facilities in reliance on medicine category and medical services of the preceding year announced by the General Statistics Office;

d) Instructing the social insurance organizations at provincial and municipal level to cooperate with the Services of Health, the Services of Finance, medical facilities in the administrative division and relevant agencies in handling difficulties within their competence or sending proposal to competent authorities for handling;

dd) Instructing the social insurance organization of all levels to provide forms, computer softwares (if any) to People’s Committees of communes for the formation and management of the list of participants by household;

e) Instructing the social insurance organizations at provincial and municipal level to determine the cumulative expenses for medical services in the year to issue the certificate of total exemption from payment on medical services to any person who has participated in health insurance for at least five years and has paid a share (valued more than six months of base pay in a year) of the expense paid on medical services with the social insurance organization not taking into account the cases going for medical examination and treatment off the line (not the same healthcare network) as defined in Point c, Clause 2, Article 22 amending and supplementing the Law on Health Insurance.

Example 12: To May 01, 2015, Mr. M’s uninterrupted period of participation in health insurance is 60 months and his share of the expense paid on medical services from January 01, 2015 to May 01, 2015 is VND 7 million (more than six months of his base pay). From May 01, 2015 to the end of December 31, 2015, Mr. A shall enjoy total exemption from payment on medical services provided within the limit of health insurance benefits as stipulated.

2. The Services of Health shall be responsible for:

a) Presiding over and cooperating with the social insurance organizations at provincial level in raising public awareness of the matter and instructing medical facilities to conduct medical examination and treatment on insured patients as stipulated by the Law on Health Insurance and the Law on amendments and supplements to a number of articles of the Law on Health Insurance, Decree No. 105/2014/NĐ-CP and this Circular;

b) Presiding over and cooperating with the Service of Health and the social insurance organizations at provincial level in the neighboring administrative division in organizing the provision of medical services and transfer of professional and technical healthcare network for the benefits of policyholders.

3. Healthcare providers shall be responsible for:

a) Stepping up the application of information technology in medical examination and treatment. Any medical facility that has or is currently developing a management software should cooperate with the social insurance organization in reaching a common agreement on statistical criteria required for medical examination and treatment; Other medical facilities that have no software should study and apply the software developed by the Vietnam Social Security, ensuring there will be a common software for all;

b) Presiding over and cooperating with the social insurance organization in constructing and applying medical service related expense management programs.

Difficulties that arise during the implementation of this Circular should be reported to the Ministry of Health and Ministry of Finance for studying and handling./.