THE SOCIALIST REPUBLIC OF VIETNAM Independence - Freedom - Happiness _ Law on Health Insurance The National Assembly’s November 14, 2008 Law No 25/2008/QH12 on Health Insurance, takes effect on July 1, 2009, and is amended and supplemented by: The National Assembly’s June 13, 2014 Law No 46/2014/QH13 Amending and Supplementing a Number of Articles of the Health Insurance Law, which takes effect on January 1, 2015 Pursuant to the 1992 Constitution of the Socialist Republic of Vietnam, which is amended and supplemented under Resolution No 51/2001/QH10; The National Assembly promulgates the Law on Health Insurance1 Chapter I GENERAL PROVISIONS Article Scope of regulation and subjects of application This Law provides the health insurance regime and policies, including participants, premium rates, responsibilities and methods of payment of health insurance premiums; health insurance cards; eligible health insurance beneficiaries; medical care for the insured; payment of costs of medical care covered by health insurance; health insurance fund; and rights and responsibilities of parties involved in health insurance This Law applies to domestic and foreign organizations and individuals in Vietnam that are involved in health insurance This Law does not apply to commercial health insurance Article Interpretation of terms In this Law, the terms below are construed as follows: Law No 46/2014/QH13 Amending and Supplementing a Number of Articles of the Health Insurance Law is promulgated: “Pursuant to the Constitution of the Socialist Republic of Vietnam; The National Assembly promulgates the Law Amending and Supplementing a Number of Articles of Law No 25/2008/QH12 on Health Insurance.” Vietnam Law & Legal Forum 1.2 Health insurance is a form of compulsory insurance applied to target groups prescribed in this Law for healthcare and non-profit purposes, the implementation of which is organized by the State All-people health insurance means health insurance joined by all persons prescribed in this Law Health insurance fund means a financial facility set up from health insurance premium payments and other lawful collections, which is used to cover costs of medical care for the insured, managerial costs of health insurance institutions and other lawful costs related to health insurance Employers include state agencies, public non-business units, people’s armed forces units, political organizations, socio-political organizations, socio-politicalprofessional organizations, social organizations, socio-professional organizations, enterprises, cooperatives, individual business households and other organizations; foreign organizations; and international organizations operating in the Vietnamese territory, which are responsible for making health insurance contributions Health insurance-covered primary care provider means the first medical examination and treatment establishment registered by an insured and indicated in the health insurance card Health insurance assessment means professional activities conducted by a health insurance institution to evaluate the reasonableness of medical care services provided to an insured, serving as a basis for the payment of costs of health insurance-covered medical care 7.3 Household participating in health insurance (below referred to as household) consists of all persons named in the household registration book or temporary residence book 8.4 Health insurance-covered basic medical service package means essential healthcare services suitable to the health insurance fund’s payment capacity Article Health insurance principles Ensuring the sharing of risks among the insured This Clause is amended and supplemented under Clause 1, Article of Law No 46/2014/QH13 Amending and Supplementing a Number of Articles of the Health Insurance Law, which takes effect on January 1, 2015 This Clause is supplemented under Clause 1, Article of Law No 46/2014/QH13 Amending and Supplementing a Number of Articles of the Health Insurance Law, which takes effect on January 1, 2015 This Clause is supplemented under Clause 1, Article of Law No 46/2014/QH13 Amending and Supplementing a Number of Articles of the Health Insurance Law, which takes effect on January 1, 2015 Vietnam Law & Legal Forum 2.5 Health insurance premium rates shall be determined in percentage of the salary which serves as the basis for payment of compulsory social insurance as prescribed by the Social Insurance Law (below referred to as monthly salary), pension, allowance or basic salary 3.6 Health insurance benefit levels shall be based on the seriousness of sickness and category of the insured within the scope of benefits and health insurance payment duration Costs of health insurance-covered medical care shall be jointly paid by the health insurance fund and the insured The health insurance fund shall be managed in a centralized, unified, public and transparent manner, ensuring the balance between revenue and expenditure, and be protected by the State Article State policies on health insurance The State shall pay, or assist payment of, health insurance premiums for people with meritorious services to the revolution and a number of social beneficiary groups The State shall adopt preferential policies for the health insurance fund’s investments in order to preserve and increase the fund The fund’s revenues and profits from its investments are tax-free The State shall create favorable conditions for organizations and individuals to join health insurance or pay health insurance premiums for several beneficiary groups The State shall encourage investment in technological development and advanced technical facilities for health insurance management Article State management agencies in charge of health insurance The Government shall perform the unified state management of health insurance The Ministry of Health shall take responsibility before the Government for performing the state management of health insurance This Clause is amended and supplemented under Clause 2, Article of Law No 46/2014/QH13 Amending and Supplementing a Number of Articles of the Health Insurance Law, which takes effect on January 1, 2015 This Clause is amended and supplemented under Clause 2, Article of Law No 46/2014/QH13 Amending and Supplementing a Number of Articles of the Health Insurance Law, which takes effect on January 1, 2015 Vietnam Law & Legal Forum 3 Ministries and ministerial-level agencies shall, within the ambit of their tasks and powers, coordinate with the Ministry of Health in performing the state management of health insurance People’s Committees at all levels shall, within the ambit of their tasks and powers, perform the state management of health insurance in localities Article The Ministry of Health’s responsibilities for health insurance To assume the prime responsibility for, and coordinate with other ministries, ministerial-level agencies and relevant agencies and organizations in, performing the following tasks: Formulating health insurance policies and law, organizing the health care system, professional and technical lines and financial sources for the protection, care and improvement of people’s health, based on all-people health insurance Formulating strategies, planning and master plans on the development of health insurance 3.7 Promulgating professional and technical regulations, medical care process and treatment guidance and patient transferal to hospitals of different levels relating to health insurance-covered medical care Working out and submitting to the Government solutions to ensure the balance of the health insurance fund Popularizing and disseminating health insurance policies and law Directing and guiding the implementation of the health insurance regime Inspecting, examining and handling violations in, and settling complaints and denunciations about, health insurance Monitoring, assessing and reviewing activities in the health insurance domain Organizing scientific research and international cooperation on health insurance 10.8 Providing the health insurance-covered basic medical service package Article The Finance Ministry’s responsibilities for health insurance To coordinate with the Ministry of Health and related agencies and organizations in formulating health insurance-related financial policies and laws This Clause is amended and supplemented under Clause 3, Article of Law No 46/2014/QH13 Amending and Supplementing a Number of Articles of the Health Insurance Law, which takes effect on January 1, 2015 This Clause is supplemented under Clause 3, Article of Law No 46/2014/QH13 Amending and Supplementing a Number of Articles of the Health Insurance Law, which takes effect on January 1, 2015 Vietnam Law & Legal Forum To inspect and examine the implementation of legal provisions on financial mechanisms applicable to health insurance and the health insurance fund Article 7a Responsibilities of the Ministry of Labor, War Invalids and Social Affairs9 To direct, guide and organize the identification and management of persons under its management prescribed at Points d, e, g, h, i and k, Clause 3, and Clause 4, Article 12 of this Law To inspect and examine employers and employees in observing law regarding the responsibility to participate in health insurance prescribed in Clause 1, Article 12 of this Law and persons under its management prescribed at Points d, e, g, h, i and k, Clause 3, and Clause 4, Article 12 of this Law Article 7b Responsibilities of the Ministry of Education and Training10 To direct, guide and organize the identification and management of persons under its management prescribed at Point n, Clause 3, and Point b, Clause 4, Article 12 of this Law To inspect and examine persons under its management prescribed at Point n, Clause 3, and Point b, Clause 4, Article 12 of this Law, in observing law regarding the responsibility to participate in health insurance To assume the prime responsibility for, and coordinate with the Ministry of Health and related ministries and sectors in, guiding the formation and consolidation of the school health system for primary healthcare for children, pupils and students Article 7c Responsibilities of the Ministry of National Defense and the Ministry of Public Security11 To direct, manage, guide and organize the identification, management and health insurance listing for persons under their management prescribed at Point a, Clause 1, Points a and n, Clause 3, and Point b, Clause 4, Article 12 of this Law To make lists of persons prescribed at Point l, Clause 3, Article 12 of this Law for request for grant of health insurance cards and provide these lists to health insurance institutions This Article is supplemented under Clause 4, Article of Law No 46/2014/QH13 Amending and Supplementing a Number of Articles of the Health Insurance Law, which takes effect on January 1, 2015 10 This Article is supplemented under Clause 4, Article of Law No 46/2014/QH13 Amending and Supplementing a Number of Articles of the Health Insurance Law, which takes effect on January 1, 2015 11 This Article is supplemented under Clause 4, Article of Law No 46/2014/QH13 Amending and Supplementing a Number of Articles of the Health Insurance Law, which takes effect on January 1, 2015 Vietnam Law & Legal Forum