Health Insurance Law 2008 (Amended 2014, 2024): Regulations Businesses Need to Understand

Article 1. Scope of regulation and subjects of application

1. This Law regulates health insurance regimes and policies, including subjects, premium levels, responsibilities and health insurance payment methods; health insurance card; scope of health insurance coverage; organize medical examination and treatment for health insurance participants; pay for medical examination and treatment costs covered by health insurance; health insurance fund; rights and responsibilities of parties related to health insurance.

2. This law applies to domestic organizations and individuals and foreign organizations and individuals in Vietnam related to health insurance.

3. This law does not apply to business health insurance.

Article 2. Explanation of terms

In this Law, the following terms are understood as follows:

1. Health insurance is a form of insurance applied in the field of health care, not for profit purposes, organized and implemented by the State and subjects responsible for participating in accordance with the provisions of this Law.

2. Universal health insurance means that all subjects specified in this Law participate in health insurance.

3. Health insurance fund is a financial fund formed from health insurance premiums and other legal revenue sources, used to pay medical examination and treatment costs for health insurance participants, management costs of health insurance organizations and other legal costs related to health insurance.

4. Employers include state agencies, public service units, people's armed units, political organizations, socio-political organizations, socio-political-professional organizations, social organizations, socio-professional organizations, enterprises, cooperatives, individual business households and other organizations; Foreign organizations and international organizations operating in Vietnamese territory are responsible for paying health insurance.

5. Initial medical examination and treatment facility covered by health insurance is the first medical examination and treatment facility registered by the health insurance participant and recorded in the health insurance card.

6. Health insurance appraisal is a professional activity conducted by a health insurance organization to evaluate the reasonableness of providing medical services to health insurance participants, as a basis for paying medical examination and treatment costs covered by health insurance.

Article 3. Health insurance principles

1. Ensure risk sharing among health insurance participants.

2. Health insurance premiums are determined by the percentage of salary, wages, pensions, benefits or the minimum wage of the administrative area (hereinafter collectively referred to as the minimum wage).

3. The level of health insurance benefits depends on the level of illness and target groups within the scope of benefits of health insurance participants.

4. Medical examination and treatment costs covered by health insurance are paid jointly by the health insurance fund and health insurance participants.

5. The health insurance fund is managed centrally, uniformly, publicly, transparently, ensuring balance of revenue and expenditure and protected by the State.

Article 4. State policy on health insurance

1. The State pays or supports health insurance premiums for people with meritorious services to the revolution and some social groups.

2. The State has preferential policies for investment activities from health insurance funds to preserve and grow the fund. The fund's revenue and profits from investment activities from the health insurance fund are exempt from tax.

3. The State creates conditions for organizations and individuals to participate in health insurance or pay health insurance for target groups.

4. The State encourages investment in developing advanced technology and technical means in health insurance management.

Article 5. State management agency on health insurance

1. The Government unifies state management of health insurance.

2. The Ministry of Health is responsible before the Government for implementing state management of health insurance.

3. Ministries and ministerial-level agencies, within the scope of their duties and powers, coordinate with the Ministry of Health to perform state management of health insurance.

4. People's Committees at all levels, within the scope of their duties and powers, perform state management of health insurance in their localities.

Article 6. Responsibilities of the Ministry of Health regarding health insurance

Preside over and coordinate with relevant ministries, ministerial-level agencies, agencies and organizations to perform the following tasks:

1. Develop policies and laws on health insurance, organize the health system, medical technical professional lines, and financial sources to serve the protection, care and improvement of people's health based on universal health insurance;

2. Develop strategies, planning, and overall plans for health insurance development;

3. Issue a list of drugs, medical supplies, technical services within the scope of benefits of health insurance participants and professional and technical regulations related to medical examination and treatment covered by health insurance;

4. Develop and submit to the Government solutions to ensure balance of the health insurance fund;

5. Propagate and disseminate policies and laws on health insurance;

6. Direct and guide the organization and implementation of the health insurance regime;

7. Inspect, examine, handle violations and resolve complaints and denunciations about health insurance;

8. Monitor, evaluate and summarize activities in the field of health insurance;

9. Organize scientific research and international cooperation on health insurance.

Article 7. Responsibilities of the Ministry of Finance regarding health insurance

1. Coordinate with the Ministry of Health, relevant agencies and organizations to develop financial policies and laws related to health insurance.

2. Inspect and examine the implementation of legal regulations on financial regimes for health insurance and health insurance funds.

Article 8. Responsibilities of People's Committees at all levels regarding health insurance

1. Within the scope of their duties and powers, People's Committees at all levels have the following responsibilities:

a) Direct the organization and implementation of policies and laws on health insurance;

b) Ensure funding for health insurance premiums for subjects paid or supported by the state budget according to the provisions of this Law;

c) Propagate and disseminate health insurance policies and laws;

d) Inspect, examine, handle violations and resolve complaints and denunciations about health insurance.

2. In addition to performing the responsibilities specified in Clause 1 of this Article, the People's Committees of provinces and centrally run cities are also responsible for managing and using funding sources as prescribed in Clause 2, Article 35 of this Law.

Article 9. Health insurance organization

1. Health insurance organizations have the function of implementing health insurance regimes, policies and laws, managing and using health insurance funds.

2. The Government specifically regulates the organization, functions, tasks and powers of health insurance organizations.

Article 10. Audit of health insurance fund

Every 3 years, the State Audit audits the health insurance fund and reports the results to the National Assembly.

In case the National Assembly, the National Assembly Standing Committee or the Government request, the State Audit will conduct an unscheduled audit of the health insurance fund.

Article 11. Prohibited acts

1. Not paying or not paying enough health insurance according to the provisions of this Law.

2. Fraud and falsification of health insurance records and cards.

3. Using health insurance premiums and health insurance funds for the wrong purpose.

4. Obstruct, cause difficulties or damage the legitimate rights and interests of health insurance participants and parties related to health insurance.

5. Intentionally reporting false information and providing false information and data about health insurance.

6. Taking advantage of positions, powers, expertise and operations to contravene the law on health insurance.

AND METHOD OF PAYING FOR HEALTH INSURANCE

Article 12. Health insurance participants

1. Employees working under an indefinite-term labor contract or a labor contract with a term of 3 months or more according to the provisions of labor law; Employees who are business managers receive salaries and wages in accordance with the law on wages and salaries; officials, civil servants and public employees according to the provisions of law (hereinafter referred to as employees).

2. Professional officers, non-commissioned officers and professional and technical officers and non-commissioned officers working in the People's Public Security force.

3. People receiving monthly pensions and disability benefits.

4. People who are receiving monthly social insurance benefits due to work accidents or occupational diseases.

5. People who have stopped receiving disability benefits are receiving monthly benefits from the state budget.

6. Commune, ward, and town officials who have quit their jobs are receiving monthly social insurance benefits.

7. Commune, ward, and town officials who have quit their jobs are receiving monthly benefits from the state budget.

8. People receiving unemployment benefits.

9. People who contributed to the revolution.

10. Veterans according to the provisions of the law on veterans.

11. People who directly participated in the resistance war against America to save the country according to Government regulations.

12. Current National Assembly deputies and People's Council deputies at all levels.

13. People eligible to receive monthly social protection benefits according to the provisions of law.

14. People from poor households; Ethnic minorities are living in areas with difficult and especially difficult socio-economic conditions.

15. Relatives of people who have contributed to the revolution according to the law on preferential treatment for people who have contributed to the revolution.

16. Relatives of the following subjects according to the provisions of law on People's Army officers, military service, People's Police and ciphers:

a) Officers and professional soldiers of the People's Army on active duty; non-commissioned officers and soldiers serving in the People's Army;

b) Professional officers, non-commissioned officers and professional and technical officers and non-commissioned officers working in the People's Public Security force; non-commissioned officers and soldiers of the People's Public Security serving for a limited period of time;

c) Officers and professional soldiers who are doing cipher work at the Government Cipher Committee and people who are doing cipher work are paid according to the salary table of People's Army officer ranks and the salary table of professional soldiers of the People's Army but are not soldiers or people's police.

17. Children under 6 years old.

18. People who have donated human body parts according to the provisions of law on donation, retrieval, transplantation of tissues, human body parts and donation and retrieval of corpses.

19. Foreigners studying in Vietnam are granted scholarships from the Vietnamese State budget.

20. People from near-poor households.

21. Students.

22. People in households engaged in agriculture, forestry, fishery and salt production.

23. The employee's relatives specified in Clause 1 of this Article that the employee is responsible for raising and living in the same household.

24. Members of cooperatives and individual business households.

25. Other subjects as prescribed by the Government.

Article 13. Health insurance premiums and responsibilities

1. Health insurance premiums and responsibilities are regulated as follows:

a) The maximum monthly payment rate of the subjects specified in Clauses 1 and 2, Article 12 of this Law is equal to 6% of the employee's monthly salary, of which the employer pays 2/3 and the employee pays 1/3. During the time the employee takes leave to enjoy maternity benefits when giving birth or raising a child under 4 months old according to the provisions of the law on social insurance, the employee and the employer do not have to pay health insurance but are still counted in the period of continuous health insurance participation to enjoy health insurance benefits;

b) The maximum monthly payment rate of the subjects specified in Clause 3, Article 12 of this Law is equal to 6% of the pension or disability allowance and is paid by the social insurance organization;

c) The monthly payment rate of the subjects specified in Clauses 4, 5 and 6, Article 12 of this Law is at most 6% of the minimum salary and is paid by the social insurance organization;

d) The maximum monthly payment rate of the subjects specified in Clause 8, Article 12 of this Law is equal to 6% of the unemployment benefit level and is paid by the social insurance organization;

d) The monthly payment rate of the subjects specified in Clauses 7, 9, 10, 11, 12, 13, 14, 15, 16, 17 and 18, Article 12 of this Law is at most 6% of the minimum wage and is paid by the state budget;

e) The maximum monthly payment of the subjects specified in Clause 19, Article 12 of this Law is equal to 6% of the minimum salary and is paid by the agency, organization or unit granting the scholarship;

g) The monthly payment rate of the subjects specified in Clauses 20, 21 and 22, Article 12 of this Law is at most 6% of the minimum salary and is paid by the subjects;

The state budget partially supports health insurance premiums for the subjects specified in Clauses 20 and 21, Article 12 of this Law and the subjects specified in Clause 22, Article 12 of this Law with an average standard of living;

h) The maximum monthly payment rate of the subjects specified in Clause 23, Article 12 of this Law is equal to 6% of the minimum wage and is paid by the employee;

i) The monthly payment rate of the subjects specified in Clause 24, Article 12 of this Law is at most 6% of the minimum salary and is paid by the subjects;

k) The maximum monthly payment rate of the subjects specified in Clause 25, Article 12 of this Law is equal to 6% of the minimum salary.

2. In case a person simultaneously belongs to many different subjects participating in health insurance as prescribed in Article 12 of this Law, the health insurance premium must be paid according to the first subject that that person identifies in the order of subjects specified in Article 12 of this Law.

In case the subjects specified in Clause 1, Article 12 of this Law have one or more labor contracts of indefinite term or with a term of 3 months or more, health insurance shall be paid according to the labor contract with the highest salary or wage.

3. The Government specifies the contribution and support levels specified in Clause 1 of this Article.

Article 14. Salaries, wages, and allowances serve as the basis for paying health insurance

1. For employees subject to the salary regime prescribed by the State, the basis for paying health insurance is the monthly salary according to rank, military rank and position allowances, extra seniority allowances, and career seniority allowances (if any).

2. For employees receiving salaries and wages according to the employer's regulations, the basis for paying health insurance is the monthly salary and wages stated in the labor contract.

3. For people receiving pensions, disability benefits, and monthly unemployment benefits, the basis for paying health insurance is the pension, disability benefits, and monthly unemployment benefits.

4. For other subjects, the basis for paying health insurance is the minimum salary.

5. The maximum wage and salary to calculate health insurance premiums is 20 times the minimum salary.

Article 15. Method of paying health insurance

1. Every month, the employer pays health insurance for the employee and deducts the health insurance premium from the employee's salary and wages to pay at the same time to the health insurance fund.

2. For agricultural, forestry, fishery, and salt enterprises that do not pay monthly salaries, every 3 months or 6 months, the employer pays health insurance for employees and deducts health insurance premiums from the employee's salary and wages to pay at the same time to the health insurance fund.

3. Every month, the social insurance organization pays health insurance for the subjects specified in Clauses 3, 4, 5, 6 and 8, Article 12 of this Law to the health insurance fund.

4. Every year, agencies and organizations managing the subjects specified in Clauses 7, 9, 10, 11, 12, 13, 14, 17 and 18, Article 12 of this Law pay health insurance for these subjects to the health insurance fund.

5. Every year, agencies and organizations managing people with meritorious services to the revolution and the subjects specified in Points a, b and c, Clause 16, Article 12 of this Law pay health insurance for their relatives to the health insurance fund.

6. Every month, agencies, organizations, and units granting scholarships pay health insurance for the subjects specified in Clause 19, Article 12 of this Law to the health insurance fund.

7. The Government specifically regulates the method of paying health insurance for subjects specified in Clauses 20, 21, 22, 23, 24 and 25, Article 12 of this Law.

Article 16. Health insurance card

1. Health insurance cards are issued to health insurance participants and serve as a basis for enjoying health insurance benefits according to the provisions of this Law.

2. Each person is only issued one health insurance card.

3. The time when the health insurance card is valid for use is specified as follows:

a) For health insurance participants prescribed in Clause 3, Article 50 of this Law who pay health insurance continuously from the second time onwards or health insurance participants specified in Clause 2, Article 51 of this Law, the health insurance card is valid from the date of health insurance payment;

b) For people participating in health insurance as prescribed in Clause 3, Article 50 of this Law paying health insurance for the first time or paying health insurance intermittently, the health insurance card is valid for use after 30 days from the date of payment of health insurance; Particularly for benefits of high-tech services, the health insurance card is valid for use after 180 days from the date of payment of health insurance;

c) For children under 6 years old, the health insurance card is valid until the child turns 72 months old.

4. Health insurance card is not valid in the following cases:

a) The card has expired;

b) The card is modified or erased;

c) The person whose name is on the card does not continue to participate in health insurance.

5. Health insurance organizations regulate health insurance card models, manage health insurance cards uniformly throughout the country and no later than January 1, 2014 must organize the issuance of health insurance cards with photos of health insurance participants.

Article 17. Issuance of health insurance cards

1. Documents for issuance of health insurance card include:

a) Document of registration to participate in health insurance from the agency or organization responsible for paying health insurance specified in Clause 1, Article 13 of this Law;

b) List of health insurance participants prepared by the agency or organization responsible for paying health insurance specified in Clause 1, Article 13 of this Law or the representative of the person voluntarily participating in health insurance;

c) Declaration of individuals and households participating in health insurance.

2. Documents for issuance of health insurance cards for children under 6 years old include:

a) Copy of birth certificate or copy of birth certificate. In case the child does not have a copy of the birth certificate or a copy of the birth certificate, there must be a confirmation from the People's Committee of the commune, ward or town where the father, mother or guardian resides;

b) List or application for health insurance card from the People's Committee of the commune, ward or town where the child resides.

3. Within 10 working days from the date of receipt of complete documents specified in Clauses 1 and 2 of this Article, the health insurance organization must issue a health insurance card to the health insurance participant.

Article 18. Re-issuance of health insurance card

1. Health insurance card is reissued in case of loss.

2. People who lose their health insurance card must submit an application to reissue the card.

3. Within 7 working days from the date of receiving the application to re-issue the card, the health insurance organization must re-issue the card to the health insurance participant. While waiting for the card to be reissued, the card holder can still enjoy the benefits of a health insurance participant.

4. The person whose health insurance card is reissued must pay the fee. The Minister of Finance regulates the fee for reissuing health insurance cards.

Article 19. Changing health insurance card

1. Health insurance cards can be exchanged in the following cases:

a) Torn, crushed or damaged;

b) Change the place of registration for initial medical examination and treatment;

c) The information recorded on the card is incorrect.

2. Documents to change health insurance card include:

a) Application to change card of health insurance participant;

b) Health insurance card.

3. Within 7 working days from the date of receipt of complete documents specified in Clause 2 of this Article, the health insurance organization must change the card for the health insurance participant. While waiting for the card to be replaced, the card holder can still enjoy the benefits of a health insurance participant.

4. People who have their health insurance card replaced because it is torn, damaged or damaged must pay a fee. The Minister of Finance regulates the fee for changing health insurance cards.

Article 20. Revocation and temporary seizure of health insurance cards

1. Health insurance card is revoked in the following cases:

a) Fraud in issuing health insurance cards;

b) The person whose name is on the health insurance card does not continue to participate in health insurance.

2. Health insurance cards are temporarily seized in cases where the person seeking medical examination or treatment uses another person's health insurance card. The person whose health insurance card is temporarily detained is responsible for returning the card and paying the fine according to the provisions of law.

Article 21. Scope of benefits of health insurance participants

1. Health insurance participants have the following costs covered by the health insurance fund:

a) Medical examination, treatment, rehabilitation, periodic prenatal examination, childbirth;

b) Medical examination for screening and early diagnosis of some diseases;

c) Transporting patients from the district level to the higher level for subjects specified in Clauses 9, 13, 14, 17 and 20, Article 12 of this Law in case of emergency or when receiving inpatient treatment requiring professional and technical transfer.

2. The Minister of Health shall specifically stipulate point b, clause 1 of this Article; Preside over and coordinate with relevant agencies to promulgate a list of drugs, chemicals, supplies, medical equipment, and medical technical services within the scope of benefits of health insurance participants.

Article 22. Health insurance benefits

1. Health insurance participants who go for medical examination and treatment according to the provisions of Articles 26, 27 and 28 of this Law will have the medical examination and treatment costs paid by the health insurance fund within the scope of benefits as follows:

a) 100% of medical examination and treatment costs for subjects specified in Clauses 2, 9 and 17, Article 12 of this Law;

b) 100% of medical examination and treatment costs in cases where the cost for one medical examination and treatment is lower than the level prescribed by the Government and medical examination and treatment at the commune level;

c) 95% of medical examination and treatment costs for subjects specified in Clauses 3, 13 and 14, Article 12 of this Law;

d) 80% of medical examination and treatment costs for other subjects.

2. In case a person belongs to many subjects participating in health insurance, he/she will receive health insurance benefits according to the subject with the highest benefit.

3. The Government regulates the level of payment for medical examination and treatment costs for cases of exceeding technical and professional levels, medical examination and treatment on request, using high-cost high-tech services and other cases not specified in Clause 1 of this Article.

Article 23. Cases not eligible for health insurance

1. Expenses in the case specified in Clause 1, Article 21 have been paid by the state budget.

2. Nursing and convalescence at nursing and convalescence facilities.

3. Health examination.

4. Pregnancy testing and diagnosis are not for treatment purposes.

5. Use assisted reproductive technology, family planning services, abortion, except in cases where pregnancy must be terminated due to fetal or maternal pathology.

6. Use cosmetic services.

7. Treatment of strabismus, nearsightedness and refractive errors of the eye.

8. Use alternative medical supplies including artificial limbs, artificial eyes, artificial teeth, eyeglasses, hearing aids, and mobility aids in medical examination, treatment and rehabilitation.

9. Medical examination, treatment, and rehabilitation for occupational diseases, labor accidents, and disasters.

10. Medical examination and treatment in cases of suicide or self-injury.

11. Medical examination and treatment of drug addiction, alcohol addiction or other addictive substances.

12. Medical examination and treatment of physical and mental injuries caused by that person's illegal acts.

13. Medical examination, forensic examination, forensic psychiatric examination.

14. Participate in clinical trials and scientific research.

FOR HEALTH INSURANCE PARTICIPANTS

Article 24. Medical examination and treatment facilities covered by health insurance

1. Health insurance covered medical examination and treatment facility is a medical facility that has signed a medical examination and treatment contract with a health insurance organization.

2. Medical examination and treatment facilities covered by health insurance include:

a) Commune health stations and equivalent, maternity homes;

b) General and specialized clinics;

c) General and specialized hospitals.

Article 25. Health insurance medical examination and treatment contract

1. Health insurance medical examination and treatment contract is a written agreement between a health insurance organization and a medical examination and treatment facility on the provision of services and payment of health insurance medical examination and treatment costs.

2. Health insurance medical examination and treatment contract includes the following main contents:

a) Subjects served and requirements for quality of service provision;

b) Payment method for medical examination and treatment costs;

c) Rights and responsibilities of the parties;

d) Contract term;

d) Liability due to breach of contract;

e) Conditions for change, liquidation, and contract termination.

3. The agreement on conditions for changing, liquidating, and terminating the contract specified in Point e, Clause 2 of this Article must ensure that it does not interrupt the medical examination and treatment of health insurance participants.

4. The Minister of Health regulates the form of health insurance medical examination and treatment contract.

Article 26. Registering for medical examination and treatment under health insurance

1. Health insurance participants have the right to register for initial health insurance medical examination and treatment at commune-level, district-level or equivalent medical examination and treatment facilities; except for cases registered at provincial or central medical examination and treatment facilities according to regulations of the Minister of Health.

In case a health insurance participant has to work mobilely or temporarily reside in another locality, he/she will receive initial medical examination and treatment at a medical examination and treatment facility appropriate to the technical and professional level and the place where he/she is working mobilely or temporarily residing according to the regulations of the Minister of Health.

2. Health insurance participants are allowed to change the initial medical examination and treatment registration facility at the beginning of each quarter.

3. The name of the initial medical examination and treatment facility covered by health insurance is written on the health insurance card.

Article 27. Treatment referral

In case of exceeding the technical and professional capacity, the health insurance medical examination and treatment facility is responsible for promptly transferring the patient to another health insurance medical examination and treatment facility according to regulations on technical and professional referral.

Article 28. Procedures for medical examination and treatment covered by health insurance

1. Health insurance participants must present their health insurance card with photo when coming for medical examination and treatment; In case the health insurance card does not have a photo, the health insurance card must be presented along with documents proving the person's identity; For children under 6 years old, only health insurance card must be presented.

2. In case of emergency, health insurance participants can receive medical examination and treatment at any medical examination and treatment facility and must present their health insurance card along with the documents specified in Clause 1 of this Article before leaving the hospital.

3. In case of referral for treatment, health insurance participants must have transfer records from the medical examination and treatment facility.

4. In case of re-examination as required for treatment, health insurance participants must have a re-examination appointment letter from the medical examination and treatment facility.

Article 29. Health insurance assessment

1. Health insurance appraisal content includes:

a) Check medical examination and treatment procedures covered by health insurance;

b) Check and evaluate the appointment of treatment, use of drugs, chemicals, supplies, medical equipment, and medical technical services for patients;

c) Check and determine medical examination and treatment costs covered by health insurance.

2. Health insurance appraisal must ensure accuracy, openness and transparency.

3. Health insurance organizations perform health insurance appraisals and are responsible before the law for the appraisal results.

Article 30. Method of payment for medical examination and treatment costs covered by health insurance

1. Payment of medical examination and treatment costs covered by health insurance is made according to the following methods:

a) Capitation payment is payment according to the norm of medical examination and treatment costs and the premium calculated on each health insurance card registered at a health insurance medical examination and treatment facility for a certain period of time;

b) Payment based on service price is payment based on the cost of drugs, chemicals, supplies, medical equipment, and medical technical services used for patients;

c) Case-based payment is payment based on predetermined medical examination and treatment costs for each case according to diagnosis.

2. The Government specifically regulates the application of the payment method for medical examination and treatment costs covered by health insurance specified in Clause 1 of this Article.

Article 31. Payment of medical examination and treatment costs covered by health insurance

1. Health insurance organizations pay medical examination and treatment costs covered by health insurance with medical examination and treatment facilities according to health insurance medical examination and treatment contracts.

2. Health insurance organizations pay health insurance medical examination and treatment costs directly for health insurance card holders who go for medical examination and treatment in the following cases:

a) At a medical examination and treatment facility without a medical examination and treatment contract with health insurance;

b) In case of medical examination and treatment not in accordance with the provisions of Articles 26, 27 and 28 of this Law;

c) Abroad;

d) Some other special cases prescribed by the Minister of Health.

3. The Ministry of Health shall preside over and coordinate with the Ministry of Finance to stipulate procedures and payment levels for the cases specified in Clause 2 of this Article.

4. Health insurance organizations pay medical examination and treatment costs on the basis of hospital fees according to Government regulations.

Article 32. Advance, payment, settlement of medical examination and treatment costs covered by health insurance

1. Health insurance organizations are responsible for making quarterly advances to health insurance medical examination and treatment facilities at least equal to 80% of the actual health insurance medical examination and treatment costs of the previous quarter that have been settled. For a medical examination and treatment facility that signs a health insurance medical examination and treatment contract for the first time, the first advance is at least equal to 80% of the health insurance medical examination and treatment cost of a quarter according to the signed contract.

2. Payment and settlement between medical examination and treatment facilities and health insurance organizations are made quarterly as follows:

a) In the first month of each quarter, medical examination and treatment facilities covered by health insurance are responsible for sending a final report on medical examination and treatment costs covered by health insurance for the previous quarter to the health insurance organization;

b) Within 30 days from the date of receiving the settlement report from the health insurance-covered medical examination and treatment facility, the health insurance organization is responsible for reviewing and notifying the cost settlement results. Within 15 days from the date of notification of settlement results, the health insurance organization must complete the payment with the medical examination and treatment facility.

3. Within 40 days from the date of receipt of complete dossier requesting payment from the health insurance participant for medical examination and treatment according to the provisions of Points a and b, Clause 2, Article 31 of this Law; Within 60 days from the date of receiving complete dossiers requesting payment from health insurance participants for medical examination and treatment according to the provisions of Points c and d, Clause 2, Article 31 of this Law, the health insurance organization must pay medical examination and treatment costs directly to these subjects.

Article 33. Sources of formation of health insurance fund

1. Health insurance premiums according to the provisions of this Law.

2. Profit from investment activities of the health insurance fund.

3. Sponsorship and aid from domestic and foreign organizations and individuals.

4. Other legal sources of income.

Article 34. Management of health insurance fund

1. The health insurance fund is managed centrally, uniformly, publicly, transparently and has decentralized management within the health insurance organization system.

2. The Government specifically regulates the management of health insurance funds; Decide on financial sources to ensure medical examination and treatment covered by health insurance in case of imbalance in revenue and expenditure of the health insurance fund.

Article 35. Use of health insurance fund

1. The health insurance fund is used for the following purposes:

a) Payment of medical examination and treatment costs covered by health insurance;

b) Expenses for managing the health insurance organization according to administrative expenditure norms of state agencies;

c) Invest to preserve and grow the health insurance fund according to the principles of safety and efficiency;

d) Establish a medical examination and treatment reserve fund for health insurance. The reserve fund must be at least equal to the total health insurance medical examination and treatment expenses of the two immediately preceding quarters and must not exceed the total health insurance medical examination and treatment expenses of the two immediately preceding years.

2. In cases where provinces and centrally run cities have health insurance revenues greater than health insurance medical examination and treatment expenses, they may use part of the surplus to serve health insurance medical examination and treatment in the locality.

3. The Government specifically regulates this Article.

RELATED TO HEALTH INSURANCE

Article 36. Rights of health insurance participants

1. Get a health insurance card when paying health insurance.

2. Select the initial medical examination and treatment facility covered by health insurance according to the provisions of Clause 1, Article 26 of this Law.

3. Receive medical examination and treatment.

4. Health insurance organizations pay medical examination and treatment costs according to the health insurance regime.

5. Request health insurance organizations, health insurance medical examination and treatment facilities and relevant agencies to explain and provide information about health insurance regimes.

6. Complain and denounce violations of the law on health insurance.

Article 37. Obligations of health insurance participants

1. Pay health insurance in full and on time.

2. Use your health insurance card for the right purpose, do not lend your health insurance card to others.

3. Implement the regulations in Article 28 of this Law when coming for medical examination and treatment.

4. Comply with the regulations and instructions of health insurance organizations and medical examination and treatment facilities when coming for medical examination and treatment.

5. Pay medical examination and treatment costs to medical examination and treatment facilities in addition to the costs paid by the health insurance fund.

Article 38. Rights of organizations and individuals to pay health insurance

1. Request health insurance organizations and competent state agencies to explain and provide information about health insurance regimes.

2. Complain and denounce violations of the law on health insurance.

Article 39. Responsibilities of organizations and individuals paying health insurance

1. Prepare an application for a health insurance card.

2. Pay health insurance in full and on time.

3. Deliver the health insurance card to the health insurance participant.

4. Provide complete and accurate information and documents related to the health insurance responsibilities of the employer and the representative of the health insurance participant when requested by the health insurance organization, the employee or the employee's representative.

5. Comply with inspection and examination of the implementation of legal regulations on health insurance.

Article 40. Rights of health insurance organizations

1. Require employers, representatives of health insurance participants and health insurance participants to provide complete and accurate information and documents related to their responsibilities for implementing health insurance.

2. Inspect and assess the implementation of medical examination and treatment covered by health insurance; revoke and temporarily hold health insurance cards for the cases specified in Article 20 of this Law.

3. Request medical examination and treatment facilities covered by health insurance to provide medical records, medical records, and documents on medical examination and treatment to serve health insurance assessment work.

4. Refuse to pay medical examination and treatment costs covered by health insurance not in accordance with the provisions of this Law or not in accordance with the content of the medical examination and treatment contract covered by health insurance.

5. Request the person responsible for compensating damages to the health insurance participant to reimburse the medical examination and treatment costs paid by the health insurance organization.

6. Propose to competent state agencies to amend and supplement policies and laws on health insurance and handle organizations and individuals that violate the law on health insurance.

Article 41. Responsibilities of health insurance organizations

1. Propagate and disseminate policies and laws on health insurance.

2. Guide documents, procedures, and organize the implementation of health insurance regimes to ensure quick, simple and convenient for health insurance participants.

3. Collect health insurance premiums and issue health insurance cards.

4. Management and use of health insurance fund.

5. Sign a health insurance medical examination and treatment contract with the medical examination and treatment facility.

6. Payment of medical examination and treatment costs covered by health insurance.

7. Provide information about medical examination and treatment facilities covered by health insurance and guide health insurance participants in choosing the initial medical examination and treatment facility.

8. Check the quality of medical examination and treatment; Health insurance appraisal.

9. Protect the rights of health insurance participants; Resolve according to authority recommendations, complaints and denunciations regarding health insurance regimes.

10. Store records and data on health insurance according to the provisions of law; Apply information technology in health insurance management, build a national database on health insurance.

11. Organize the implementation of statistics, reports, and professional guidance on health insurance; Report periodically or unexpectedly when required on the management and use of health insurance funds.

12. Organize training, professional development, scientific research and international cooperation on health insurance.

Article 42. Rights of medical examination and treatment facilities covered by health insurance

1. Request the health insurance organization to provide complete and accurate information related to health insurance participants and medical examination and treatment costs for health insurance participants at medical examination and treatment facilities.

2. Receive advance funding from the health insurance organization and pay medical examination and treatment costs according to the signed medical examination and treatment contract.

3. Recommend to competent state agencies to handle organizations and individuals violating the law on health insurance.

Article 43. Responsibilities of medical examination and treatment facilities covered by health insurance

1. Organize quality medical examination and treatment with simple and convenient procedures for health insurance participants.

2. Provide medical records and documents related to medical examination and treatment and payment of medical examination and treatment costs for health insurance participants at the request of health insurance organizations and competent state agencies.

3. Ensure necessary conditions for health insurance organizations to perform assessment work; Coordinate with health insurance organizations in propagating and explaining health insurance regimes to health insurance participants.

4. Check, detect and notify health insurance organizations of violations regarding the use of health insurance cards; Coordinate with health insurance organizations to revoke and temporarily hold health insurance cards for the cases specified in Article 20 of this Law.

5. Manage and use funds from the health insurance fund in accordance with the provisions of law.

6. Organize the implementation of statistics and reports on health insurance according to the provisions of law.

Article 44. Rights of employee representative organizations and employer representative organizations

1. Require health insurance organizations, medical examination and treatment facilities and employers to provide complete and accurate information related to employees' health insurance policies.

2. Recommend to competent state agencies to handle violations of the law on health insurance that affect the legitimate rights and interests of employees and employers.

Article 45. Responsibilities of employee representative organizations and employer representative organizations

1. Propagate and disseminate health insurance policies and laws to employees and employers.

2. Participate in developing and recommending amendments and supplements to policies and laws on health insurance.

3. Participate in monitoring the implementation of health insurance laws.

AND HANDLING OF VIOLATIONS ON HEALTH INSURANCE

Article 46. Health insurance inspection

Health inspectors perform specialized inspection functions on health insurance.

Article 47. Complaints and denunciations about health insurance

Complaints and settlement of complaints about administrative decisions and administrative acts on health insurance, denunciations and settlement of denunciations of violations of the law on health insurance are carried out in accordance with the provisions of law on complaints and denunciations.

Article 48. Disputes over health insurance

1. Dispute about health insurance is a dispute related to the rights, obligations and responsibilities of health insurance between the following subjects:

a) Health insurance participants as prescribed in Article 12 of this Law, representatives of health insurance participants;

b) Organizations and individuals pay health insurance according to the provisions of Clause 1, Article 13 of this Law;

c) Health insurance organization;

d) Medical examination and treatment facilities covered by health insurance.

2. Disputes over health insurance are resolved as follows:

a) The disputing parties are responsible for conciliating the content of the dispute themselves;

b) In case conciliation fails, the disputing parties have the right to sue in court according to the provisions of law.

Article 49. Handling of violations

1. Anyone who violates the provisions of this Law and other provisions of law related to health insurance shall, depending on the nature and severity of the violation, be disciplined, administratively sanctioned or prosecuted for criminal liability. If causing damage, compensation must be made according to the provisions of law.

2. Agencies, organizations, and employers who are responsible for paying health insurance but do not pay or pay in full according to the provisions of law must, along with paying the full amount not yet paid, also pay interest during the period of late payment according to the basic interest rate announced by the State Bank; If not, at the request of the person competent to handle administrative violations, banks, other credit institutions, and the state treasury will be responsible for deducting money from the deposit account of the person responsible for paying health insurance to pay the unpaid amount, late payment and interest on this amount into the account of the health insurance fund.

Article 50. Transitional provisions

1. Health insurance cards and free medical examination and treatment cards for children under 6 years old that were issued before the effective date of this Law have the following validity:

a) According to the expiry date stated on the card in case the card shows validity until December 31, 2009;

b) Until December 31, 2009 in case the card has a validity after December 31, 2009.

2. The scope of benefits of people who are issued health insurance cards before this Law takes effect shall comply with current regulations of the law on health insurance until December 31, 2009.

3. Subjects specified in Clauses 21, 22, 23, 24 and 25, Article 12 of this Law who have not yet implemented the provisions of Points b, c, d and dd, Clause 2, Article 51 of this Law, have the right to voluntarily participate in health insurance according to the Government's regulations.

Article 51. Effectiveness of implementation

1. This Law takes effect from July 1, 2009.

2. The roadmap for implementing universal health insurance is prescribed as follows:

a) Subjects specified in Clauses 1 to 20, Article 12 of this Law shall have health insurance from the effective date of this Law;

b) Subjects specified in Clause 21, Article 12 of this Law shall have health insurance from January 1, 2010;

c) Subjects specified in Clause 22, Article 12 of this Law shall have health insurance from January 1, 2012;

d) Subjects specified in Clause 23 and Clause 24, Article 12 of this Law shall have health insurance from January 1, 2014;

d) Subjects specified in Clause 25, Article 12 of this Law shall have health insurance according to the Government's regulations no later than January 1, 2014.

Article 52. Detailed regulations and implementation instructions

The Government details and guides the implementation of assigned articles and clauses in the Law; guide other necessary contents of this Law to meet the requirements of state management.

___________________________________________________________

This Law was passed by the 12th National Assembly of the Socialist Republic of Vietnam, 4th session, on November 14, 2008.

CHAIRMAN OF THE NATIONAL ASSEMBLY (signed) Nguyen Phu Trong

LAW

AMENDING AND SUPPLEMENTING SOME ARTICLES OF THE HEALTH INSURANCE LAW

Pursuant to the Constitution of the Socialist Republic of Vietnam;

The National Assembly promulgates the Law amending and supplementing a number of articles of the Health Insurance Law No. 25/2008/QH12.

Article 1. Amending and supplementing a number of articles of the Health Insurance Law:

1. Amend and supplement clause 1; Add Clause 7 and Clause 8, Article 2 as follows:

“1. Health insurance is a form of compulsory insurance applied to subjects prescribed by this Law for health care, not for profit purposes, organized by the State.”

“7. Households participating in health insurance (hereinafter referred to as households) include all people named in the household registration book or temporary residence book.

8. The basic medical service package paid for by the health insurance fund is essential medical services for health care, consistent with the payment ability of the health insurance fund.”

2. Amend and supplement clause 2 and clause 3 of Article 3 as follows:

“2. The health insurance premium is determined by the percentage of salary as the basis for compulsory social insurance payment according to the provisions of the Social Insurance Law (hereinafter referred to as monthly salary), pension, allowance or base salary.

3. Health insurance coverage depends on the level of illness, target groups within the scope of benefits, and duration of health insurance participation.”

3. Amend and supplement clause 3; Clause 10, Article 6 is added as follows:

“3. Promulgate professional and technical regulations, medical examination and treatment procedures and treatment instructions; referrals related to medical examination and treatment covered by health insurance;”

"10. Issue a basic medical service package paid for by the health insurance fund."

4. Add Articles 7a, 7b and 7c after Article 7 as follows:

“Article 7a. Responsibilities of the Ministry of Labor, War Invalids and Social Affairs

1. Direct and guide the organization and implementation of identification and management of subjects managed by the Ministry of Labor, War Invalids and Social Affairs specified in Points d, e, g, h, i and k, Clause 3 and Clause 4, Article 12 of this Law.

2. Inspect and examine the implementation of legal provisions on the responsibility to participate in health insurance of employers and employees specified in Clause 1, Article 12 of this Law and subjects managed by the Ministry of Labor, War Invalids and Social Affairs specified in Points d, e, g, h, i and k, Clause 3 and Clause 4, Article 12 of this Law.

Article 7b. Responsibility of the Ministry of Education and Training

1. Direct and guide the organization of identification and management of subjects managed by the Ministry of Education and Training specified in Point n, Clause 3 and Point b, Clause 4, Article 12 of this Law.

2. Inspect and examine the implementation of legal provisions on the responsibility to participate in health insurance of subjects managed by the Ministry of Education and Training as prescribed in Point n, Clause 3 and Point b, Clause 4, Article 12 of this Law.

3. Preside and coordinate with the Ministry of Health and relevant ministries and branches to guide the establishment and consolidation of the school health system to provide primary health care for children, pupils and students.

Article 7c. Responsibilities of the Ministry of National Defense and the Ministry of Public Security

1. Direct, manage, guide, and organize the identification, management, and preparation of health insurance lists for subjects managed by the Ministry of National Defense and the Ministry of Public Security as prescribed in Point a, Clause 1, Points a and n, Clause 3, Point b, Clause 4, Article 12 of this Law.

2. Make a list and provide a list of requests for health insurance cards for the subjects specified in Point 1, Clause 3, Article 12 of this Law to the health insurance organization.

3. Inspect and examine the implementation of legal provisions on the responsibility to participate in health insurance of subjects managed by the Ministry of National Defense and the Ministry of Public Security as prescribed in Point a, Clause 1, Points a and n, Clause 3, Point b, Clause 4, Article 12 of this Law.

4. Coordinate with the Ministry of Health and relevant ministries and branches to guide medical examination and treatment facilities of the Ministry of National Defense and the Ministry of Public Security to sign health insurance medical examination and treatment contracts with health insurance organizations to provide medical examination and treatment for health insurance participants.”

5. Amend and supplement clause 2; Clause 3 Article 8 is added as follows:

“2. The People's Committees of provinces and centrally run cities, in addition to performing the responsibilities specified in Clause 1 of this Article, are responsible for directing the building of apparatus and resources to carry out state management of health insurance in the locality and manage and use funding sources as prescribed in Clause 3, Article 35 of this Law.

3. The People's Committee of communes, wards and towns (hereinafter referred to as the Commune People's Committee), in addition to performing the responsibilities specified in Clause 1 of this Article, is responsible for preparing a list of health insurance participants in the area for the subjects specified in Clauses 2, 3, 4 and 5, Article 12 of this Law according to households, except for the subjects specified in Points a, 1 and n, Clause 3 and Point b, Clause 4, Article 12 of the Law. hey; The Commune People's Committee must prepare a list of requests for issuance of health insurance cards to children at the same time as issuance of birth certificates."

6. Amend and supplement Article 12 as follows:

“Article 12. Subjects participating in health insurance

1. Groups owned by employees and employers include:

a) Employees working under an indefinite-term labor contract or a labor contract with a term of 3 months or more; The employee is a business manager and receives a salary; officials, civil servants, and public employees (hereinafter collectively referred to as employees);

b) Persons working part-time in communes, wards and towns according to the provisions of law.

2. Groups paid by social insurance organizations include:

a) People receiving monthly pension or disability allowance;

b) People who are receiving monthly social insurance benefits due to a work accident, occupational disease or a disease on the list of diseases requiring long-term treatment; people aged 80 or older who are receiving monthly death benefits;

c) Commune, ward, and town officials who have retired and are receiving monthly social insurance benefits;

d) People receiving unemployment benefits.

3. Groups paid for by the state budget include:

a) Officers, professional soldiers, non-commissioned officers, active military soldiers; Professional officers, non-commissioned officers and professional and technical officers and non-commissioned officers working in the People's Public Security force, People's Police cadets, non-commissioned officers and soldiers serving for a limited time in the People's Public Security force; People who do cipher work are paid the same as soldiers; Cipher students are entitled to benefits and policies according to the regimes and policies for students at military and police schools;

b) Commune, ward, and town officials who have quit their jobs and are receiving monthly benefits from the state budget;

c) People who have stopped receiving disability benefits and are currently receiving monthly benefits from the state budget;

d) People with meritorious services to the revolution, veterans;

d) Current National Assembly deputies and People's Council deputies at all levels;

e) Children under 6 years old;

g) People eligible for monthly social protection benefits;

h) People from poor households; Ethnic minorities living in areas with difficult socio-economic conditions; people living in areas with particularly difficult socio-economic conditions; people living in island communes and island districts;

i) Relatives of people who have contributed to the revolution are the father, mother, spouse, or children of martyrs; people who have contributed to nurturing martyrs;

k) Relatives of people with meritorious services to the revolution, except for the subjects specified in Point i of this Clause;

l) Relatives of the subjects specified in Point a, Clause 3 of this Article;

m) People who have donated human organs according to the provisions of law;

n) Foreigners studying in Vietnam are granted scholarships from the Vietnamese State budget.

4. Groups supported by the state budget include:

a) People from near-poor households;

b) Pupils and students.

5. The group participating in household health insurance includes people belonging to the household, except for the subjects specified in Clauses 1, 2, 3 and 4 of this Article.

6. The Government regulates subjects other than those specified in Clauses 3, 4 and 5 of this Article; regulate the issuance of health insurance cards for subjects managed by the Ministry of National Defense and the Ministry of Public Security and subjects specified in Point 1, Clause 3 of this Article; stipulates the roadmap for implementing health insurance, scope of benefits, health insurance benefits, medical examination and treatment covered by health insurance, management and use of funds for medical examination and treatment covered by health insurance, health insurance assessment, payment and settlement of health insurance for the subjects specified in point a, clause 3 of this Article.”

7. Amend and supplement Article 13 as follows:

“Article 13. Health insurance premiums and responsibilities

1. Health insurance premiums and responsibilities are regulated as follows:

a) The maximum monthly payment of the subjects specified in Point a, Clause 1, Article 12 of this Law is equal to 6% of the monthly salary, of which the employer pays 2/3 and the employee pays 1/3. During the time the employee takes leave to enjoy maternity benefits according to the provisions of the law on social insurance, the maximum monthly payment is equal to 6% of the employee's monthly salary before maternity leave and is paid by the social insurance organization;

b) The maximum monthly payment rate of the subjects specified in Point b, Clause 1, Article 12 of this Law is equal to 6% of the base salary, of which the employer pays 2/3 and the employee pays 1/3;

c) The maximum monthly payment rate of the subjects specified in Point a, Clause 2, Article 12 of this Law is equal to 6% of pension and disability allowance and is paid by the social insurance organization;

d) The maximum monthly payment rate of the subjects specified in Points b and c, Clause 2, Article 12 of this Law is equal to 6% of the base salary and is paid by the social insurance organization;

d) The maximum monthly payment rate of the subjects specified in Point d, Clause 2, Article 12 of this Law is equal to 6% of unemployment benefits and is paid by the social insurance organization;

e) The monthly payment rate of the subjects specified in Point a, Clause 3, Article 12 of this Law is at most 6% of the monthly salary for salary earners, up to 6% of the base salary for people receiving living expenses and is paid by the state budget;

g) The monthly payment rate of the subjects specified in Points b, c, d, dd, e, g, h, i, k, l and m, Clause 3, Article 12 of this Law is at most 6% of the base salary and is paid by the state budget;

h) The maximum monthly payment of the subjects specified in Point n, Clause 3, Article 12 of this Law is equal to 6% of the base salary and is paid by the agency, organization, or unit granting the scholarship;

i) The monthly payment rate of the subjects specified in Clause 4, Article 12 of this Law is at most 6% of the base salary paid by the subjects themselves and is partially supported by the state budget;

k) The maximum monthly payment rate of the subjects specified in Clause 5, Article 12 of this Law is equal to 6% of the base salary and is paid by the subjects per household.

2. In case a person simultaneously belongs to many different subjects participating in health insurance as prescribed in Article 12 of this Law, the health insurance premium must be paid according to the first subject that that person identifies in the order of subjects specified in Article 12 of this Law.

In case the subjects specified in Point a, Clause 1, Article 12 of this Law have one or more labor contracts of indefinite term or labor contracts with a term of 3 months or more, health insurance must be paid according to the labor contract with the highest salary.

In case the subjects specified in Point b, Clause 1, Article 12 of this Law simultaneously belong to many different health insurance participants specified in Article 12 of this Law, health insurance premiums shall be paid in the following order: paid by the social insurance organization, paid by the state budget, paid by the subject and the commune-level People's Committee.

3. All members of the household as prescribed in Clause 5, Article 12 of this Law must participate in health insurance. The contribution level is gradually reduced from the second member onwards, specifically as follows:

a) The first person contributes a maximum of 6% of the base salary;

b) The second, third, and fourth person pay 70%, 60%, and 50% of the first person's payment, respectively;

c) From the fifth person onwards, the payment is equal to 40% of the first person's payment.

4. The Government specifically regulates the contribution and support levels specified in this Article.

8. Amend and supplement Clauses 4 and 5, Article 14 as follows:

“4. For other subjects, the basis for paying health insurance is the base salary.

5. The maximum monthly salary to calculate health insurance premiums is 20 times the base salary.”

9. Amend and supplement Article 15 as follows:

“Article 15. Method of paying health insurance

1. Every month, the employer pays health insurance for the employee and deducts the health insurance premium from the employee's salary to pay at the same time to the health insurance fund.

2. For enterprises in the fields of agriculture, forestry, fishery, and salt production that do not pay monthly salaries, every 3 months or every 6 months, the employer pays health insurance for employees and deducts health insurance premiums from the employee's salary to pay at the same time to the health insurance fund.

3. Every month, the social insurance organization pays health insurance according to the provisions of Points c, d and dd, Clause 1, Article 13 of this Law into the health insurance fund.

4. Every quarter, agencies, organizations, and units granting scholarships pay health insurance according to the provisions of Point h, Clause 1, Article 13 of this Law to the health insurance fund.

5. Every quarter, the state budget transfers the amount of health insurance contributions and support as prescribed in Points e, g and i, Clause 1, Article 13 of this Law to the health insurance fund.

6. Every 3 months, 6 months or 12 months, representatives of households, organizations and individuals pay the full amount of responsibility to the health insurance fund.”

10. Amend and supplement Clause 3 and Clause 5, Article 16 as follows:

“3. The time when the health insurance card is valid for use is specified as follows:

a) Subjects specified in Clauses 1, 2 and 3, Article 12 of this Law participating in health insurance for the first time, the health insurance card is valid from the date of payment of health insurance;

b) For those who participate in health insurance continuously from the second time onwards, the health insurance card will be valid for use continuing with the expiration date of the previous card;

c) Subjects specified in Clauses 4 and 5, Article 12 of this Law who participate in health insurance from the effective date of this Law or participate intermittently for 3 months or more in the fiscal year, their health insurance cards will be valid for use after 30 days from the date of payment of health insurance;

d) For children under 6 years old, the health insurance card is valid until the child turns 72 months old. In case a child is 72 months old but has not yet entered school, the health insurance card is valid until September 30 of that year.

“5. The health insurance organization issues the health insurance card form after obtaining the consensus of the Ministry of Health.”

11. Amend and supplement Article 17 as follows:

“Article 17. Issuance of health insurance cards

1. Documents for issuance of health insurance card, including:

a) Health insurance participation declaration of organizations, individuals, and households for first-time health insurance participants;

b) List of health insurance participants of subjects specified in Clause 1, Article 12 of this Law prepared by the employer.

The list of health insurance participants of subjects specified in Clauses 2, 3, 4 and 5, Article 12 of this Law is prepared by the commune-level People's Committee according to households, except for the subjects specified in Points a, 1 and n, Clause 3 and Point b, Clause 4, Article 12 of this Law.

The list of health insurance participants managed by the Ministry of Education and Training and the Ministry of Labor, War Invalids and Social Affairs according to the provisions of Point n, Clause 3 and Point b, Clause 4, Article 12 of this Law is prepared by educational and training establishments and vocational establishments.

The list of health insurance participants managed by the Ministry of National Defense and the Ministry of Public Security is specified in Point a Clause 1, Point a and n Clause 3, Point b Clause 4 Article 12 of this Law and the list of subjects specified in Point 1 Clause 3 Article 12 of this Law is prepared by the Ministry of National Defense and the Ministry of Public Security.

2. Within 10 working days from the date of receipt of complete documents specified in Clause 1 of this Article, the health insurance organization must transfer the health insurance card to the agency or organization managing the subject or to the health insurance participant.

3. The health insurance organization shall issue the application form specified in Clause 1 of this Article after obtaining the consensus of the Ministry of Health.”

12. Amend and supplement Clauses 3 and 4, Article 18 as follows:

“3. Within 7 working days from the date of receiving the application to re-issue the card, the health insurance organization must re-issue the card to the health insurance participant. While waiting for the card to be reissued, health insurance participants will still enjoy health insurance benefits.

4. The person whose health insurance card is reissued must pay the fee. The Minister of Finance regulates the fee for reissuing health insurance cards. In case the error is caused by the health insurance organization or the agency that compiles the list, the person who is re-issued the health insurance card does not have to pay the fee.

13. Add Point c, Clause 1, Article 20 as follows:

“c) Issuing duplicate health insurance cards.”

14. Abolish point b, clause 1, Article 21; Amend and supplement point c, clause 1 and clause 2, Article 21 as follows:

“b) Transporting patients from the district level to the higher level for subjects specified in Points a, d, e, g, h and i, Clause 3, Article 12 of this Law in case of emergency or when undergoing inpatient treatment requiring professional and technical transfer.

2. The Minister of Health shall preside over and coordinate with relevant ministries and branches to promulgate the list, rates, and payment conditions for drugs, chemicals, medical supplies, and medical technical services within the scope of benefits of health insurance participants.”

15. Amend and supplement Article 22 as follows:

“Article 22. Health insurance benefits

1. Health insurance participants who go for medical examination and treatment according to the provisions of Articles 26, 27 and 28 of this Law will have the health insurance fund pay medical examination and treatment costs within the scope of entitlement with the following benefits:

a) 100% of medical examination and treatment costs for subjects specified in Points a, d, e, g, h and i, Clause 3, Article 12 of this Law. Medical examination and treatment costs outside the scope of health insurance coverage for subjects specified in Point a, Clause 3, Article 12 of this Law are paid from the health insurance funding source for medical examination and treatment of this group of subjects; In case this funding source is not enough, it will be guaranteed by the state budget;

b) 100% of medical examination and treatment costs in cases where the cost for one medical examination and treatment is lower than the level prescribed by the Government and medical examination and treatment at the commune level;

c) 100% of medical examination and treatment costs when the patient has participated in health insurance for 5 consecutive years or more and has the amount of money to pay for medical examination and treatment costs in the year greater than 6 months of base salary, except in cases where he or she self-goes for medical examination and treatment at the wrong level;

d) 95% of medical examination and treatment costs for subjects specified in Point a Clause 2, Point k Clause 3 and Point a Clause 4 Article 12 of this Law;

d) 80% of medical examination and treatment costs for other subjects.

2. In case a person belongs to many subjects participating in health insurance, he/she will receive health insurance benefits according to the subject with the highest benefit.

3. In case a person with a health insurance card goes for medical examination or treatment at the wrong route, the health insurance fund will pay the benefit specified in Clause 1 of this Article at the following rate, except for the case specified in Clause 5 of this Article:

a) At central hospitals, it is 40% of inpatient treatment costs;

b) At provincial hospitals, it is 60% of inpatient treatment costs from the effective date of this Law to December 31, 2020; 100% of inpatient treatment costs from January 1, 2021 nationwide;

c) At district hospitals, it is 70% of medical examination and treatment costs from the effective date of this Law to December 31, 2015; 100% of medical examination and treatment costs from January 1, 2016.

4. From January 1, 2016, health insurance participants who register for initial medical examination and treatment at a commune-level medical station or general clinic or district hospital are entitled to medical examination and treatment under health insurance at a commune-level medical station or general clinic or district hospital in the same province with the benefit level as prescribed in Clause 1 of this Article.

5. Ethnic minorities and people from poor households participating in health insurance are living in areas with difficult socio-economic conditions, areas with extremely difficult socio-economic conditions; Health insurance participants living in island communes and island districts who go for medical examination and treatment at the wrong level will be paid by the health insurance fund for medical examination and treatment costs for district hospitals, inpatient treatment for provincial and central hospitals and have benefits as prescribed in Clause 1 of this Article.

6. From January 1, 2021, the health insurance fund will pay inpatient treatment costs according to the benefits specified in Clause 1 of this Article for health insurance participants when they go for medical examination and treatment at the wrong level at provincial medical examination and treatment facilities nationwide.

7. The Government specifically regulates the benefit levels for medical examination and treatment covered by health insurance in bordering areas; Cases of medical examination and treatment upon request and other cases not specified in Clause 1 of this Article.”

16. Abolish Clause 10 and Clause 12, Article 23; Amend and supplement Clause 7 and Clause 9, Article 23 as follows:

“7. Treatment of strabismus, nearsightedness and refractive errors of the eyes, except for children under 6 years old.”

“9. Medical examination, treatment, and rehabilitation in case of disaster.”

17. Amend and supplement Article 24 as follows:

“Article 24. Medical examination and treatment facilities covered by health insurance

Health insurance covered medical examination and treatment facility is a medical facility according to the provisions of the Law on Medical Examination and Treatment that has signed a medical examination and treatment contract with a health insurance organization.”

18. Amend and supplement point a, clause 2 and clause 4, Article 25 as follows:

“a) Subjects served and requirements for scope of service provision; expected number of cards and structure of health insurance participants for primary medical examination and treatment facilities covered by health insurance.”

"4. The Ministry of Health shall preside over and coordinate with the Ministry of Finance to stipulate the form of health insurance medical examination and treatment contract."

19. Amend and supplement point a, clause 1, Article 30 as follows:

“a) Capitation payment is payment at a predetermined fee according to the scope of service for a card registered at a medical service provider for a certain period of time;”

20. Amend and supplement clause 2; Clause 5, Article 31 is added as follows:

“2. Health insurance organizations pay health insurance medical examination and treatment costs directly for health insurance card holders who go for medical examination and treatment in the following cases:

a) At a medical examination and treatment facility without a medical examination and treatment contract with health insurance;

b) Medical examination and treatment not in accordance with the provisions of Article 28 of this Law;

c) Other special cases prescribed by the Minister of Health.”

"5. The Minister of Health shall preside over and coordinate with the Minister of Finance to uniformly regulate the prices of medical examination and treatment services covered by health insurance among hospitals of the same class nationwide."

21. Amend and supplement Article 32 as follows:

“Article 32. Advance, payment, settlement of medical examination and treatment costs covered by health insurance

1. The advance payment of funds by health insurance organizations to medical examination and treatment facilities covered by health insurance is carried out quarterly as follows:

a) Within 5 working days from the date of receiving the previous quarterly settlement report of the medical examination and treatment facility, the health insurance organization shall make a one-time advance payment equal to 80% of the medical examination and treatment costs covered by health insurance according to the previous quarterly settlement report of the medical examination and treatment facility;

b) For medical examination and treatment facilities that sign a health insurance medical examination and treatment contract for the first time and have registered for initial health insurance medical examination and treatment, they will receive an advance of 80% of the funding used at the medical examination and treatment facility according to the notice at the beginning of the period from the health insurance organization; In case there is no initial medical examination and treatment registration under health insurance, based on the amount of medical examination and treatment expenses after one month of contract implementation, the health insurance organization estimates and advances 80% of the medical examination and treatment expenses covered by health insurance in the quarter;

c) In case the advance funding for medical examination and treatment facilities covered by health insurance in the province exceeds the amount of funding used in the quarter, the health insurance organization of the province or centrally run city reports to Vietnam Social Insurance to supplement funding.

2. Payment and settlement between medical examination and treatment facilities and health insurance organizations are carried out as follows:

a) Within the first 15 days of each month, the health insurance medical examination and treatment facility is responsible for sending a summary of the request for payment of health insurance medical examination and treatment costs of the previous month to the health insurance organization; Within the first 15 days of each quarter, health insurance-covered medical examination and treatment facilities are responsible for sending a final report on health insurance medical examination and treatment costs of the previous quarter to the health insurance organization;

b) Within 30 days from the date of receiving the previous quarterly settlement report of the medical examination and treatment facility, the health insurance organization is responsible for notifying the assessment results and the settlement number of health insurance medical examination and treatment costs including actual medical examination and treatment costs within the scope of health insurance benefits and benefits to the medical examination and treatment facility;

c) Within 10 days from the date of notification of the final settlement of medical examination and treatment costs covered by health insurance, the health insurance organization must complete the payment with the medical examination and treatment facility;

d) The appraisal of the annual settlement of the health insurance fund and payment of unused funds (if any) to provinces and centrally run cities must be done before October 1 of the following year.

3. Within 40 days from the date of receiving complete dossiers requesting payment from health insurance participants for medical examination and treatment according to the provisions of Clause 2, Article 31 of this Law, the health insurance organization must pay medical examination and treatment costs directly to these subjects.

22. Amending and supplementing clause 1; Clause 3, Article 34 is added as follows:

“1. The health insurance fund is managed centrally, uniformly, publicly, transparently and has decentralized management within the health insurance organization system.

The Vietnam Social Insurance Management Council according to the provisions of the Social Insurance Law is responsible for managing the health insurance fund and consulting on health insurance policies.”

“3. Every year, the Government reports to the National Assembly on the management and use of the health insurance fund.”

23. Amend and supplement Article 35 as follows:

“Article 35. Allocation and use of health insurance fund

1. The health insurance fund is allocated and used as follows:

a) 90% of the health insurance premium is for medical examination and treatment;

b) 10% of the health insurance premium is reserved for the reserve fund and health insurance fund management costs, of which at least 5% of the health insurance premium is reserved for the reserve fund.

2. Temporarily idle money of the health insurance fund is used for investment according to the forms prescribed by the Social Insurance Law. The Vietnam Social Insurance Management Council decides and is responsible to the Government for the form and investment structure of the health insurance fund based on the request of Vietnam Social Insurance.

3. In cases where a province or centrally run city has health insurance revenue for medical examination and treatment greater than the amount of medical examination and treatment expenditure in the year, after being appraised and settled by Vietnam Social Insurance, the unused funds will be allocated according to the following schedule:

a) From the effective date of this Law until December 31, 2020, 80% will be transferred to the reserve fund, 20% will be transferred to localities for use in the following order of priority:

Support medical examination and treatment funds for the poor; Support health insurance premiums for some target groups in accordance with local socio-economic conditions; Purchase medical equipment appropriate to the capacity and qualifications of medical staff; Purchase vehicles to transport patients at the district level.

Within 1 month from the date Vietnam Social Insurance appraises the settlement, Vietnam Social Insurance must transfer 20% of the unused funds to the locality.

Within 12 months from the date Vietnam Social Insurance appraises the settlement, the unused funds will be transferred to the reserve fund;

b) From January 1, 2021, the unused funds will be fully accounted for in the reserve fund for general regulation.

4. In case a province or centrally run city has health insurance revenue for medical examination and treatment that is smaller than the amount of medical examination and treatment expenditure in the year, after evaluating the settlement, Vietnam Social Insurance is responsible for supplementing the entire difference in funding from the reserve fund.

5. The Government shall detail Clause 1 of this Article.”

24. Amend and supplement Clause 2, Article 36 as follows:

“2. Receive health insurance by household at health insurance agents nationwide; have the right to choose a medical examination and treatment facility covered by initial health insurance according to the provisions of Clause 1, Article 26 of this Law.”

25. Amend and supplement Clause 2 and Clause 10, Article 41 as follows:

“2. Organize for the subjects specified in Clause 5, Article 12 of this Law to conveniently pay health insurance according to their households at health insurance agents. Guide documents, procedures, where to register for health insurance and organize the implementation of health insurance regimes, ensuring quick, simple and convenient for health insurance participants. Review, synthesize and confirm the list of health insurance participants to avoid issuing duplicate health insurance cards to subjects specified in Article 12 of this Law, except subjects managed by the Ministry of National Defense and the Ministry of Public Security."

“10. Store records and data on health insurance according to the provisions of law; Determine the time to participate in health insurance to ensure benefits for health insurance participants; Apply information technology in health insurance management, build a national database on health insurance.”

26. Amend and supplement clause 2; Add Clause 7 and Clause 8, Article 43 as follows:

“2. Provide medical records and documents related to medical examination and treatment and payment of medical examination and treatment costs for health insurance participants at the request of health insurance organizations and competent state agencies; For dossiers requesting direct payment, within 5 working days from the date of receiving the request from the health insurance organization, the health insurance medical examination and treatment facility is responsible for providing medical records and documents related to medical examination and treatment of the health insurance participant.

“7. Prepare a list of medical examination and treatment costs covered by health insurance and be responsible before the law for the legality and accuracy of this list.

8. Provide a list of medical examination and treatment costs to health insurance participants upon request.”

27. Amend and supplement Clause 3, Article 45 as follows:

“3. Participate in monitoring the implementation of health insurance laws, urge employers to pay health insurance for employees and participate in resolving cases of evasion and debt of health insurance payments.

28. Amend and supplement Article 49 as follows:

“Article 49. Handling of violations

1. People who violate the provisions of this Law and other provisions of law related to health insurance shall, depending on the nature and severity of the violation, be disciplined, administratively sanctioned or prosecuted for criminal liability. If causing damage, they must compensate in accordance with the provisions of law.

2. Agencies and organizations that violate the provisions of this Law and other provisions of law related to health insurance shall be administratively sanctioned. If causing damage, they must compensate in accordance with the provisions of law.

3. Agencies, organizations, and employers who are responsible for paying health insurance but do not pay or pay insufficiently according to the provisions of law will be handled as follows:

a) Must pay the outstanding amount and pay interest equal to twice the interbank interest rate calculated on the amount and time of late payment; If not done, at the request of the competent person, bank, other credit institution, the state treasury is responsible for deducting money from the deposit account of the agency, organization or employer responsible for paying health insurance to pay the unpaid amount, late payment and interest of this amount into the account of the health insurance fund;

b) Must reimburse all expenses to the employee within the scope of health insurance benefits and benefits that the employee has paid while not having a health insurance card.”

Article 2. 1. This Law takes effect from January 1, 2015.

2. The Government regulates in detail the assigned articles and clauses in the Law.

This Law was passed by the 13th National Assembly of the Socialist Republic of Vietnam, 7th session, on June 13, 2014.

CHAIRMAN OF THE NATIONAL ASSEMBLY Nguyen Sinh Hung

LAW

AMENDING AND SUPPLEMENTING SOME ARTICLES OF THE HEALTH INSURANCE LAW

Pursuant to the Constitution of the Socialist Republic of Vietnam;

The National Assembly promulgates the Law amending and supplementing a number of articles of the Law on Health Insurance No. 25/2008/QH12, which has been amended and supplemented with a number of articles under Law No. 32/2013/QH 13, Law No. 46/2014/QH13, Law No. 97/2015/QH13, Law No. 35/2018/QH14, Law No. 68/2020/QH14 and Law No. 30/2023/QH15.

Article 1. Amending and supplementing a number of articles of the Health Insurance Law

1. Add Clause 9 after Clause 8, Article 2 as follows:

"9. The reference level is the amount decided by the Government to use to calculate the payment and benefit levels of some cases of health insurance participation specified in this Law.".

2. Amend and supplement Clause 2, Article 3 as follows:

"2. The health insurance premium is determined by the percentage of salary as the basis for compulsory social insurance payment according to the provisions of the Social Insurance Law (hereinafter referred to as monthly salary), pension, allowance or reference level.".

3. Amend and supplement a number of clauses of Article 6 as follows:

a) Amend and supplement Clause 1 as follows:

"1. Promulgate according to authority or submit to competent authorities to promulgate policies and laws on health insurance, organization of the health system, and financial resources to serve the protection, care and improvement of people's health based on universal health insurance; Solutions to strengthen medical examination and treatment capacity with health insurance for grassroots healthcare;";

b) Amend and supplement clauses 3 and 4 as follows:

"3. Promulgate regulations, procedures, and professional instructions on medical examination and treatment; Regularly review and update diagnostic and treatment guidelines; regulations on assessing the reasonableness of providing medical examination and treatment services; regulations on the application of information technology, digital transformation, data sharing in the field of health insurance, the connection and use of laboratory results between medical examination and treatment facilities covered by health insurance in accordance with professional requirements;

4. Issue according to authority or submit to competent authorities for promulgation solutions to ensure balance of health insurance fund;".

4. Amend and supplement Article 7a as follows:

"Article 7a. Responsibilities of the Ministry of Labor, War Invalids and Social Affairs

1. Direct and guide the organization and implementation of identification and management of subjects managed by the Ministry of Labor, War Invalids and Social Affairs specified in Points e, h, i, k, o, r, s and t, Clause 3, Points a, b, d and g, Clause 4, Article 12 of this Law.

2. Inspect and examine the implementation of legal provisions on the responsibility to participate in health insurance of employers and employees specified in Clause 1, Article 12 of this Law and subjects managed by the Ministry of Labor, War Invalids and Social Affairs specified in Points e, h, i, k, o, r, s and t Clause 3, Points a, b, d and g Clause 4 Article 12 of this Law, except for subjects managed by the Ministry of National Defense and the Ministry Police management.".

5. Amend and supplement a number of clauses of Article 7c as follows:

a) Amend and supplement Clause 1 as follows:

"1. Direct, manage, guide, and organize the identification, management, and preparation of health insurance participation lists for subjects managed by the Ministry of National Defense and the Ministry of Public Security as prescribed in Points a, c, e, h and i, Clause 1, Points a, b, c, d, l and n, Clause 3, Point b, Clause 4, Article 12 of this Law.";

b) Amend and supplement clause 3 as follows:

"3. Inspect and examine the implementation of legal provisions on the responsibility to participate in health insurance of subjects managed by the Ministry of National Defense and the Ministry of Public Security as prescribed in Points a, c, e, h and i, Clause 1, Points a, b, c, d, l and n, Clause 3, Point b, Clause 4, Article 12 of this Law.".

6. Amend and supplement Clauses 2 and 3, Article 8 as follows:

"2. People's Committees of provinces and centrally run cities, in addition to performing the responsibilities specified in Clause 1 of this Article, are responsible for directing the building of apparatus and resources to carry out state management of health insurance in the locality.

3. People's Committees of communes, wards and towns (hereinafter collectively referred to as Commune People's Committees) have the following responsibilities:

a) Carry out responsibilities specified in Clause 1 of this Article;

b) Prepare a list of health insurance participants for subjects in the area specified in Clauses 2, 3, 4 and 5, Article 12 of this Law according to households, except for subjects under the management authority of Ministries, branches, agencies and other units specified in Points a, b, c, d, l and n, Clause 3, Point b, Clause 4, Article 12 of this Law;

c) Making a list of requests for health insurance cards for children must be done at the same time as issuing birth certificates.".

7. Amend and supplement Article 9 as follows:

"Article 9. Health insurance implementing agency

1. The social insurance agency has the function of implementing health insurance regimes, policies and laws, managing and using health insurance funds.

2. The Government specifically regulates the functions, tasks, powers and organizational structure of the social insurance agency in organizing health insurance implementation.".

8. Amend and supplement Article 10 as follows:

"Article 10. Audit of health insurance fund

1. The State Audit, every three years, audits the health insurance fund and reports the results to the National Assembly; Carry out unexpected audits of the health insurance fund at the request of the National Assembly, the National Assembly Standing Committee, the President, the Government, and the Prime Minister.

2. Annually, the State Audit audits the content of organizational expenditures and health insurance activities when auditing the final settlement report of organizational expenditures and social insurance activities.".

9. Amend and supplement Clause 1, Article 11 as follows:

"1. Late payment, evasion of paying health insurance.".

10. Amend and supplement Article 12 as follows:

"Article 12. Subjects participating in health insurance

1. Groups paid or jointly paid by the employer or employee include:

a) Employees working under an indefinite-term labor contract or a definite-term labor contract with a term of 01 month or more, including cases where the employee and the employer agree by a different name but have content expressing paid employment, salary and management, administration and supervision of one party; enterprise managers, controllers, representatives of state capital, and representatives of enterprise capital according to the provisions of law; members of the Board of Directors, General Director, Director, members of the Supervisory Board or controllers and other elected management positions of cooperatives and unions of cooperatives according to the provisions of the Law on Cooperatives with salaries;

b) Enterprise managers, controllers, representatives of state capital, and representatives of enterprise capital according to the provisions of law; Members of the Board of Directors, General Director, Director, members of the Supervisory Board or controllers and other elected management positions of cooperatives and cooperative unions according to the provisions of the Law on Cooperatives do not receive salaries;

c) The employee is a foreign citizen working in Vietnam when working under a fixed-term labor contract with a term of 12 months or more with an employer in Vietnam, except in the case of a person moving within the enterprise according to the provisions of law on foreign workers working in Vietnam or at the time of signing the labor contract who has reached the retirement age as prescribed in Clause 2, Article 169 of the Labor Code or international treaties that the Republic of Vietnam has signed. Socialist Republic of Vietnam is a member with different regulations;

d) Employees working under an indefinite-term labor contract, a definite-term labor contract with a term of 01 full month or more, including cases where the employee and the employer agree by a different name but have content indicating paid employment, salary and management, administration, supervision of one party, agreement with the employer to work part-time, with monthly salary equal to or higher than the salary as a basis for insurance contributions. The lowest compulsory social insurance according to the provisions of law on social insurance;

d) The business household owner of a registered business household is subject to compulsory social insurance according to the provisions of law on social insurance;

e) Officials, civil servants and public employees;

g) Persons who operate part-time at the commune level according to the provisions of law;

h) Defense workers and officials serving in the army, police workers working in the people's police; other people working in the cipher organization specified in the Cipher Law;

i) Relatives of defense workers and officials serving in the military, relatives of police workers working in the People's Public Security are not subject to health insurance as prescribed in Points a, b, c, d, dd, e, g and h of this Clause, Clauses 2 and 3 of this Article.

2. Groups paid by social insurance agencies include:

a) People receiving monthly pension or disability allowance;

b) People who leave work receive monthly labor accident and occupational disease benefits; People who take leave to enjoy sickness benefits for employees who are sick on the list of diseases that require long-term treatment or employees who take leave to enjoy sickness benefits for 14 working days or more in a month according to the provisions of law on social insurance; People who take maternity leave for 14 working days or more in a month according to the provisions of law on social insurance;

c) Commune, ward, and town officials who have retired and are receiving monthly social insurance benefits;

d) People receiving unemployment benefits.

3. Groups paid by the state budget include:

a) People's army officers and professional soldiers on active duty; officers, professional non-commissioned officers and technical officers and non-commissioned officers working in the People's Public Security force; People who do cipher work are paid the same as soldiers;

b) Non-commissioned officers and soldiers of the People's Army on active duty; non-commissioned officers and soldiers on duty in the People's Public Security; Military cadets, police cadets, and cipher cadets who receive living expenses are Vietnamese;

c) Military students, police students, and cipher students receiving living expenses are foreigners;

d) Students training as reserve officers for 3 months or more have not yet participated in social insurance or health insurance;

d) Standing militia;

e) People with meritorious services to the revolution according to the provisions of the Ordinance on Preferential treatment for people with meritorious services to the revolution; veteran;

g) Current National Assembly deputies and People's Council deputies at all levels;

h) Children under 6 years old;

i) Relatives of martyrs and people who have contributed to nurturing martyrs according to the provisions of the Ordinance on Preferential treatment for people with meritorious services to the revolution;

k) Relatives of people with meritorious services to the revolution, spouses of martyrs married to other husbands or other wives who are receiving monthly death benefits and related individuals according to the provisions of the Ordinance on Preferential treatment of people with meritorious services to the revolution, except for the subjects specified in Point i of this Clause;

l) Relatives of the subjects specified in Points a and b of this Clause according to the provisions of law;

m) People who have donated human organs according to the provisions of law;

n) Foreigners studying in Vietnam are granted scholarships from the Vietnamese State budget;

o) People from poor households; Ethnic minorities from near-poor households residing in communes and villages in ethnic minority and mountainous areas; Ethnic minorities residing in areas with difficult socio-economic conditions; people residing in areas with particularly difficult socio-economic conditions; people living in island communes and island districts;

p) Commune, ward, and town officials who have quit their jobs and are receiving monthly benefits from the state budget;

q) People who have stopped receiving disability benefits and are receiving monthly benefits from the state budget;

r) People receiving monthly social benefits; People who are receiving monthly foster care allowance according to relevant laws; People who are receiving monthly death benefits and are eligible for social benefits;

s) People from full 75 years old or older are receiving monthly survivor benefits, people from full 70 years old to under 75 years old in near-poor households are receiving monthly survivor benefits;

t) People who are receiving monthly social pension benefits according to the provisions of law on social insurance;

u) Employees who are not eligible to receive pensions and are not old enough to receive social pension benefits are currently receiving monthly benefits according to the provisions of law on social insurance.

4. Groups supported by the state budget include:

a) People from near-poor households;

b) Pupils and students;

c) People participating in the force participating in protecting security and order at the facility;

d) People in households engaged in agriculture, forestry, fishery and salt production have an average standard of living according to the provisions of law;

d) Village health workers; village midwives;

e) People who work part-time in villages and residential groups according to the provisions of law;

g) Ethnic minorities living in communes determined to no longer be in areas with difficult or especially difficult socio-economic conditions will be supported by the state budget to pay health insurance according to Government regulations;

h) People awarded the title of People's Artist, Meritorious Artist according to the provisions of the Law on Cultural Heritage;

i) Victims according to the provisions of the Law on Prevention and Combat of Human Trafficking.

5. Self-paying health insurance groups include:

a) Household members participate in household health insurance;

b) People living and working, people being raised and cared for in charitable and religious organizations and establishments;

c) Employees on unpaid leave or labor contract suspension;

d) People who do not fall into the cases specified in Points a, b and c of this Clause.

6. Subjects other than those specified in Clauses 1, 2, 3, 4 and 5 of this Article according to the provisions of law and ordinance.

7. The Government regulates subjects other than those specified in Clauses 1, 2, 3, 4, 5 and 6 of this Article including:

a) Subjects participating in health insurance as prescribed by law before January 1, 2025;

b) Subjects other than those specified in Point a of this Clause after reporting to the National Assembly Standing Committee.".

11. Amend and supplement Article 13 as follows:

"Article 13. Health insurance premiums and responsibilities

1. The premium paid by the employer or paid by the employee or jointly paid is prescribed as follows:

a) The maximum monthly payment rate of the subjects specified in Points a, c, d and e, Clause 1, Article 12 of this Law is equal to 6% of the monthly salary, of which the employer pays two-thirds and the employee pays one-third;

b) The maximum monthly payment rate of the subjects specified in Point b, Clause 1, Article 12 of this Law is equal to 6% of the monthly salary as a basis for compulsory social insurance payment and is paid by the subjects;

c) The maximum monthly payment rate of the subjects specified in Point dd, Clause 1, Article 12 of this Law is equal to 6% of the monthly salary as a basis for compulsory social insurance payment and is paid by the subjects;

d) The maximum monthly payment rate of the subjects specified in Point g, Clause 1, Article 12 of this Law is equal to 6% of the reference rate, of which the employer pays two-thirds and the employee pays one-third;

d) The maximum monthly payment rate of the subjects specified in Point h, Clause 1, Article 12 of this Law is equal to 6% of the monthly salary and the payment responsibility is according to the Government's regulations;

e) The maximum monthly payment rate of the subjects specified in Point i, Clause 1, Article 12 of this Law is equal to 6% of the reference level and the payment responsibility is according to the Government's regulations.

2. The premium paid by the social insurance agency is prescribed as follows:

a) The maximum monthly payment rate of the subjects specified in Point a, Clause 2, Article 12 of this Law is equal to 6% of pension or disability allowance;

b) The maximum monthly payment rate of the subjects specified in Points b and c, Clause 2, Article 12 of this Law is equal to 6% of the reference rate;

c) The maximum monthly payment rate of the subjects specified in Point d, Clause 2, Article 12 of this Law is equal to 6% of unemployment benefits.

3. Contribution levels paid by the state budget and payment support levels are prescribed as follows:

a) The maximum monthly payment of the subjects specified in Point a, Clause 3, Article 12 of this Law is equal to 6% of the monthly salary and is paid by the state budget;

b) The monthly payment rate of the subjects specified in Points b, c, d, dd, e, g, h, i, k, l, m, o, p, q, r, s, t and u, Clause 3, Article 12 of this Law is at most 6% of the reference level and is paid by the state budget;

c) The monthly payment of the subjects specified in Point n, Clause 3, Article 12 of this Law is at most 6% of the reference level and is paid by the state budget through agencies, organizations, and scholarship-granting units;

d) The monthly payment rate of the subjects specified in Clause 4, Article 12 of this Law is at most 6% of the reference rate paid by the subjects themselves and is partially supported by the state budget.

4. The maximum monthly payment rate of the subjects specified in Clause 5, Article 12 of this Law is equal to 6% of the reference rate and is paid by the subjects according to their households or individual participants.

5. Determine the order of health insurance payment in case a person simultaneously belongs to many different health insurance participants as follows:

a) A person who simultaneously belongs to many different subjects participating in health insurance as prescribed in Article 12 of this Law shall pay health insurance according to the first subject that that person is determined in the order of subjects specified in Article 12 of this Law, except for the cases specified in Points c, d, dd, e and g of this Clause;

b) People who fall under the provisions of Points a, c, d, dd and e, Clause 1, Article 12 of this Law and have one or more labor contracts shall pay health insurance according to the labor contract as a basis for participating in compulsory social insurance;

c) People who are subject to the provisions at Point g, Clause 1, Article 12 of this Law and who are also participating in many different health insurance subjects specified in Article 12 of this Law, pay health insurance in the order of being paid by the social insurance agency, paid by the state budget, paid by the state budget supporting the payment level, and paid jointly by the subject and the commune-level People's Committee;

d) People who belong to the subjects specified in Points a and c, Clause 2, Article 12 of this Law and at the same time belong to many different health insurance participants specified in Article 12 of this Law, will participate according to the subjects paid by the social insurance agency;

d) People who belong to the subjects specified in Points s, t and u, Clause 3, Article 12 of this Law and also belong to many different health insurance participants specified in Article 12 of this Law, will participate according to the subjects paid by the state budget;

e) People who belong to the subjects specified in Points a, c, d, dd, e, g, h and i, Clause 4, Article 12 of this Law and also belong to the subjects specified in Point a, Clause 5, Article 12 of this Law may choose to participate in health insurance;

g) People belonging to many subjects who are supported by the state budget at the level of payment specified in Clause 4, Article 12 of this Law are selected to participate according to the subject with the highest level of support;

h) People who belong to the subjects specified in Points b and c, Clause 5, Article 12 of this Law and also belong to the subjects specified in Point a, Clause 5, Article 12 of this Law may choose to participate in health insurance in the form of households.

6. Household members specified in Point a, Clause 5, Article 12 of this Law who jointly participate in health insurance in the form of households during the fiscal year will have their contributions deducted as follows:

a) The first person contributes a maximum of 6% of the reference level;

b) The second, third, and fourth person pay 70%, 60%, and 50% of the first person's payment, respectively;

c) From the fifth person onwards, the payment is equal to 40% of the first person's payment.

7. The Government regulates the following contents:

a) Contribution level and payment support level specified in this Article;

b) Payment responsibilities, payment levels, and payment support levels for the subjects specified in Clauses 6 and 7, Article 12 of this Law.".

12. Amend and supplement Clauses 4 and 5, Article 14 as follows:

"4. For subjects not specified in Clauses 1, 2 and 3 of this Article, the basis for paying health insurance is the reference level.

5. The maximum monthly salary to calculate health insurance premiums is 20 times the reference level.".

13. Amend and supplement a number of clauses of Article 15 as follows:

a) Amend and supplement clauses 2, 3, 4 and 5 as follows:

"2. For enterprises, cooperative groups, cooperatives, cooperative unions, and business households operating in the fields of agriculture, forestry, fishery, and salt production that pay wages based on products or by contract, the payment method is monthly, every 3 months or every 6 months.

3. Every month, the social insurance agency pays health insurance according to the provisions of Clause 2, Article 13 of this Law into the health insurance fund.

4. Every quarter, agencies, organizations, and units granting scholarships pay health insurance according to the provisions of Point c, Clause 3, Article 13 of this Law to the health insurance fund.

5. Every quarter, the state budget transfers the health insurance payment and support payments according to the provisions of Points a, b and d, Clause 3, Article 13 of this Law into the health insurance fund.";

b) Add Clauses 7 and 8 after Clause 6 as follows:

"7. Subjects specified in Points b and dd, Clause 1, Article 12 of this Law pay the full amount of payment directly to the social insurance agency or through business households, enterprises, cooperatives, and cooperative unions participating in management by payment method every month, every 3 months or every 6 months.

8. The latest health insurance payment deadline for employers is specified as follows:

a) The last day of the following month for monthly payment method;

b) The last day of the next month immediately following the payment cycle for payment method every 03 months or every 06 months.".

14. Amend and supplement a number of clauses of Article 16 as follows:

a) Amend and supplement clause 1 and clause 2 as follows:

"1. Health insurance cards with health insurance codes are issued to health insurance participants and serve as a basis for enjoying health insurance benefits according to the provisions of this Law. Health insurance cards are issued in electronic and paper versions and have the same legal value.

2. Each person is only issued one health insurance code.";

b) Amend and supplement point c, clause 3 as follows:

"c) People participating in health insurance as prescribed in Clauses 4 and 5, Article 12 of this Law who participate in health insurance for the first time or have participated in health insurance according to one of the subjects specified in Article 12 of this Law but not continuously for 90 days or more, their health insurance card will be valid for use after 30 days from the date of full payment of health insurance;";

c) Amend and supplement Clause 5 as follows:

"5. Vietnam Social Insurance issues a sample health insurance card after obtaining the consensus of the Ministry of Health.".

15. Amend and supplement Article 17 as follows:

"Article 17. Issuance of health insurance cards

1. Documents for issuance of health insurance card are as follows:

a) Health insurance participation declaration of agencies, organizations, units, individuals, and households for first-time health insurance participants;

b) The list of health insurance participants of the subjects specified in Clause 1, Article 12 of this Law shall be drawn up by the employer within 30 days from the date the employee is eligible to participate in health insurance. In case health insurance participants are subjects specified in Points b and dd, Clause 1, Article 12 of this Law, they self-submit, the dossier is the declaration specified in Point a of this Clause, submitted to the social insurance agency within 30 days from the date of being determined to be eligible to participate in health insurance;

c) The list of health insurance participants of the subjects specified in Clauses 2, 3, 4 and 5, Article 12 of this Law is drawn up by the commune-level People's Committee by household, except for the subjects on the list specified in Points d and dd of this Clause;

d) List of health insurance participants of subjects managed by the Ministry of Education and Training, the Ministry of Labor, War Invalids and Social Affairs and other ministries and branches specified in Point n, Clause 3, Point b, Clause 4, Article 12 of this Law, prepared by educational institutions and vocational education institutions;

d) List of health insurance participants managed by the Ministry of National Defense and the Ministry of Public Security specified in Points a, c, e and h Clause 1, Points a, b, c, d, 1 and n Clause 3, Point b Clause 4 Article 12 of this Law and the list of subjects specified in Point i Clause 1 Article 12 of this Law prepared by the Ministry of National Defense and the Ministry of Public Security.

2. Within 05 working days from the date of receipt of complete documents specified in Clause 1 of this Article, the social insurance agency must issue a health insurance card to the health insurance participant and notify or hand over the card to the management agency or organization, and make a list of subjects.

3. The Government regulates the issuance of health insurance cards in paper and electronic copies.".

16. Amend and supplement Article 21 as follows:

"Article 21. Scope of benefits of health insurance participants

1. Health insurance participants have the following expenses paid by the health insurance fund:

a) Medical examination and treatment, including remote medical examination and treatment, remote medical examination and treatment support, family medicine medical examination and treatment, home medical examination and treatment, rehabilitation, periodic prenatal examination, and childbirth;

b) Transporting patients for subjects specified in Points a, b, c, d, dd, e, h, i, o and r, Clause 3, Article 12 of this Law who are undergoing inpatient or emergency treatment and must be transferred to a medical examination and treatment facility specified in Article 27 of this Law;

c) Expenses for using medical technical services, drugs, medical equipment, blood, blood products, medical gases, supplies, instruments, tools, and chemicals used in medical examination and treatment are within the scope of payment by the health insurance fund.

2. The Minister of Health stipulates the following contents:

a) Principles and criteria for building a list of drugs, principles for building a list of medical equipment and medical technical services within the scope of benefits of health insurance participants;

b) Issue a list of drugs, medical equipment, and medical technical services within the scope of benefits of health insurance participants based on the principles and criteria specified in Point a of this Clause;

c) Payment rate for drugs, medical equipment, and medical technical services within the scope of benefits of health insurance participants;

d) Levels, conditions and payment of drugs, medical equipment, medical technical services within the scope of benefits of health insurance participants;

d) Payment for blood, blood products, medical gases, supplies, instruments, tools, and chemicals used in medical examination and treatment falls within the scope of benefits of health insurance participants.

3. The Government regulates the following contents:

a) Payment of patient transportation costs specified in Point b, Clause 1 of this Article;

b) Scope of benefits of the subjects specified in Points a, b, c, d and dd, Clause 3, Article 12 of this Law;

c) Subjects who do not apply the payment rate specified in Point c, Clause 2 of this Article.".

17. Amend and supplement Article 22 as follows:

"Article 22. Health insurance benefits of health insurance participants

1. Health insurance participants who undergo medical examination and treatment according to the provisions of Articles 26 and 27 of this Law will have the medical examination and treatment costs paid by the health insurance fund within the scope of their benefits with the following benefits:

a) 100% of medical examination and treatment costs for subjects specified in Points a, b, c, d, dd, e, h, i, o, r and s, Clause 3, Article 12 of this Law. Medical examination and treatment costs outside the scope of health insurance coverage for subjects specified in Points a, b, c, d and dd, Clause 3, Article 12 of this Law are paid from the health insurance funding source for medical examination and treatment of this group of subjects; In case this funding source is not enough, it will be guaranteed by the state budget;

b) 100% of medical examination and treatment costs in cases where the cost for one medical examination and treatment is lower than the level prescribed by the Government;

c) 100% of medical examination and treatment costs at medical examination and treatment facilities at the primary medical examination and treatment level, including: medical stations; family medicine medical examination and treatment facilities; military-civilian medical station, military-civilian medical clinic; District-level medical centers with medical examination and treatment activities are licensed to operate as clinics; health agencies, units and organizations prescribed by the Minister of Health; medical examination and treatment establishments at the level of initial medical examination and treatment in the military and police as prescribed by the Minister of National Defense and the Minister of Public Security. 100% of outpatient medical examination and treatment costs at regional polyclinics;

d) 100% of medical examination and treatment costs when the patient has participated in health insurance for 5 consecutive years or more and has the amount of money to pay for medical examination and treatment costs during the year of medical examination and treatment visits as prescribed in Clause 3, Points a, b, c, dd and e Clause 4, Clause 5 of this Article, Article 26 and Article 27 of this Law is greater than 6 times the reference level;

d) 95% of medical examination and treatment costs for the subjects specified in Point a, Clause 2, Point k, Clause 3, Points a and g, Clause 4, Article 12 of this Law;

e) 80% of medical examination and treatment costs for other subjects.

2. People belonging to many subjects participating in health insurance are entitled to health insurance benefits according to the subject with the highest benefits.

3. People who register for initial medical examination and treatment covered by health insurance at specialized and basic level medical examination and treatment facilities when receiving medical examination and treatment at the wrong place of registration for initial health insurance medical examination and treatment due to a change in temporary residence or place of residence, will be examined and treated at a basic level medical examination and treatment facility appropriate to the new temporary residence or residence and will be paid by the health insurance fund according to the provisions of Clause 1 of this Article. The Minister of Health regulates the procedures and cases of stay to receive medical examination and treatment covered by health insurance as prescribed in this Clause.

4. Health insurance participants who self-go for medical examination and treatment at the wrong facility registered for medical examination and treatment under initial health insurance, or in contravention of the regulations on patient transfer specified in Articles 26 and 27 of this Law, except for the cases specified in Clauses 3 and 5 of this Article, will be paid by the health insurance fund according to the percentage of the benefit level specified in Clause 1 of this Article as follows:

a) 100% of benefits when medical examination and treatment at basic or specialized medical examination and treatment facilities in case of diagnosis and treatment of a number of rare diseases, dangerous diseases, diseases requiring surgery or using high technology as prescribed by the Minister of Health;

b) 100% of benefits for ethnic minorities and people from poor households living in areas with difficult socio-economic conditions, areas with extremely difficult socio-economic conditions, and people living in island communes and island districts when receiving inpatient medical examination and treatment at specialized level medical examination and treatment facilities;

c) 100% of benefits when medical examination and treatment at the primary medical examination and treatment facility;

d) 100% of benefits for inpatient medical examination and treatment at basic level medical examination and treatment facilities;

d) 100% of benefits for medical examination and treatment at basic and specialized medical examination and treatment facilities that, before January 1, 2025, have been determined by competent authorities to be district-level;

e) From 50% to 100% of the benefit level for outpatient medical examination and treatment at a basic level medical examination and treatment facility based on the results of technical and professional leveling according to the roadmap and specific benefit rate prescribed by the Government, except for the cases specified in Points a and dd of this Clause;

g) 40% of the benefit level for inpatient medical examination and treatment at an intensive level medical examination and treatment facility, except for the cases specified in Points a, b, dd and h of this Clause;

h) 50% of the benefit level for outpatient medical examination and treatment according to the roadmap prescribed by the Government and 100% of the benefit level for inpatient medical examination and treatment in case of medical examination and treatment at an intensive level medical examination and treatment facility that, before January 1, 2025, has been determined by a competent authority to be a provincial level.

5. Health insurance participants are entitled to 100% of the benefits specified in Clause 1 of this Article when medical examination and treatment at any medical examination and treatment facility in case of emergency.

6. The Government shall detail the benefit levels for the subjects specified in Points a, b, c, d and dd, Clause 3, Article 12 of this Law; regulate the benefit level for cases where health insurance participants use medical examination and treatment services upon request and other cases not specified in Clause 1 of this Article.".

18. Amend and supplement Clause 7 and Clause 8, Article 23 as follows:

"7. Treatment of strabismus and refractive errors of the eyes for people aged 18 years and older.

8. Using replacement medical equipment including artificial legs, artificial hands, artificial eyes, artificial teeth, eyeglasses, hearing aids, and mobility aids in medical examination, treatment and rehabilitation.".

19. Amend and supplement Article 24 as follows:

"Article 24. Medical examination and treatment facilities covered by health insurance

Health insurance medical examination and treatment facility is a medical examination and treatment facility according to the provisions of the Law on Medical Examination and Treatment that has signed a health insurance medical examination and treatment contract with the social insurance agency according to the Government's regulations. ".

20. Amend and supplement a number of points and clauses of Article 25 as follows:

a) Amend and supplement point e, clause 2 as follows:

"e) Conditions for changing, liquidating, suspending, terminating the contract.";

b) Amend and supplement clauses 3 and 4 as follows:

"3. The agreement on conditions for changing, liquidating, suspending, and terminating the contract specified in Point e, Clause 2 of this Article must ensure that it does not interrupt the medical examination and treatment of health insurance participants.

4. The Government shall detail this Article and prescribe the form of health insurance medical examination and treatment contract.".

21. Amend and supplement Article 26 as follows:

"Article 26. Registration of initial health insurance medical examination and treatment

1. Health insurance participants have the right to register for initial medical examination and treatment covered by health insurance at an initial or basic medical examination and treatment facility; has the right to change the initial medical examination and treatment facility covered by health insurance within the first 15 days of each quarter.

2. The allocation of the number of health insurance cards to establishments registering for medical examination and treatment covered by initial health insurance ensures balance, in accordance with the needs of medical examination and treatment covered by initial health insurance of the people, the response capacity of medical examination and treatment establishments and the actual capacity in the locality.

3. The Minister of Health shall detail Clauses 1 and 2 of this Article; Regulates cases of registration for initial medical examination and treatment covered by health insurance at specialized medical examination and treatment facilities.

4. The Minister of Public Security and the Minister of National Defense regulate the registration of initial medical examination and treatment under health insurance for initial, basic and specialized medical examination and treatment facilities and health insurance participants under their management authority.".

22. Amend and supplement Article 27 as follows:

"Article 27. Transfer of patients between medical examination and treatment facilities covered by health insurance

1. Patient transfer between medical examination and treatment establishments is carried out according to the professional requirements and ability of the medical examination and treatment establishment.

2. The Minister of Health regulates the transfer of patients to primary medical examination and treatment facilities covered by health insurance for treatment, management and monitoring of chronic diseases, including the use of drugs, medical equipment and medical technical services that have been prescribed and designated according to the professional capacity of the facility where chronic diseases are treated, managed and monitored; detailed regulations in Clause 1 of this Article, except for the cases specified in Clause 3 of this Article.

3. The Minister of Public Security and the Minister of National Defense regulate the transfer of patients under their management authority between medical examination and treatment facilities covered by health insurance under their management authority.".

23. Amend and supplement Article 28 as follows:

"Article 28. Procedures for medical examination and treatment covered by health insurance

1. Health insurance participants must present information about their health insurance card and documents proving their identity when undergoing medical examination and treatment; Children under 6 years old and people who have donated human organs who have not yet been issued a health insurance card must present other legal documents. In case of emergency, the patient must present information about the health insurance card and documents as prescribed in this clause before the end of treatment.

The Government regulates this clause in detail.

2. In case of re-examination according to professional requirements in medical examination and treatment, health insurance participants are scheduled for re-examination by the medical examination and treatment facility according to procedures prescribed by the Minister of Health.

3. In case of transferring a medical examination and treatment facility covered by health insurance according to professional requirements while providing inpatient treatment to a patient, the medical examination and treatment facility where the patient is transferred must have a dossier for transferring the medical examination and treatment facility according to the regulations of the Minister of Health.".

24. Amend and supplement Article 30 as follows:

"Article 30. Method of payment for medical examination and treatment costs covered by health insurance

1. Payment of medical examination and treatment costs covered by health insurance is made according to the following methods:

a) Payment according to capitation;

b) Payment according to service price;

c) Payment by diagnostic group.

2. The Government shall detail Clause 1 of this Article and prescribe the application of payment methods for medical examination and treatment costs covered by health insurance.".

25. Amend and supplement Article 31 as follows:

"Article 31. Payment of medical examination and treatment costs covered by health insurance

1. The social insurance agency pays medical examination and treatment costs covered by health insurance with medical examination and treatment facilities according to health insurance medical examination and treatment contracts.

2. The social insurance agency pays medical examination and treatment costs covered by health insurance directly to health insurance card holders when examining and treating diseases in the following cases:

a) At a medical examination and treatment facility without a medical examination and treatment contract with health insurance;

b) Medical examination and treatment not in accordance with the provisions of Article 28 of this Law;

c) Other special cases prescribed by the Government.

3. In case at the time the patient is prescribed to use drugs, medical equipment or para-clinical services within the coverage of the health insurance fund, but medical examination and treatment facilities are not available and cannot be replaced with other drugs, medical equipment, or para-clinical services, the medical examination and treatment facility may receive drugs and medical equipment transferred from other health insurance-covered medical examination and treatment facilities to treat the patient, and may transfer the patient or medical samples to the facility. otherwise qualified to perform paraclinical services.

The medical examination and treatment facility covered by health insurance that receives drugs, medical equipment, transfers patients or patient samples summarizes the costs of these drugs, medical equipment or paraclinical services and makes payments to the social insurance agency.

4. The Government regulates the following contents:

a) Conditions and authority to decide on cases of receiving drugs and medical equipment transferred from other health insurance covered medical examination and treatment facilities to treat patients and payment of costs of transferred drugs and medical equipment specified in Clause 3 of this Article;

b) Manage and use funds for medical examination and treatment covered by health insurance, assessment and payment, settlement of medical examination and treatment costs covered by health insurance for subjects specified in Points a, b, c, d and dd, Clause 3, Article 12 of this Law;

c) Payment and finalization of medical examination and treatment costs with health insurance appropriate to subjects belonging to the people's armed forces and people in border areas, islands, villages and communes are particularly difficult to ensure national defense and security policies.

5. The Government stipulates in detail points a and b, clause 2, clause 3 of this Article, except for the cases specified in clause 4 of this Article.".

26. Amend and supplement Article 32 as follows:

"Article 32. Advance, payment, settlement of medical examination and treatment costs covered by health insurance

1. The advance payment of funds by the social insurance agency to medical examination and treatment facilities covered by health insurance is carried out quarterly as follows:

a) Within 05 working days from the date of receipt of the previous quarterly settlement report of the medical examination and treatment facility, the social insurance agency shall make a one-time advance equal to 90% of the medical examination and treatment costs covered by health insurance according to the previous quarterly settlement report of the medical examination and treatment facility;

b) For medical examination and treatment facilities that sign a health insurance medical examination and treatment contract for the first time, based on the medical examination and treatment costs of the month before signing the health insurance medical examination and treatment contract, the social insurance agency shall advance 90% of the health insurance medical examination and treatment costs for the first month of contract implementation; After one month of implementing the contract, the social insurance agency estimates and advances 90% of the medical examination and treatment costs covered by health insurance in the quarter according to the provisions of Point a of this Clause;

c) In case the advance funding for medical examination and treatment facilities covered by health insurance in the province exceeds the amount of funding used in the quarter, the social insurance agency of the province or centrally run city reports to Vietnam Social Insurance to supplement funding.

2. Payment and settlement between medical examination and treatment facilities and social insurance agencies are carried out as follows:

a) Within the first 15 days of each month, the health insurance medical examination and treatment facility is responsible for sending a summary of the request for payment of health insurance medical examination and treatment costs of the previous month to the social insurance agency; Within the first 15 days of each quarter, medical examination and treatment facilities covered by health insurance are responsible for sending a final report on medical examination and treatment costs covered by health insurance for the previous quarter to the social insurance agency;

b) Within 30 days from the date of receipt of the previous quarterly settlement report of the medical examination and treatment facility, the social insurance agency is responsible for notifying the assessment results and the settlement number of medical examination and treatment costs covered by health insurance, including actual medical examination and treatment costs within the scope of health insurance benefits and levels of the medical examination and treatment facility. For the fourth quarter of the year, the time limit for notification of assessment results and settlement of medical examination and treatment costs covered by health insurance is no more than 60 days from the date the social insurance agency receives the fourth quarter settlement report of the medical examination and treatment facility;

c) Within 10 days from the date of notification of the final settlement of medical examination and treatment costs covered by health insurance, the social insurance agency must complete the payment with the medical examination and treatment facility;

d) The appraisal of the annual settlement of the health insurance fund must be done before October 1 of the following year.

3. Within 40 days from the date of receiving complete payment request documents from the health insurance participant in the case specified in Clause 2, Article 31 of this Law, the social insurance agency must pay the medical examination and treatment costs covered by health insurance directly to this subject.".

27. Amend and supplement Article 35 as follows:

"Article 35. Allocation and use of health insurance fund

1. The health insurance fund is allocated and used as follows:

a) 92% of health insurance premiums are for medical examination and treatment;

b) 8% of the health insurance premium is reserved for the reserve fund, organizational expenses and health insurance operations, of which at least 4% of the health insurance premium is reserved for the reserve fund.

2. The investment of temporarily idle money of the health insurance fund is subject to the provisions of the Social Insurance Law on principles, categories, investment methods and management of social insurance fund investment activities.

3. In case the amount of health insurance revenue for medical examination and treatment is greater than the amount of medical examination and treatment expenditure in the year, the unused portion of the budget shall be fully accounted for in the reserve fund for general regulation.

4. In case the amount of health insurance revenue for medical examination and treatment is smaller than the amount of medical examination and treatment expenditure in the year, Vietnam Social Insurance is responsible for supplementing it from the reserve fund.

5. The Government shall detail this Article and regulations on the organization and operation of health insurance.".

28. Amend and supplement Clause 2, Article 36 as follows:

"2. To register as a medical examination and treatment facility covered by initial health insurance according to the provisions of Article 26 of this Law.".

29. Amend and supplement Clause 3, Article 39 as follows:

"3. Deliver the card or notify the result of issuance of health insurance card to the health insurance participant within 03 working days from the date of receiving the card or receiving notice of the result of issuance of health insurance card from the social insurance agency.".

30. Amend and supplement Clause 2, Article 40 as follows:

"2. Check the implementation of health insurance medical examination and treatment contracts; health insurance appraisal; revocation and temporary seizure of health insurance cards in the cases specified in Article 20 of this Law.".

31. Amend and supplement Clause 8, Article 41 as follows:

"8. Check the implementation of health insurance medical examination and treatment contracts; Health insurance appraisal.".

32. Add Clause 9 after Clause 8, Article 43 as follows:

"9. Ensure eligibility for health insurance medical examination and treatment activities according to the provisions of the law on health insurance, the law on medical examination and treatment and according to the health insurance medical examination and treatment contract.".

33. Add Article 48a and Article 48b after Article 48 as follows:

"Article 48a. Late payment of health insurance

Late payment of health insurance is an act of the employer in one of the following cases:

1. Have not paid or have not paid the full amount of health insurance premium from the latest health insurance payment date specified in Clause 8, Article 15 of this Law, except for the case specified in Point c, Clause 1, Article 48b of this Law;

2. Failure to make a list or making an incomplete list of the number of people who must participate in health insurance within 60 days from the expiration date as prescribed in Point b, Clause 1, Article 17 of this Law;

3. Falling into a case that is not considered evasion of paying health insurance according to the provisions of Clause 2, Article 48b of this Law.

Article 48b. Avoid paying health insurance

1. Evasion of paying health insurance is an act of the employer in one of the following cases:

a) After 60 days from the expiration date specified in Point b, Clause 1, Article 17 of this Law, the employer does not make a list or makes an incomplete list of the number of people required to participate in health insurance;

b) Register a salary as a basis for paying health insurance that is lower than the salary specified in Article 14 of this Law;

c) Failure to pay or incomplete payment of the amount registered for health insurance after 60 days from the date of payment of health insurance at the latest as prescribed in Clause 8, Article 15 of this Law and has been urged by a competent agency according to the Government's regulations;

d) Other cases are considered evasion of paying health insurance according to Government regulations.

2. The Government shall detail this Article; stipulates that cases falling under Clause 1 of this Article but having a legitimate reason are not considered evasion of paying health insurance.".

34. Amend and supplement Article 49 as follows:

"Article 49. Handling of violations of the law on health insurance

1. Agencies, organizations and individuals that violate the law on health insurance will, depending on the nature and severity of the violation, be disciplined, administratively sanctioned or prosecuted for criminal liability. If causing damage, they must compensate in accordance with the law.

2. Measures to handle late payment of health insurance include:

a) Compulsory payment of late payment interest in full; Pay an amount equal to 0.03%/day calculated on the amount of late payment of health insurance and the number of days of late payment to the health insurance fund;

b) Penalties for administrative violations according to the provisions of law;

c) Not considering emulation titles and forms of reward.

3. Measures to handle the act of evading health insurance payments include:

a) Compulsory payment in full of the missed payment amount; Pay an amount equal to 0.03%/day calculated on the amount of health insurance evasion and the number of days of evasion of payment to the health insurance fund;

b) Penalize administrative violations or prosecute criminal liability according to the provisions of law;

c) Not considering emulation titles and forms of reward.

4. Agencies, organizations, and employers who delay or evade payment of health insurance for employees must refund all medical examination and treatment costs within the scope of health insurance benefits and benefits that the employee has paid while not having a health insurance card due to delay in payment or evasion of health insurance payment.

5. The Government shall detail point a, clause 2, point a, clause 3 and clause 4 of this Article.".

35. Replace phrases at some of the following points and clauses:

a) Replace the phrase "health insurance organization" with the phrase "social insurance agency" in Clause 3 and Clause 6 Article 2, Clause 2 and Clause 4 Article 7c, Clause 3 Article 18, Clause 3 Article 19, Clause 1 Article 25, Clause 3 Article 29, Clause 1 Article 34, Clause 4 and Clause 5 Article 36, Clause 4 Article 37, Clause 1 Article 38, Clause 4, Article 39, Article name and Clause 5, Article 40, Article 41 name, Clause 1 and Clause 2, Article 42, Clauses 2, 3 and 4, Article 43, Clause 1, Article 44, Point c, Clause 1, Article 48;

b) Replace the phrase "Vietnam Social Insurance Management Council" with the phrase "Social Insurance Management Council" in Clause 1, Article 34.

Article 2. Amendments and supplements to the Law on Forces participating in protecting security and order at grassroots levels No. 30/2023/QH15

Abolish Clause 2, Article 32 of the Law on Forces participating in protecting security and order at facilities No. 30/2023/QH15.

Article 3. Implementation provisions

1. This Law takes effect from July 1, 2025, except for the provisions in Clauses 2 and 3 of this Article.

2. Regulations related to levels of technical expertise in medical examination and treatment, registration of initial health insurance medical examination and treatment, patient transfer between health insurance medical examination and treatment facilities, and health insurance medical examination and treatment procedures in Clauses 3, 16, 17, 21, 22, 23 and 28, Article 1 of this Law take effect from January 1, 2019. 2025.

3. Regulations on the scope of benefits in Clause 16, Article 1 of this Law, except for regulations on remote medical examination and treatment, support for remote medical examination and treatment, family medicine medical examination and treatment, medical examination and treatment at home and principles for building a list of medical equipment and technical services within the scope of benefits of health insurance participants and regulations on benefit levels in Clause 17, Article 1 of this Law apply to the following cases. This is effective from January 1, 2025:

a) Subjects specified in Clause 10, Article 1 of this Law that have been specified in Article 12 of the Law on Health Insurance No. 25/2008/QH12, which has been amended and supplemented with a number of articles according to Law No. 32/2013/QH13, Law No. 46/2014/QH13, Law No. 97/2015/QH13, Law No. 35/2018/QH14, Law No. 68/2020/QH14 and Law No. 30/2023/QH15,

b) Subjects specified in Point a of this Clause receive medical examination and treatment at medical examination and treatment facilities before January 1, 2025 and end the treatment period from January 1, 2025.

4. No later than January 1, 2027, carry out interoperability and use of paraclinical results between medical examination and treatment facilities covered by health insurance in accordance with professional requirements according to Government regulations.

5. Transitional regulations:

a) In case a patient is not subject to the provisions of Points a and b, Clause 3 of this Article, medical examination and treatment at a medical examination and treatment facility before July 1, 2025 and the treatment period ends from July 1, 2025, the provisions of this Law shall apply;

b) The reference level specified in this Law applies to the base salary. In case the salary policy changes, the Government decides the specific reference level;

c) Health insurance medical examination and treatment contracts signed before July 1, 2025 but still valid after July 1, 2025 are implemented in accordance with the Government's regulations;

d) For the amount of health insurance that the employer is responsible for paying according to the provisions of Health Insurance Law No. 25/2008/QH12, which has been amended and supplemented with a number of articles according to Law No. 32/2013/QH13, Law No. 46/2014/QH13, Law No. 97/2015/QH13, Law No. 35/2018/QH14, Law No. 68/2020/QH14 and Law No. 30/2023/QH15 but by the end of June 30, 2025, if you do not pay or do not pay in full, it will be handled according to the provisions on late payment of this Law.

This Law was passed by the 15th National Assembly of the Socialist Republic of Vietnam, 8th session, on November 27, 2024.

CHAIRMAN OF THE NATIONAL ASSEMBLY

(Signed)

Tran Thanh Man