• DETAIL
Name Health insurance-covered medical care
Type Health Insurance
Fields Implementation of health insurance policies
Implementing Agency Provincial- and district-level health insurance agencies
Public date
Step by step

1. Step 1: For persons seeking medical care services: - A health insurance card holder seeking medical care services shall produce his/her health insurance card stuck with his/her photo; a card without a photo must be produced together with a valid written proof of personal identity stuck with a photo granted by a competent agency. Besides, other papers must be additionally produced (specified in dossier components), depending on each case. - In case of emergency, in order to fully enjoy health insurance benefits at the medical examination and treatment establishment, a patient shall produce his/her health insurance card together with a valid paper stuck with a photo before he/she is discharged from hospital. 2. Step 2: For medical examination and treatment establishments To receive and examine the validity of papers produced by patients; in case of eligibility, to permit the patients to enjoy health insurance benefits right at medical examination and treatment establishments.

Process

At health insurance-covered medical examination and treatment establishments

Profile component

1. For those who seek medical care services at the primary medical care registration places indicated in their health insurance cards - A valid health insurance card (the original); - To produce one of the following valid personal identity papers stuck with a photo, which is granted by a competent agency: people’s identity card, passport, Party membership card, people’s security card, soldier’s card, trade union membership card, pupil’s card, student’s card, veteran’s card, driver’s license or another valid paper stuck with photo. - For an under-6 child seeking medial care services, to produce his/her health insurance card; in case the child is not yet granted a health insurance card, to produce his/her birth certificate or written certification of birth; in case the child must undergo treatment right after birth but is not yet granted written certification of birth, the head of the medical examination and treatment establishment and his/her father (mother) or guardian shall sign in his/her medical record for settlement with the health insurance agency. - For a body organ donor who is not yet granted health insurance card, to produce the hospital discharge paper issued upon release from hospital after organ donation. - Pending re-grant or renewal of their health insurance cards, the insured who seek medical care services shall produce written dossier receipts-and-result return appointments issued by social insurance agencies (made according to Form No. 01 issued together with the Vietnam Social Security’s Decision No. 999/QD-BHXH of September 24, 2015), which must contain all information as indicated in the insured’s card. Such a written dossier receipt-and-result return appointment shall be valid for 7 days from the date of issuance and must be signed and sealed by the director of a provincial- or district-level social insurance agency; - To additionally produce the written certification of share of cost in the year made according to Form No. 05/BHYT issued together with the Vietnam Social Security’s Decision No. 1399/QD-BHXH in order to be eligible for cost-share exemption in the year when seeking medical care service at health insurance-covered medical examination and treatment establishments of proper levels (if any). 2. Other cases In addition to the papers prescribed at Point 1 above, the following papers must be produced, depending on each case: - In case of transferal to a higher-level medical examination and treatment establishment according to the Ministry of Health’s regulations: A transferal paper as prescribed in Appendix 01 to Circular No. 14/2014/TT-BYT-BTC; - In case of re-examination at the request of a higher-level health insurance-covered medical examination and treatment establishment not through the primary medical care registration place: The medical examination and treatment establishment’s notice of re-examination appointment (higher-level medical examination and treatment establishments may write down the request for re-examination on hospital discharge papers or medical examination booklets) (the original). Each notice of appointment shall be valid for one use within the time limit stated therein. - For a health insurance card holder who is on a working trip, does a mobile job, attends a concentrated training course or temporarily resides (not in the state of emergency), he/she may receive primary medical care at a medical examination and treatment establishment of the same or equivalent level with the health establishment indicated in his/her card and shall produce one of the following documents: working trip paper, decision on sending to study or temporary residence registration paper (the original or copy).

Number of records 01
Term of settlement

Immediate processing

Unit Health insurance card holders
Fee None
Form

None No attached file


No attachment
Requirements

None

Legal

- Document No. 01/VBHN-VPQH of July 10, 2014, consolidating the Law on Health Insurance which takes effect on January 1, 2015. - The Government’s Decree No. 105/2014/ND-CP of November 15, 2014, detailing and guiding a number of articles of the Law on Health Insurance. - Joint Circular No. 41/2014/TTLT-BYT-BTC of November 24, 2014, of the Ministry of Health and the Ministry of Finance, guiding the implementation of health insurance. - Decision No. 1399/QD-BHXH of December 22, 2014, of the Director of Vietnam Social Security, organizing the implementation of health insurance in medial examination and treatment. - Decision No. 1018/QD-BHXH of October 10, 2014, of the Director of Vietnam Social Security, amending a number of contents of decisions promulgating the regulations on management of health insurance-related receipts and expenditures. - Decision No. 999/QD-BHXH of September 24, 2015, of the Vietnam Social Security, promulgating the regulation on dossier receipt, processing and result return of administrative procedures on social insurance, health insurance and unemployment insurance.

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