Guidance for Health Insurance card issuance, replacement and benefit settlement for card holders

29/01/2019 09:05 AM


Recently, Vietnam Social Security (VSS) has given instructions to ensure health insurance (HI) benefits for HI card holders, complying with the provisions of Decree No. 146/2018/ND-CP dated October 17, 2018 of the Government detailing and guiding the implementation of some articles of the HI Law and other documents guiding the implementation of HI scheme. Details are as follows:

HI card issuance and replacement

The VSS provincial offices coordinate with the HI participants’ management units to identify those whom have to change their HI identification number (ID) and benefit code according to the provisions of Decree No. 146/2018/ND-CP. After that, the VSS offices update the participants’ data in VSS professional software, printing and granting HI cards promptly to the HI participants.

Benefit settlement for HI card holders

In case the patient was admitted to the hospital before December 1st 2018 and discharged from the hospital from December 1st 2018 onwards, or the patient was treated at the hospital from December 1st 2018, they are entitled to HI benefits as prescribed by the HI Law and Article 14 of Decree No. 146/2018/ND-CP, specifically as follows:

- In case the patient has been granted, changed a new HI card or changed their ID, benefit code (showed on the HI Database System): they are entitled to new HI benefits from the date their new card is valid.

- In case the patient has not been granted, changed a new HI card or not changed their ID, benefit code on the HI Database System: they are entitled to the recent HI benefits for the entire treatment.

The healthcare providers are required to look up the HI card data of their patients on the HI Database System to provide suitable HI benefits as instructed.

VSS payment of bed fee at inter polyclinics

The VSS provincial offices pay the bed fee for patients at inter polyclinics as guided in Clause 4, Article 4 of the Circular No. 39/2018/TT-BYT dated November 30th 2018 of the Ministry of Health unifying prices of medical examination and treatment services covered by HI among hospitals of the same class nationwide and guidelines for applying prices, payments of healthcare services in certain case, specifically as follows:

- For inter polyclinics which have been granted a hospital operation license: applying the price of a Grade IV hospital from the date of being granted a hospital operation license.

- For inter polyclinics in mountainous and/or remote areas, which have been established and operated before November 12th 2018, are permitted by the provincial People's Committees to perform inpatient treatment as stipulated in Clause 12, Article 11 of Decree No. 155/2018/ND-CP dated November 12, 2018 of the Government amending and supplementing some regulations related to business conditions under state management of the Ministry of Health: Payment will only be made at the rate of hospital in Grade IV as specified in Appendix II of Circular No. 39/2018/TT-BYT from December 15th 2018.

 

 

Vietnam Social Security