From 1^st January 2023, the Decision No. 3618/QĐ-BHXH of Viet Nam Social Security (VSS) has introduced new regulations on the process of HI claim review.

To implement parallel 2 forms for the new process of HI claim review from 1^st January 2023

According to this Decision, the subjects of application would be VSS Offices at all levels and organizations and individuals involved in medical examination and treatment activities covered by HI.

Decision No. 3618/QD-BHXH has specifically guided two forms of claim review carried out in parallel, including proactive claim review (this is directly performed by the VSS Offices); Automatic claim review (this is a form to use software to check information in electronic data).

In addition, the new process of claim review also guides in detail the claim review of costs of medical examination and treatment covered by HI in three forms: data-based; records, documents and direct payment.

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The registration of buying HI card at home

According to the Decision No. 3510/QĐ-BHXH in 2022 (would take effect from 1^st January 2023) of VSS, the case of only enrolling in HI, including the first registration, continuing to pay HI premiums, changing from another group to a group supported by the state budget, or participating according to households, the following procedures can continue to register to pay and issue HIcards on the National Public Service Portal.

From 1^st January 2023, people can buy HI cards on the National Public Service Portal.

Therefore, from 1^st January 2023, people can register to buy HI cards and pay HI premiums at home through the National Public Service Portal instead of coming directly to VSS Offices.

However, the Article 2 of Decision No. 3510/QD-BHXH stipulates that the online HI registration feature on the National Public Service Portal is only applicable to HI participants who are eligible for state budget support for HI premiums; people belonging to near-poor households, multidimensionally poor households, households engaged in agriculture, forestry, fishery and salt production with average living standards; participants in household HI.

The correction of direction on subjects that participate household HI

Article 37 of the Law on Residence 2020 has revised the term of households participating in HI in the Law on HI 2008, amended and supplemented in 2014 with the following definition: "Household participating in health insurance (hereinafter referred to as household) are those who jointly register for permanent residence or jointly register for temporary residence at a lawful place of residence in accordance with the law on residence."

To ensure consistency, the Government issued Decree 104/2022/ND-CP amending regulations on groups of subjects participating in household HI, including those whose names are in the same household with regular registration of residence; people named in the same household register for temporary residence; people with dignitaries, positions, monks; people living in social protection establishments without state budget support to pay HI.

Receiving HI cards for relatives without carrying household registration book

According to Clause 3, Article 38 of the Law on Residence 2020, the issued household registration books and temporary residence books can only be used until December 31, 2022. From 1^st January 2023, these two types of books are no longer valid. Accordingly, the Government has issued Decree 104/2022/ND-CP adjusting some procedures related to HI after removing the household registration book.

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Specifically, in Section 4, the guidance part of Form No. 4 issued together with Decree 146/2018/ND-CP, Decree 104 has removed the phrase "copy of household registration book" from among the documents that the applicant to receive results instead must present in order to prove the relationship as personal or guardian to the person who is issued with the HI card. Thus, in case relatives or guardians go to receive results on their behalf, they must present an appointment letter; Identity card/Citizen identity card; Papers proving family relationship, including copy of birth certificate or birth certificate or Marriage certificate or Certificate of residence or Notice of personal identification number and citizen information in the National Database on population or decision to recognize guardianship.