LUAT BHYT - SONG NGU VIET ANH.pdf

8/11/2019 LUAT BHYT - SONG NGU VIET ANH.pdf

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Bn dch khng chnh thcUnofficial copy

LUTBO HIM Y T

CA QUC HI KHA XII, KHP THTS25/2008/QH12 NGY 14 THNG 11 NM 2008

LAWON SOCIAL HEALTH INSURANCE

FROM THE 4THMEETING OF XIITHNATIONAL ASSEMBLY

NO.25/2008/QH12 ON NOV 14, 2008

Cn cHin php nc Cng ha x hi chngha Vit Nam nm 1992 c sa i, b

sung theo Nghquyt s51/2001/QH10;

Pursuant to the 1992 Constitution of the Socialist Republic of Vietnam, which was amended

and supplemented under Resolution No.51/2001/QH10;Quc hi ban hnh Lut bo him y t.

National Assembly promulgate this Law on social health insurance

CHNG I NHNG QUY NH CHUNG

CHAPTER I GENERAL PROVISIONS

iu 1. Phm vi iu chnh v i tng p dng

Article 1. Regulation scope and subjects of application

1. Lut ny quy nh vch, chnh sch bo him y t, bao gm i tng,

mc ng, trch nhim v phng thc ng bo him y t; thbo him y t;

phm vi c hng bo him y t; tchc khm bnh, cha bnh cho ngi

tham gia bo him y t; thanh ton chi ph khm bnh, cha bnh bo him y t;

qubo him y t; quyn v trch nhim ca cc bn lin quan n bo him y

t.

1. This Law provides the social health insurance regime and policies including

the coverage, premiums rates, resposibilities and methods contribution; social

health insurance card; scope of social health insurance benefits; medical care

for insureds; payment for medical care fees under scope of social health

insurance benefits; social health insurance fund; rights and responsibilities of

parties involved in social health insurance.

2. Lut ny p dng i vi t chc, c nhn trong nc v tchc, c nhn

nc ngoi ti Vit Nam c lin quan n bo him y t.

2. This Law applies to domestic and overseas individuals, organizations in

Vietnam that are involved in social health insurance.

3. Lut ny khng p dng i vi bo him y tmang tnh kinh doanh.

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


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iu 2. Gii thch tng

Article 2. Difinitions

Trong Lut ny, cc tngdi y c hiu nhsau:

In this Law, the following terms shall be construed as follows:

1. Bo him y t l hnh thc bo him c p dng trong lnh vc chm scsc khe, khng v mc ch li nhun, do Nh nc tchc thc hin v cc

i tng c trch nhim tham gia theo quy nh ca Lut ny.

1. Social health insurancemeans a kind of insurance applying in medical care

sector, non profits goal, organize by State and participants must take the

provisions of this Law.

2. Bo him y t ton dn l vic cc i tng quy nh trong Lut ny u

tham gia bo him y t.

2. Universal Coveragemeans all of participants stipulated in this Law shall be

covered by this Law.

3. Qubo him y tl quti chnh c hnh thnh tngun ng bo him y

tv cc ngun thu hp php khc, c sdng chi trchi ph khm bnh,

cha bnh cho ngi tham gia bo him y t, chi ph qun l bmy ca tchc

bo him y tv nhng khon chi ph hp php khc lin quan n bo him y

t.

3. Social Health Insurance Fund means a financial fund is established by

collected premiums and other revenues of lawful sources, paying for medical

care costs of the insureds, spending for administrative management of social

health insurance organizations and other lawful charges.

4.Ngi sdng lao ngbao gm cquan nh nc, n vsnghip cng

lp, n vv trang nhn dn, t chc chnh tr, t chc chnh tr - x hi, t

chc chnh trx hi - nghnghip, tchc x hi, tchc x hi - nghnghip,

doanh nghip, hp tc x, hkinh doanh c thv tchc khc; tchc nc

ngoi, t chc quc thot ng trn lnh thVit Nam c trch nhim ng

bo him y t.

4. Employers involves state bodies, state units, security services, polictical

organizations, social-polictical organizations, societies, professional

associations, entrepreneur, cooperatives, business individuals and other

organizations; foreign organizations, international organizations operating in

Vietnam land responsible for contributing premium.

5. Cskhm bnh, cha bnh bo him y tban ul cskhm bnh, cha

bnh u tin theo ng k ca ngi tham gia bo him y tv c ghi trong

thbo him y t.

5. Primary health care providermeans a health care establishment is chosen by

the insured and is shown on his/her social health insurance card.


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6. Gim nhbo him y tl hot ng chuyn mn do tchc bo him y t

tin hnh nhm nh gi shp l ca vic cung cp dch v y t cho ngi

tham gia bo him y t, lm csthanh ton chi ph khm bnh, cha bnh

bo him y t.

6. Social health insurance assessmentmeans a professional work is performed by

social health insurance organizations to assess the services of providers for the

insureds and those services shall be paid on the basic of the assessment.

iu 3. Nguyn tc bo him y t

Article 3. Priciples of social health insurance

1. Bo m chia sri ro gia nhng ngi tham gia bo him y t.

1. Assure the sharing among the risk of social health insurance participants.

2. Mc ng bo him y tc xc nh theo tlphn trm ca tin lng,tin cng, tin lng hu, tin tr cp hoc mc lng ti thiu ca khu vc

hnh chnh (sau y gi chung l mc lng ti thiu).

2. Social health insurance contribution shall be difined by percentage of, salary,

remuneration, old-age pension, allowances, minimum salary of administrative

sector (hereinafter refer as minimum salary).

3. Mc hng bo him y ttheo mc bnh tt, nhm i tng trong phm

vi quyn li ca ngi tham gia bo him y t.

3. The level of social health insurance entitlement depends on the participantgroup, extent of diseases involved in scope of social health insurance benefits.

4. Chi ph khm bnh, cha bnh bo him y tdo qubo him y tv ngi

tham gia bo him y tcng chi tr.

4. Social health insurance expenditures shall be co-paid by social health

insurance fund and the insureds

5. Qubo him y tc qun l tp trung, thng nht, cng khai, minh bch,

bo m cn i thu, chi v c Nh nc bo h.

5. The social health insurance fund shall be managed in a concentrate, uniform,

open and transparent manner, be assured in a balance of collecting and

spending account, and be protected by State.

iu 4. Chnh sch ca Nh nc vbo him y t

Article 4. State policies on social health insurance

1. Nh nc ng hoc h tr tin ng bo him y tcho ngi c cng vi

cch mng v mt snhm i tng x hi.

1. The State shall pay or support premiums to the merit and some social groups


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2. Nh nc c chnh sch u i i vi hot ng u ttqubo him y t

bo ton v tng trng qu. Ngun thu ca quv s tin sinh li thot

ng u ttqubo him y tc min thu.

2. The State shall adopt preferential policies of investment in social health

insurance fund to preserve and grow the fund. The collected premiums and the

revenues from activities investment of social health insurance fund are tax free.

3. Nh nc to iu kin tchc, c nhn tham gia bo him y thoc ng

bo him y tcho cc nhm i tng.

3. The State shall create conditions for individuals and organizations to

participate in social health insurance or to pay premium for some participant

groups.

4. Nh nc khuyn khch u tpht trin cng nghv phng tin kthut

tin tin trong qun l bo him y t.4. The State shall encourage investment in development of technologies and

advanced technical equipments in social health insurance management.

iu 5. Cquan qun l nh nc vbo him y t

Article 5. State management agencies in charge of social health insurance

1. Chnh phthng nht qun l nh nc vbo him y t.

1. The Government shall perform the uniform state management of social health

insurance.

2. BY tchu trch nhim trc Chnh phthc hin qun l nh nc vbo

him y t.

2. The Ministry of Health shall take responsibility on behalf of the Government

for performing the state management of social health insurance.

3. B, cquan ngang btrong phm vi nhim v, quyn hn ca mnh phi hp

vi BY tthc hin qun l nh nc vbo him y t.

3. Ministries, ministerial-level agencies shall, within the ambit of their

respective tasks and powers, cooperate Ministry of Health performing the state

management of social health insurance.

4. Uban nhn dn cc cp trong phm vi nhim v, quyn hn ca mnh thc

hin qun l nh nc vbo him y tti a phng.

4. People's Committees at all levels shall, within the ambit of their respective

tasks and powers, perform the state management of social health insurance

within their localities.

iu 6. Trch nhim ca BY tvbo him y t

Article 6. Responsibilities of Ministry of Health for social health insurance


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Chtr, phi hp vi cc b, cquan ngang b, cquan, tchc c lin quan thc hin

nhim vsau y:

Chair, cooperate with ministries, ministries-level agencies, related bodies,

organizations performing the tasks as follows:

1. Xy dng chnh sch, php lut vbo him y t, tchc hthng y t, tuyn

chuyn mn kthut y t, ngun ti chnh phc vcng tc bo v, chm sc vnng cao sc khe nhn dn da trn bo him y tton dn;

1. Elaborate the legislation, policies on social health insurance; organize the

healthcare systems, the technical and professional healthcare line, the financial

resources for improving, protecting peoples health base on universal coverage;

2. Xy dng chin lc, quy hoch, khoch tng thpht trin bo him y t;

2. Formulate in general the plan, strategies, schemes, developing social health

insurance;

3. Ban hnh danh mc thuc, vt ty t, dch vk thut thuc phm vi c

hng ca ngi tham gia bo him y tv cc quy nh chuyn mn kthut

lin quan n khm bnh, cha bnh bo him y t;

3. Promulgate the list of social health insurance benefits in medicines, technical

services, medical materials; and the professional, technical regulations relating

to medical care on social health insurance;

4. Xy dng v trnh Chnh phcc gii php nhm bo m cn i qubo

him y t;

4. Formulate and submit to Government the solutions for ensuring social health

insurance balance;

5. Tuyn truyn, phbin chnh sch, php lut vbo him y t;

5. Propagate and disseminate, policies and legislation on social health

insurance;

6. Cho, hng dn tchc trin khai thc hin chbo him y t;

6. Conduct the performing social health insurance schemes;

7. Thanh tra, kim tra, xl vi phm v gii quyt khiu ni, tco vbo him

y t;

7. Inspect, check, handle violations, and settle complaints and denunciations

about social health insurance;

8. Theo di, nh gi, tng kt cc hot ng trong lnh vc bo him y t;

8. Monitor, assess, and sum up activities of social health insurance sector;

9. Tchc nghin cu khoa hc v hp tc quc tvbo him y t.

9. Organize science research and international cooperation on social healthinsurance.


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iu 7. Trch nhim ca BTi chnh vbo him y t

Article 7. Responsibilities of Ministry of Finance for social health insurance

1. Phi hp vi BY t, cquan, t chc c lin quan xy dng chnh sch,

php lut vti chnh lin quan n bo him y t.

1. Cooperate with Ministry of Health, related bodies, organizations establishing

financial policies, legilation on social health insurance.

2. Thanh tra, kim tra vic thc hin cc quy nh ca php lut vch ti

chnh i vi bo him y t, qubo him y t.

2. Inspect and check the implementation of the financial regulations on social

health insurance and social health insurance fund.

iu 8. Trch nhim ca Uban nhn dn cc cp vbo him y t

Article 8. Responsibilities of People's Committees at all levelsfor social health

insurance

1. Trong phm vi nhim v, quyn hn ca mnh, Uban nhn dn cc cp c

trch nhim sau y:

1. People's Committees at all levels shall, within the ambit of their respective

tasks and powers, have the responsibilities as follows:

a) Cho tchc trin khai thc hin chnh sch, php lut vbo him y

t;

a) Conduct the performing legislation, policies on social health insurance;

b) Bo m kinh ph ng bo him y tcho cc i tng c ngn sch

nh nc ng hoc htrtheo quy nh ca Lut ny;

b) Ensure budget of sponsored premiums for participants funding by state

budget as stipulated in this Law;

c) Tuyn truyn, phbin chnh sch, php lut vbo him y t;

c) Propagate and disseminate policies and legislation on social health

insurance;

d) Thanh tra, kim tra, xl vi phm v gii quyt khiu ni, tco vbo

him y t.

d) Inspect, check, handle violations and settle complaints, denunciations

about social health insurance.

2. Ngoi vic thc hin trch nhim quy nh ti khon 1 iu ny, Uban nhn

dn tnh, thnh phtrc thuc trung ng cn c trch nhim qun l, sdng

ngun kinh ph theo quy nh ti khon 2 iu 35 ca Lut ny.

2. In addition to implementing responsibilities stipulated in Clause 1 of this

Article, the People's Committees of provinces and cities under central authority

shall have the responsibilities to manage and use the funds as stipulated in

Clause 2 of Article 35 of this Law.


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iu 9. Tchc bo him y t

Article 9. Social health insurance organization

1. Tchc bo him y tc chc nng thc hin ch, chnh sch, php lut

vbo him y t, qun l v sdng qubo him y t.

1. Social health insurance organizations functioning of the regimes, policies and

legislation on social health insurance, management and utilization of social

health insurance fund.

2. Chnh phquy nh cthvtchc, chc nng, nhim vv quyn hn ca

tchc bo him y t.

2. The Government shall specify the organization, functions, duties and powers

of social health insurance organizations.

iu 10. Kim ton qubo him y t

Article 10. Auditing of social health insurance fund

nh k3 nm, Kim ton nh nc thc hin kim ton qubo him y tv

bo co kt quvi Quc hi.

Periodic of three years, the State audit office shall audit the social health

insurance fund and report on the results to National Assembly.

Trng hp Quc hi, U ban thng v Quc hi hoc Chnh ph yu cu,

Kim ton nh nc thc hin kim ton t xut qubo him y t.

On the request of the National Assembly, the National Assembly Standing

Committee or the Government, the State audit office shall unexpectedly audit the

social health insurance fund.

iu 11. Cc hnh vi bnghim cm

Article 11. Prohibited acts

1. Khng ng hoc ng bo him y tkhng y theo quy nh ca Lut

ny.

1. Not paying or inadequately paying social health insurance premiums

according to the provisions of this Law.

2. Gian ln, gimo hs, thbo him y t.

2. Falsifying and forging dossiers, social health insurance cards.

3. Sdng tin ng bo him y t, qubo him y tsai mc ch.

3. Using the premiums, social health insurance fund for improper purposes.

4. Cn tr, gy kh khn hoc lm thit hi n quyn, li ch hp php ca

ngi tham gia bo him y tv ca cc bn lin quan n bo him y t.

4. Causing troubles or obstacles to, harming the legitimate rights and interests

of, the insureds and parties involed in social health insurance.


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5. C bo co sai stht, cung cp sai lch thng tin, sliu vbo him y t.

5. Making false reports, supplying false information, data on social health

insurance.

6. Li dng chc v, quyn hn, chuyn mn, nghip v lm tri vi quy

nh ca php lut vbo him y t.

6. Abusing the positions, powers, professional services contrary to the

legislation on social health insurance.

CHNG II - I TNG, MC NG, TRCH NHIM V PHNG THC

NG BO HIM Y T

CHAPTER II - THE COVERAGE, RATES, LIABILITIES AND METHODS OF

PAYMENT OF SOCIAL HEALTH INSURANCE PREMIUMS

iu 12. i tng tham gia bo him y t

Article 12: The coverage

1. Ngi lao ng lm vic theo hp ng lao ng khng xc nh thi hn,

hp ng lao ng c thi hn t3 thng trln theo quy nh ca php lut

v lao ng; ngi lao ng l ngi qun l doanh nghip hng tin lng,

tin cng theo quy nh ca php lut v tin lng, tin cng; cn b, cng

chc, vin chc theo quy nh ca php lut (sau y gi chung l ngi lao

ng).1.Employees working under fixed-term contracts of 3 months and over or

unfixed term contracts according to the Labour Code; employees working as

managers, earning monthly salary, remuneration according to legal regulations

on salary, remuneration; civil servants, governmental officers (hereinafter

referred to as emlpoyees).

2. Squan, h squan nghip vv squan, h squan chuyn mn, k thut

ang cng tc trong lc lng Cng an nhn dn.

2. Professional officers and non-commissioned officers, technical officers andnon-commissioned officers are in-service of the Peoples Police Force.

3. Ngi hng lng hu, trcp mt sc lao ng hng thng.

3. Old-age pensioners, allowance pensioners.

4. Ngi ang hng trcp bo him x hi hng thng do btai nn lao ng,

bnh nghnghip.

4. Allowance pensioners due to work - injury or occupational diseases.

5. Ngi thi hng trcp mt sc lao ng ang hng trcp hng thngtngn sch nh nc.

5. Allowance pensioners subsidized by the State Budget


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6. Cn bx, phng, thtrn nghvic ang hng trcp bo him x hi

hng thng.

6. Retired administrative staff members of commune/wards/towns enjoying the

monthly subsidy from social security fund.

7. Cn bx, phng, thtrn nghvic ang hng trcp tngn sch nh

nc hng thng.7. Retired administrative staff members of commune/ward/town enjoying the

monthly subsidy from State budget.

8. Ngi ang hng trcp tht nghip.

8. Unemployment beneficiaries.

9. Ngi c cng vi cch mng.

9. Persons who have the merit of assisting the Revolution.

10. Cu chin binh theo quy nh ca php lut vcu chin binh.10. Veterans in accordance with the legislation about veterans.

11. Ngi trc tip tham gia khng chin chng Mcu nc theo quy nh ca

Chnh ph.

11. Persons directly participated in the Resistance War against the US invaders

as stipulated in the Government regulations.

12. i biu Quc hi, i biu Hi ng nhn dn cc cp ng nhim.

12. In-service members of Parliament and of the Peoples Council of all levels.

13. Ngi thuc din hng trcp bo trx hi hng thng theo quy nh ca

php lut.

13. Other people who are socially sponsored.

14. Ngi thuc hgia nh ngho; ngi dn tc thiu sang sinh sng ti

vng c iu kin kinh t- x hi kh khn, c bit kh khn.

14. Members of poor households, ethnic minorities living in the remote and

difficult socio-economic conditions.

15. Thn nhn ca ngi c cng vi cch mng theo quy nh ca php lut vu i ngi c cng vi cch mng.

15. Family members of meritorious groups as stipulated in law.

16. Thn nhn ca cc i tng sau y theo quy nh ca php lut vsquan

Qun i nhn dn, ngha vqun s, Cng an nhn dn v cyu:

16. Family members of the following subjects as regulated in legal provisions on

peoples army officers, military service, peoples police, and governmental

essential services:

a) Squan, qun nhn chuyn nghip thuc Qun i nhn dn ang ti

ng; hsquan, binh sang phc vtrong Qun i nhn dn;


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a) Professional officers and soldiers are in-service of peoples army force;

non-commissioned officers and soldiers are working for the Peoples Army

Force;

b) Squan, h squan nghip v v squan, h squan chuyn mn, k

thut ang cng tc trong lc lng Cng an nhn dn; hsquan, chin s

Cng an nhn dn phc vc thi hn;b) Professional officers and non-commissioned officers, technical officers

and non-commissioned officers are in-service of the Peoples Police

Force; non-commissioned officers and soldiers are working for the

Peoples Police Force force with specified period;

c) Squan, qun nhn chuyn nghip ang lm cng tc cyu ti Ban C

yu Chnh phv ngi ang lm cng tc cyu hng lng theo bng

lng cp bc qun hm squan Qun i nhn dn v bng lng qun

nhn chuyn nghip thuc Qun i nhn dn nhng khng phi l qunnhn, cng an nhn dn.

c) Professional officers and soldiers are in essential service of the Board of

Governmental Essential Services, and those who are carrying out essential

service and entitled to salary levels as specified in the salary bands for

peoples army officers and for professional soldiers in peoples army, not

normal soldiers and police.

17. Trem di 6 tui.

17. Children under 6 years old.

18. Ngi hin bphn cthngi theo quy nh ca php lut vhin, ly,

ghp m, bphn cthngi v hin, ly xc.

18. Persons donated their organs in accordance with the legislation on tissues,

organs and body donation/transplant.

19. Ngi nc ngoi ang hc tp ti Vit Nam c cp hc bng tngn

sch ca Nh nc Vit Nam.

19. Foreign students studying in Vietnam, who are granted scholarships by

Vietnamese Government.

20. Ngi thuc hgia nh cn ngho.

20. Members of the near poor households.

21. Hc sinh, sinh vin.

21. Students.

22. Ngi thuc hgia nh lm nng nghip, lm nghip, ngnghip v dim

nghip.

22. Members of households working in the agriculture, forestry, fish-culture and

salt industry.


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23. Thn nhn ca ngi lao ng quy nh ti khon 1 iu ny m ngi lao

ng c trch nhim nui dng v sng trong cng hgia nh.

23. Dependents who live in the same households and be feed by employees

specified at Clause 1, of this Article.

24. X vin hp tc x, hkinh doanh c th.

24. Members of Co-operatives and self-employed households.

25. Cc i tng khc theo quy nh ca Chnh ph.

25. Others as stipulated by the Government.

iu 13. Mc ng v trch nhim ng bo him y tArticle 13. Contribution rates and responsibility

1. Mc ng v trch nhim ng bo him y tc quy nh nhsau:

1. Contribution rates and contribution responsibilities are stipulated as follows:

a) Mc ng hng thng ca i tng quy nh ti khon 1 v khon 2

iu 12 ca Lut ny ti a bng 6% mc tin lng, tin cng thng

ca ngi lao ng, trong ngi sdng lao ng ng 2/3 v ngi

lao ng ng 1/3. Trong thi gian ngi lao ng nghvic hng ch

thai sn khi sinh con hoc nui con nui di 4 thng tui theo quy

nh ca php lut vbo him x hi th ngi lao ng v ngi s

dng lao ng khng phi ng bo him y tnhng vn c tnh vo

thi gian tham gia bo him y tlin tc hng chbo him y t;

a) The contribution rates for the insureds specified at Clauses 1, 2,

Article 12 of this Law shall be a maximum 6% of their monthly salary,

remuneration, of which 2/3rd shall be contributed by the employer and

1/3rd by the employee. During the emlpoyees leave for maternity or

adoption of child under 4 months of age in accordance with law on

social insurance, the employers and employees do not have to contribute

the social health insurance premiums and get the benefits as usual;

b) Mc ng hng thng ca i tng quy nh ti khon 3 iu 12 ca

Lut ny ti a bng 6% mc lng hu, trcp mt sc lao ng v do

tchc bo him x hi ng;

b) The contribution rates for the insureds specified at Clause 3, Article

12 of this Law shall be a maximum 6% of their monthly pension and shall

be contributed by the Social security organization;

c) Mc ng hng thng ca i tng quy nh ti cc khon 4, 5 v 6

iu 12 ca Lut ny ti a bng 6% mc lng ti thiu v do tchc

bo him x hi ng;

c) The contribution rates for the insureds specified at Clauses 4, 5, 6,

Article 12 of this Law shall be a maximum 6% of common minimum

salary and shall be contributed by the Social security organization;


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d) Mc ng hng thng ca i tng quy nh ti khon 8 iu 12 ca

Lut ny ti a bng 6% mc trcp tht nghip v do tchc bo him

x hi ng;

d) The contribution rates for the insureds specified at Clause 8, Article

12 of this Law shall be a maximum 6% of their unemployment benefits

and shall be contributed by the Social security organization;

) Mc ng hng thng ca i tng quy nh ti cc khon 7, 9, 10,

11, 12, 13, 14, 15, 16, 17 v 18 iu 12 ca Lut ny ti a bng 6%

mc lng ti thiu v do ngn sch nh nc ng;

) The contribution rates for the insureds specified at Clauses 7, 9, 10,

11, 12, 13, 14, 15, 16, 17, 18, Article 12 of this Law shall be a maximum

6% of the common minimum salary and shall be contributed by the State

budget;

e) Mc ng hng thng ca i tng quy nh ti khon 19 iu 12ca Lut ny ti a bng 6% mc lng ti thiu v do cquan, tchc,

n vcp hc bng ng;

e) The contribution rates for the insureds specified at Clause 19, Article

12 of this Law shall be a maximum 6% of the common minimum salary

and shall be contributed by organisations or institutions granting their

scholarship;

g) Mc ng hng thng ca i tng quy nh ti cc khon 20, 21 v

22 iu 12 ca Lut ny ti a bng 6% mc lng ti thiu v do i

tng ng;

g) The contribution rates for the insureds specified at Clauses 20, 21, 22,

Article 12 of this Law shall be a maximum 6% of the common minimum

salary and shall be contributed by themselves;

Ngn sch nh nc h trmt phn mc ng bo him y tcho i

tng quy nh ti khon 20 v khon 21 iu 12 ca Lut ny v i

tng quy nh ti khon 22 iu 12 ca Lut ny m c mc sng trung

bnh;

The State budget subsidizes a part of social health insurance premiums

to the insureds specified at Clauses 20, 21, Article 12 of this Law and to

the insureds, who have average standard of living, at Clause 22, Article

12 of this Law;

h) Mc ng hng thng ca i tng quy nh ti khon 23 iu 12

ca Lut ny ti a bng 6% mc lng ti thiu v do ngi lao ng

ng;

h) The contribution rates for the insureds specified at Clause 23, Article


and shall be contributed by the employees;


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i) Mc ng hng thng ca i tng quy nh ti khon 24 iu 12 ca

Lut ny ti a bng 6% mc lng ti thiu v do i tng ng;

i) The contribution rates for the insureds specified at Clause 24, Article


and shall be contributed by themselves;

k) Mc ng hng thng ca i tng quy nh ti khon 25 iu 12ca Lut ny ti a bng 6% mc lng ti thiu.

k) The contribution rates for the insureds specified at Clause 24, Article

12 of this Law shall be a maximum 6% of the common minimum salary.

2. Trng hp mt ngi ng thi thuc nhiu i tng tham gia bo him y

tkhc nhau quy nh ti iu 12 ca Lut ny th ng bo him y ttheo i

tng u tin m ngi c xc nh theo th tca cc i tng quy

nh ti iu 12 ca Lut ny.

Trng hp i tng quy nh ti khon 1 iu 12 ca Lut ny c thm mthoc nhiu hp ng lao ng khng xc nh thi hn hoc c thi hn t3

thng trln th ng bo him y ttheo hp ng lao ng c mc tin lng,

tin cng cao nht.

2. In case of a person is subjected to more than one form of mandatory social

health insurance schemes, her/his contribution shall be chosen at the first form

in order of the coverage specified at Article 12 of this Law.

In case of a person specified at Clause 1, Article 12 of this Law has more than

one fixed-term contracts of 3 months and over or unfixed term contracts, her/hispremium shall be based on the contract with the highest salary or remuneration.

3. Chnh phquy nh cthmc ng, mc htrquy nh ti khon 1 iu

ny.

3. The Government shall specify the contribution rates and subsidy as stipulated

at Clause 1 of this Article.

iu 14. Tin lng, tin cng, tin trcp lm cn cng bo him y t

Article 14. Salary, remuneration and allowances as basis of health insurancecontribution

1. i vi ngi lao ng thuc i tng thc hin chtin lng do Nh

nc quy nh th cn cng bo him y tl tin lng thng theo ngch

bc, cp qun hm v cc khon ph cp chc v, ph cp thm nin vt

khung, phcp thm nin ngh(nu c).

1. For employees subject to the salary regime set by the State, their monthly

social health insurance contribution shall be their rank or grade based salaries,

or military rank based salaries and position allowances, extra-seniorityallowances or professional seniority allowances (if any).


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2. i vi ngi lao ng hng tin lng, tin cng theo quy nh ca ngi

sdng lao ng th cn cng bo him y tl tin lng, tin cng thng

c ghi trong hp ng lao ng.

2. For employees subject to the salary or remuneration regime set by the

employers, their monthly social health insurance contribution shall be the

salaries or remuneration stated in their labour contracts.

3. i vi ngi hng lng hu, trcp mt sc lao ng, trcp tht nghip

hng thng th cn cng bo him y tl tin lng hu, trcp mt sc

lao ng, trcp tht nghip hng thng.

3. For old-age pensioners, allowance pensioners, unemployment beneficiaries,

their monthly social health insurance contribution shall be their monthly pension

or benefits.

4. i vi cc i tng khc th cn cng bo him y tl mc lng ti

thiu.4. For other insureds, the social health insurance contribution is based on the

common minimum salary.

5. Mc tin cng, tin lng ti a tnh mc ng bo him y t l 20 ln

mc lng ti thiu.

5. The monthly social health insurance premiums do not exceed twenty times of

common minimum salary.

iu 15. Phng thc ng bo him y tArticle 15. Social health insurance contribution methods

1. Hng thng, ngi sdng lao ng ng bo him y tcho ngi lao ng

v trch tin ng bo him y tttin lng, tin cng ca ngi lao ng

np cng mt lc vo qubo him y t.

1. Employers have responsibilities contributing their premium and their

employees premium to social health insurance fund, in monthly.

2. i vi cc doanh nghip nng nghip, lm nghip, ngnghip, dim nghip

khng trlng theo thng th 3 thng hoc 6 thng mt ln, ngi sdng lao

ng ng bo him y tcho ngi lao ng v trch tin ng bo him y tt

tin lng, tin cng ca ngi lao ng np cng mt lc vo qubo him

y t.

2. For the business of agriculture, forestry, fishery, salt industry, have

responsibilities contributing their premium and their employees premium to

social health insurance fund, in quaterly or in half yearly.

3. Hng thng, tchc bo him x hi ng bo him y tcho cc i tng

quy nh ti cc khon 3, 4, 5, 6 v 8 iu 12 ca Lut ny vo qubo him y

t.


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3. Social health insurance organizations have responsibilities contributing

premiums of the insureds specified at Clauses 3, 4, 5, 6, 8, Article 12 of this Law

to social health insurance fund, in monthly.

4. Hng nm, cquan, tchc qun l i tng quy nh ti cc khon 7, 9, 10,

11, 12, 13, 14, 17 v 18 iu 12 ca Lut ny ng bo him y tcho cc i

tng ny vo qubo him y t.4. Organizations and institutions, in which the insureds belong to as specified at

Clauses 7, 9, 10, 11, 12, 13, 14, 17, 18, Article 12 of this Law, have

responsibilities contributing their premiums to social health insurance fund, in

yearly.

5. Hng nm, cquan, tchc qun l ngi c cng vi cch mng v cc i

tng quy nh ti cc im a, b v c khon 16 iu 12 ca Lut ny ng bo

him y tcho thn nhn ca hvo qubo him y t.

5. Organizations and insitutions, in which the insureds and the meritorious

persons to be under as specified at points a, b and c, Clause 16, Article 12 of this

Law have responsibilities contributing their premiums to social health insurance

fund, in yearly.

6. Hng thng, cquan, tchc, n vcp hc bng ng bo him y tcho

i tng quy nh ti khon 19 iu 12 ca Lut ny vo qubo him y t.

6. Organizations and insitutions, which sponsor scholarships for foreign

students as specified at Clause 19, Article 12 of this Law have responsibilities

contributing their premiums to social health insurance fund, in monthly.

7. Chnh phquy nh cthphng thc ng bo him y tca i tng quy

nh ti cc khon 20, 21, 22, 23, 24 v 25 iu 12 ca Lut ny.

7. The Government shall specify the social health insurance contribution

methods of the insureds specified at Clauses 20, 21, 22, 23, 24, 25, Article 12 of

this Law.

CHNG III - THBO HIM Y TCHAPTER III - SOCIALHEALTH INSURANCE CARDS

iu 16. Thbo him y t

Article 16. Social health insurance cards

1. Thbo him y tc cp cho ngi tham gia bo him y tv lm cn c

c hng cc quyn li vbo him y ttheo quy nh ca Lut ny.

1. Social health insurance cards are issued to the insureds and are based on

enjoying social health insurance benefits specified at this Law.

2. Mi ngi chc cp mt thbo him y t.


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2. The insureds shall be granted only one social health insurance card for each

one.

3. Thi im thbo him y tc gi trsdng c quy nh nhsau:

3. The validity of social health insurance cards is defined as follows:

a) i vi ngi tham gia bo him y ttheo quy nh ti khon 3 iu 50

ca Lut ny ng bo him y tlin tc ktln thhai tri hoc ngi

tham gia bo him y tquy nh ti khon 2 iu 51 ca Lut ny th th

bo him y tc gi trsdng ktngy ng bo him y t;

a) Social health insurance cards shall be valid immediately from the date

of contribution for those, specifed at Clause 3, Article 50 of this Law, who

pay premium continuously from the second time and for whom is stipulated

in Clause 2, Article 51 of this Law.

b) i vi ngi tham gia bo him y ttheo quy nh ti khon 3 iu 50

ca Lut ny ng bo him y tln u hoc ng bo him y tkhng

lin tc th thbo him y tc gi tr sdng sau 30 ngy, k tngy

ng bo him y t; ring i vi quyn li vdch vkthut cao th th

bo him y tc gi trsdng sau 180 ngy, ktngy ng bo him y

t;

b) Social health insurance cards shall be valid in 30 days from the date of

contribution for those, specifed at Clause 3, Article 50 of this Law, who do

not pay premium continuously or pay in the first time; and shall be valid in

180 days from the date of contribution in case of using medical hi-

technique services;

c) i vi trem di 6 tui th thbo him y tc gi trsdng n

ngy tr72 thng tui.

c) For children under 6 years old, social health insurance cards shall be

valid until they reach 72 months of age.

4. Thbo him y tkhng c gi trsdng trong cc trng hp sau y:

4. Social health insurance cards shall be invalid in cases as follows:

a) Th ht thi hn sdng;

a) The card has expired;

b) Thbsa cha, ty xo;

b) Information printed on the card has been corrected, erased;

c) Ngi c tn trong thkhng tip tc tham gia bo him y t.

c) The insured is not continue to pay premium.

5. Tchc bo him y tquy nh mu thbo him y t, qun l thbo him ytthng nht trong cnc v chm nht n ngy 01 thng 01 nm 2014 phi


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tchc thc hin vic pht hnh thbo him y tc nh ca ngi tham gia

bo him y t.

5. An organization, which manage social health insurance, shall defined the

uniform management and sample of social health insurance card in whole

country. At the latest on January 01st, 2014 the cards with participants photo

have to be issued.

iu 17. Cp thbo him y t

Article 17. Issuance of the health insurance cards

1. Hscp thbo him y tbao gm:

1. Documents for issuing social health insurance cards consist of:

a) Vn bn ng k tham gia bo him y tca cquan, tchc c trch

nhim ng bo him y tquy nh ti khon 1 iu 13 ca Lut ny;

a) The application form from agencies and organizations which have

responsibilities for contributing premium specified at Clause 1, Article 13

of this Law;

b) Danh sch ngi tham gia bo him y tdo cquan, tchc c trch

nhim ng bo him y tquy nh ti khon 1 iu 13 ca Lut ny hoc

ngi i din ca ngi tnguyn tham gia bo him y tlp;

b) The list of the insureds prepared by representative person of the

voluntary insureds or by agencies and organizations which have

responsibilities for contributing premium specified at Clause 1, Article 13

of this Law;

c) Tkhai ca c nhn, hgia nh tham gia bo him y t.

c) Information sheet prepared by the individual or household to apply for

social health insurance contribution.

2. Hscp thbo him y ti vi trem di 6 tui bao gm:

2. Dossiers for granting social health insurance card for children under 6 years

old consist of:

a) Bn sao giy chng sinh hoc bn sao giy khai sinh. Trng hp trem

cha c bn sao giy chng sinh hoc bn sao giy khai sinh th phi c

giy xc nhn ca Uban nhn dn x, phng, thtrn ni ctr ca cha,

mhoc ngi gim h;

a) A birth certificate or a birth confirmation sheet in certified copy. In case

of a child does not have any birth certificate or a birth confirmation sheet,

the certification by the Peoples Committee of the commune/ward/town

where parents or guardian live must be included;

b) Danh sch hoc giy nghcp thbo him y tca Uban nhn dn

x, phng, thtrn ni trem ctr.


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b) The list or requested sheet for granting social health insurance card

prepared by the Peoples Committee of the commune/ward/town where

children are living.

3. Trong thi hn 10 ngy lm vic, ktngy nhn hsquy nh ti khon

1 v khon 2 iu ny, tchc bo him y tphi cp thbo him y tcho

ngi tham gia bo him y t.3. Within 10 working days from the date of receiving full documentation as

stipulated in the Clauses 1, 2 of this Article, the social health insurance

organizations must issue the social health insurance card for the insureds.

iu 18. Cp li thbo him y t

Article 18. Re-issuing Health Insurance Card

1. Thbo him y tc cp li trong trng hp bmt.

1. The social health insurance card shall be re-issued in case of loss.

2. Ngi bmt thbo him y tphi c n nghcp li th.

2. Those that lost their social health insurance cards must prepared the

application form for re-issuing the card.

3. Trong thi hn 7 ngy lm vic, ktngy nhn c n nghcp li th,

tchc bo him y tphi cp li thcho ngi tham gia bo him y t. Trong

thi gian chcp li th, ngi c thvn c hng quyn li ca ngi tham

gia bo him y t.

3. Within 7 working days from the date of receiving the application form for re-

issuing the card, the social health insurance organization must re-issue card for

the insureds. During waiting period of card re-issuing, the insureds is still

entitled to all benefits of social health insurance scheme.

4. Ngi c cp li thbo him y tphi np ph. B trng BTi chnh

quy nh mc ph cp li thbo him y t.

4. A charge shall be paid by the insureds who has requested re-issuing the social

health insurance card. The Minister of Finance shall provide regulations on

charges for issuing social health insurance card.

iu 19. i thbo him y t

Article 19. Replacement of Health Insurance Card

1. Thbo him y tc i trong trng hp sau y:

1. Social health insurance card shall be replaced in case of follows:

a) Rch, nt hoc hng;

a) Being torn, crushed or damaged;

b) Thay i ni ng k khm bnh, cha bnh ban u;

b) Change for primary health care establishments;


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c) Thng tin ghi trong thkhng ng.

c) Incorrect information printed on the card.

2. Hsi thbo him y tbao gm:

2. Dossiers for replacing social health insurance card shall comprise of:

a) n nghi thca ngi tham gia bo him y t;

a) An application form for replacing the card prepared by the insureds;

b) Thbo him y t.

b) The social health insurance card.

3. Trong thi hn 7 ngy lm vic, ktngy nhn hsquy nh ti khon

2 iu ny, tchc bo him y tphi i thcho ngi tham gia bo him y t.

Trong thi gian chi th, ngi c thvn c hng quyn li ca ngi

tham gia bo him y t.

3. Within 7 working days from the date of receiving full dossiers as stipulated inClause 2 of this Article, the social health insurance organizations must replace

the card for the insureds. During waiting period of card replacement, the

insureds is still entitled to all benefits of social health insurance.

4. Ngi c i thbo him y tdo thbrch, nt hoc hng phi np ph.

B trng BTi chnh quy nh mc ph i thbo him y t.

4.A charge shall be paid by the insureds who has requested replacing the social

health insurance card. The Minister of Finance shall provide regulations on

charges for replacing social health insurance card.

iu 20. Thu hi, tm githbo him y t

Article 20. Withdrawal and temporary detainment of Social Health Insurance Card

1. Thbo him y tbthu hi trong trng hp sau y:

1. Social health insurance card shall be withdrawn in cases of follows:

a) Gian ln trong vic cp thbo him y t;

a) Fraud in social health insurance card issuance;

b) Ngi c tn trong thbo him y tkhng tip tc tham gia bo him yt.

b) The insured is not continue to pay premium.

2. Th bo him y t b tm gi trong trng hp ngi i khm bnh, cha

bnh sdng thbo him y tca ngi khc. Ngi c thbo him y tb

tm gic trch nhim n nhn li thv np pht theo quy nh ca php lut.

2. Social health insurance card shall be temporarily detained in case of to be

used for medical care by another insured. In this case, the insured shall be

responsible for re-collecting the card and paying fine according to the legal

regulations.


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CHNG IV - PHM VI C HNG BO HIM Y T

CHAPTER IV - SCOPE OF HEALTH INSURANCE BENEFITS

iu 21. Phm vi c hng ca ngi tham gia bo him y t

Article 21. Scope of benefits for the insureds

1. Ngi tham gia bo him y tc qubo him y tchi trcc chi ph sau

y:

1. The medical care costs of the insureds shall be paid by social health

insurance fund as follows:

a) Khm bnh, cha bnh, phc hi chc nng, khm thai nh k, sinh

con;

a) Medical examination, diagnosis and treatment. Rehabilitation,

periodical pregnancy examination and giving birth;

b) Khm bnh sng lc, chn on sm mt sbnh;

b) Medical examination for screening and diagnose some diseases earlier;

c) Vn chuyn ngi bnh ttuyn huyn ln tuyn trn i vi i tng

quy nh ti cc khon 9, 13, 14, 17 v 20 iu 12 ca Lut ny trong

trng hp cp cu hoc khi ang iu tr ni tr phi chuyn tuyn

chuyn mn kthut.

c) Transporting the insureds specified at Clauses 9, 13, 14 and 17, Article

12 of this Law from a health care establishment to other ones in emergency

or inpatient cases.

2. Btrng BY tquy nh cthim b khon 1 iu ny; chtr, phi hp

vi cquan lin quan ban hnh danh mc thuc, ha cht, vt t, thit by t,

dch vkthut y tthuc phm vi c hng ca ngi tham gia bo him y

t.

2. Minister of ministry of health shall specify point b, Clause 1 of this Article;

preside and co-ordinate with the stakeholders issuing the list of drugs,

chemicals, material, medical equipments, medical technical services within the

scope of social health insurance benefits.

iu 22. Mc hng bo him y t

Article 22 . Extent of social health insurance benefits

1. Ngi tham gia bo him y tkhi i khm bnh, cha bnh theo quy nh ti

cc iu 26, 27 v 28 ca Lut ny th c qubo him y tthanh ton chi ph

khm bnh, cha bnh trong phm vi c hng nhsau:


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1. Medical examination and treatment costs for the insureds specified at Articles

26, 27, 28 of this Law shall be paid by social health insurance fund, within scope

of social health insurance benefits, as follows:

a) 100% chi ph khm bnh, cha bnh i vi i tng quy nh ti cc

khon 2, 9 v 17 iu 12 ca Lut ny;

a) 100% of medical examination and treatment costs for the coverages

specified at Clauses 2, 9, 17, Articles 12 of this Law;

b) 100% chi ph khm bnh, cha bnh i vi trng hp chi ph cho mt

ln khm bnh, cha bnh thp hn mc do Chnh phquy nh v khm

bnh, cha bnh ti tuyn x;

b) 100% of medical examination and treatment costs at commune health

care establishments or if the costs lower than the Governments norms;

c) 95% chi ph khm bnh, cha bnh i vi i tng quy nh ti cc

khon 3, 13 v 14 iu 12 ca Lut ny;

c) 95% of medical examination and treatment costs for the coverages

specified at Clauses 3, 13, 14, Articles 12 of this Law;

d) 80% chi ph khm bnh, cha bnh i vi cc i tng khc.

d) 80% of medical examination and treatment costs for the others

coverages.

2. Trng hp mt ngi thuc nhiu i tng tham gia bo him y tth c

hng quyn li bo him y ttheo i tng c quyn li cao nht.2. In case of a person is subjected to more than one form of the coverage, he/she

shall be entitled to the form which provides highest benefits.

3. Chnh phquy nh mc thanh ton chi ph khm bnh, cha bnh i vi cc

trng hp vt tuyn chuyn mn k thut, khm bnh, cha bnh theo yu

cu, s dng dch v k thut cao chi ph ln v cc trng hp khc khng

thuc quy nh ti khon 1 iu ny.

3. The Government shall specify the payment for medical examination and

treatment costs in cases of professional technology beyond rank, healthcare

services on requests, high technical services with high costs and the other cases

as not specified at Clause 1 of this Article .

iu 23. Cc trng hp khng c hng bo him y t

Article 23. Social health insurance benefit exemption

1. Chi ph trong trng hp quy nh ti khon 1 iu 21 c ngn sch nh

nc chi tr.

1. The costs specified at Clause 1 of Article 21, covered by the state budget.

2. iu dng, an dng ti csiu dng, an dng.

2. Recovering and convalescent at nursing facilities.


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3. Khm sc khe.

3. Periodical general medical examination.

4. Xt nghim, chn on thai khng nhm mc ch iu tr.

4. Laboratory tests and diagnosis for pregnancy which is not treatment purpose.

5. Sdng kthut htrsinh sn, dch vkhoch ha gia nh, no ht thai,

ph thai, tr trng hp phi nh ch thai nghn do nguyn nhn bnh l ca

thai nhi hay ca sn ph.

5. Using of support reproductive techniques, family planning services, and

abortion services, except for the case of termination of pregnancy due to

certified pathological reasons of fetus or of pregnancy woman.

6. Sdng dch vthm m.

6. Using of aesthetic services.

7. iu trlc, cn thv tt khc xca mt.7. Treatment of squint, myopia and refractive eye defects.

8. Sdng vt ty tthay thbao gm chn tay gi, mt gi, rng gi, knh mt,

my tr thnh, phng tin tr gip vn ng trong khm bnh, cha bnh v

phc hi chc nng.

8. Using of medical replacement supplies including artificial limbs, glass eyes,

false teeth, hearing aid device, and motional supporting device for the purpose

of medical examination and treatment, and rehabilitation.

9. Khm bnh, cha bnh, phc hi chc nng i vi bnh nghnghip, tai nn

lao ng, thm ha.

9. Medical examination and treatment, rehabilitation for occupational diseases,

work-injured and disasters.

10. Khm bnh, cha bnh trong trng hp tt, tgy thng tch.

10. Medical examination and treatment in case of suicide and self injured cases.

11. Khm bnh, cha bnh nghin ma ty, nghin ru hoc cht gy nghin

khc.

11. Medical examination and treatment in case of drug addiction, alcoholism

and other addictive substances.

12. Khm bnh, cha bnh tn thng vthcht, tinh thn do hnh vi vi phm

php lut ca ngi gy ra.

12. Medical examination and treatment of physical and mental injury due to the

act of law violation caused byself.

13. Gim nh y khoa, gim nh php y, gim nh php y tm thn.

13. Medical, forensic and mental forensic assessment.

14. Tham gia thnghim lm sng, nghin cu khoa hc.

14. Participating in clinical trials and scientific research.


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CHNG V - TCHC KHM BNH, CHA BNH CHO NGI THAM GIA

BO HIM Y T

CHAPTER V - ORGANIZATION OF MEDICAL CARE FOR THE INSURED

iu 24. Cskhm bnh, cha bnh bo him y t

Article 24. Health care providers for Social Health Insurance Schemes

1. Cskhm bnh, cha bnh bo him y tl csy tc k hp ng khm

bnh, cha bnh vi tchc bo him y t.

1. Health care provider for social health insurance schemes shall be a health

care establisment contracting with a social health insurance organization for

medical care.

2. Cskhm bnh, cha bnh bo him y tbao gm:2. Health care providers for medical care include the following:

a) Trm y tx v tng ng, nh hsinh;

a) Commune health stations or equivalent; and maternity clinics;

b) Phng khm a khoa, chuyn khoa;

b) Specialized clinics and general clinics;

c) Bnh vin a khoa, chuyn khoa.

c) Specialized hospitals and general hospitals.

iu 25. Hp ng khm bnh, cha bnh bo him y t

Article 25. Contract of Medical care for Social health insurance Schemes

1. Hp ng khm bnh, cha bnh bo him y tl vn bn thothun gia t

chc bo him y tvi cskhm bnh, cha bnh vvic cung ng dch vv

thanh ton chi ph khm bnh, cha bnh bo him y t.

1. The contract of medical care for social health insurance schemes shall be an

agreement document between a social health insurance organization and a

health care provider on health service provisions and payment of medical care

costs for social health insurance schemes.

2. Hp ng khm bnh, cha bnh bo him y tgm cc ni dung chyu sau

y:

2. The contract of medical care for social health insurance schemes shall

contain the main following items:

a) i tng phc vv yu cu vcht lng cung ng dch v;

a) Clients and requirements of service delivery quality;

b) Phng thc thanh ton chi ph khm bnh, cha bnh;

b) Methods of payment for medical care costs;


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c) Quyn v trch nhim ca cc bn;

c) Rights and obligations of each party;

d) Thi hn hp ng;

d) Contract duration;

) Trch nhim do vi phm hp ng;

) Responsibilities for contract violations;

e) iu kin thay i, thanh l, chm dt hp ng.

e) Terms and conditions for contract amendment, liquidation and

termination.

3. Vic tha thun viu kin thay i, thanh l, chm dt hp ng quy nh

ti im e khon 2 iu ny phi bo m khng lm gin on vic khm bnh,

cha bnh ca ngi tham gia bo him y t.

3. Negotiating terms and conditions for contract amendment, liquidation andtermination specified at point e, Clause 2 of this Article must not interrupt the

medical care for the insureds.

4. Btrng BY tquy nh mu hp ng khm bnh, cha bnh bo him y

t.

4. Minister of Ministry of Health shall provide a medical care contract form for

social health insurance schemes.

iu 26. ng k khm bnh, cha bnh bo him y t

Article 26. Registration of Medical care for Social health insurance Schemes

1. Ngi tham gia bo him y tc quyn ng k khm bnh, cha bnh bo

him y t

ban u ti c s khm bnh, cha bnh tuyn x, tuyn huyn hoc tng

ng; trtrng hp c ng k ti cskhm bnh, cha bnh tuyn tnh

hoc tuyn trung ng theo quy nh ca Btrng BY t.

Trng hp ngi tham gia bo him y tphi lm vic lu ng hoc n tm

tr ti a phng khc th c khm bnh, cha bnh ban u ti cskhm

bnh, cha bnh ph hp vi tuyn chuyn mn kthut v ni ngi ang

lm vic lu ng, tm tr theo quy nh ca Btrng BY t.

1. The insureds shall have registration medical care at a health care provider at

commune, district or equivalent level, except for the case in which the insureds is

allowed to register in a health care provider at provincial or central level as

regulated by the Minister of Ministry of Health.

In case of the insureds have mobile working or temporary residenceat another

locality, he/she shall be entitled to medical care at the primary health careprovider suitable to a rank of technical, professional services and to the location


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where he/she is working or residence, as regulated by the Minister of Ministry of

Health.

2. Ngi tham gia bo him y tc thay i csng k khm bnh, cha

bnh ban u vo u mi qu.

2. The insureds shall be allowed to change the primary health care provider at

the beginning of each quarter.

3. Tn cskhm bnh, cha bnh bo him y tban u c ghi trong th

bo him y t.

3. The name of the primary health care provider shall be written on the social

health insurance card.

iu 27. Chuyn tuyn iu tr

Article 27. Referral

Trng hp vt qu khnng chuyn mn kthut th cskhm bnh, cha

bnh bo him y tc trch nhim chuyn ngi bnh kp thi n cskhm

bnh, cha bnh bo him y tkhc theo quy nh vchuyn tuyn chuyn mn

kthut.

In case of the patients treatment requires higher technical capacity, the primary

health care provider shall be responsible, as stipulated in the regulation on

referral, for timely referring the patient to the another health care provider.

iu 28. Thtc khm bnh, cha bnh bo him y tArticle 28. Proceduresof Medical care for Social health insurance Schemes

1. Ngi tham gia bo him y tkhi n khm bnh, cha bnh phi xut trnh

thbo him y tc nh; trng hp thbo him y tcha c nh th phi xut

trnh thbo him y tcng vi giy tchng minh vnhn thn ca ngi ;

i vi trem di 6 tui chphi xut trnh thbo him y t.

1. The insureds must present the social health insurance card enclosing a photo

when visiting for medical care; in case of the social health insurance card does

not enclose a photo, he/her must be presented an identity documentation; as for

children under six years of age, only social health insurance card is needed.

2. Trng hp cp cu, ngi tham gia bo him y tc khm bnh, cha

bnh ti bt kcskhm bnh, cha bnh no v phi xut trnh thbo him

y tcng vi giy tquy nh ti khon 1 iu ny trc khi ra vin.

2. In emergency, the insureds shall be entitled to medical care at any health care

provider, and must present the social health insurance card together with other

documentation specified at Clause 1 of this Article before being discharged from

hospital.


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3. Trng hp chuyn tuyn iu tr, ngi tham gia bo him y tphi c hs

chuyn vin ca cskhm bnh, cha bnh.

3. In case of referral, the insureds must have the hospital records for referral

issued by the health care institution.

4. Trng hp khm li theo yu cu iu tr, ngi tham gia bo him y tphi

c giy hn khm li ca cskhm bnh, cha bnh.4. In case of re-examination as required by providers, the insureds must have an

appointment paper for re-examination issued by the health care provider.

iu 29. Gim nh bo him y t

Article 29. Social health insurance Assessment

1. Ni dung gim nh bo him y tbao gm:

1. Social health insurance Assessmentshall consist of:

a) Kim tra thtc khm bnh, cha bnh bo him y t;

a) To check the procedures of medical care for social health insurance

scheme;

b) Kim tra, nh gi vic chnh iu tr, sdng thuc, ha cht, vt t,

thit by t, dch vkthut y tcho ngi bnh;

b) To check and evaluate the prescriptions for treatment, using of

medicine, chemicals, medical supplies, and equipment and health services

for patients;

c) Kim tra, xc nh chi ph khm bnh, cha bnh bo him y t.

c) To check and define the medical care costs for social health insurance

scheme.

2. Vic gim nh bo him y tphi bo m chnh xc, cng khai, minh bch.

2. The Social health insurance Assessmentmust ensure the accuracy, openness

and transparency.

3. Tchc bo him y tthc hin vic gim nh bo him y tv chu trch

nhim trc php lut vkt qugim nh.

3. Social health insurance organizations shall conduct Social health insurance

Assessment and be responsible for its results and legality.


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CHNG VI - THANH TON CHI PH KHM BNH, CHA BNH BO HIM

Y T

CHAPTER VI - PAYMENT OF MEDICAL CARE COSTS FOR SOCIAL HEALTH

INSURANCE SCHEMES

iu 30. Phng thc thanh ton chi ph khm bnh, cha bnh bo him y tArticle 30. Payment methods of medical care costs for Social health insurance

Schemes

1. Vic thanh ton chi ph khm bnh, cha bnh bo him y tc thc hin

theo cc phng thc sau y:

1. Payment of medical care costs for Social health insurance Schemes shall be

carried out in the following methods:

a) Thanh ton theo nh sut l thanh ton theo nh mc chi ph khm

bnh, cha bnh v mc ng tnh trn mi thbo him y tc ngk ti c skhm bnh, cha bnh bo him y t trong mt khong thi

gian nht nh;

a) Capitation is a payment method for medical care sevices in which a

health care provider is paid a contracted rate for each member assigned in

a certain period of time.

b) Thanh ton theo gi dch v l thanh ton da trn chi ph ca thuc,

ha cht, vt t, thit by t, dch vkthut y tc sdng cho ngi

bnh;

b) Fee-for-service is a payment method for the costs of drugs, chemicals

and supplies, medical equipments, medical care services are used for

patients;

c) Thanh ton theo trng hp bnh l thanh ton theo chi ph khm bnh,

cha bnh c xc nh trc cho tng trng hp theo chn on.

c) Diagnosis payment is a payment method for medical care services in

which a health care provider is paid a contracted rate for each diagnosis.

2. Chnh phquy nh cthvic p dng phng thc thanh ton chi ph khm

bnh, cha bnh bo him y tquy nh ti khon 1 iu ny.

2. The Government shall specify the application of payment method for medical

care costs covered by social health insurance scheme as stipulated in Clause 1

of this Article.

iu 31. Thanh ton chi ph khm bnh, cha bnh bo him y t

Article 31. Payment of medical care costs for Social health insurance Schemes

1. Tchc bo him y tthanh ton chi ph khm bnh, cha bnh bo him y tvi cskhm bnh, cha bnh theo hp ng khm bnh, cha bnh bo him

y t.


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1. Social health insurance agencies shall cover medical care costs, based on the

contract of medical care, to the health care providers.

2. Tchc bo him y tthanh ton chi ph khm bnh, cha bnh bo him y t

trc tip cho ngi c th bo him y ti khm bnh, cha bnh trong cc

trng hp sau y:

2. Social health insurance agencies shall provide direct payment for medical

care costs to the insureds examinated and treated, as follows:

a) Ti cskhm bnh, cha bnh khng c hp ng khm bnh, cha

bnh bo him y t;

a) At a medical care establishment not engaged in medical care contract

for social health insurance schemes.

b) Trng hp khm bnh, cha bnh khng ng quy nh ti cc iu 26,

27 v 28 ca Lut ny;

b) Not according to specifed at Articles 26, 27, 28 of this Law;

c) Ti nc ngoi;

c) At abroad;

d) Mt strng hp c bit khc do Btrng BY tquy nh.

d) Other special cases regulated by the Minister of Ministry of Health.

3. BY tchtr, phi hp vi BTi chnh quy nh thtc, mc thanh ton

i vi cc trng hp quy nh ti khon 2 iu ny.

3. The Ministry of Health shall be in charge and coordinate with the Ministry of

Finance to provide regulations on the procedures and rate of payment for cases

specified at Clause 2 of this Article.

4. Tchc bo him y t thanh ton chi ph khm bnh, cha bnh trn c s

vin ph theo quy nh ca Chnh ph.

4. Social health insurance agencies shall pay medical care costs based on

hospital-related fees regulated by the Government.

iu 32. Tm ng, thanh ton, quyt ton chi ph khm bnh, cha bnh bohim y t

Article 32. Payment, payment in advance and liquidation of Medical care Costs for

Social health insurance Scheme

1. Tchc bo him y tc trch nhim tm ng kinh ph hng qu cho cs

khm bnh, cha bnh bo him y t ti thiu bng 80% chi ph khm bnh,

cha bnh bo him y tthc tca qu trc c quyt ton. i vi cs

khm bnh, cha bnh ln u k hp ng khm bnh, cha bnh bo him y t

th mc tm ng ln u ti thiu bng 80% mc kinh ph khm bnh, cha bnh

bo him y tca mt qu theo hp ng k.


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1. Social health insurance agencies shall be responsible for providing quarterly

payment in advance for the health care establishments at minimum of 80% of

actual liquidated medical care costs of the previous quarter. For the health care

establishments engaged in frist time with medical care contract, the first

payment in advance equals to minimum of 80% of quarterly medical care costs

as specified in the signed contract.

2. Vic thanh ton, quyt ton gia cskhm bnh, cha bnh v tchc bo

him y tc thc hin hng qu nhsau:

2. The payment and liquidation between the health care establishments and

social health insurance agencies shall be quarterly carried out as follows:

a) Trong thng u ca mi qu, cskhm bnh, cha bnh bo him y

tc trch nhim gi bo co quyt ton chi ph khm bnh, cha bnh bo

him y tca qu trc cho tchc bo him y t;

a) Within the first month of each quarter, the health care providers shall be

responsible for sending previous quarter liquidation report on medical

care costs to the social health insurance agencies;

b) Trong thi hn 30 ngy, k tngy nhn c bo co quyt ton ca

cskhm bnh, cha bnh bo him y t, tchc bo him y tc trch

nhim xem xt v thng bo kt ququyt ton chi ph. Trong thi hn 15

ngy, ktngy thng bo kt ququyt ton, tchc bo him y tphi

hon thnh vic thanh ton vi cskhm bnh, cha bnh.

b) Within 30 days from the date of receiving the liquidation report from the

health care providers, the social health insurance agencies shall be

responsible for consideration and informing liquidation results. Within 15

days from the date of informing liquidation results, the social health

insurance agencies must complete the payment for medical care costs to

the health care providers.

3. Trong thi hn 40 ngy, k t ngy nhn h s ngh thanh ton ca

ngi tham gia bo him y tkhm bnh, cha bnh theo quy nh ti im a v

im b khon 2 iu 31 ca Lut ny; trong thi hn 60 ngy, ktngy nhn

hsnghthanh ton ca ngi tham gia bo him y tkhm bnh, cha

bnh theo quy nh ti im c v im d khon 2 iu 31 ca Lut ny, tchc

bo him y tphi thanh ton chi ph khm bnh, cha bnh trc tip cho cc i

tng ny.

3. Within 40 days from the date of receiving full documentation on request of

payment medical care cost from the insureds as specified at Points a, b, Clause

2, Article 31 of this Law; and within 60 days from the date of receiving full

documentation on request of payment medical care cost from the insureds as

specified at Points c, d, Clause 2, Article 31 of this Law, the social health


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insurance agencies must complete the payment for medical care costs direct to

the insureds.

CHNG VII - QUBO HIM Y T

CHAPTER VII - SOCIAL HEALTH INSURANCE FUND

iu 33. Ngun hnh thnh qubo him y t

Article 33. Sources for formation of Social health insuranceFund

1. Tin ng bo him y ttheo quy nh ca Lut ny.

1. Premiums of social health insurance are paid under the provisionS of this

Law.

2. Tin sinh li thot ng u tca qubo him y t.

2. Profits from activities of investment from the fund.

3. Ti tr, vin trca cc tchc, c nhn trong nc v nc ngoi.

3. Donation, aid from domestic and overseas individuals or organizations.

4. Cc ngun thu hp php khc.

4. Other lawful sources of revenues.

iu 34. Qun l qubo him y t

Article 34. Management of Social health insurance Fund

1. Qubo him y tc qun l tp trung, thng nht, cng khai, minh bch

v c sphn cp qun l trong hthng tchc bo him y t.

1. Social health insurance fund is managed in a concentrate, uniform, public,

transparent manner and is decentralized in management of social health

insurance organizational system.

2. Chnh phquy nh cthvic qun l qubo him y t; quyt nh ngun

ti chnh bo m vic khm bnh, cha bnh bo him y ttrong trng hp

mt cn i thu, chi qubo him y t.2. The Government shall detail the management of social health insurance fund,

decide finacial source to assure medical examination, treatment in case of the

fund is in unbalance.

iu 35. Sdng qubo him y t

Article 35. Utilization of Social health insurance Fund

1. Qubo him y tc sdng cho cc mc ch sau y:

1. The fund is used for:

a) Thanh ton chi ph khm bnh, cha bnh bo him y t;

a) To pay for medical care costs of the insureds;


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b) Chi ph qun l bmy tchc bo him y ttheo nh mc chi hnh

chnh ca cquan nh nc;

b) To pay for management costs of social health insurance organizations

according to the expenditure norm of administrive state bodies;

c) u tbo ton v tng trng qubo him y ttheo nguyn tc an

ton, hiu qu;c)To iInvest for preservation and growth of the fund in safety and effective

principles;

d) Lp qudphng khm bnh, cha bnh bo him y t. Qudphng

ti thiu bng tng chi khm bnh, cha bnh bo him y tca hai qu

trc lin kv ti a khng qu tng chi khm bnh, cha bnh bo him

y tca hai nm trc lin k.

d) To settle a providing fund for medical treatment. The providing fund

equal to total social health insurance expenditure of two preceding

quarters at least and of two preceding years at maximum.

2. Trng hp cc tnh, thnh phtrc thuc trung ng c sthu bo him y t

ln hn schi khm bnh, cha bnh bo him y tth c sdng mt phn

kt dphc vkhm bnh, cha bnh bo him y tti a phng.

2. In cases of provinces, cities under the central have premium renevue more

than medical expenditure, the rest will be partly used for medical treatment in

that province, city.

3. Chnh phquy nh cthiu ny.

3. The Government shall specify the implementation of this Article.

CHNG VIII - QUYN V TRCH NHIM CA CC BN LIN QUAN N

BO HIM Y T

CHAPTER VIII -RIGHTS AND RRESPONSIBILITIES OF PARTIES INVOLVED IN

SOCIAL HEALTH INSURANCE

iu 36. Quyn ca ngi tham gia bo him y t

Article 36. Rights of Insureds

1. c cp thbo him y tkhi ng bo him y t.

1. To be granted social health insurance card as paying social health insurance

premium.

2. La chn cskhm bnh, cha bnh bo him y tban u theo quy nh

ti khon 1 iu 26 ca Lut ny.2. To choose the primary health care establishment according to Clause 1

Article 26 of this Law.


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3. c khm bnh, cha bnh.

3. To be examined and treated.

4. c tchc bo him y tthanh ton chi ph khm bnh, cha bnh theo ch

bo him y t.

4. To be paid medical expenditures by social health insurance schemes.

5. Yu cu tchc bo him y t, cskhm bnh, cha bnh bo him y tv

cquan lin quan gii thch, cung cp thng tin vchbo him y t.

5. To request social health insurance organizations, health care establishments

and related organizations explaning, informating about social health insurance

schemes.

6. Khiu ni, tco hnh vi vi phm php lut vbo him y t.

6. To complain, to accuse the violations of social health insurance.

iu 37. Ngha vca ngi tham gia bo him y t

Article 37. Obligations of Insureds

1. ng bo him y ty , ng thi hn.

1. To pay the primium completely, in term.

2. Sdng thbo him y tng mc ch, khng cho ngi khc mn th

bo him y t.

2. To use social health insurance card as stipulated and it is not available to be

use by another one.

3. Thc hin cc quy nh ti iu 28 ca Lut ny khi n khm bnh, cha

bnh.

3. To implement the provisions of article 28 of this Law whenever being

examined and treated.

4. Chp hnh cc quy nh v hng dn ca tchc bo him y t, cskhm

bnh, cha bnh khi n khm bnh, cha bnh.

4. To execute the provisions and guides from social health insurance

organizations, health care establishments whenever being examined and treated.

5. Thanh ton chi ph khm bnh, cha bnh cho cskhm bnh, cha bnh

ngoi phn chi ph do qubo him y tchi tr.

5. To pay byself for medical costs in which do not cover by social health

insurance fund.

iu 38. Quyn ca tchc, c nhn ng bo him y t

Article 38. Rights of Individuals, Organizations

1. Yu cu tchc bo him y t, cquan nh nc c thm quyn gii thch,

cung cp thng tin vchbo him y t.


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1. To request social health insurance organizations, competent state bodies for

explaning, informating on social health insurance schemes.

2. Khiu ni, tco hnh vi vi phm php lut vbo him y t.

2. To complaint, accuse the violations in social health insurance.

iu 39. Trch nhim ca tchc, c nhn ng bo him y tArticle 39. Responsibilities of Individuals, Organizations conducting Social health

insurance.

1. Lp hsnghcp thbo him y t.

1. To compile dossiers for to be granted social health insurance cards.

2. ng bo him y ty , ng thi hn.

2. To pay the primium completely, in term.

3. Giao thbo him y tcho ngi tham gia bo him y t.3. To deliver social health insurance cards to the insureds.

4. Cung cp y , chnh xc thng tin, ti liu c lin quan n trch nhim

thc hin bo him y t ca ngi s dng lao ng, ca i din cho ngi

tham gia bo him y tkhi c yu cu ca tchc bo him y t, ngi lao ng

hoc i din ca ngi lao ng.

4. To supply accurate documents, information completely which relevant to

responsibilities of insured representatives and employers at the request of

social health insurance organizations, employees or employees representative.

5. Chp hnh vic thanh tra, kim tra vvic thc hin cc quy nh ca php

lut vbo him y t.

5. To take the inspectorate, checking of carring out social health insurance

legislation.

iu 40. Quyn ca tchc bo him y t

Article 40. Rights of Social health insurance Organizations

1. Yu cu ngi sdng lao ng, i din ca ngi tham gia bo him y t

v ngi tham gia bo him y tcung cp y , chnh xc thng tin, ti liu c

lin quan n trch nhim ca hvvic thc hin bo him y t.

1. To request the insuredsrepresentative, employers providing documents,

information in adequately and accurately which concerned about their

responsibilities for implementaion of social health insurance.

2. Kim tra, gim nh vic thc hin khm bnh, cha bnh bo him y t; thu

hi, tm githbo him y ti vi cc trng hp quy nh ti iu 20 ca

Lut ny.


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2. To check and supervise the implementation of medical examination and

treatment of social health insurance; to withdraw or temporary detainment

social health insurance card as stated at article 20 of this Law.

3. Yu cu cskhm bnh, cha bnh bo him y tcung cp hs, bnh n,

ti liu vkhm bnh, cha bnh phc vcng tc gim nh bo him y t.

3. To request the health care establishments providing patient records,

documents related to the social health insurance examination and treatment for

appraise.

4. Tchi thanh ton chi ph khm bnh, cha bnh bo him y tkhng ng

quy nh ca Lut ny hoc khng ng vi ni dung hp ng khm bnh,

cha bnh bo him y t.

4. To refuse the payment for medical examination and treatment costs not

complying with the provisions of this Law or not complying with the content of

social health insurance examination and treatment contract.

5. Yu cu ngi c trch nhim bi thng thit hi cho ngi tham gia bo

him y thon trchi ph khm bnh, cha bnh m tchc bo him y t chi

tr.

5. To request the persons who must compensate the insured for medical costs

which social health insurance organization had paid for the insured.

6. Kin nghvi cquan nh nc c thm quyn sa i, bsung chnh sch,

php lut vbo him y tv xl tchc, c nhn vi phm php lut vbo

him y t.

6. To propose competent authorities amending, supplementing social health

insurance policies, legislation and handling with violations of individuals,

organizations in social health insurance.

iu 41. Trch nhim ca tchc bo him y t

Article 41. Responsibilities of Social health insurance Organizations

1. Tuyn truyn, phbin chnh sch, php lut vbo him y t.

1. To propagate and disseminate social health insurance policies, legislation.

2. Hng dn hs, th tc, tchc thc hin chbo him y tbo m

nhanh chng, n gin v thun tin cho ngi tham gia bo him y t.

2. To conduct the dossiers, prcedures in quickly, simply and conviniently for the

insured to implement social health insurance schemes.

3. Thu tin ng bo him y tv cp thbo him y t.

3. To collect social health insurance premiums and issue social health

insunrance card.

4. Qun l, sdng qubo him y t.

4. To manage and use social health insurance fund.


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5. K hp ng khm bnh, cha bnh bo him y tvi cskhm bnh, cha

bnh.

5. To sign a contract with health care establishments for the medical

examination and treatment.

6. Thanh ton chi ph khm bnh, cha bnh bo him y t.

6. To pay the medical examination and treatment expenditures.

7. Cung cp thng tin v cc c s khm bnh, cha bnh bo him y t v

hng dn ngi tham gia bo him y tla chn cskhm bnh, cha bnh

ban u.

7. To supply the information of primary health establishments and guide the

insured choosing one of them.

8. Kim tra cht lng khm bnh, cha bnh; gim nh bo him y t.

8. To check the quality of medical examination and treament; supervise the

social health insurance.

9. Bo v quyn li ca ngi tham gia bo him y t; gii quyt theo thm

quyn cc kin ngh, khiu ni, tco vchbo him y t.

9. To protect the insured benefits; to handle with the proposal, complaint,

deuniciation regarding social health insurance.

10. Lu trh s, s liu v bo him y t theo quy nh ca php lut; ng

dng cng nghthng tin trong qun l bo him y t, xy dng hcsdliu

quc gia vbo him y t.10. To archive the dossiers, records of social health insurance according to the

provisions of legislation; to apply informatic technology to social health

insurance management, building national database of social health insurance

system.

11. Tchc thc hin cng tc thng k, bo co, hng dn nghip vvbo

him y t; bo co nh khoc t xut khi c yu cu vqun l, sdng qu

bo him y t.

11. To organize report, statistical work, providing professional guidance onsocial health insurance; to report in termly, suddenly at the request of the using,

management of social health insurance.

12. Tchc o to, bi dng nghip v, nghin cu khoa hc v hp tc quc

tvbo him y t.

12. To organize training, foster professional ability, research science and

establish international cooperation on social health insurance.


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iu 42. Quyn ca cskhm bnh, cha bnh bo him y t

Article 42. Rights of Health care establishments

1. Yu cu tchc bo him y tcung cp y , chnh xc cc thng tin c

lin quan n ngi tham gia bo him y t, kinh ph khm bnh, cha bnh cho

ngi tham gia bo him y tti cskhm bnh, cha bnh.

1. To request the social health insurance organizations providing full and

accurate information of the insured, of the fund for the health care

establishment examination and treatment.

2. c t chc bo him y t tm ng kinh ph v thanh ton chi ph khm

bnh, cha bnh theo hp ng khm bnh, cha bnh k.

2. To be paid in advanced health care expenditure according to the signed

contract

3. Kin ngh vi c quan nh nc c thm quyn x l t chc, c nhn vi

phm php lut vbo him y t.

3. To propose competent authorities handling with violations of individuals,

organizations in social health insurance.

iu 43. Trch nhim ca cskhm bnh, cha bnh bo him y t

Article 43. Responsibilities of Health care establishments

1. T chc khm bnh, cha bnh bo m cht lng vi th tc n gin,

thun tin cho ngi tham gia bo him y t.

1. To assure the quality of examination and treatment with a convenient and

simple procedure for the insureds.

2. Cung cp hsbnh n, ti liu lin quan n khm bnh, cha bnh v thanh

ton chi ph khm bnh, cha bnh ca ngi tham gia bo him y ttheo yu

cu ca tchc bo him y tv cquan nh nc c thm quyn.

2. To supply the patient reords, documents related to payment the costs of

examination and treatment of the insureds at the request of social health

insurance organizations and competent state agencies.

3. Bo m iu kin cn thit cho t chc bo him y t thc hin cng tc

gim nh; phi hp vi tchc bo him y ttrong vic tuyn truyn, gii thch

vchbo him y tcho ngi tham gia bo him y t.

3. To assure the basic conditions for supervisory work of social health insurance

organizations; to coordinate with social health insurance organizations

propaganding, explaning social health insurance schemes to the insureds.

4. Kim tra, pht hin v thng bo cho tchc bo him y tnhng trng hp

vi phm vsdng thbo him y t; phi hp vi tchc bo him y tthuhi, tm githbo him y ti vi cc trng hp quy nh ti iu 20 ca

Lut ny.


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4. To check, find out, inform misusing social health insurance cards to social

health insurance organizations; cooperate with social health insurance

organizations to withdraw or temporary detainment social health insurance card

as specified at Article 20 of this Law.

5. Qun l v sdng kinh ph tqubo him y t theo ng quy nh ca

php lut.5. To manage and use budget of the social health insurance fund according to

the provisions of legislation.

6. Tchc thc hin cng tc thng k, bo co vbo him y ttheo quy nh

ca php lut.

6. To organize statiscal and reporting work on social health insurance

according to the provisions of legislation.

iu 44. Quyn ca tchc i din ngi lao ng v tchc i din ngisdng lao ng

Article 45. Rights of Employees representative Organization and Employers

representative Organization

1. Yu cu tchc bo him y t, cskhm bnh, cha bnh v ngi sdng

lao ng cung cp y , chnh xc thng tin lin quan n chbo him y

tca ngi lao ng.

1. To request the social health insurance organizations and health care

establishments providing full and accurate information of employees social

health insurance regime.

2. Kin nghvi cquan nh nc c thm quyn xl hnh vi vi phm php

lut vbo him y t lm nh hng n quyn v li ch hp php ca ngi

lao ng, ngi sdng lao ng.

2. To propose competent authorities handling with violations of activities in

social health insurance.

iu 45. Trch nhim ca tchc i din ngi lao ng v tchc i dinngi sdng lao ng

Article 45. Responsibilities of Employees representative Organization and

Employers representative Organization

1. Tuyn truyn, phbin chnh sch, php lut vbo him y ti vi ngi

lao ng, ngi sdng lao ng.

1. To propagate and disseminate social health insurance policies, legislation for

employees and employers.

2. Tham gia xy dng, kin nghsa i, bsung chnh sch, php lut vbo

him y t.


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2. To participate in elaboration, proposal for amending, supplementing of social

health insurance policies, legislation.

3. Tham gia gim st vic thi hnh php lut vbo him y t.

3. To participate in supervising the implementtation of the law on social health

insurance.

CHNG IX - THANH TRA, KHIU NI, TCO, GII QUYT TRANH CHP

V XL VI PHM VBO HIM Y T

CHAPTER IX - INSPECTION, COMPLAINT, DENUNCIATION, SETTLEMENT OF

DISPUTES AND HANDLING OF VIOLATIONS IN SOCIAL

HEALTH INSURANCE

iu 46. Thanh tra bo him y tArticle 46. Social health insurance Inspectorate

Thanh tra y tthc hin chc nng thanh tra chuyn ngnh vbo him y t.

Health inspectorate shall perform the functions of specialized social health

insurance inspection.

iu 47. Khiu ni, tco vbo him y t

Article 47. Complaints, denunciations regarding Social health insurance

Vic khiu ni v gii quyt khiu ni i vi quyt nh hnh chnh, hnh vi

hnh chnh vbo him y t, vic tco v gii quyt tco vi phm php lut

vbo him y tc thc hin theo quy nh ca php lut vkhiu ni, tco.

Complaints and the settlement of complaints about administrative decisions or

administrative acts regarding social health insurance, denunciations and the

settlement of denunciations about violations of law on social health insurance

shall be as provided for in the law on complaints and denunciations.

iu 48. Tranh chp vbo him y tArticle 48. Disputes on Social health insurance

1. Tranh chp vbo him y tl tranh chp lin quan n quyn, ngha vv

trch nhim bo him y tgia cc i tng sau y:

1. Social health insurance disputes are the disputes which on related rights,

duties, resposibilities of social health insurance among the persons as follows:

a) Ngi tham gia bo him y ttheo quy nh ti iu 12 ca Lut ny,

ngi i din ca ngi tham gia bo him y t;

a) Employees covered by social health insurance according to the

provisions of Article 12 of this Law, and their representatives;


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b) Tchc, c nhn ng bo him y ttheo quy nh ti khon 1 iu 13

ca Lut ny;

b) Organizations, individuals pay social health insurance premiums

according to the provisions of Clause 1, Article 13 of this Law;

c) Tchc bo him y t;

c) Social health insurance organizations;

d) Cskhm bnh, cha bnh bo him y t.

d) Health Care Establishments for the insureds.

2. Tranh chp vbo him y tc gii quyt nhsau:

2. Social health insurance disputes are settled as follows:

a) Cc bn tranh chp c trch nhim tha gii vni dung tranh chp;

a) Disputing parties do responsibility for recociliation by themselve on

disputing contents;

b) Trng hp ha gii khng thnh th cc bn tranh chp c quyn khi

kin ti Ta n theo quy nh ca php lut.

b) In case of the reconciliation fails, each party to the dispute entitle to

initiate lawsuits at a court according to the legislation.

iu 49. Xl vi phm

Article 49. Handling of violations

1. Ngi no c hnh vi vi phm cc quy nh ca Lut ny v cc quy nh

khc ca php lut c lin quan n bo him y tth ty theo tnh cht, mc

vi phm m bxl klut, xpht vi phm hnh chnh hoc btruy cu trch

nhim hnh s, nu gy thit hi th phi bi thng theo quy nh ca php lut.

1. Any person who commit law-breaking acts specified in this Law and other

related law shall be disciplined, administratively sanctioned, or examined for

penal liability, depending on the nature and severity of their violations; if

causing damage, they must pay compensations therefor in accordance with law.

2. Cquan, tchc, ngi sdng lao ng c trch nhim ng bo him y t

m khng ng hoc ng khng y theo quy nh ca php lut th cng

vi vic phi ng stin cha ng, cn phi np stin li trong thi gian

chm ng theo mc li sut cbn do Ngn hng nh nc cng b; nu khng

thc hin th theo yu cu ca ngi c thm quyn xl vi phm hnh chnh,

ngn hng, tchc tn dng khc, kho bc nh nc c trch nhim trch tin t

ti khon tin gi ca ngi c trch nhim ng bo him y tnp s tin

cha ng, chm ng v li ca stin ny vo ti khon ca qu bo him y

t.2.Agencies, organizations, employers have responsibilities for paying social

health insurance premium, apart from paying the amounts not yet paid or paid


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late and being handled in accordance with law, pay the amounts must be paid

and the interests on it at the interest rate of the investment from the State Bank in

the year. In case the agencies, organizations, employer fails to comply with the

request of the persons competent to impose administrative sanctions, the bank,

credit institution or state treasury shall deduct money from the deposit account

of the agencies, organizations, employers to pay the amount not yet paid or paidlate and the interest on such amount into social health insurance fund.

CHNG X - IU KHON THI HNHCHAPTER X - IMPLEMENTATION PROVISIONS

iu 50. iu khon chuyn tip

Article 50. Transition provisions

1. Thbo him y tv thkhm bnh, cha bnh min ph cho trem di 6tui c cp trc ngy Lut ny c hiu lc c gi trsdng nhsau:

1. Health social insurance cards and Free medical care card for children under

6 years old which issued before this law takes effect, have the valid using as

follow:

a) Theo thi hn ghi trn thtrong trng hp thghi gi trsdng n

ngy 31 thng 12 nm 2009;

a) at the end of the valid time and/or at the end of December 31st, 2009

notice on card;

b) n ht ngy 31 thng 12 nm 2009 trong trng hp thghi gi trs

dng sau ngy 31 thng 12 nm 2009.

b) at the end of December 31st, 2009 if the card have the valid using after

2009.

2. Phm vi quyn li ca ngi c cp thbo him y ttrc khi Lut ny c

hiu lc c thc hin theo quy nh hin hnh ca php lut vbo him y t

cho n ht ngy 31 thng 12 nm 2009.

2. Scope of social health insurance benefits before this Law takes effect shall still

comply with the previous regulations to the end of December 31st, 2009.

3. i tng quy nh ti cc khon 21, 22, 23, 24 v 25 iu 12 ca Lut ny

khi cha thc hin quy nh ti cc im b, c, d v khon 2 iu 51 ca Lut

ny th c quyn tnguyn tham gia bo him y ttheo quy nh ca Chnh ph.

3. When the participants specifiedat Clauses 21, 22, 23, 24, 25, Article 12 of

this Law not yet comply with points b, c, d, of Clause 2, Article 51 of this Law

are voluntary entitled to social health insurance schemes in accordance with

provisions of Government.


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iu 51. Hiu lc thi hnh

Article 51. Implementation effect

1. Lut ny c hiu lc thi hnh tngy 01 thng 7 nm 2009.

1. This Law takes effect on July 1st, 2009.

2. Ltrnh thc hin bo him y tton dn c quy nh nhsau:

2. Implementary map for universal social health insurance is defined as follow:

a) i tng quy nh tkhon 1 n khon 20 iu 12 ca Lut ny thc

hin bo him y ttngy Lut ny c hiu lc thi hnh;

a)The coverage specifiedat Clauses from 1 to 20, Article 12 of this Law

entitle to implementation since the date this law takes effect;

b) i tng quy nh ti khon 21 iu 12 ca Lut ny thc hin bo

him y ttngy 01 thng 01 nm 2010;b) The coverage specified at Clause 21, Article 12 of this Law entitle to

implementtion since January 1st, 2010;

c) i tng quy nh ti khon 22 iu 12 ca Lut ny thc hin bo

him y ttngy 01 thng 01 nm 2012;

c) The coverage specified at Clau

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