The Ministry of Health is soliciting public comments on the Draft Circular detailing the implementation of certain provisions of the Law on Social Insurance and the Law on Health Insurance (referred to as the Draft Circular). It amends, supplements, and repeals certain regulations related to the payment activities for medical examination and treatment (MET) covered by health insurance (HI) as follows:
Article table of contents
Forgetting the health insurance card means the patient must remember their health insurance card number when getting medical care
Article 8 of Joint Circular 41/2014/TTLT-BYT-BTC stipulates that participants of health insurance must present their health insurance cards when getting medical care (KCB). However, the Draft Circular has added that if a patient forgets their health insurance card at home, they must provide the health insurance card number. To be specific:
- Health insurance participants must provide the health insurance card number or present the photo health insurance card when undergoing medical examination and treatment.- In case a patient does not bring the health insurance card at the time of KCB procedures, they are responsible for providing the KCB facility with their health insurance card number and one of the identification documents.- If the patient does not bring the health insurance card at the time of KCB procedures and cannot provide both the health insurance card number and identification documents simultaneously, they will have to pay as an uninsured person and will only be reimbursed for KCB costs from the moment the health insurance card is presented.
Thus, remembering the health insurance card number is crucial to ensure the patient’s rights when covering KCB expenses.
Also in this Draft Circular, the Ministry of Health proposed more specific regulations for presenting identification documents as follows:
In case the health insurance card does not have a photo, the patient must provide the personal identification number or present one of the following documents: 1- Valid citizen identification card; 2- Valid identity card (including military ID); 3- Valid passport; 4- Valid student card (for students under age for identity card); 5- Other photo identification documents issued or certified by a state management agency or the organization the person is working for.
Healthcare facilities are not allowed to temporarily hold the patient’s health insurance card
Under Clause 9 Article 26 of the Draft Circular, the Ministry of Health stipulates: Healthcare facilities and social insurance organizations are not allowed to impose additional administrative procedures in KCB under health insurance. Apart from the stipulated procedures, healthcare facilities and social insurance organizations are not permitted to temporarily hold the patient’s health insurance card. If they need to copy the health insurance card, referral letter, or any documents related to KCB, they must make the copies themselves and not require the patient to do so or cover any associated costs.
Notes on the validity of the referral letter
According to the Draft Circular, a referral letter is valid for a maximum of 30 days (unlike the current regulation of 10 days- Circular 40/2015/TT-BYT).
The use of referral letters for patients with health insurance suffering from diseases or groups of diseases listed in Appendix 01 issued with Circular 40/2015/TT-BYT has a few notes as follows:
- The referral letter is valid for 12 months from the date of issuance.- If the referral period extends over two years, the patient must inform the KCB facility of the validity status of the health insurance card on January 1 of the new year, except for retirees.
Example: A referral letter issued on November 30, 2017, would be valid until November 30, 2018, but on January 1, 2018, if the patient is still undergoing inpatient treatment, they must inform the KCB facility whether they have been issued the 2018 health insurance card or whether there have been any changes in health insurance coverage for 2018.
Referral without having to contact the anticipated receiving KCB facility
According to the current regulations in Circular 14/2014/TT-BYT, when a patient needs emergency referral between KCB facilities, the initial receiving KCB facility must contact the anticipated receiving KCB facility. However, the Draft Circular proposes abolishing this regulation, instead, requiring only a final check of the patient’s condition before transfer; and preparing the means to provide emergency care during the transfer.
The Circular is expected to take effect from June 1, 2017, replacing Circular 14/2016/TT-BYT and abolishing the regulations at:
- Point c Clause 1 Article 5 of Circular 14/2014/TT-BYT;- Point c and d Clause 2 Article 9 of Circular 37/2014/TT-BYT;- Clauses 2, 3, and 4 Article 15 of Joint Circular 41/2014/TTLT-BYT-BTC.
See the details of the Draft Circular HERE.
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