Medical examinations and treatment procedures under Health insurance in Vietnam (latest update)

Medical examinations and treatment procedures under Health insurance in Vietnam (latest update) (Internet image) 

On December 1, 2023, the Ministry of Health issued Decision 4384/QD-BYT announcing 02 amended and supplemented administrative procedures in the field of health finance within the scope of management functions of the Ministry of Health stipulated in Decree 75/2023/ND-CP and 02 abolished administrative procedures in the field of health insurance within the scope of management functions of the Ministry of Health specified in Decision 7291/QD-BYT dated December 7, 2018 announcing new administrative procedures in the field of health insurance within the scope of management functions of the Ministry of Health in Decree 146/2018/ND-CP.

1. Procedures for medical examination and treatment under health insurance (latest update)

* Step 1: For health insurance participants

- Health insurance participants must present their health insurance card with a photo or citizen identification card when going to a medical examination and treatment facility; If you present your health insurance card without a photo, the applicants must also present one of the identification documents with a photo issued by a competent agency or organization or confirmation from the commune-level police or other documents certified by the educational institution where the student is managed; other legal identity documents or level 2 electronic identification documents as prescribed in Decree 59/2022/ND-CP; and for children under 6 years old, only a health insurance card must be presented.

- In case of emergency, health insurance participants receive medical treatment at any health care facility and must present their health insurance card along with the documents specified in Clause 1, Step 1, before leaving the hospital.

- In case of a referral for treatment, the health insurance participant must have a referral certificate for medical examination and treatment covered by health insurance and hospital transfer records from the medical facility.

- In cases of re-examination as required for treatment, the health insurance participant must have a re-examination appointment letter from the medical facility.

- In cases where the technical expertise is beyond the health insurance medical facility, the health insurance medical facility is responsible for promptly transferring the patient to another health insurance health care facility according to regulations on technical and professional referral.

- Some specific cases for health insurance participants:

+ Health insurance participants must present their health insurance card with a photo or citizen identification card when undergoing medical examination and treatment; If you present your health insurance card without a photo, you must also present one of the identification documents with a photo issued by a competent agency or organization or confirmation from the commune-level police or other documents certified by the educational institution where the student is managed; Other legal identification documents or level 2 electronic identification documents as prescribed in Decree 59/2022/ND-CP.

+ Children under 6 years old who come to a medical examination only have to present their health insurance card. In cases where the child has not been issued a health insurance card, a copy of the birth certificate or a copy of the birth certificate must be presented; In cases where treatment is required immediately after birth without a birth certificate, the head of the health care facility and the child's father, mother, or guardian must sign the medical record for confirmation as a basis for payment according to the provisions of Clause 1, Article 27 of Decree 146/2018/ND-CP and are responsible for this confirmation.

+ Health insurance participants while waiting for the card to be reissued or changed to health insurance when coming to the medical facility must present a declaration of participation and adjustment of social insurance and health insurance information according to Form TK1-TS (issued together with Decision 490/QD-BHXH dated March 28, 2023 of Vietnam Social Insurance) and a document proving that person's identity.

+ People who have donated body parts for medical examination and treatment must present the documents specified in points (1) or (3) above. In case treatment is required immediately after donation, the head of the medical facility where the body part was taken and the patient or the patient's relative must sign the medical record for confirmation as a basis for payment according to the provisions of Clause 2, Article 27 of Decree 146/2018/ND-CP and is responsible for this confirmation.

+ In case of medical referral, health insurance participants must present the medical facility's referral record and referral certificate according to Form No. 6, Appendix issued with Decree 75/2023/ND-CP. In case the referral document is valid until December 31 of the calendar year but the treatment period has not ended, the referral document can be used until the end of the treatment period.

In case of re-examination according to treatment requirements, health insurance participants must have a re-examination appointment from the medical facility according to Form No. 5, Appendix issued with Decree 75/2023/ND-CP.

+ In case of emergency, health insurance participants can go for medical treatment at any medical facility and must present the documents specified in Clause 6, Article 1 of Decree 75/2023/ND-CP, Clause 2 or Clause 3, Article 15 of Decree 146/2018/ND-CP before discharge from the hospital. When the emergency period ends, if a patient is transferred by a health care facility to another department or treatment room at that health care facility for continued monitoring, treatment, or referred to another health care facility, it is determined to be at the right medical care facility.

+ People participating in health insurance while on business trips, mobile work, studying in various forms of training, training programs, and temporary residence receive initial medical treatment at medical facilities at the same technical and professional level or equivalent to the initial medical treatment registration facility recorded on the health insurance card and must present the documents specified in Clause 6, Article 1 of Decree 75/2023/ND-CP or Clause 2 or Clause 3, Article 15 of Decree 146/2018/ND-CP and one of the following documents (original or copy): work papers, decision to send to school, student card, documents proving temporary residence registration, school transfer papers.

* Step 2: For medical facilities

- Organize medical examination and treatment to ensure quality with simple and convenient procedures for health insurance participants.

- Receive patients with health insurance cards into medical facilities for diagnosis and treatment.

2. Components of health insurance medical examination and treatment records

- Health insurance card and documents proving that person's identity; For children under 6 years old, only health insurance card must be presented.

- Copy of birth certificate or copy of birth certificate for children under 6 years old.

- Declaration of participation and adjustment of social insurance and health insurance information according to Form TK1-TS (Issued together with Decision 490/QD-BHXH dated March 28, 2023 of Vietnam Social Insurance) .

- Form No. 5. Appointment letter for re-examination.

- Form No. 6. Health insurance medical examination and treatment referral form.

- Referral records of health insurance medical facilities.

More details can be found in Decision 4384/QD-BYT taking effect on October 19, 2023.

Ho Quoc Tuan

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