Procedure for for direct payment of health insurance-covered medical care costs in Vietnam

Latest regulations on procedure for direct payment of health insurance-covered medical care costs in Vietnam (Image from the Internet)

On July 16, 2024, the General Director of Vietnam Social Security issued Decision 1003/QD-BHXH announcing amended administrative procedures in the field of implementing health insurance policies under the authority of Vietnam Social Security.

Procedure for for direct payment of health insurance-covered medical care costs in Vietnam

According to the regulations in Part II of the Appendix issued together with Decision 1003/QD-BHXH in 2024, the procedure for direct payment of health insurance-covered medical care costs/granting a non-co-payment certificate in the year is as follows:

(1) Execution Order:

- Step 1. Prepare and submit the dossier

The patient or their family member or legal representative as per the law prepares the payment request dossier according to the regulations in item 3.3, part II of the Appendix issued together with Decision 1003/QD-BHXH in 2024 (Dossier components); submit the dossier to the Social Security Agency.

Step 2. The Social Security Agency receives and processes the dossier.

Step 3. Receive results

- For payment requests: receive money via the method registered when filing the dossier. If rejected: receive a written explanation from the Social Security Agency.

- For requests for a non-co-payment certificate: receive the certificate. If rejected, the Social Security Agency provides a written explanation.

(2) Methods of implementation

* Submit the dossier online, directly at the Social Security Agency, or via public postal service.

* Receive results:

- For document results: through public postal service or directly at the One-stop department of the Social Security Agency.

- For cash results: receive at the Finance - Accounting Department of the Social Security Agency.

+ Direct recipient: Provide appointment slip and present citizen ID card/e-ID card (via electronic identity account level 02) or valid ID card.

+ For an authorized recipient:

++ If a family member or legal guardian: Provide appointment slip and present citizen ID card/e-ID card or valid ID card; provide documents proving the relationship as family member/legal guardian of the health insurance beneficiary (copy or photograph and original for comparison such as Birth Certificate, Birth Report, Marriage Certificate...).

In cases with no natural guardian as per the law, provide appointment slip; present citizen ID card/e-ID card or valid ID card; provide a court-approved guardianship decision (certified copy or photograph and original for comparison).

++ If not a family member or legal guardian: provide Application Receipt and appointment slip; citizen ID card/e-ID card or valid ID card; Power of Attorney.

(3) Dossier Components

* For direct payment of medical expenses:

- Photocopies of the following (along with originals for comparison if submitted directly):

+ Health insurance card and one of the valid photo ID documents if health insurance card does not have a photo (citizen ID card/e-ID card or valid ID card, Passport, Communist Party membership card, People's Public Security card, Military ID, Union membership card, Student card, Veteran card, Driver’s license or other valid photo ID); Birth Certificate, Birth Report in case of children under 6 years without a health insurance card.

+ Hospital discharge paper, medical examination slip, or medical examination book of the visit for which payment is requested.

- Originals: invoices, medical fee receipts, and other related documents.

- In case the health insurance participant wishes to use the original invoices and receipts for other purposes, the One-Stop Department of the Social Security Agency will photograph and certify the photocopies, returning the originals to the health insurance participant.

- If the health insurance participant loses the original invoices and receipts, submit photocopies or photocopies with confirmation from the medical facility where they received examinations or treatments, or a list of medical costs.

- In case the dossier is submitted via public postal service or online in photocopy form, the originals or photocopies certified by the medical facility must be presented when receiving the result for comparison.

* For requests for a non-co-payment certificate in the year (with or without direct payment of medical expenses): Dossier similar to section 1 of item 3.3 part II of the Appendix issued together with Decision 1003/QD-BHXH in 2024 (Dossier components).

(4) Number of dossiers: 01 set

(5) Processing time

- Maximum of 40 days from the date the Social Security Agency receives a complete dossier.

- For issuing a non-co-payment certificate in the year. Processing times are as follows:

+ 01 working day from the date of receipt of a complete dossier if the health insurance participant has continuous participation only in one province, or the health insurance card indicates continuous participation for 05 years.

+ 03 working days from the date of receipt of a complete dossier if the health insurance participant submits a complete dossier but has continuous participation in multiple provinces, or the health insurance card does not indicate continuous participation for 05 years.

+ 05 working days from the date of receipt of a complete dossier if the health insurance participant submits a complete dossier but only receives intra-provincial medical services, and the receipts, invoices do not clearly show the co-payment amount, or if the health insurance participant submits photocopies of invoices, receipts, or a list of medical costs as per Form 01/KBCB as defined in Decision 6556/QD-BYT in 2018.

Form 01/KBCB

+ 10 working days from the date of receipt of a complete dossier if the health insurance participant submits a complete dossier receiving medical services in multiple provinces, and the receipts, invoices do not clearly show the co-payment amount, or if the health insurance participant submits photocopies of invoices, receipts, or a list of medical costs as per Form 01/KBCB as defined in Decision 6556/QD-BYT in 2018.

(6) Subjects of the procedure: Individuals

(7) Implementing Agency: Provincial/District Social Security Agency

(8) Result of the procedure:

- Receive payment for medical expenses via registered method (bank transfer or cash at the Finance - Accounting Department of the Social Security Agency).

- Non-co-payment certificate (if eligible).

- If not eligible for payment or non-co-payment certificate: receive a written explanation from the Social Security Agency.

(9) Fees: None

(10) Application form or declaration form

- Application Receipt and Appointment Slip.

- Power of Attorney (Form 13-HSB).

	Form 13-HSB

(11) Requirements or conditions: None

More details can be found in Decision 1003/QD-BHXH issued on July 16, 2024.

Vo Tan Dai

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