Proposal to amend the regulations on contracts on health insurance-covered medical care in Vietnam

Proposal to amend the regulations on contracts on health insurance-covered medical care in Vietnam (Internet image) 

Regarding this matter, LawNet would like to answer as follows: 

The Ministry of Health is seeking opinions on the draft Law amending certain articles of the Law on Health Insurance (hereinafter referred to as the draft Law).

Proposal to amend the regulations on contracts on health insurance-covered medical care in Vietnam

According to Clause 1 of Article 15 of the draft Law proposing amendments to Article 25 of the Law on Health Insurance 2008, regulations on contracts on health insurance-covered medical care areas in Vietnam follows:

- The contract on health insurance-covered medical care is a contract signed between the social insurance agency and the healthcare facility regarding the provision of health insurance-covered medical care and the payment of costs of medical care covered by health insurance under the prescribed form by the Government.

- The main contents of the contract on health insurance-covered medical care include:

+ Target beneficiaries; expected number of individuals participating in health insurance registering for medical examination and treatment under health insurance initially and the composition of the group of individuals participating in health insurance for the healthcare facility initially;

+ Scope of service provision appropriate to the professional scope of the healthcare facility;

+ Price and method of payment for costs of medical care covered by health insurance;

+ Rights and responsibilities of the parties;

+ Contract term;

+ Liability for contract violations;

+ Conditions for amendment, supplementation, suspension, and termination of the contract;

+ Validity of the contract;

+ Resolution of difficulties and contract disputes.

- The signing, implementation, amendment, supplementation, suspension, and termination of contracts on health insurance-covered medical care must comply with the provisions of civil law and the Law on Health Insurance 2008.

Proposal to supplement regulations on conclusion, implementation, amendment, supplementation, suspension, and termination of contracts on health insurance-covered medical care in Vietnam

According to Article 16 of the draft Law proposing supplementation of Article 25a after Article 25 of the Law on Health Insurance 2008, the conclusion, implementation, amendment, supplementation, suspension, and termination of contracts on health insurance-covered medical care in Vietnam are as follows:

- Public healthcare facilities that meet the conditions prescribed by the laws on healthcare must provide health insurance-covered medical care to the public and conclude contracts on health insurance-covered medical care with the social insurance agency. Private healthcare facilities that meet the conditions prescribed by the laws on healthcare and have the need to conclude contracts on health insurance-covered medical care may conclude contracts on health insurance-covered medical care with the social insurance agency. The social insurance agency must complete the contract within 15 working days from the receipt of the request from the healthcare facility.

- The contract takes effect from the signing date and does not have a specified term. In case there are changes to the contents of the signed contract, the parties shall agree to adjust, amend, supplement the contract, or add an appendix to the contract. In case the healthcare facility has changes in information related to the contract contents without changing the scope of professional healthcare activities, the contract continues to be valid until the parties agree to adjust, amend, or supplement the contract or add an appendix to the contract.

- In case of a change in the healthcare facility due to separation, merger, or reorganization, the new facility inherits the rights and responsibilities of the old facility according to the contents of the contract and the principles of civil law.

- In case of an agreement on supplementation, amendment, suspension, or termination of the contract, the social insurance agency and the healthcare facility are responsible for ensuring that healthcare and the rights of health insurance participants are not disrupted.

- Vietnam Social Security publicly discloses the list of healthcare facilities that have signed health insurance contracts.

- The contract is partially suspended in cases where the healthcare facility does not meet the conditions to carry out one or some areas of professional healthcare activities according to the operating license for healthcare and the signed contract.

- The contract is completely suspended for a period not exceeding 12 months in the following cases:

+ The healthcare facility is suspended or has its operating license for healthcare revoked according to the decision of the competent authority.

+ Violation of the contract provisions to the extent that the contract must be suspended.

+ The healthcare facility temporarily suspends its activities for a period not exceeding 12 months.

- The contract is completely terminated in the following cases:

+ The healthcare facility has its operating license for healthcare revoked according to the decision of the competent authority.

+ Violation of the contract provisions to the extent that the contract must be terminated.

+ The healthcare facility terminates its activities.

+ The healthcare facility temporarily suspends its activities for more than 12 months.

+ The healthcare facility is suspended or has its operating license for healthcare revoked for a period exceeding 12 months, according to the decision of the competent authority.

More details can be found in the draft Law amending certain articles of the Law on Health Insurance.

To Quoc Trinh

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