Cases of termination of health insurance-covered medical service contracts in Vietnam

Cases of termination of health insurance-covered medical service contracts in Vietnam (Internet image)

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

1. Cases of termination of health insurance-covered medical service contracts in Vietnam

Cases of termination of health insurance-covered medical service contracts in Vietnam under Article 23 of Decree 146/2018/ND-CP include:

(1) A contract shall be terminated in case the contracting healthcare establishment is subject to business closure, dissolution, bankruptcy or revocation of its license.

(2) A contract shall be terminated in case both parties agree on contract termination in accordance with laws.

(3) In the course of implementation of a health insurance-covered medical service contract, if a social insurance agency, entity, organization or individual discovers that any healthcare establishment commits any violation against the contract, they must inform the provincial Department of Health, the Ministry of Health or a health authority of a ministry or sectoral administration with respect to the healthcare establishment under its respective control (hereinafter referred to as regulatory authority).

Within duration of 5 working days of receipt of the notification, the regulatory authority shall be responsible for sending the defaulting healthcare establishment a written request for submission of a written explanation for matters relating to the allegation of violations.

After receipt of the written explanation from the regulatory authority, the healthcare establishment shall be responsible for sending the regulatory authority the written explanation, enclosing evidences (if any).

After receipt of the written explanation from the defaulting healthcare establishment, the regulatory authority shall be responsible for cooperating with the same-level social insurance agency in carrying out review, verification and judgement of the allegation of violations.

The judgement must clearly conclude whether or not the healthcare establishment at question commits any violation and may suggest remedial actions (if any).

(4) In the course of implementation of a health insurance-covered medical service contract, if an entity, organization or individual discovers that a social insurance agency commits any violation against the contract, a notification of such violation must be sent to the regulatory authority.

Within duration of 05 working days of receipt of the abovementioned notification, the regulatory authority shall be responsible for sending the social insurance agency a written explanation for matters relating to the allegation of violations.

After receipt of the written request for explanation from the regulatory authority, the social insurance agency shall be responsible for sending the regulatory authority the written explanation, enclosing evidences (if any).

After receipt of the written explanation from the social insurance agency, the regulatory agency shall be responsible for cooperating with the same-level social insurance agency (in the event that the same-level social insurance agency is the body reported for violations, the higher-level social insurance agency is invited to cooperate with the regulatory authority) in carrying out the review, verification and judgement of the allegation of violations.

The judgement must clearly conclude whether or not the social insurance agency at question commits any violation and may recommend remedial actions (if any).

2. Regulations on health insurance-covered medical service contracts amendment in Vietnam

According to Article 22 of Decree 146/2018/ND-CP, regulations on health insurance-covered medical service contracts amendment in Vietnam are as follows:

- In the course of implementation of a health insurance-covered medical service contract, if there is any party requesting amendments or supplements to contractual terms and conditions, they must inform the other party in writing for at least 30 days in advance of which terms and conditions subject to amendment or supplementation in that contract.

- In case where both parties agrees on which terms and conditions are amended or supplemented, amendment and supplementation shall be carried out by bearing their signatures on appendices or entering into a new contract.

- In case where both parties fail to reach agreement on amendment or supplementation, the existing contract shall remain valid for implementation.

Le Truong Quoc Dat

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