Documents for first-time health insurance-covered service contract in Vietnam

Documents for first-time health insurance-covered service contract in Vietnam (Internet image)

Regarding this issue, LawNet responded as follows:

1. Documents for first-time health insurance-covered service contract in Vietnam

According to Clause 1, Article 16 of Decree 146/2018/ND-CP, in case of a first-time health insurance-covered service contract, documents shall include:

- Request form for signing the contract, prepared by the requesting healthcare establishment;

- Duplicate of the healthcare license, issued by a competent regulatory authority to the requesting healthcare establishment;

- Internally stamped duplicate of the decision on ranking of hospitals made by a competent regulatory authority (if any) or the decision on medical level issued by a competent regulatory authority with respect to non-public healthcare establishments;

- List of medical technology services, medicines, chemicals or medical supplies, approved by a competent regulatory authority (whether in the written or electronic form).

2. Regulations on conclusion of health insurance-covered service contracts in Vietnam

Regulations on conclusion of health insurance-covered service contracts according to Article 18 of Decree 146/2018/ND-CP are as follows:

- In case of entering into a health insurance-covered service contract for the first time:

+ A healthcare establishment sends 01 set of documents referred to in Article 16 hereof to a social insurance agency;

+ Within duration of 30 days of receipt of all required documents (based on the postmark date of received document), a social insurance agency must complete the processing of submitted documents and contract signing.

In case of refusal to sign a health insurance-covered service contract, a written response clearly stating reasons for such refusal must be sent.

- Validity period of a health insurance-covered service contract:

+ The validity period of a contract shall range from January 1 to end of December 31 of each year, but shall be restricted to 36 months;

+ In case of the health insurance-covered service contract signed for the first time, the validity period of this contract shall start from the signature date to end of December 31 in the year on which the contract expires, but shall not exceed 36 months;

+ In case of signing a health insurance-covered service contract on an annual basis, a healthcare establishment and a social insurance agency shall completely conclude the contract of the following year before December 31 of that year.

10 days before the contract expires, if the healthcare establishment and the social insurance agency agree on the contract extension and negotiate about the implementation of the contract based on an appendix to that contract, that appendix shall have legal value, unless otherwise agreed upon.

- If a policyholder receives medical services prior to January 1, but is discharged from a healthcare establishment ahead of January 1, his/her medical costs shall be subject to the following regulations:

+ In case where that healthcare establishment continues to sign a health insurance-covered service contract, such medical costs shall be taken into account as the following year's medical costs;

+ In case where that healthcare establishment decides not to continue to sign a health insurance-covered service contract, such medical costs shall be taken into account as that year's medical costs.

- A health insurance-covered service contract shall clearly specify the method for payment of health insurance-covered medical costs where relevant to actual conditions of that healthcare establishment.

- Contracting parties shall be responsible for assuring rights and interests of patients holding health insurance cards under laws on health insurance and preventing any suspension of medical services provided for patients holding health insurance cards.

3. Regulations on amendments to first-time health insurance-covered service contract in Vietnam

Regulations on amendments to first-time health insurance-covered service contract in Vietnam under Article 22 of Decree 146/2018/ND-CP 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.

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