Payment of medical examination and treatment expenses covered by health insurance for police officers in Vietnam

Payment of medical examination and treatment expenses covered by health insurance for police officers in Vietnam (Internet image)

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

1. Scope of payment for medical examination and treatment by health insurance for police officers in Vietnam

According to Article 10 of Circular 43/2016/TT-BCA, for cadres and soldiers, when providing medical examination and treatment, which are covered by health insurance according to the provisions of Articles 26, 27, and 28 of the Law on Health Insurance 2008 (amended 2014) and Article 15 of Decree 70/2015/ND-CP, the following expenses shall be paid by the medical examination and treatment fund by health insurance:

(i) Expenses for medical examination, treatment, rehabilitation, periodical antenatal care, and childbirth.

(ii) Transportation costs as prescribed in Clause 5, Article 11 of Decree 70/2015/ND-CP.

(iii) Expenses for medical examination and treatment outside the scope of health insurance coverage, including:
drugs, chemicals, medical supplies licensed for circulation in Vietnam, and medical technical services approved by competent authorities according to professional designations.

(iv) Expenses for medical examination and treatment at (i) do not apply the limit on payment rates for some drugs, chemicals, medical supplies, and technical medical services as prescribed by the Minister of Health.

2. Payment of medical examination and treatment expenses covered by health insurance for police officers in Vietnam

According to Article 11 of Circular 43/2016/TT-BCA on the payment of medical examination and treatment expenses covered by health insurance for officers of the People's Police of Vietnam:

(1) Payment of medical examination and treatment expenses within the scope of health insurance coverage specified in Clause 1, Article 11 of Decree 70/2015/ND-CP

- In cases of medical examination and treatment at a non-public medical examination and treatment establishment, the health insurance fund shall cover the cost of medical examination and treatment according to the price of medical services at that establishment but not exceeding the price of medical services at medical examination and treatment establishments covered by public health insurance equivalent on professional and technical lines.

The difference is paid by officers and soldiers themselves to medical examination and treatment establishments;

- For public health facilities that provide socialized health services, payment is according to the price set by the medical facility but not exceeding the payment price of health insurance approved by the competent authority.

In case of using medical services to socialize cadres and soldiers, they must pay the difference with medical examination and treatment establishments.

(2) Payment of medical examination and treatment expenses outside the scope of health insurance coverage specified in Clause 2, Article 10 of Decree 70/2015/ND-CP

Payment terms:

+ Officers and soldiers provide medical examination and treatment in accordance with Articles 26, 27 and 28 of the Law on Health Insurance 2008 (amended 2014) or provide medical examination and treatment in case of emergency;

+ Drugs and chemicals must be allowed to be circulated in Vietnam; medical supplies must be on the list of licensed uses; the list of medical techniques must be approved by a competent authority;

+ Prices of technical services approved by competent authorities; prices of drugs, chemicals, and medical supplies according to the winning results in accordance with the law on bidding for the procurement of drugs, chemicals, and medical supplies;

+ Using drugs, chemicals, medical supplies, or medical technical services outside the payment list of health insurance must be consulted, or the head of the medical examination and treatment establishment (or an authorized person) must sign for approval and keep it in the medical record.

- Medical examination and treatment establishments shall settle expenses outside the scope of health insurance coverage (if any) with the Social Insurance of provinces and centrally run cities (hereinafter collectively referred to as the Provincial Social Insurance) or the Center for Health Insurance Assessment and Multi-Line Payment or the People's Police Social Insurance.

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