Procedures for insurance covered healthcare services in Vietnam

Procedures for insurance covered healthcare services in Vietnam (Internet image)

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

1. Procedures for insurance covered healthcare services in Vietnam

According to Article 15 of Decree 146/2018/ND-CP, procedures for insurance covered healthcare services are as follows:

- When visiting healthcare establishments for medical examination or treatment services, health insurance policyholders must present photo health insurance cards;

In case of absence of the photo, they shall be required to present one of their photo identity documents issued by competent bodies or authorities, or certificates endorsed by commune-level police authorities or others endorsed by educational institutions in charge of management of pupils or students; other legitimate personal identification documents.

- When children under 6 years of age go to healthcare establishments to receive medical examination or treatment services, only health insurance cards shall be needed. If a child is not awarded health insurance cards, a copy of the written evidence of birth or a copy of the birth certificate must be shown;

In case where such child needs medical treatment after birth but he/she is not awarded the written evidence of birth, the head of the healthcare establishment, parents or guardian of that child shall be required to sign in the medical record as a basis for payment of health insurance benefits as prescribed in clause 1 of Article 27 of Decree 146/2018/ND-CP and shall bear responsibility for their endorsement.

- When visiting healthcare establishments to receive medical examination or treatment services, a health insurance policyholder who is expecting a new health insurance card which is reissued or replaces the preexisting one must present the note of appointment for reissuance and replacement of health insurance card issued by the social insurance agency or any entity or individual authorized by the social insurance agency to receive applications for reissuance and replacement of health insurance cards by using the Form No. 4 of the Appendix to Decree 146/2018/ND-CP, and any document evidencing personal identity of that policyholder.

Form No. 4

- When a health insurance policyholder who has donated his/her organ visits healthcare establishments to receive medical examination or treatment services, he/she must present documents referred to in clause 1 or clause 3 of Article 15 of Decree 146/2018/ND-CP.

In case where the medical treatment is needed immediately after the organ donation, the head of the healthcare establishment performing organ procurement and the patient or the patient's relative must bear their signature on the medical record as a basis for payment of health insurance benefits in accordance with clause 2 of Article 27 of Decree 146/2018/ND-CP, and shall be responsible for their endorsement.

- In case of a referral to another healthcare establishment at the different level, a policyholder shall be required to present his/her referral dossier formulated by the referring healthcare establishment and the referral form by using the Form No. 6 of the Appendix to Decree 146/2018/ND-CP.

Form No. 6

In case where the referral form is valid until the end of December 31 while the medical treatment has not yet been completed, use of that referral form till the end of that medical treatment shall be allowed.

In case of a follow-up examination, a health insurance policyholder must show the note of follow-up appointment of the healthcare establishment which is prepared by using the Form No. 5 of the Appendix to Decree 146/2018/ND-CP.

Form No. 5

- In case the emergency treatment service is needed, a health insurance policy may choose to be hospitalized at any healthcare establishment and shall be required to present documents referred to in clause 1, clause 2 or clause 3 of Article 15 of Decree 146/2018/ND-CP before discharge from that healthcare establishment.

After the emergency treatment stage, if the insured patient is allowed by the healthcare establishment to implement procedures for referral to another ward or department of that healthcare establishment in order for them to receive further health monitoring and treatment, or to be referred to another healthcare establishment, these referrals shall be defined as appropriate-level referrals.

The healthcare establishment that does not enter into the health insurance-covered healthcare service contract shall be responsible for providing patients allowed for hospital discharge with valid documents and evidences relating to medical costs which they use for directly claiming payments of their health insurance benefits at social insurance agencies under the provisions of Article 28, 29 and 30 of Decree 146/2018/ND-CP.

- If a health insurance policyholder takes up a temporary residence while going on a business trip, working on the move or taking a full-time training program, he/she shall be entitled to receive primary health care at an appropriate-level healthcare establishment or the healthcare establishment at the level equivalent to the healthcare establishment providing primary care which is inscribed on his/her health insurance card, and shall be required to present documents stipulated in clause 1, clause 2 or clause 3 of Article 15 of Decree 146/2018/ND-CP and one of the following documents (either in the form of an authentic copy or a duplicate): business travel form, decision to send personnel to participate in a training course, student identity card, temporary residence evidencing document and school transfer approval form.

- Healthcare establishments and social insurance agencies shall not be allowed to adopt supplemental procedures for health insurance-covered services in addition to those procedures stipulated in Article 15 of Decree 146/2018/ND-CP.

In case where healthcare establishments or social insurance agencies need copies of the health insurance card and other documents relating to medical examination and treatment of patients to serve administrative tasks, they shall be required to make copies at their expense and shall not be allowed to request patients to make copies or pay photocopy costs.

2. Validity period of health insurance cards

According to Article 13 of Decree 146/2018/ND-CP, the validity period of health insurance cards is as follows:

- With respect to policyholders specified in clause 6 of Article 2 of Decree 146/2018/ND-CP, health insurance cards shall have validity from the first month of entitlement to unemployment benefits which is determined in the decision on entitlement to unemployment benefits, issued by a competent regulatory authority.

- With regard to policyholders specified in clause 7 of Article 3 of Decree 146/2018/ND-CP:

+ If a child is born before September 30, his/her health insurance card shall be valid until the end of September 30 of the year in which he/she reaches 72 months of age;

+ If a child is born after September 30, his/her health insurance card shall be valid until the end of the last date of the month in which he/she reaches 72 months of age.

- With respect to policyholders referred to in clause 8 of Article 3 of Decree 146/2018/ND-CP, their health insurance cards shall be valid from the date of social welfare entitlement determined in the decision issued by the district-level People’s Committee.

- With respect to the policyholders specified in clause 9 of Article 3 of Decree 146/2018/ND-CP, or the policyholders prescribed in clause 1 of Article 4 of Decree 146/2018/ND-CP, if their health insurance contributions are wholly supported by the state budget, their health insurance cards shall be valid from the date specified in the decision on approval of the list of policyholders, issued by a competent authority.

- With respect to the policyholders specified in clause 10 of Article 3 of Decree 146/2018/ND-CP, their health insurance cards shall be valid from the date specified on the decision on approval of the list of policyholders, issued by a competent authority.

- With respect to the policyholders specified in clause 14 of Article 3 of Decree 146/2018/ND-CP, their health insurance cards shall be valid immediately after the date of donation of their organs.

- With regard to policyholders specified in clause 3 of Article 4 of Decree 146/2018/ND-CP:

+ Health insurance cards shall be annually issued to students at general education institutions, including the following cases:

++ As regards 1st - grade pupils, each health insurance card shall be valid from the 1st day of October of the first year of elementary education;

++ As regards12th - grade students, each health insurance card shall be valid till the end of September 30 of that school year.

+ Each health insurance card shall be annually issued to pupils and students at higher education establishments and vocational training facilities, including the following cases:

++ As regards first-year students of academic programs, each health insurance card shall be valid from the first date of the academic year, except the case in which 12th - grade students hold their health insurance cards remaining valid;

++ As regards last-year students of academic programs, each health insurance card shall be valid till the last date of the final month of each academic program.

- With regard to others, each health insurance card shall be valid from the first date of payment of health insurance contribution.

If the policyholders referred to in clause 4 of Article 4, Article 5 and 6 of Decree 146/2018/ND-CP participate in the health insurance for the first time or do not incessantly participate in the health insurance for at least 3 months in a financial year, each health insurance card shall have the validity period of 12 months from the date on which it is in effect as per point c of clause 3 of Article 16 in the Law on Health Insurance.

- The validity of each health insurance card as prescribed in Article 13 of Decree 146/2018/ND-CP shall be equivalent to the amount of health insurance contribution in accordance with regulations in force, except policyholders who are children under 6 years of age.

Ho Quoc Tuan

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