Regulations on conclusion of first-time health insurance-covered service contracts in Vietnam

Regulations on conclusion of first-time health insurance-covered service contracts in Vietnam (Internet image)

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

1. Regulations on conclusion of first-time health insurance-covered service contracts in Vietnam

According to Article 18 of Decree 146/2018/ND-CP, conclusion of first-time health insurance-covered service contracts in Vietnam 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 of Decree 146/2018/ND-CP 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.

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

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

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

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

- 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).

- 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).

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