Intergrated document No. 22/VBHN-VPQH dated February 26, 2025 Law health insurance
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OFFICE OF THE
NATIONAL ASSEMBLY OF VIETNAM |
SOCIALIST
REPUBLIC OF VIETNAM |
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No: 22/VBHN-VPQH |
Hanoi, February 26, 2025 |
LAW
HEALTH INSURANCE
Pursuant to the Law on Health Insurance No. 25/2008/QH12 dated November 14, 2008 of the National Assembly of Vietnam, effective as of July 1, 2009, amended by:
1. Law No. 32/2013/QH13 dated June 19, 2013 of the National Assembly on amendments to the Law on Corporate Income Tax, effective from January 01, 2014;
2. Law No. 46/2014/QH13 dated June 13, 2014 of the National Assembly on amendments to the Law on Health Insurance, effective from January 01, 2015;
3. Law on Fees and Charges No. 97/2015/QH13 dated November 25, 2015 of the National Assembly, effective from January 01, 2017;
4. Law No. 35/2018/QH14 dated November 20, 2018 of the National Assembly on amendments to some articles concerning planning of 37 laws, effective from January 01, 2019;
5. Law on Residence No. 68/2020/QH14 dated November 13, 2020 of the National Assembly, effective from July 01, 2021;
6. Law on Grassroots-level Security and Order Protection Forces No. 30/2023/QH15 dated November 28, 2023 of the National Assembly, effective from July 01, 2024;
7. Law No. 51/2024/QH15 dated November 27, 2024 of the National Assembly on amendments to the Law on Health Insurance, effective from July 01, 2025.
Pursuant to the Constitution of the Socialist Republic of Vietnam 1992 amended by Resolution No. 51/2001/QH10;
The National Assembly hereby promulgates the Law on Health Insurance.
Chapter I
GENERAL PROVISIONS
Article 1. Scope and regulated entities
1. This Law provides for health insurance benefits and policies, including eligible health insurance participants, health insurance premium rates, responsibilities and methods of health insurance premium payment; health insurance cards; health insurance benefits; provision of medical care for health insurance participants; payments of health insurance -covered medical costs; health insurance fund; rights and responsibilities of parties involved in health insurance.
2. This Law applies to Vietnamese organizations and individuals and foreign organizations and individuals in Vietnam involved in health insurance.
3. This Law does not apply to commercial health insurance.
Article 2. Definitions
For the purposes of this Regulation, the following terms shall be construed as follows:
1. "Health insurance" means a form of compulsory insurance which is implemented by the State to look after the health of health insurance participants prescribed in this Law for non-profit purposes.
2. "Universal health coverage" means that all persons prescribed in this Law participate in health insurance.
3. "Health insurance fund" means a financial fund established from paid health insurance premiums and other lawful revenues and used to cover medical costs for health insurance participants, managerial costs of social security authorities , and other lawful health insurance-related costs.
4. "Employers" means authorities, public service providers, people's armed forces, political organizations, socio-political organizations, socio-political-professional organizations, social organizations, socio-professional organizations, enterprises, cooperatives, household businesses, and other organizations; foreign organizations and international organizations operating within the territory of Vietnam, which are responsible for paying health insurance premiums.
5. "Health insurance-covered primary care provider" means a health facility registered by a health insurance participant and stated in his/her health insurance card.
6. "Health insurance assessment" means a professional operation conducted by a social security authority to assess the appropriateness of medical services provided to health insurance participants, serving as a basis for payment of health insurance-covered medical costs.
7. "Household participating in health insurance (hereinafter referred to as "household")" means persons who have registered permanent or temporary residence at the same lawful place of residence in accordance with the law on residence.
8. "Basic medical service package covered by the health insurance fund" means essential medical services for healthcare, in accordance with the affordability of the health insurance fund.
9. "Reference level" is an amount decided by the Government to calculate the premiums and payouts (reimbursements) of certain types of health insurance specified in this Law.
Article 3. Health insurance principles
1. The risk-sharing among health insurance participants must be assured.
2. Health insurance premium rates shall be a percentage (%) of the salary serving as the basis for the compulsory social insurance premium payment in accordance with the Law on Social Insurance (hereinafter referred to as “monthly salary”), retirement pensions, allowances or reference level.
3. Health insurance reimbursement rates shall vary depending on the severity of the diseases, eligible health insurance participants and the health insurance premium payment period.
4. Health insurance-covered medical costs shall be co-paid by the health insurance fund and the insured.
5. The health insurance fund shall be guaranteed by the State and managed in a centralized, uniform, public, and transparent manner, ensuring the revenue-expenditure balance.
Article 4. State policies on health insurance
1. The State shall pay or subsidize the health insurance premiums for revolutionary contributors and specific social beneficiaries.
2. The State shall adopt preferential policies for investment derived from the health insurance fund to preserve and grow the fund. The fund’s revenues and profits from such investment shall be eligible for tax exemption.
3. The State shall facilitate organizations and individuals to participate in health insurance or pay health insurance premiums on behalf of health insurance participants.
4. The State encourages investment in the development of technologies and advanced technical equipment for health insurance management.
Article 5. State management agencies in charge of health insurance
1. The Government performs the uniform state management of health insurance.
2. The Ministry of Health shall take responsibility before the Government for performing state management of health insurance.
3. Ministries and ministerial-level agencies shall, within their jurisdiction, cooperate with the Ministry of Health in performing state management of health insurance.
4. People’s Committees at all levels shall, within their jurisdiction, perform state management of health insurance in their respective administrative divisions.
Article 6. Responsibilities of the Ministry of Health for health insurance
The Ministry of Health shall take charge of and cooperate with ministries, ministerial-level agencies, relevant agencies and organizations in performing the following tasks:
1. Promulgate or propose promulgation of policies and laws on health insurance, organization of the medical system, financial sources for the protection, care and improvement of the people’s health based on universal health coverage; solutions to enhance the capacity of secondary health facilities in providing health insurance-covered medical services;
2. Formulate strategies and master plans on development of health insurance;
3. Promulgate regulations, procedures, and professional guidelines for medical examination and treatment; frequently review and update instructions on diagnosis and treatment; regulations on assessment of rationality of provision of medical services; regulations on application of information technology, digital transformation, sharing of information about health insurance, synchronization of paraclinical results among health insurance-covered health facilities in a manner that satisfies professional requirements;
4. Implement or propose implementation of solutions for balancing the health insurance fund;
5. Disseminate and popularize policies and laws on health insurance;
6. Direct and provide guidance on the provision of health insurance benefits;
7. Conduct inspections and audits, handle violations found therefrom, and settle complaints and denunciations related to health insurance;
8. Monitor, assess, and review activities in the health insurance sector;
9. Conduct scientific research and international cooperation in the health insurance sector;
10. Promulgate the basic medical service package covered by the health insurance fund.
Article 7. Responsibilities of the Ministry of Finance for health insurance
1. Cooperate with the Ministry of Health, relevant agencies and organizations in formulating health insurance-related financial policies and regulations.
2. Conduct inspections and audits of compliance with the legal regulations on financial mechanisms applicable to health insurance and the health insurance fund.
Article 7a. Responsibilities of the Ministry of Labour, Invalids and Social Affairs
1. Direct and provide guidance on the determination and management of health insurance participants under the management of the Ministry of Labour, Invalids and Social Affairs as prescribed in points e, h, i, k, o, r, s and t, clause 3, points a, b, d and g, clause 4, Article 12 of this Law.
2. Conduct inspections and audits of compliance with the legal regulations on the responsibility to participate in health insurance of employers and employees as prescribed in clause 1, Article 12 of this Law and persons under the management of the Ministry of Labour, Invalids and Social Affairs as prescribed in points e, h, i, k, o, r, s and t, clause 3, points a, b, d and g, clause 4, Article 12 of this Law, except for those under the management of the Ministry of National Defense and the Ministry of Public Security.
Article 7b. Responsibilities of the Ministry of Education and Training
1. Direct and provide guidance on the determination and management of health insurance participants under the management of the Ministry of Education and Training as prescribed in point n, clause 3, point b, clause 4, Article 12 of this Law.
2. Conduct inspections and audits of compliance with the legal regulations on the responsibility to participate in health insurance of persons under the management of the Ministry of Education and Training as prescribed in point n, clause 3, point b, clause 4, Article 12 of this Law.
3. Take charge and cooperate with the Ministry of Health, relevant ministries and central authorities in providing guidance on the establishment and completion of the school medical system to provide the primary medical care for children and students.
Article 7c. Responsibilities of the Ministry of National Defense and the Ministry of Public Security
1. Administer and provide guidance on the determination, management and compilation of the list of health insurance participants under the management of the Ministry of National Defense and the Ministry of Public Security as prescribed in points a, c, e, h and i, clause 1, points a, b, c, d, l and n, clause 3, point b, clause 4, Article 12 of this Law.
2. Compile and send a list of requests of the issuance of the health insurance cards for participants as prescribed in point l, clause 3, Article 12 of this Law to the social security authority.
3. Conduct inspections and audits of compliance with the legal regulations on the responsibility to participate in health insurance of persons under the management of the Ministry of National Defense and the Ministry of Public Security as prescribed in points a, c, e, h and i, clause 1, points a, b, c, d, l and n, clause 3, point b, clause 4, Article 12 of this Law.
4. Cooperate with the Ministry of Health, relevant ministries and central authorities in providing guidance for health facilities of the Ministry of National Defense and the Ministry of Public Security to conclude a contract for provision of health insurance-covered medical services with social security authorities .
Article 8. Responsibilities of People’s Committees at all levels for health insurance
1. People’s Committees at all levels shall, within their jurisdiction, perform the following tasks:
a) Direct the implementation of policies and laws on health insurance;
b) Sufficiently grant the state budget-derived funding for payment or subsidization of health insurance premiums for eligible participants as prescribed in this Law.
c) Disseminate and popularize policies and laws on health insurance;
d) Conduct inspections and audits, handle violations found therefrom, and settle complaints and denunciations related to health insurance;
2. The People’s Committees of provinces and municipalities, in addition to performance of the tasks specified in clause 1 of this Article, shall provide guidance on development of apparatus and resources to serve state management of health insurance in their provinces and municipalities.
3. The People’s Committees of communes, wards and commune-level towns (hereinafter referred to as “communes”) shall:
a) Perform the tasks specified in clause 1 of this Article;
b) Compile a list of health insurance participants in their communes as prescribed in clause 2, 3, 4 and 5, Article 12 of this Law by households; except for those under the management of Ministries, central authorities and other units prescribed in points a, b, c, d, l and n, clause 3, point b, clause 4 Article 12 of this Law;
c) Compile a list of requests of issuance of health insurance cards for children as the same time as issuance of birth certificates.
Article 9. Health insurance authorities
1. Social security authorities shall implement policies and laws on health insurance, manage and use the health insurance fund.
2. The Government shall elaborate the functions, tasks, powers and organizational structure of social security authorities with regard to implementation of health insurance.
Article 10. Audit of the health insurance fund
1. State Audit Office of Vietnam shall conduct audit of the health insurance fund every three years and submit reports on audit results to the National Assembly; conduct ad hoc audit of the health insurance fund at the request of the National Assembly, Standing committee of the National Assembly, the President of Vietnam, the Government, the Prime Minister of Vietnam.
2. Annually, State Audit Office of Vietnam shall conduct audit of the expenditures on organization and operation of health insurance during audit of the statement of organization and operation of social insurance.
Article 11. Prohibited acts
1. Delay in payment or fail to pay health insurance premiums.
2. Falsify or forge documents and health insurance cards.
3. Use collected health insurance premiums or the health insurance fund against law.
4. Obstruct, trouble or cause damage to the legitimate rights and interests of health insurance participants and parties related to health insurance.
5. Deliberately make false reports or provide false information and data on health insurance.
6. Abuse one’s position, power, or professional operations to act in contravention of legal regulations on health insurance.
Chapter II
HEALTH INSURANCE PARTICIPANTS, HEALTH INSURANCE PREMIUM RATES, RESPONSIBILITIES AND METHODS OF HEALTH INSURANCE PREMIUM PAYMENT
Article 12. Eligible health insurance participants
1. Participants whose insurance premiums are paid by the employers, the employees, or both:
a) Employees working under indefinite-term contracts or fixed-term contracts with duration of at least 01 month, even if these contracts are referred to as other names by employees and employers as long as they have contents about payment of wage or salary, the management and supervision by a party; business executives, controllers, state capital representatives, enterprise’s capital representative prescribed by law; members of the Board of Directors, General Director, Director, members of the Board of Controllers or controllers and other elected managerial positions of cooperatives, cooperative unions under regulations of the Law on Cooperatives who receive salaries;
b) Business executives, state capital representatives, enterprise’s capital representative prescribed by law; salaried members of the Board of Directors, General Director, Director, members of the Board of Controllers or controllers and other elected managerial positions of cooperatives, cooperative unions under regulations of the Law on Cooperatives who do not receive salaries;
c) Employees who are foreign citizens working in Vietnam under fixed-term employment contracts that last at least 12 months with employers in Vietnam, except persons reassigned within an enterprise according to regulations of law on foreign workers in Vietnam or those ho have reached the retirement age upon the conclusion of the employment contracts according to clause 2, Article 169 of the Labor Code, or otherwise prescribed by an international treaty to which the Socialist Republic of Vietnam is a signatory;
d) Employees working under indefinite-term contracts or fixed-term contracts with duration of at least 01 month, even if these contracts are referred to as other names by employees and employers as long as they have contents about payment of wage or salary, the management and supervision by a party; having agreements with employers on part-time work and receiving a monthly salary that is equal to or higher than the lowest salary serving as the basis for compulsory social insurance payment according to social insurance laws;
dd) Owners of registered household businesses that are compulsory social insurance participants according to social insurance laws;
e) Officials and public employees;
g) Part-time workers of commune-level agencies as prescribed by law;
h) National defense workers and public employees who are serving in the army, police workers who are working for the police; people doing other works in cipher organizations as prescribed by the Law on Cipher;
i) Family of national defense workers and public employees who are serving in the army, family of police workers who are working for the police who are not eligible participants specified in points a, b, c, d, dd, e, g and h of this clause, clause 2 and clause 3 of this Article.
2. Participants whose insurance premiums are paid by the social security authorities:
a) People who are receiving monthly retirement pensions, incapacity allowances;
b) People who are taking leave and receiving monthly occupational accident or occupational disease allowance; people who are taking leave and receiving sickness benefits due to diseases on the list of diseases requiring long-term treatment or employees who are taking leave and receiving sickness benefits for at least 14 working days in the month according to social insurance laws; people who are taking leave and receiving maternity benefits for at least 14 working days in the month according to social insurance laws;
c) Retired officials of communes who are receiving monthly social insurance benefits;
d) People who are receiving unemployment benefits.
3. Participants whose insurance premiums are paid by the state budget:
a) Officers and career military personnel of the people's army; officers and non-commissioned officers in police forces; and people doing cipher work and receiving the same salaries as military personnel;
b) Non-commissioned officers and soldiers of the people’s army; non-commissioned officers and conscripts of the police; military, police and cipher cadets who are receiving subsistence allowances and are Vietnamese citizens;
c) Military cadets, police cadets, cipher cadets who are receiving subsistence allowances and are foreigners;
d) Reserve officer trainees for at least 03 months who have not participated in social insurance or health insurance;
dd) Standing militia personnel;
e) Revolutionary contributors as prescribed by the Ordinance on preferential treatment for revolutionary contributors; veterans;
g) Incumbent deputies of the National Assembly or the People’s Councils at all levels;
h) Children under the age of 6;
i) Family of martyrs or caregivers of martyrs according to the Ordinance on preferential treatment for revolutionary contributors;
k) Family of revolutionary contributors, spouses of martyrs who have remarried and are receiving monthly death benefits, and relevant individuals according to the Ordinance on preferential treatment for revolutionary contributors, except for those specified in point i of this clause;
l) Family of the persons specified in point a and point b of this clause as prescribed by law;
m) Persons who have donated body parts under the regulations of the law;
n) Foreigners who are studying in Vietnam and granted scholarships funded by the state budget of Vietnam;
o) Poor household members, ethnics who are near-poor household members living in communes, villages in ethnic regions and mountainous regions; ethnics living in economically and socially disadvantaged areas; people living in particularly disadvantaged areas; people living on commune-level and district-level islands;
p) Retired officials of communes who are receiving monthly allowances from state budget;
q) People who have stopped receiving incapacity allowances and are receiving monthly allowances from state budget;
r) People who are receiving monthly social allowances; people who are receiving monthly nursing allowances according to relevant laws; people who are receiving monthly death benefits and are also eligible for social allowances;
s) People aged 75 or older who are receiving monthly death benefits; people aged 70 to under 75 who are members of near-poor households and receiving monthly death benefits;
t) People receiving social retirement benefits according to social insurance laws;
u) Employees who are not eligible for pension, have not reached the age for social retirement benefits and are receiving monthly allowances according to social insurance laws.
4. Participants whose insurance premiums are subsidized by state budget:
a) Members of near-poor households;
b) Students;
c) Participants in internal security forces;
d) Members of households doing agriculture, forestry, aquaculture and salt production with average living standards as prescribed by law;
dd) Health workers of villages; midwives of villages;
e) Part-time workers of villages and neighborhoods as prescribed by law;
g) Ethnics living in communes that are no longer disadvantaged or exceptionally disadvantaged areas will have health insurance premiums subsidized by state budget according to regulations of the Government.
h) People who are awarded the title of “Nghệ nhân nhân dân” (“People's Craftsperson”) or “Nghệ nhân ưu tú” (“Eminent Craftsperson”) according to the Law on Cultural Heritage;
i) Human trafficking victims defined by the Law on Prevention of Human Trafficking.
5. Participants who pay health insurance premiums themselves:
a) Members of households that buy health insurance for the entire household;
b) People living and working, being raised or cared for in charitable or religious organizations;
c) Employees during unpaid leave or suspension of their employment contracts;
d) People who are not in the cases specified in points a, b and c of this clause.
6. Participants other than those specified in clauses 1, 2, 3, 4 and 5 of this Article according to regulations of Laws and Ordinances.
7. The Government shall specify participants other than those specified in clauses 1, 2, 3, 4, 5 and 6 of this Article, including:
a) Eligible health insurance participants prescribed by law before January 1, 2025;
b) Participants other than those mentioned in Point a of this Clause after reporting to Standing committee of the National Assembly.
Article 13. Health insurance premium rates and responsibilities to pay health insurance premiums
1. Health insurance premiums paid by the employers, the employees, or both:
a) The monthly premium of a participant prescribed in points a, c, d and e Clause 1 Article 12 of this Law must not exceed 6% of the monthly salary, two thirds of which is paid by the employer and the remaining one third is paid by the employee;
b) The monthly premium of a participant prescribed in Point b Clause 1 Article 12 of this Law must not exceed 6% of the monthly salary serving as the basis for payment of compulsory social insurance and shall be paid by the participant;
c) The monthly premium of a participant prescribed in point dd, clause 1 Article 12 of this Law must not exceed 6% of the monthly salary serving as the basis for payment of compulsory social insurance and shall be paid by the participant;
d) The monthly premium of a participant prescribed in point g, clause 1 Article 12 of this Law must not exceed 6% of the reference level, two thirds of which is paid by the employer and the remaining one third is paid by the employee;
dd) The monthly premium of a participant prescribed in point h, clause 1, Article 12 of this Law must not exceed 6% of the monthly salary and the liability prescribed by the Government;
e) The monthly premium of a participant prescribed in point i, clause 1, Article 12 of this Law must not exceed 6% of the reference level and the liability prescribed by the Government.
2. Health insurance premiums paid by social security authorities:
a) The monthly premium of a participant prescribed in point a, clause 2, Article 12 of this Law must not exceed 6% of the pension or incapacity allowance;
b) The monthly premium of a participant prescribed in point b and point c, clause 2 Article 12 of this Law must not exceed 6% of the reference level;
c) The monthly premium of a participant prescribed in point d, clause 2, Article 12 of this Law must not exceed 6% of the unemployment benefit.
3. Health insurance premiums paid and subsidized by the state budget:
a) The monthly premium of a participant prescribed in point a, clause 3, Article 12 of this Law must not exceed 6% of the monthly salary and shall be paid by state budget;
b) The monthly premium of a participant prescribed in points b, c, d, dd, e, g, h, i, k, l, m, o, p, q, r, s, t and u, clause 3, Article 12 of this Law must not exceed 6% of the reference level and shall be paid by state budget;
c) The monthly premiums of the participants prescribed in Point n Clause 3 Article 12 of this Law must not exceed 6% of the reference level and shall be paid by state budget via the scholarship providers;
dd) The monthly premiums of the participants prescribed in Clause 4 Article 12 of this Law must not exceed 6% of the reference level and shall be paid by the participants and subsidized by state budget.
4. The monthly premiums of the participants prescribed in Clause 5 Article 12 of this Law must not exceed 6% of the reference level and shall be paid for the entire household or each individual.
5. Order of health insurance premium payment in case a person is eligible for more than one form of health insurance participation:
a) In case a person is an eligible participant under multiple scenarios prescribed in Article 12 of this law, he/she shall pay health insurance according to the first applicable scenario listed in Article 12, except in the cases specified in points c, d, dd, e and g of this clause;
b) A participant specified in points a, c, d, dd and e, clause 1, Article 12 of this Law who has one or multiple employment contracts shall pay health insurance under the employment contract used as the basis for compulsory social insurance participation;
c) In case a participant prescribed in point g, clause 1, Article 12 of this Law is also an eligible participant in multiple cases specified in Article 12 of this Law, health insurance premiums shall be paid in the following order: paid by social security authority, paid by state budget, subsidized by state budget, shared between the participant and the People’s Committee of the commune;
d) In case a participant prescribed in point a and point c, clause 2, Article 12 of this Law is also an eligible participant in multiple cases specified in Article 12 of this Law, health insurance premiums shall be paid by the social security authority;
dd) In case a participant prescribed in points s, t and u, clause 3, Article 12 of this Law is also an eligible participant in multiple cases specified in Article 12 of this Law, health insurance premiums shall be paid by state budget;
e) In case a participant prescribed in points a, c, d, dd, e, g, h and i, clause 4, Article 12 of this Law is also an eligible participant prescribed in point a, clause 5, Article 12 of this Law, he/she may choose a form of health insurance participation according to his/her preference;
g) Participants whose health insurance premiums are subsidized by state budget as prescribed in clause 4, Article 12 of this Law may choose the form of participation with the highest rate of subsidization;
h) In case a participant prescribed in point b and point c, clause 5, Article 12 of this Law is also an eligible participant prescribed in point a, clause 5, Article 12 of this Law, he/she may choose to participate in health insurance as a household.
6. Members of a household prescribed in point a, clause 5, Article 12 of this Law who participate in health insurance as a household in a fiscal year will be eligible for the following reductions:
a) The first participant shall pay up to 6% of the reference level;
b) The second, third, fourth participants shall pay 70%, 60%, 50% of the premiums paid by the first participant respectively;
c) The premiums paid by the fifth participant onwards shall be equal to 40% of the premiums paid by the first participant.
7. The Government shall elaborate the following regulations:
a) Rates of health insurance premiums and subsidization mentioned in this Article;
b) Responsibility for payment, rates of health insurance premiums and subsidization for the participants specified in clause 6 and clause 7 Article 12 of this Law.
Article 14. Salaries, remuneration, allowances serving as a basis for health insurance premium payment
1. Employees salaried as prescribed by the State shall pay health insurance premiums calculated on the basis of their monthly salaries paid according to their ranks or grades, and leader allowances, extra-seniority allowances or seniority allowances (if any).
2. Employees salaried or remunerated as prescribed by their employers shall pay health insurance premiums calculated on the basis of their monthly salaries or remuneration specified in their employment contracts.
3. Persons receiving monthly pensions, labor incapacity allowances for unemployment benefits shall pay health insurance premiums calculated on the basis of the received amount.
4. The basis for health insurance premium payment by participants other than those prescribed in clauses 1, 2 and 3 of this Article is the reference level.
5. 5. The maximum monthly salary for calculation of health insurance premium payment shall be 20 times the reference level.
Article 15. Methods of health insurance premium payment
1. Employers shall pay monthly health insurance premiums for the employees and transfer the health insurance premiums deducted from the employees’ salaries to the health insurance fund concurrently.
2. Enterprises, artels, cooperatives, cooperative unions, household businesses that operate in the fields of agriculture, forestry, fishery, salt production and pay piece-rate or project-based salaries, health insurance premiums shall be paid every 01, 03 or 06 months.
3. Social security authorities shall pay monthly health insurance premiums prescribed in clause 2, Article 13 of this Law to the health insurance fund.
4. Scholarship providers shall pay quarterly health insurance premiums prescribed in point c, clause 3, Article 13 of this Law to the health insurance fund.
5. The State budget shall transfer quarterly health insurance premiums and health insurance subsidies prescribed in points a, b and d, clause 3, Article 13 of this Law to the health insurance fund.
6. The representatives of households, organizations and individuals shall make the quarterly, biannual or annual payments under their responsibilities to the health insurance fund.
7. The participants prescribed in point b and point c, clause 1, Article 12 of this Law shall fully pay the amounts payable by themselves directly to the social security authorities or via the household businesses, enterprises, cooperatives, cooperative unions every 01, 03 or 06 months.
8. Deadlines for health insurance premium payment by employers:
a) The last day of the succeeding month for monthly payment;
b) The last day of the month succeeding the payment cycle for quarterly or biannual payment.
Chapter III
HEALTH INSURANCE CARDS
Article 16. Health insurance cards
1. A health insurance card has a unique health insurance number, is issued to a participant and used as a basis for enjoying health insurance benefits prescribed by this Law. Health insurance cards are issued in electronic and physical forms with equal legal value.
2. Each individual has only one health insurance number.
3. The date on which a health insurance card is valid is specified as follows:
a) The health insurance cards of participants prescribed in clauses 1, 2 and 3 Article 12 of this Law who purchase health insurance for the first time shall become effective from the date on which health insurance premiums is paid;
b) The second health insurance cards and the following ones of participants who continuously purchase health insurance shall become effective from the date on which the immediately preceding one expires;
c) In case a health insurance participant prescribed in clause 4 and clause 5, Article 12 of this Law either participates in health insurance for the first time or has participated intermittently for at least 90 days under any of the scenarios specified in Article 12 of this Law, the health insurance card will become effective after 30 days from the day on which health insurance is fully paid;
The health insurance cards of children aged under 6 shall become effective until they are full 72 months old. The health insurance cards of full-72-month-old children before their school year begins shall become effective until September 30 in such year.
4. The date on which a health insurance card is invalid is specified as follows:
a) Its validity period expires;
b) It has been modified or erased;
c) The card holder no longer participates in health insurance.
5. Vietnam Social Security shall issue the health insurance card template after reaching a consensus with the Ministry of Health.
Article 17. Issuance of health insurance cards
1. Applications for issuance of health insurance cards shall consist of:
a) Declaration forms submitted by agencies, organizations, units, individuals, households participating in social insurance for the first time;
b) The list of health insurance participants prescribed in Clause 1 Article 12 of this Law which is compiled by the employer within 30 days from the day on which the employees are eligible for health insurance participation. In case of participants prescribed in point b and point dd, clause 1 Article 12 of this Law, the application shall be the declaration form mentioned in Point a of this Clause submitted to the social security authority within 30 days from the day on which the individual is eligible for health insurance participation;
c) The list of health insurance participants prescribed in clauses 2, 3, 4 and 5, Article 12 which is compiled by the People’s Committee of the commune by household, except for the participants on the list mentioned in point d and point dd of this clause;
d) The list of health insurance participants under the management of the Ministry of Education and Training, the Ministry of Labour, Invalids and Social Affairs, other Ministries and central authorities prescribed in point n, clause 3 and point b, clause 4, Article 12 of this Law compiled by educational institutions and vocational education and training institutions;
dd) The list of health insurance participants under the management of the Ministry of National Defense and the Ministry of Public Security prescribed in points a, c, e and h, clause 1, points a, b, c, d, l and n, clause 3, point b, clause 4, Article 12 of this Law compiled by the Ministry of National Defense and the Ministry of Public Security.
2. Within 05 working days from the receipt of the valid application prescribed in clause 1 of this Article, the social security authority shall issue health insurance cards to participants and notify or send the cards to the applying organization.
3. The Government shall promulgate regulations on issuance of physical and electronic health insurance cards.
Article 18. Re-issuance of health insurance cards
1. A health insurance card shall be re-issued in case of loss.
2. A person whose health insurance card is lost shall submit an application form for card re-issuance.
3. Within 07 working days from the receipt of such application form, the social security authority shall issue a new health insurance card to the applicant. The applicant are still entitled health insurance benefits while waiting for a new health insurance card.
Article 19. Replacement of health insurance cards
1. A health insurance card shall be replaced in the following cases:
a) It is torn, rumpled or damaged;
b) The primary care provider is changed;
c) The information stated on the card is incorrect.
2. An application for replacement of a health insurance card shall consist of:
a) An application form for replacement of health insurance card;
b) Issued health insurance card.
3. Within 07 working days from the receipt of the complete application as prescribed in clause 2 or this Article, the social security authority shall issue a new health insurance card to the applicant. The applicant are still entitled health insurance benefits while waiting for a new health insurance card.
4. The applicant whose health insurance card is torn, rumpled or damaged shall pay fees for card replacement at the rate prescribed by the Minister of Finance.
Article 20. Revocation and suspension of health insurance cards
1. A health insurance card shall be revoked in the following cases:
a) There is fraud in the issuance of the card;
b) The card holder no longer participates in health insurance;
c) A health insurance participant is concurrently issued with more than one health insurance cards.
2. In case a person uses a health insurance card of anther person for receiving medical care, such health insurance card shall be suspended. The person whose health insurance card is suspended shall receive his/her card and pay fines as prescribed by law.
Chapter IV
HEALTH INSURANCE COVERAGE
Article 21. Health insurance coverage
1. Health insurance participants shall have the following costs covered:
a) Medical costs, including telemedicine services, telemedicine assistance, family medicine services, at-home medical care, rehabilitation, regular prenatal care check-ups and childbirth;
b) Costs of patient transports for participants prescribed in points a, b, c, d, dd, e, h, i, o and r, clause 3, Article 12 of this Law who are undergoing inpatient treatment or have to be referred to another health facility as prescribed in Article 27 of this Law;
c) Costs of medical services, medicines, use of medical devices, blood, blood products, medical gas, supplies, tools, instruments, chemicals for medical services covered by the health insurance fund.
2. The Minister of Health shall elaborate the following regulations:
a) Rules and criteria for compilation of lists of medicines, rules for compilation of lists of medical devices and services covered by health insurance;
b) The promulgation of lists of medicines, rules for compilation of lists of medical devices and services covered by health insurance on the basis of the rules and criteria mentioned in point a of this clause;
c) Ratios of payment for medicines, medical devices and medical services covered by health insurance;
d) Rates and conditions for payment for medicines, medical devices and medical services covered by health insurance;
dd) The payment for blood, blood products, medical gas, supplies, tools, instruments, chemicals for medical services covered by the health insurance fund.
3. The Government shall elaborate the following regulations:
a) The payment for patient transport mentioned in point b, clause 1 of this Article;
b) Coverage for the participants prescribed in points a, b, c, d and dd, clause 3 Article 12 of this Law;
c) Participants to whom the co-payment rates mentioned in point c, clause 2 of this Article do not apply.
Article 22. Health insurance reimbursement rates
1. When health insurance participants receives medical care as prescribed in Article 26 and Article 27 of this Law, they will be reimbursed by the health insurance fund for the covered medical costs as follows:
a) 100% of the medical costs for the participants prescribed in points a, b, c, d, dd, e, h, i, o, r and s clause 3, Article 12 of this Law. The uncovered medical costs incurred by the participants prescribed in Points a, b, c, d and dd Clause 3 Article 12 of this Law shall be paid by the health insurance budget for medical care of these participants; in case this budget is insufficient, they will be covered by state budget;
b) 100% of the medical costs if the cost of one medical examination/treatment occasion is lower than the level prescribed by the Government;
c) 100% of the medical costs at primary healthcare facilities, including: health stations, family medicine facilities; civil – military health station, civil – military health clinics; medical centers of districts that provide medical care and are licensed to operate as clinics; health departments of agencies, units and organizations prescribed by the Minister of Health; primary healthcare facilities of the army and the police prescribed by the Minister of National Defense and the Minister of Public Security. 100% of the costs outpatient care at local general clinics;
d) 100% of the medical costs when the patient has a period of health insurance participation of at least 5 consecutive years and has paid a co-payment of more than 6 times the reference level in the year prescribed in Clause 3, points a, b, c, dd and e, clause 4, clause 5 of this Article, Article 26 and Article 27 of this Law;
d) 95% of the medial costs for the participants prescribed in point a clause 2, point k, clause 3, point a and point g, clause 4 Article 12 of this Law;
e) 80% of the medial costs for other participants.
2. A person who is eligible for multiple forms of health insurance participation will be entitled to the most advantageous health insurance benefits.
3. In case a person registers a tertiary health facility or secondary health facility as a health insurance-covered primary care provider but receives medical care at another health facility due to change of the temporary residence or accommodation, he/she may receive medical care at a secondary health facility that is suitable for the new temporary residence or accommodation and have the costs covered by the health insurance fund in accordance with clause 1 of this Article. The Minister of Health shall specify procedures and the cases mentioned in this clause.
4. In case a health insurance participant visits a health facility that is not the registered primary care provider or against regulations on referral prescribed in Article 26 and Article 27 of this Law, except for the cases specified in clause 3 and clause 5 of this Article, he/she will be reimbursed by the health insurance fund at the rates specified in clause 1 of this Article. To be specific:
a) 100% reimbursement when receiving medical care at a secondary health facility or tertiary health facility in case of definitive diagnosis and treatment of certain rare diseases, terminal diseases, diseases that require surgery or high technology prescribed by the Minister of Health;
b) 100% reimbursement for ethnics and poor household members living in disadvantaged and extremely disadvantaged areas; people living on commune-level and district-level islands when they receive inpatient care at tertiary health facilities;
c) 100% reimbursement when using receiving medical care at primary healthcare facilities;
d) 100% reimbursement when receiving inpatient care at secondary health facilities;
dd) 100% reimbursement when using medical services at secondary and tertiary health facilities that have been classified as district-level health facilities by competent authorities before January 1, 2025;
e) 50% - 100% reimbursement when receiving outpatient care at secondary health facilities according to their professional classification and specific reimbursement rates prescribed by the Government, except in the cases specified in point a and point dd of this clause;
g) 40% reimbursement when receiving inpatient care at tertiary health facilities, except in the cases specified in points a, b, dd and h of this clause;
h) 50% reimbursement when receiving outpatient care following the road map of the Government and 100% reimbursement when receiving inpatient care at tertiary health facilities that have been classified as province-level health facilities by competent authorities before January 1, 2025.
5. Health insurance participants will be entitled to 100% reimbursement prescribed in clause 1 of this Article when receiving emergency care at any health facility.
6. The Government shall specify the reimbursement rates for the participants prescribed in points a, b, c, d and dd, clause 3, Article 12 of this Law; reimbursement rates for health insurance participants using medical service on demand and other cases not specified in clause 1 of this Article.
Article 23. Cases not eligible for health insurance benefits
1. Costs specified in clause 1, Article 21 of this Law that are already paid by the state budget..
2. Convalescence and health rehabilitation at convalescent and rehabilitation establishments.
3. Health check-ups.
4. Prenatal tests and diagnosis for non-treatment purposes.
5. Use of obstetric supportive techniques, family planning services or abortion services, except for cases of discontinuation of pregnancy due to fetal or maternal diseases.
6. Use of aesthetic services.
7. Treatment of squint and refractive errors for people aged 18 and older.
8. Use of prostheses including artificial limbs, eyes, teeth, glasses, hearing aids or movement aids in medical examination, treatment and function rehabilitation.
9. Provision of medical care and functional rehabilitation in case of disasters.
11. Provision of medical care for persons addicted to drugs, alcohol or other habit-forming substances.
13. Medical assessment, forensic examination, forensic psychiatric assessment.
14. Participation in clinical trials or scientific research.
Chapter V
PROVISION OF MEDICAL CARE FOR HEALTH INSURANCE PARTICIPANTS
Article 24. Health insurance-covered facilities
Health insurance-covered facilities (hereinafter referred to as “covered facilities”) are health facilities that have signed health insurance-covered medical care contracts with the social security authority as per regulations of the Government.
Article 25. Health insurance-covered medical care contracts
1. A health insurance-covered medical care contract means a written agreement between a social security authority and a health facility on the provision of health insurance-covered medical services and making payments therefor.
2. A health insurance-covered medical care contract must contain at least the following contents:
a) Insured person and service coverage requirements; the estimated quantity of health insurance cards and health insurance participants with regard to primary care providers;
b) Payment methods of medical costs
c) Rights and responsibilities of the parties;
d) Term of the contract;
dd) Liabilities upon breach of the contract;
e) Conditions for revision, finalization, suspension and termination of the contract.
3. Any agreement on conditions for revision, finalization, suspension and termination of a contract prescribed in point e, clause 2 of this Article must not interrupt the provision of medical care for the participant.
4. The Government shall elaborate this Article and provide a model contract for covered medical services.
Article 26. Registration of health insurance-covered primary care providers
1. Health insurance participants may register a primary healthcare facility or secondary health facility as a health insurance-covered primary care provider, and may change this primary care provider within the first 15 days of each quarter.
2. The distribution of health insurance cards to health insurance-covered primary care providers must be balanced, appropriate for the primary care demand of the people, capacity of the health facilities and the local area.
3. The Minister of Health shall elaborate clause 1 and clause 2 of this Article; specify the cases in which tertiary health facilities may be registered as health insurance-covered primary care providers.
4. The Minister of Public Security and the Minister of National Defense shall elaborate regulations on registration of primary healthcare facilities, secondary health facility and tertiary health facilities as health insurance-covered primary care providers, and health insurance participants under their management.
Article 27. Patient referral among covered facilities
1. The patient referral among health facilities shall be carried out according to the professional requirements and capacity of the involved health facilities.
2. The Minister of Health shall promulgate regulations on referral of patients to health insurance-covered primary care providers for treatment, management and monitoring of chronic diseases, including the use of medicines, medical devices and medical services that have been prescribed according to the capacity of the facilities treating, managing and monitoring chronic diseases; elaborate clause 1 of this Article, except for cases specified in clause 3 of this Article.
3. The Minister of Public Security and the Minister of National Defense shall promulgate regulations on referral of patients under their management among covered facilities under their management.
Article 28. Procedures for health insurance-covered medical care
1. When receiving medical care, the health insurance participant shall present information about the health insurance card, his/her identification; children aged under 6 and people who have donated human organs and have not been issued with health insurance cards shall present other valid documents. In case of emergency, the patient must present the information specified in this clause before the end of the treatment.
The Government shall elaborate this clause.
2. In case of follow-up examination according to professional requirements, health insurance participants shall get appointments following the procedures established by the Minister of Health.
3. In case of referral according to professional requirements during inpatient care, the referring facility shall prepare referral documents in accordance with regulations of the Minister of Health.
Article 29. Health insurance assessment
1. Health insurance assessment covers:
a) Scrutinize procedures for health insurance-covered medical care;
b) Inspect and evaluate treatment indication, use of medicines, chemicals, medical supplies, medical devices, and technical medical services for patients;
c) Inspect and determine health insurance-covered medical costs.
2. The health insurance assessment must be conducted in an accurate, public, and transparent manner.
3. Social security authorities shall conduct the health insurance assessment and take responsibility before law for the assessment results.
Chapter VI
PAYMENT OF HEALTH INSURANCE-COVERED MEDICAL COSTS
Article 30. Payment methods of health insurance-covered medical costs
1. Health insurance-covered medical costs shall be paid by one of the following methods:
a) Rate-based payment;
b) Service price-based payment;
c) Diagnosis-related group payment.
2. The Government shall elaborate clause 1 of this Article and regulations on application of methods of payment of health insurance-covered medical costs.
Article 30. Payment of health insurance-covered medical costs
1. Social security authorities shall pay the health insurance-covered medical costs to health facilities under health insurance-covered medical care contracts.
2. Social security authorities shall pay the health insurance-covered medical costs directly to health insurance card holders when they receive medical care in the following cases:
a) Medical care is provided at a health facility without a health insurance-covered medical care contract;
b) Medical care is provided against Article 28 of this Law;
c) Other cases prescribed by the Government.
3. In case the medicine, medical device or paraclinical service which is prescribed for the patient and covered by health insurance is not available at the health facility and cannot be replaced by any other medicine, medical device or paraclinical service, the health facility may receive medicine, medical device or paraclinical service transferred from another covered facility to serve the treatment of the patient, or refer the patient or send the specimen to another facility capable of providing the paraclinical service.
The covered facility that receives the medicine, medical device, refers the patient or sends the specimen shall prepare a statement of the costs of these medicine, medical device or paraclinical service and receive payment from the social security authority.
4. The Government shall elaborate the following regulations:
a) Conditions, authority for deciding the cases in which a health facility may receive medicines and medical devices from other covered facilities for treatment of patients and the payment of these medicines and medical devices prescribed in clause 3 of this Article;
b) Management, use of funds for health insurance-covered medical care, assessment, payment and statement of health insurance-covered medical costs incurred by the participants prescribed in points a, b, c, d and dd, clause 3, Article 12 of this Law;
c) Payment and statement of health insurance-covered medical costs incurred by participants in the people’s armed forces, the people living in bordering areas, on islands, particularly disadvantaged villages and communes in order to ensure defense and security.
5. The Government shall elaborate point a and point b, clause 2, clause 3 of this Article, except the cases specified in clause 4 of this Article.
Article 32. Advance payment, payment, statement of health insurance-covered medical costs
1. The advance payment by social security authorities to covered facilities shall be carried out quarterly as follows:
a) Within 05 working days from the receipt of the previous quarter’s statement from the health facility, the social security authority shall advance a lump sum of 90% of the health insurance-covered medical costs in the statement;
b) In case a health facility that signs the first contract for health insurance-covered medical care, the social security authority shall, on the basis of the medical costs of the month preceding the month in which the contract is signed, advance 90% of the costs for the first month of executing the contract; after one month, the social security authority shall estimate and advance 90% of the health insurance-covered medical costs in the quarter according to point a of this clause;
c) If the total advanced payment to covered facilities in province are advanced exceeds the quarterly budget, the social security authority of the province shall send a report to Vietnam Social Security for provision of extra funds.
2. The payment and statement between the heath facilities and the social security authorities shall be carried out as follows:
a) Within the first 15 days of every month, covered facilities shall send a written request for payment of health insurance-covered medical care costs of the previous month to the social security authority; within the first 15 days of every quarter, covered facilities shall submit the statements of health insurance-covered medical care costs of the previous quarter to the social security authority;
b) Within 30 days from the receipt of the previous quarter’s statement from each covered facility, the social security authority shall notify the verification result and the agreed payment for health insurance-covered medical care, including the covered medical costs. For the fourth quarter of the year, the time limit for notifying the verification result and the agreed payment for health insurance-covered medical care shall be 60 days from the day on which the social security authority receives the fourth quarter’s statement from the health facility;
c) Within 10 days from the notification of the verification result, the social security authority must fully pay the health facility;
d) The annual statement of the health insurance fund shall be verified before October 01 of the next year.
3. Within 40 days from the receipt of the satisfactory application for the payment from the health insurance participant in the cases specified in clause 2, Article 31 of this Law, the social security authority shall pay the health insurance-covered medical care costs directly to the participant.
Chapter VII
HEALTH INSURANCE FUND
Article 33. Financial sources for setting up the health insurance fund
1. Health insurance premiums prescribed in this Law.
2. Profits from investments by the fund.
3. Sponsorships, aids from Vietnamese and foreign organizations.
4. Other lawful revenues.
Article 34. Management of the health insurance fund
1. The health insurance fund shall be managed in a centralized, uniform, public, and transparent manner. There must be hierarchy to manage among social security authorities.
The Social Insurance Management Council as prescribed in the Law on Social Insurance shall manage the health insurance fund and provide consultancy on the health insurance policies.
2. The Government shall elaborate the management of the health insurance fund; decide financial sources to ensure health insurance-covered medical care in case the health insurance fund faces a revenue-expenditure imbalance.
3. The Government shall send an annual report on the management and use of the health insurance fund.
Article 35. Allocation and use of the health insurance fund
1. The health insurance fund shall be allocated and used as follows:
a) 92% of the health insurance premiums shall be used to pay for medical care;
b) 8% of the health insurance premiums shall be used to contribute to the reserve fund, cover the expenditures on health insurance organization and operation, at least 4% of which shall be contributed to the reserve fund.
2. Investment of the temporarily idle money of the health insurance fund shall comply with regulations of the Law on Social Insurance on the principles, portfolio, methods and management of investment of the social insurance fund.
3. In case the collected health insurance premiums are greater than the payment for medical care in the year, the remainder shall be transferred in full to the reserve fund for general use.
4. In case the collected health insurance premiums are smaller than the payment for medical care in the year, Vietnam Social Security shall provide extra funds from the reserve fund.
5. The Government shall elaborate this Article and regulations on health insurance organization and operation.
Chapter VIII
RIGHTS AND RESPONSIBILITIES OF PARTIES INVOLVED IN HEALTH INSURANCE
Article 36. Rights of health insurance participants
1. Have a health insurance card issued upon payment of health insurance premiums.
2. Select a health insurance-covered primary care provider according to Article 26 of this Law.
3. Receive medical care.
4. Have health insurance-covered medical costs paid by the social security authority.
5. Request social security authorities, covered facilities, and relevant agencies to provide explanations and information on health insurance benefits.
6. File complaints or denunciations against violations of laws on health insurance.
Article 37. Responsibilities of health insurance participants
1. Pay health insurance premiums fully and on time.
2. Use health insurance cards for proper purposes, fail to allow others use their health insurance cards.
3. Abide by the provisions of Article 28 of this Law upon visit of health facilities for receiving medical care.
4. Comply with regulations and guidance of social security authorities and health facilities upon receiving medical care.
5. Pay medical costs to health facilities, in addition to health insurance-covered ones.
Article 38. Rights of organizations and individuals paying health insurance premiums
1. Request social security authorities and competent authorities to provide explanations and information on health insurance benefits.
2. File complaints or denunciations against violations of laws on health insurance.
Article 39. Responsibilities of organizations and individuals paying health insurance premiums
1. Prepare applications for issuance of health insurance cards.
2. Pay health insurance premiums fully and on time.
3. Provide the health insurance card or notify the health insurance card issuance result to the health insurance participant within 03 working days from the receipt of the card or the notification from the social security authority.
4. Provide full and accurate information and documents related to the responsibilities for health insurance of employers and representatives of health insurance participants upon request of social security authorities, employees or representatives of employees.
5. Be subject to inspection and audit of compliance with the law on health insurance.
Article 40. Rights of social security authorities
1. Request employers and representatives of health insurance participants to provide full and accurate information and documents related to their responsibilities for health insurance.
2. Inspect the execution of health insurance-covered medical care contracts; carry out health insurance assessment; revoke, suspend health insurance cards in the cases specified in Article 20 of this Law.
3. Request covered facilities to provide medical records and medical care documents for health insurance assessment.
4. Refuse payment of health insurance-covered medical costs against this Law or the health insurance-covered medical care contracts.
5. Request liable persons to pay recompense for any damage to health insurance participants to refund medical costs which have been paid by social security authorities.
6. Propose competent authorities to make amendments to policies or laws on health insurance and take actions against organizations and individuals that commit violations of laws on health insurance.
Article 40. Responsibilities of social security authorities
1. Disseminate and popularize policies and laws on health insurance;
2. Enable persons specified in clause 5, Article 12 of this Law to pay household-based health insurance premiums at any health insurance authority. Provide guidance on applications, procedures for participation in health insurance and application-receiving authorities and provide participants with the health insurance benefits quickly, simply and conveniently. Review, compile, and confirm the list of health insurance participants to not concurrently issued with more than one health insurance cards to one participant prescribed in Article 12 of this Law, except for health insurance participants under the management of the Ministry of National Defense and the Ministry of Public Security.
3. Collect health insurance premiums and issue health insurance cards.
4. Manage and use the health insurance fund.
5. Conclude health insurance-covered medical care contracts with health facilities.
6. Pay health insurance-covered medical costs.
7. Provide information on covered facilities and guidance on select primary care providers to health insurance participants.
8. Inspect the execution of health insurance-covered medical care contract; conduct health insurance assessment.
9. Protect the rights and interests of health insurance participants; settle recommendations, complaints, and denunciations on health insurance benefits.
10. Archive documents and data on health insurance in accordance with law; specify the time limit for participation in health insurance to ensure the rights and interests of health insurance participants; apply the information technology in the management of health insurance and building of the national database on health insurance.
11. Produce statistics and prepare reports, provide professional guidance on health insurance; make periodic or ad hoc reports on the management and use of the health insurance fund.
12. Provide professional training and retraining , conduct scientific research and international cooperation on health insurance.
Article 42. Rights of covered facilities
1. Request social security authorities to provide full and accurate information on health insurance participants and the funding allocated to them for the provision of medical care for health insurance participants.
2. Receive advance and medical cost payments made by social security authorities under the concluded contracts.
3. Propose competent authorities to take actions against organizations and individuals that commit violations of laws on health insurance.
Article 43. Responsibilities of covered facilities
1. Provide quality medical services according to simple and convenient procedures for health insurance participants.
2. Provide medical records and medical care documents and pay medical costs for health insurance participants at the request of social security authorities and competent authorities; provide the medical records and medical care documents of health insurance participants with regard to the applications for the direct payment within 05 working days from the receipt of the request of social security authorities.
3. Ensure necessary conditions for social security authorities to conduct assessment; cooperate with social security authorities in disseminating and providing explanations on health insurance benefits to health insurance participants.
4. Inspect and report found violations against the regulations on use of health insurance cards to social security authorities; cooperate with social security authorities in revoking and suspending health insurance cards in the cases specified in Article 20 of this Law.
5. Manage and use the funding derived from the health insurance fund in accordance with law.
6. Produce statistics and prepare reports on health insurance in accordance with law.
7. Prepare the statement on health insurance-covered medical costs and take responsibility before law for the legality and accuracy of such statement.
8. Provide the statement on medical costs at the request of health insurance participants.
9. Maintain the fulfillment of conditions for health insurance-covered medical care in accordance with regulations of law on health insurance, medical care, and health insurance-covered medical care contracts.
Article 44. Rights of organizations representing employees and those representing employers
1. Request social security authorities, health facilities, and employers to provide full and accurate information on health insurance benefits of employees.
2. Propose competent authorities to take actions against violations of laws on health insurance that impact the legislative rights and interests of employees and employers.
Article 45. Responsibilities of organizations representing employees and those representing employers
1. Disseminate and popularize policies and laws on health insurance to employers and employees.
2. Engage in formulation of policies or laws on health insurance and propose amendments thereto.
3. Participate in the supervision of compliance with the law on health insurance, expedite the payment of health insurance premiums for their employees by employers and the handling of payers who evade or delay the payment of health insurance premiums.
Chapter IX
INSPECTION, COMPLAINT, DENUNCIATION, SETTLEMENT OF DISPUTES AND HANDLING OF VIOLATIONS AGAINST THE LAW ON HEALTH INSURANCE
Article 46. Inspection on health insurance
The health inspectorate shall conduct specialized inspections on health insurance.
Article 47. Complaints , denunciations related to health insurance
Complaints against administrative decisions and administrative acts related to health insurance, and denunciations against violations of laws on health insurance shall be filed and settled in accordance with the law on complaints and denunciations.
Article 48. Disputes over health insurance
1. Disputes over health insurance are those related to rights, duties and responsibilities for health insurance of:
a) Health insurance participants as defined in Article 12 of this Law and their representatives;
b) Organizations and individuals paying health insurance premiums as defined in clause 1, Article 13 of this Law;
c) Social security authorities;
d) Covered facilities.
2. Disputes over health insurance shall be settled as follows:
a) Parties shall reconcile their dispute;
b) In case of unsuccessful reconciliation, parties may initiate a lawsuit at a court in accordance with law.
Article 48a. Late payment of health insurance premiums
Late payment of health insurance premiums is the act of the employer in one of the following cases:
1. Failure to pay or fully pay the health insurance premiums payable after the deadline for payment of health insurance premiums specified in clause 8, Article 15 of this Law, except for cases specified in point c, clause 1, Article 48b of this Law;
2. Failure to compile a list or a full list of health insurance participants within 60 days from the deadline specified in point b, clause 1 Article 17 of this Law;
3. It will be considered evasion of health insurance premium payment in the case specified in clause 2 Article 48b of this Law.
Article 48b. Evasion of health insurance premium payment
1. Evasion of health insurance premium payment is the act of the employer in one of the following cases:
a) Failure to compile a list or a full list of health insurance participants after 60 days from the deadline specified in point b, clause 1, Article 17 of this Law;
b) Registration of a lower salary as the basis for health insurance premium payment than that specified in Article 14 of this Law;
Failure to pay or fully pay the registered health insurance premiums after the 60 days from the deadline for health insurance premium payment specified in clause 8, Article 15 of this Law despite being reminded by the competent authority according to regulations of the Government;
d) Other cases in which it is considered evasion of health insurance premium payment according to regulations of the Government.
2. The Government shall elaborate this Article and specifies the cases mentioned in clause 1 of this Article that are not considered evasion of health insurance premium payment for justifiable reasons.
Article 49. Actions against violations of laws on health insurance
1. Agencies, organizations and individuals that commit violations against health insurance laws shall, depending on the nature and severity of the violations, face disciplinary actions, administrative penalties, or criminal prosecution, and pay recompense for any damage caused.
2. Actions against late payment of health insurance premiums:
a) Enforced payment of the arrears plus an interest of 0,03%/day on the arrears multiplied by (x) the number of days of late payment to the health insurance fund;
b) Administrative penalties as prescribed by law;
c) Disqualification from commendation and awards.
3. Actions against evasion of health insurance premium payment:
a) Enforced payment of the arrears plus an interest of 0,03%/day on the arrears multiplied by (x) the number of days of late payment to the health insurance fund;
b) Administrative penalties or criminal prosecution as prescribed by law;
c) Disqualification from emulation titles and awards.
4. Agencies, organizations, employers that commit evasion or late payment of health insurance for employees shall return all the covered medical costs to the employees which accrue over the time health insurance cards are not issued due to such evasion or late payment.
5. The Government shall elaborate point a, clause 2, point a, clause 3 and clause 4 of this Article.
Chapter X
IMPLEMENTATION PROVISIONS
Article 50. Transitional provisions
1. Health insurance cards and free medical care cards issued to children aged under 6 before the effective date of this Law will become effective:
a) Until their expiry dates for cards valid until December 31, 2009;
b) Until December 31, 2009 for cards valid after December 31, 2009.
2. The health insurance coverage for persons whose health insurance cards are issued before this Law shall follow the applicable regulations on health insurance until December 31, 2009.
3. Health insurance participants as defined in clauses 21, 22, 23, 24 and 25, Article 12 of this Law may, when complying with points b, c, d and e, clause 2, Article 51 of this Law, voluntarily participate in health insurance under the Government’s regulations.
Article 51. Entry in force
1. This Law comes into force from July 1, 2009.
2. The roadmap for achieving universal health insurance is provided for as follows:
a) Health insurance participants as defined in clauses 1 through 20, Article 12 of this Law shall participate in health insurance from the effective date of this Law;
b) Health insurance participants as defined in clause 21, Article 12 of this Law shall participate in health insurance from January 1, 2010.
c) Health insurance participants as defined in clause 22, Article 12 of this Law shall participate in health insurance from January 1, 2012.
d) Health insurance participants as defined in clauses 23 and 24, Article 12 of this Law shall participate in health insurance from January 1, 2014.
dd) Health insurance participants as defined in clause 25, Article 12 of this Law shall participate in health insurance accordance with the Government’s regulations from January 1, 2014 at the latest.
Article 52. Elaboration and guidance
The Government shall elaborate and provide guidance on the implementation of articles and clauses of this Law as assigned, and provide guidance on other necessary provisions of this Law to meet state management requirements./.
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