New regulations related to health insurance referral papers from December 3

From December 3, 2023, the form of referral form for medical examination and treatment under health insurance (or health insurance referral form) prescribed in Decree 75/2023/ND-CP amending Decree 146/2018/ND-CP guiding the Law on Health Insurance (effective from December 3, 2023) will be applied.

About health insurance benefits

In case a person with a health insurance card goes to a medical examination and treatment facility that is not in the right line, and is then transferred to another medical examination and treatment facility by the receiving facility, the health insurance fund will pay for the medical examination and treatment costs according to the benefit level prescribed in Clause 3, Article 22 of the Law on Health Insurance, except in the following cases: emergency; inpatient treatment is discovered to have another disease outside the scope of expertise of the medical examination and treatment facility; the disease progresses beyond the professional capacity of the medical examination and treatment facility.

Procedures for medical examination and treatment under health insurance when there is a referral

To enjoy health insurance coverage when having a referral, patients need to follow the correct procedures for health insurance examination and treatment in Article 15 of Decree 146/2018/ND-CP (amended and supplemented in Decree 75/2023/ND-CP). Accordingly, when referring to a medical examination and treatment facility, patients must present the following documents:

- Health insurance participants must present their health insurance card with photo or citizen identification card when seeking medical examination or treatment.

In case of presenting a health insurance card without a photo, it is necessary to present one of the following identification documents with a photo issued by a competent authority or organization, or a certificate issued by the commune-level police, or other documents certified by theeducational institution where the student is managed; other legal identification documents or documents with level 2 electronic identification as prescribed in Decree 59/2022/ND-CP.

- In case of referral for medical examination and treatment, the health insurance participant must present the referral record of the medical examination and treatment facility and the referral form according to the health insurance referral form mentioned above.

In case the referral form is valid until December 31 but the treatment period has not ended, the referral form can be used until the end of the treatment period.

In case of re-examination as required for treatment, health insurance participants must have a re-examination appointment paper from the medical examination and treatment facility.

About payment of patient transportation costs

Health insurance participants who are subject to the provisions of Clauses 3, 4, 7, 8, 9 and 11, Article 3 of Decree 146/2018/ND-CP in case of emergency or inpatient treatment must be transferred to a technical specialist from a district-level medical examination and treatment facility to a higher level, including:

+ From district to provincial level;

+ From district to central level.

Level of payment for transportation costs: In case of using the means of transport of the medical examination and treatment facility designated for transfer, the Health Insurance Fund shall pay the transportation costs for both the outbound and return trips to that medical examination and treatment facility at the rate of 0.2 liters of gasoline/km calculated based on the actual distance between the two medical examination and treatment facilities and the gasoline price at the time of transferring the patient. If more than one patient is transported on the same means of transport, the payment level shall be calculated as for the transportation of one patient. The medical examination and treatment facility receiving the patient shall sign the confirmation on the vehicle dispatch form of the facility transferring the patient; in case of being outside of working hours, there must be the signature of the doctor receiving the patient;

In case the means of transport of the medical examination and treatment facility is not used, the health insurance fund will pay the one-way transportation cost (outgoing direction) for the patient at the rate of 0.2 liters of gasoline/km calculated based on the actual distance between the two medical examination and treatment facilities and the gasoline price at the time of transferring the patient to a higher level. The medical examination and treatment facility that designates the transfer is responsible for paying this cost directly to the patient before the transfer, then paying the social insurance agency.

Minh Hoa (reported by Lao Dong, Nguoi Lao Dong)

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