Please let me know what are the latest regulations on medical examination and treatment under health insurance? - Reader Ha Linh
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| Procedures for medical examination and treatment under health insurance (latest update). (Source: Internet) |
On December 14, 2023, the Ministry of Health issued Decision 4524/QD-BYT on promulgating amended and supplemented administrative procedures in the field of health finance in Decree 75/2023/ND-CP amending and supplementing a number of articles of Decree 146/2018/ND-CP detailing and guiding measures to implement a number of articles of the Law on Health Insurance.
Health insurance medical examination and treatment procedures (latest update)
(1) Implementation sequence
Step 1: For health insurance participants
- When coming for medical examination and treatment, health insurance participants must present a health insurance card with a photo; in case the health insurance card does not have a photo, the health insurance card must be presented along with documents proving the person's identity; for children under 6 years old, only the health insurance card must be presented.
- In case of emergency, health insurance participants can be examined and treated at any medical examination and treatment facility and must present their health insurance card along with the documents specified in Clause 1, Step 1 before being discharged from the hospital.
- In case of transfer of treatment, health insurance participants must have a transfer record from the medical examination and treatment facility.
- In case of re-examination upon treatment request, health insurance participants must have a re-examination appointment paper from the medical examination and treatment facility.
- In case of exceeding technical expertise, the health insurance medical examination and treatment facility is responsible for promptly transferring the patient to another health insurance medical examination and treatment facility according to regulations on technical expertise transfer.
- Some specific cases for health insurance participants:
+ When seeking medical examination or treatment, health insurance participants must present a health insurance card with a photo or a citizen identification card; in case of presenting a health insurance card without a photo, they must also present one of the following identification papers with a photo issued by a competent authority or organization or a certificate issued by the commune-level police or other papers certified by the educational institution where the student is managed; other legal identity papers or level 2 electronic identification papers as prescribed in Decree 59/2022/ND-CP.
+ Children under 6 years old coming to see a doctor or receive treatment only need to present their health insurance card. In case the child has not been issued a health insurance card, they must present a copy of the birth certificate or a copy of the birth certificate; in case they need to be treated immediately after birth and do not have a birth certificate, the head of the medical examination and treatment facility and the child's father, mother or guardian must sign the medical record to serve as the basis for payment according to the provisions of Clause 1, Article 27 of Decree 146/2018/ND-CP and be responsible for this confirmation.
+ Health insurance participants, while waiting for re-issuance or exchange of health insurance cards, when coming to see a doctor or receive medical treatment, must present an appointment paper for re-issuance or exchange of health insurance cards issued by the Social Insurance agency or an organization or individual authorized by the Social Insurance agency to receive applications for re-issuance or exchange of cards according to Form No. 4 of the Appendix issued with Decree 146/2018/ND-CP and a type of document proving the identity of that person.
+ The person who donated the body part to come for medical examination and treatment must present the documents specified in point (1) or point (3) above. In case of immediate treatment after donation, the head of the medical examination and treatment facility where the body part was taken and the patient or the patient's relative must sign the confirmation in the medical record as the basis for payment according to the provisions of Clause 2, Article 27 of Decree 146/2018/ND-CP and be responsible for this confirmation.
+ 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 Paper according to Form No. 6 of the Appendix issued with Decree 75/2023/ND-CP. In case the referral paper is valid until December 31 of the calendar year but the treatment period has not ended, the referral paper can be used until the end of the treatment period.
In case of re-examination upon treatment request, health insurance participants must have a Re-examination Appointment Form from the medical examination and treatment facility according to Form No. 5 of the Appendix issued with Decree 75/2023/ND-CP.
+ In case of emergency, health insurance participants can go to any medical examination and treatment facility and must present the documents specified in Clause 6, Article 1 of Decree 75/2023/ND-CP or Clause 2 or Clause 3, Article 15 of Decree 146/2018/ND-CP before being discharged from the hospital. When the emergency phase is over, the medical examination and treatment facility will transfer the patient to another department or treatment room at that medical examination and treatment facility for continued monitoring and treatment or transfer to another medical examination and treatment facility, which is determined to be the correct medical examination and treatment facility.
+ Health insurance participants during business trips, mobile work, concentrated study in training forms, training programs, or temporary residence are entitled to receive initial medical examination and treatment at medical examination and treatment facilities of the same technical level or equivalent to the facility registered for initial medical examination and treatment stated on the health insurance card and must present the documents specified in Clause 6, Article 1 of Decree 75/2023/ND-CP or Clause 2 or Clause 3, Article 15 of Decree 146/2018/ND-CP and one of the following documents (original or copy): work permit, decision to send to study, student card, temporary residence registration certificate, school transfer certificate.
Step 2: For medical examination and treatment facilities
- Organize medical examination and treatment to ensure quality with simple and convenient procedures for health insurance participants.
- Admit patients with health insurance cards to medical examination and treatment facilities for diagnosis and treatment.
(2) Profile components
- Health insurance card and identification documents of that person; for children under 6 years old, only health insurance card must be presented.
- Copy of birth certificate or birth certificate for children under 6 years old.
- Form No. 4. Receipt of application and appointment for results of issuance, re-issuance and exchange of health insurance cards.
- Form No. 5. Re-examination appointment form.
- Form No. 6. Referral form for medical examination and treatment under health insurance.
- Referral records of health insurance medical examination and treatment facilities.
Decision 4524/QD-BYT takes effect from December 3, 2023, replacing Decision 4384/QD-BYT in 2023.
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