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| Latest health insurance medical examination and treatment procedures. (Source: TVPL) |
On October 19, the Government issued 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.
Latest health insurance medical examination and treatment procedures
Specifically, Article 15 of Decree 146/2018/ND-CP, amended by Decree 75/2023/ND-CP, stipulates the procedures for medical examination and treatment under health insurance as follows:
(1) 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 documents or level 2 electronic identification documents as prescribed in Decree 59/2022/ND-CP.
(2) Children under 6 years old coming for medical examination and treatment only need to present their health insurance card.
In case the child has not been issued a health insurance card, a copy of the birth certificate or birth certificate must be presented; in case treatment is required immediately after birth without a birth certificate, the head of the medical examination and treatment facility and the child's father, mother or guardian must sign the confirmation on the medical record as a basis for payment according to the provisions of Clause 1, Article 27 of Decree 146/2018/ND-CP and be responsible for this confirmation.
(3) 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.
(4) A person who has donated a body part to come for medical examination and treatment must present the documents specified in (1) or (3). In case treatment is required immediately 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 a basis for payment according to the provisions of Clause 2, Article 27 of Decree 146/2018/ND-CP and be responsible for this confirmation.
(5) 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 146/2018/ND-CP. In case the referral paper is valid until December 31 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 paper from the medical examination and treatment facility according to Form No. 5 of the Appendix issued with Decree 146/2018/ND-CP.
(6) In case of emergency, health insurance participants may seek medical examination and treatment at any medical examination and treatment facility and must present the documents specified in (1) or (2) or (3) 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 considered to be the correct medical examination and treatment facility.
Medical examination and treatment facilities that do not have health insurance medical examination and treatment contracts are responsible for providing patients upon discharge with valid documents and certificates related to medical examination and treatment costs so that patients can pay directly to the social insurance agency according to the provisions of Articles 28, 29 and 30 of Decree 146/2018/ND-CP.
(7) 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 level or equivalent to the initial medical examination and treatment facility registered on the health insurance card and must present the documents specified in (1) or (2) or (3) and one of the following documents (original or photocopy): work permit, decision to send to study, student card, temporary residence registration certificate, school transfer certificate.
(8) Medical examination and treatment facilities and social insurance agencies are not allowed to prescribe additional procedures for medical examination and treatment under health insurance in addition to the above procedures.
In case medical examination and treatment facilities or social insurance agencies need to photocopy health insurance cards and documents related to medical examination and treatment of patients for management purposes, they must photocopy themselves and must not require patients to photocopy or pay for this expense.
Decree 75/2023/ND-CP takes effect from December 3, 2023. Except for Clause 1, Points a and b, Clause 2, Clauses 3, 4, 5 and 6, Article 1 of Decree 75/2023/ND-CP shall be applied from October 19, 2023.
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