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The latest procedures for medical examination and treatment under health insurance (HI) are guided in Decision 4384/QD-BYT in 2023, specifically as follows:
1. Latest health insurance medical examination and treatment records
Latest health insurance medical examination and treatment records include:
- Health insurance card and identification documents of that person; for children under 6 years old, only the health insurance card must be presented.
- Copy of birth certificate or birth certificate for children under 6 years old.
- Declaration of participation and adjustment of social insurance and health insurance information according to Form TK1-TS (Issued with Decision 490/QD-BHXH dated March 28, 2023).
- Form No. 5. Re-examination appointment form.
- Form No. 6. Health insurance referral form.
- Referral records of health insurance facilities.
Note: Patients do not need to present all of the above documents, but depending on each case in section 2, present the corresponding documents.
2. Latest procedures for medical examination and treatment under health insurance
* Step 1: For health insurance participants
(1) When going to a medical examination and treatment facility, 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 present one of the following identification papers with a photo issued by a competent agency or organization or a certificate from 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; for children under 6 years old, they must only present a health insurance card.
(2) In case of emergency, health insurance participants can receive medical examination and treatment at any medical examination and treatment facility and must present their health insurance card along with the documents specified in (i) before being discharged from the hospital.
(3) In case of referral for treatment, health insurance participants must have a referral form for medical examination and treatment under health insurance and a referral record from the medical facility.
(4) In case of re-examination as required for treatment, the health insurance participant must have a re-examination appointment paper from the medical facility.
(5) In cases where technical expertise is beyond the scope of the health insurance facility, the health insurance facility is responsible for promptly transferring the patient to another health insurance facility according to regulations on technical expertise transfer.
(6) Some specific cases for health insurance participants:
6.1. 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 papers or level 2 electronic identification papers as prescribed in Decree 59/2022/ND-CP.
6.2. 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 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.
6.3. Health insurance participants waiting for re-issuance or exchange of health insurance cards when coming to receive medical examination and treatment must present the Social Insurance and Health Insurance Participation and Information Adjustment Form according to Form TK1-TS (Issued with Decision 490/QD-BHXH dated March 28, 2023) and a document proving their identity.
6.4. A person who has donated an organ for medical examination or treatment must present the documents specified in 6.1 or 6.3. In case treatment is required immediately after donation, the head of the medical facility where the organ 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.
6.5. 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 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, the health insurance participant must have a Re-examination Appointment Form from the medical facility according to Form No. 5 of the Appendix issued with Decree 75/2023/ND-CP.
6.6. In case of emergency, health insurance participants can go to any health care facility for medical examination and treatment 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 health care facility will transfer the patient to another department or treatment room at that health care facility for continued monitoring and treatment or transfer to another health care facility, which is considered to be the correct health care facility.
6.7. Health insurance participants during business trips, mobile work, concentrated study in training forms, training programs, or temporary residence shall receive initial medical examination and treatment at medical examination and treatment facilities of the same technical level or equivalent to the initial medical examination and treatment facility registered 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 facilities
- Organizing quality health care services with simple and convenient procedures for health insurance participants.
- Admit patients with health insurance cards to medical facilities for diagnosis and treatment.
Source
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