Decree 75/2023/ND-CP: New points increase benefits for participants and beneficiaries of health insurance policies
(Baonghean.vn) - On October 19, 2023, the Government issued Decree 75/2023/ND-CP amending and supplementing a number of articles of Decree No. 146/2018/ND-CP dated October 17, 2018 of the Government detailing and guiding measures to implement a number of articles of the Law on Health Insurance (Decree No. 75).
Compared with Decree No. 146/2018/ND-CP, Decree No. 75 has amended and supplemented 10 contents, 3 forms and abolished 4 clauses, including some notable new points as follows:
The first, adding 2 groups of subjects that are paid by the state budget and supported for health insurance premiums, including: People in safe zone communes and revolutionary safety zones (ATK) to the group paid by the state budget; Ethnic minorities living in communes that have just escaped from difficult and especially difficult areas in ethnic minority and mountainous areas in the period of 2021 - 2025 according to the Prime Minister's decision to the group supported by the state budget for health insurance premiums (supported at least 70% of the premium for 36 months from November 1, 2023).
The addition of Decree No. 75 to include ethnic minorities living in communes that have just escaped from difficult or extremely difficult areas in ethnic minority and mountainous areas in the 2021-2025 period according to the Prime Minister's decision to the group receiving state budget support for health insurance premiums is extremely important in order to create favorable conditions for all people, especially disadvantaged groups, to have the opportunity to participate in and benefit from health insurance policies, thereby contributing to maintaining and developing health insurance coverage.
The regulation that the state budget continues to support for a period of time after escaping poverty so that people can accumulate and have enough economic conditions to participate in health insurance demonstrates the Government's policy of ensuring social security and sustainable poverty reduction.
Monday, supplement and increase the level of health insurance examination and treatment benefits:
People participating in the resistance war and defending the Fatherland: Increase the benefit level from 80% to 100% of health insurance examination and treatment costs.
People serving revolutionary contributors living at home: Increase the benefit level from 80% to 95% of health insurance examination and treatment costs.
Spouses of martyrs who remarry but are receiving monthly allowances according to the provisions of the Ordinance on preferential treatment for people with revolutionary contributions (code TG): receive 95% of health insurance examination and treatment costs.
Tuesday, regulations on medical examination and treatment procedures under health insurance: Allowing the presentation of citizen identification card in lieu of health insurance card with photo; other legal identification documents or documents that have been electronically identified at level 2 on VNeID when going for medical examination and treatment.
Regulations on the validity period of the re-examination appointment: In case the re-examination appointment time is exceeded, within 10 days from the date of re-examination appointment, the patient must contact the medical staff to register for a suitable appointment or come for a re-examination in person.
Wednesday, amending the principles of payment for health insurance examination and treatment costs between medical examination and treatment facilities and Social Insurance agencies. Decree No. 75 abolishes the regulations on payment according to the total payment level for health insurance examination and treatment costs, and implements payment according to the service price payment method applied from January 1, 2019.
At the same time, regulations on financial planning and settlement, based on the estimates assigned by the Prime Minister, Vietnam Social Security assigns the estimates for medical examination and treatment expenses under health insurance to the Social Insurance of the Ministry of National Defense, the Social Insurance of the People's Public Security, and the Social Insurance of provinces and centrally-run cities within the scope of 90% of the estimated national health insurance revenue.
Then, on the basis of the proposal ofmedical facility, The Social Insurance of the province or centrally-run city shall notify the estimated amount of health insurance examination and treatment expenses to the medical examination and treatment facility (not applicable as a basis for advance payment, payment, and settlement of health insurance examination and treatment expenses of the medical examination and treatment facility in case of exceeding the estimated amount of expenses).
Medical examination and treatment facilities are responsible for complying with the provisions of the law on health insurance, the law on medical examination and treatment, and the law on procurement and bidding, to ensure the supply of drugs, chemicals, medical supplies, and medical technical services with quality, efficiency, and economy.
According to the new regulations, the costs of medical examination and treatment under health insurance within the scope of benefits and the level of benefits of health insurance participants that have been assessed by the Social Insurance agency will be covered by the health insurance fund. The payment mechanism is based on the actual technical services, medicines, medical supplies, etc. used for patients and the prices according to current regulations. These regulations create conditions for medical examination and treatment facilities to improve the quality and efficiency of their operations and ensure the rights of health insurance patients, and to manage and use the health insurance fund safely and in accordance with regulations.
Thursday, amend and supplement the rights and responsibilities of relevant parties in implementing health insurance policies.
For health insurance medical examination and treatment facilities: Add the right: "To be provided with timely information when the health insurance appraisal information system detects an increase in health insurance medical examination and treatment costs compared to the average cost of medical examination and treatment facilities of the same class, same level, same specialty to promptly review, verify, and implement appropriate adjustment solutions". Strengthen the responsibility of medical examination and treatment facilities in complying with regulations on procurement and bidding, to ensure the supply of drugs, chemicals, medical supplies, and medical technical services with quality, efficiency, and savings.
The Decree also stipulates that medical examination and treatment facilities must review and promptly issue procedures, professional instructions, and measures to prevent abuse and profiteering of health insurance funds according to their authority; regularly organize inspections and verify increased health insurance examination and treatment costs at the facility according to recommendations and warnings from the Social Insurance agency and make appropriate adjustments.
For the Ministry of Health: Strengthen the responsibility of the Ministry of Health in directing medical examination and treatment facilities to comply with legal regulations on medical examination and treatment under health insurance, in purchasing and bidding for drugs, chemicals, and medical supplies.
At the same time, the Decree also stipulates the responsibility of the Ministry of Health in regularly updating and amending the list, conditions, scope, and payment rates for drugs, supplies, technical services, and goods covered by the health insurance fund, in regulating and guiding the interconnection of data on test results, functional imaging diagnostics, and medical examination and treatment information to use the health insurance fund economically and effectively.
For Vietnam Social Security: Responsible for completing the information technology system to meet the requirements of receiving, appraising and promptly responding to medical examination and treatment facilities about health insurance medical examination and treatment data; ensuring accuracy, safety, confidentiality of information and rights of related parties; proactively reviewing, detecting and promptly sending warning information to medical examination and treatment facilities about health insurance medical examination and treatment costs that are higher than the average cost of medical examination and treatment facilities of the same class, same level, same specialty.
On November 9, 2023, Nghe An Social Insurance issued Official Dispatch No. 2498/BHXH - GĐBHYT to Social Insurance of districts and towns; Health insurance examination and treatment facilities in Nghe An province on instructions for implementing Decree No. 75/2023/ND-CP, in which it is noted to implement a number of contents such as: Issuing and changing health insurance cards according to the provisions of Decree No. 75/2023/ND-CP; Supplementing the subject code and health insurance benefit level code recorded on the health insurance card for new health insurance participants as prescribed in Decree No. 75/2023/ND-CP and Decree No. 131/2021/ND-CP; Health insurance examination and treatment procedures are implemented according to the amended and supplemented provisions in Clause 6, Article 1, Decree No. 75/2023/ND-CP; Payment of medical examination and treatment costs under health insurance during the transition period shall be implemented in accordance with the provisions of Article 4, Decree No. 75/2023/ND-CP... Nghe An Provincial Social Insurance also notes that during the implementation process, if there are any difficulties or problems, please report them to Nghe An Provincial Social Insurance (through the Health Insurance Appraisal Department) for guidance on resolution.