Learn about Health Insurance Law

Question: From January 1, 2015, the amended Law on Health Insurance will come into effect. People want to know how to allocate and use the health insurance fund effectively?

Answer: The total health insurance revenue in the province or centrally run city according to the contribution rate prescribed in Article 2 of this Decree shall be allocated and used as follows: 1. 90% of the health insurance contribution for medical examination and treatment shall be used for the following purposes: a) Payment of expenses within the scope of benefits of health insurance participants according to the provisions of Article 22 amended and supplemented of the Law on Health Insurance and Article 4 of this Decree.

b) Reserved for educational institutions in the national education system that meet the conditions prescribed by the Ministry of Health. The reserve for educational institutions in the national education system is equal to 7% of the total health insurance fund revenue calculated on the total number of students studying at educational institutions participating in health insurance; equal to 5% of the total health insurance fund revenue calculated on the total number of children under 6 years old studying at preschools.

c) Reserved for agencies, organizations, and enterprises with agency health organizations to conduct medical examination and treatment in primary health care for subjects managed by the agencies, organizations, and enterprises (except for agencies, organizations, and enterprises with agency health organizations that have signed contracts for primary health insurance medical examination and treatment with the Social Insurance organization).

2. 10% of the health insurance premium is for the reserve fund and health insurance fund management costs, of which at least 5% of the health insurance premium is for the reserve fund and is regulated as follows: a) The total annual health insurance fund management cost is decided by the General Director of Vietnam Social Security within the total management cost of Vietnam Social Security approved by the Prime Minister; b) The reserve fund is the remaining amount after deducting the health insurance fund management costs.

3. The management and use of health insurance proceeds are implemented as follows: a) Social insurance at all levels under the Vietnam Social Security shall directly collect health insurance contributions from subjects and transfer them to the Vietnam Social Security for management according to the guidance of the Vietnam Social Security; b) The Vietnam Social Security shall be responsible for transferring sufficient and timely funding needs to the provincial and municipal Social Security to advance and pay for medical examination and treatment costs under health insurance according to regulations.

4. Based on the annual settlement data approved by the Vietnam Social Security Management Board, the unused portion of the budget of provinces and cities with health insurance revenue for medical examination and treatment greater than the medical examination and treatment expenditure in the year shall be used as follows: a) For the unused portion of the budget for medical examination and treatment in 2014, Vietnam Social Security shall be responsible for accounting for the entire amount into the reserve fund; b) From January 1, 2015 to December 31, 2020, Vietnam Social Security shall be responsible for accounting for 80% into the reserve fund, and at the same time notify the locality of 20% of the unused budget for medical examination and treatment to implement in accordance with the provisions of Point a, Clause 3, Article 35, amended and supplemented by the Law on Health Insurance. c) From January 1, 2021, Vietnam Social Security is responsible for accounting for all unused funds into the reserve fund for general regulation.

Provincial Social Insurance – Nghe An Newspaper

(Coordinate implementation)