Thông tư 30/2019/TT-BLĐTBXH hướng dẫn lập danh sách đối tượng tham gia bảo hiểm y tế

CIRCULAR

GUIDELINES FOR PREPARING LIST OF BENEFICIARIES OF HEALTH INSURANCE UNDER MANAGEMENT OF MINISTRY OF LABOR – WAR INVALIDS AND SOCIAL AFFAIRS

Pursuant to Law on Health Insurance dated November 14, 2008;

Pursuant to Law on amendments to Law on Health Insurance dated June 13, 2014;

Pursuant to Decree No. 146/2018/ND-CP dated October 10, 2018 of the Government on elaborating to Law on Health Insurance;

Pursuant to Decree No. 14/2017/ND-CP dated February 17, 2017 of the Government administers functions, tasks, powers, and organizational structure of the Ministry of Labor - War Invalids and Social Affairs;

At the request of Director General of Department of Legal Affairs,

Minister of Labor – War Invalids and Social Affairs promulgate Circular providing guidelines for preparing list of beneficiaries under management of Ministry of Labor - War Invalids and Social Affairs.

Article 1. Scope of regulation and regulated entities

1. This Circular provide guidelines for preparing list of beneficiaries of health insurance under management of Ministry of Labor – War Invalids and Social Affairs according to Clause 4 Article 1 of Law on amendments to Law on Health Insurance and Point b Clause 4 Article 42 of Decree No. 146/2018/ND-CP dated October 17, 2018 of Government on elaborating to law on Health Insurance.

2. This Circular applies to agencies, organizations and individuals related to preparing list of beneficiaries of health insurance under management of Ministry Labor – War Invalids and Social Affairs.

Article 2. Beneficiaries of health insurance

1. People with meritorious services to the revolution specified in Order for preferential treatment for people with meritorious services to the revolution;

2. Relatives of people with meritorious services to the revolution, including:

a) Biology fathers, mothers, spouses and children of war invalids; persons having rendered meritorious services in nurturing war invalids;

b) Biology parents, spouses, children from exceeding 6 years of age to under 18 years of age or from 18 years of age and continuing to study or suffering from severe disabilities, very severe disabilities of: revolutionary activists before January 1, 1945; revolutionary activists from January 1, 1945 to before the August revolution in 1945; People's Armed Forces Heroes and Heroes of Labor in war time; war invalids, diseased soldiers, partisans infected with chemical toxic substances with bodily injury rate of at least 61%;

b) Biology children from 6 years of age or higher of partisans suffering from deformation, disabilities due to chemical toxic substances and receiving monthly benefits.

3. Servers of people with meritorious services to the revolution, including:

a) Attendants of Vietnamese heroic Mothers living with families;

b) Attendants of war invalids, diseased soldiers and partisans infected with chemical toxic substances and suffering from bodily injury of 81% or higher living with families;

4. War veterans, including:

a) Veterans participating in the resistance war up to April 30, 1975 according to Clauses 1, 2, 3 and 4 Article 2 Decree No. 150/2006/ND-CP dated December 12, 2006 of Government on elaborating to Order on war veterans (hereinafter referred to as “Decree No. 150/2006/ND-CP”) and amendments thereto under Clause 1 Article 1 of Decree No. 157/2016/ND-CP dated November 24, 2016 of Government on amendments to Decree No. 150/2006/ND-CP dated December 12, 2006 of Government on elaborating to Order on war veterans (hereinafter referred to as “Decree No. 157/2016/ND-CP”).

b) Veterans participating in the resistance war from April 30, 1975 according to Clause 5 Article 2 Decree No. 150/2006/ND-CP dated December 12, 2006 of Government on elaborating to Order on war veterans and under Clause 1 Article 1 of Decree No. 157/2016/ND-CP dated November 24, 2016 of Government on amendments to Decree No. 150/2006/ND-CP, including:

- Serviceman and national defense officials receiving benefits according to Decision No. 62/2011/QD-TTg dated November 9, 2011 of Prime Minister on benefits for individuals participating in war for defending the country, participating in international missions in Cambodia, assisting Laos after April 30, 1975 who have been demobilized, discharged or retired (hereinafter referred to as “Decision No. 62/2011/QD-TTg”);

- Officers, professional servicemen, non-commissioned officers, soldiers and national defense officials directly participating in war for defending the country, participating in international missions in Cambodia, assisting Laos after April 30, 1975 who are later assigned to work in agencies, organizations and enterprises (not receiving benefits according to “Decision No. 62/2011/QD-TTg”);

- Officers and professional servicemen finishing their active duties during nation development and restoration period who have been demobilized, retired or assigned to work in agencies, organizations or enterprises;

- Militia and self-defense forces fighting and serving after April 30, 1975 who have received benefits according to Decision No. 62/2011/QD-TTg.

5. Individuals participating in resistance wars and protecting the nation, including:

a) Individuals participating in the resistance war against America who have received benefits according to any of following documents: Decision No. 290/2005/QD-TTg dated November 8, 2005 of Prime Minister on policies for individuals directly participating in resistance war against America but have not received the benefits of the Communist Party and the Government; Decision No. 188/2007/QD-TTg dated December 6, 2007 of Prime Minister on amendments to Decision No. 290/2005/QD-TTg; Decision No. 142/2008/QD-TTg dated October 27, 2008 of Prime Minister on policy implementation of servicemen participating in resistance war against America with less than 20 years of service in the military who have been demobilized, discharged and returned to provincial divisions.

b) Individuals receiving benefits according to Decision No. 62/2011/QD-TTg dated November 9, 2011 of Prime Minister on benefits for individuals participating in war for defending the country, participating in international missions in Cambodia, assisting Laos after April 30, 1975 who have been demobilized, discharged or retired;

c) Officials and officers of People’s Public Security receiving benefits according to Decision No. 53/2010/QD-TTg dated August 20, 2010 of Prime Minister on benefits for officials and officers of People’s Public Security participating in resistance war against America with less than 20 years of service in People’s Public Security who have retired or returned to provincial divisions;

d) Members of the Thanh Nien Xung Phong (TNXP) Organizations receiving benefits according to Decision No. 170/2008/QD-TTg dated December 18, 2008 of Prime Minister on health insurance and burial costs for members of the TNXP Organizations during resistance war against the France, Decision No. 40/2011/QD-TTg dated July 27, 2011 of Prime Minister on policies for members of the TNXP Organizations completing missions in the resistance wars and Decree No. 112/2017/ND-CP dated October 6, 2017 of Government on policies and benefits for members of the southern TNXP Organizations participating in the resistance wars during 1965-1975;

dd) Logistics workers participating in resistance wars against the France, American, defending the nation and implementing international missions according to Decision No. 49/2015/QD-TTg dated October 14, 2015 of Prime Minister on policies and benefits for logistics workers participating in resistance wars against the France, American, defending the nation and implementing international mission.

6. Individuals of 80 years of age or older benefiting from monthly death benefits according to social insurance laws.

7. Beneficiaries of monthly social protection according to regulations and law on old people, people with disabilities and social protection beneficiaries.

8. Children under 6 years of age.

9. Individuals living in poor households; ethnics living in areas with difficult socio-economic conditions; individuals living in areas with particularly difficult socio-economic conditions; individuals living in islands or archipelagoes, to be specific:

a) Individuals living in poor households according to income criteria, individuals living in households of multidimensional poverty suffering from shortage of health insurance according to Decision No. 59/2015/QD-TTg dated November 19, 2015 of Prime Minister on issuance of multidimensional poverty standards applicable to 2016 – 2020 and other decisions of competent agencies capable of amending or replacing poverty standards applicable to each phase;

b) Ethnics living in areas with difficult socio-economic conditions according to regulations and law of the Government and Prime Minister;

c) Individual living in areas with particularly difficult socio-economic conditions according to regulations and law of the Government and Prime Minister;

d) Individuals living in islands and archipelagoes according to regulations and law of the Government and Prime Minister.

10. Individuals living in near-poor households according to near-poor standards according to regulations and law of the Government and Prime Minister.

11. Individuals living in households of multidimensional poverty not specified in Point a Clause 9 of this Article.

12. Students and learners studying in vocational education facilities under management of Ministry of Labor – War Invalids and Social Affairs.

13. Individuals living in agriculture, forestry, fishery and salt industry with medium living standards according to regulations and law of the Government and Prime Minister.

Article 3. Principles of preparing list

1. In case a person is simultaneously qualified as multiple beneficiaries of health insurance, prepare the list including the beneficiary of the highest health insurance.

2. Preparation of list of beneficiaries of health insurance under management of Ministry of Labor – War Invalids and Social Affairs must rely on documents and papers issued by competent agencies.

3. List of beneficiaries of health insurance must comply with forms attached to Decree No. 146/2018/ND-CP dated October 17, 2018 of Government on elaborating to Law on Health Insurance (hereinafter referred to as “Decree No. 146/2018/ND-CP”).

Article 4. Entitlement for preparation of the list

1. People’s Committees of communes, wards and towns (hereinafter referred to as “Commune-level People's Committees”) shall prepare lists of individuals living in the community.

2. Nursing facilities shall prepare lists of individuals receiving regular care in nursing and care facilities for war veterans and people with meritorious services to the revolution and social assistance facilities (hereinafter referred to as “nursing facilities”).

3. Vocational education facilities shall prepare lists of students and learners studying in the vocational education facilities affiliated to Ministry of Labor - War Invalids and Social Affairs.

Article 5. Documents serving as the basis for identifying beneficiaries of health insurance

1. People with meritorious services to the revolution.

Based on Decision on acknowledgement of competent agencies or Decisions on processing policies of Directors of Departments of Labor, Invalids and Social Affairs of provinces and central-affiliated cities.

2. Relatives of people with meritorious services to the revolution, people nursing war invalids, attendants of people with meritorious services to the revolution.

Based on Decisions on processing policies of Directors of Departments of Labor, Invalids and Social Affairs of provinces and central-affiliated cities; in case of no decisions available, rely on list of benefit payment for people with meritorious services to the revolution and relatives thereof.

3. Individuals participating in resistance wars and protecting the nation, war veterans.

Based on Decisions on receiving benefits of competent agencies.

4. Beneficiaries of monthly social insurance according to regulations and law on old people and people with disabilities.

a) Beneficiaries of monthly social protection: based on Decisions on social benefits of Chairpersons of People’s Committees of districts and communes (hereinafter referred to as “District-level People’s Committees”);

b) People with severe disabilities and particularly severe disabilities not receiving monthly social protection: rely on copies of documents confirming disabilities.

5. Individuals of 80 years of age or older benefiting from monthly death benefits according to social insurance laws.

Based on Decisions on receiving monthly death benefits of competent agencies.

6. Children under 6 years of age.

Based on guidelines under Joint Circular No. 05/2015/TTLT-BTP-BCA-BYT dated May 15, 2015 of Ministry of Justice, Ministry of Public Security and Ministry of Medical on providing guidelines for implementation of bridge program of administrative procedures regarding birth registration, permanent residence registration and issuance of health insurance cards for children under 6 years of age.

7. Individuals living in poor households and near-poor households; ethnics living in areas with socio-economic conditions; individuals living in areas with particularly difficult socio-economic conditions; individuals living in islands or archipelagoes; individuals living in households practicing agriculture, forestry, fishery and salt industry with medium living standards.

Based on lists confirmed by Chairpersons of Commune-level People’s Committees on a yearly basis.

8. People with meritorious services to the revolution receiving social protection and care in nursing facilities.

Based on list of care beneficiaries of nursing facilities.

9. For students and learners studying in vocational education facilities under management of Ministry of Labor – War Invalids and Social Affairs.

Based on list of students and learners of vocational education facilities.

Article 6. Procedures of preparing list

1. With respect to beneficiaries living in community:

a) Persons operating in labor – war invalid and social affairs in communes or persons assigned according to Article 5 of this Circular to examine, reckon and prepare list of beneficiaries of health insurance using forms attached to Decree No. 146/2018/ND-CP and request Chairpersons of Commune-level People’s Committees to approve.

b) Chairpersons of Commune-level People’s Committees shall send the approved list to District-level People’s Committees (agencies specialized in labor affiliated to District-level People’s Committees) and social insurance agencies of districts;

c) Within 5 working days from the date on which the lists are received, agencies specialized in labor affiliated to District-level People’s Committees shall take charge and cooperate with social insurance agencies of districts to review and examine the lists.

In case of discovering incorrect beneficiaries or inadequate information of beneficiaries, agencies specialized in labor in districts shall request Commune-level People’s Committees to prepare another list.

d) Within 10 working days from the date of receiving the lists, social insurance agencies of districts shall issue health insurance cards.

dd) Social insurance agencies of districts shall send the lists together with health insurance cards to Commune-level People’s Committees which will transfer to the beneficiaries.

Social insurance agencies of districts must send lists of beneficiaries provided with health insurance cards to agencies specialized in labor affiliated to District-level People’s Committees for monitor and management.

2. With respect to beneficiaries receiving continuous care in nursing facilities:

a) Nursing facilities shall prepare lists according to forms under Decree No. 146/2018/ND-CP and send to social insurance agencies of districts.

b) Within 10 working days from the date of receiving the lists, social insurance agencies of districts shall examine and issue health insurance cards.

c) Social insurance agencies of districts shall transfer lists together with health insurance cards to nursing facilities.

3. With respect to students and learners studying in vocational education facilities under management of Ministry of Labor – War Invalids and Social Affairs.

a) Vocational education facilities shall prepare list using forms under Decree No. 146/2018/ND-CP and send to social insurance agencies of districts.

b) Within 10 working days from the date of receiving the lists, social insurance agencies of districts shall examine and issue health insurance cards.

c) Social insurance agencies of districts shall send the lists together with health insurance cards to vocational education facilities which will transfer to the beneficiaries.

Article 7. Implementation

1. People’s Committees of all levels

a) People’s Committees of provinces and central-affiliated cities shall: direct and instruct People’s Committees of districts and communes to implement this Circular; ensure adequate identification of beneficiaries of health insurance and examine implementation and difficulty handling during implementation.

b) People’s Committees of districts shall: direct agencies specialized in labor of districts to review, examine and inspect lists of beneficiaries of health insurance; produce annual reports to agencies specialized in labor affiliated to Provincial-level People's Committees depicting results of local issuance of health insurance card.

c) Commune-level People’s Committees shall: prepare list of beneficiaries of health insurance under their management according to this Circular; on a quarterly basis, increase or reduce number of beneficiaries of health insurance and submit agencies specialized in labor affiliated to District-level People’s Committees and social insurance agencies of districts.

2. Nursing facilities and vocational education facilities shall: prepare list of beneficiaries of health insurance under their management according to this Circular; on a quarterly basis, increase or reduce number of beneficiaries of health insurance and submit agencies specialized in labor affiliated to District-level People’s Committees and social insurance agencies of districts.

3. Vietnam Social Security shall: direct implementation and provide professional instruction in systems of social insurance agencies; direct social insurance agencies of all levels to cooperate with relevant agencies in implementing issuance of health insurance cards for beneficiaries under management of Ministry of Labor - War Invalids and Social Affairs.

Article 8. Entry into force

1. This Circular comes into force from February 12, 2020. Circular No. 25/2016/TT-BLDTBXH dated July 26, 2016 of Minister of Labor - War Invalids and Social Affairs providing guidelines for identifying and managing beneficiaries of health insurance according to Clause 4 Article 1 of Law on amendments to Law on Health Insurance expires from the date on which this Circular comes into force.

2. In case documents containing papers referred to in this Circular are replaced or revised, the new versions shall be applied.

3. Ministry of Labor – War Invalids and Social Affairs and Vietnam Social Security shall perform interdisciplinary inspection, publicize, popularize and provide training for individuals implementing issuance of health insurance cards according to this Circular.

4. Difficulties that arise during the implementation of this Circular should be reported to the Ministry for consideration./.