Latest instructions on medical examination and treatment procedures under health insurance

The Ministry of Health has issued a decision to promulgate two amended and supplemented administrative procedures in the field of health finance under the management scope of the Ministry of Health as prescribed in Decree No. 75/2023/ND-CP dated October 19, 2023 of the Government and promulgate two abolished administrative procedures in the field of health insurance.

Accordingly, the Ministry of Health abolished 2 administrative procedures in the field of health insurance, including: (1.003048) signing a contract for medical examination and treatment under health insurance for the first time; (1.003034) signing a contract for medical examination and treatment under health insurance for medical examination and treatment facilities approved by competent authorities to supplement functions, tasks, scope of expertise, hospital class in performing medical examination and treatment, which will cease to be effective when this decision takes effect in Decision No. 7291/QD-BYT of the Minister of Health.

Procedures for medical examination and treatment under health insurance are guided as follows:

Profile components:

- Health insurance card and identification documents of that person; for children under 6 years old, only health insurance card must be presented.

- Copy of birth certificate or birth certificate for children under 6 years old.

- Application form for participation and adjustment of social insurance and health insurance information according to form TK1-TS.

- Re-examination appointment paper.

- Referral paper for medical examination and treatment under health insurance.

- Referral records of health insurance medical examination and treatment facilities.

Implementation sequence:

- Health insurance participants must present their health insurance card with photo or citizen identification card when going to a medical examination and treatment facility.

In case of presenting a health insurance card without a photo, one of the following identification documents with a photo issued by a competent authority or organization must be presented... or a document with level 2 electronic identification.

For children under 6 years old only need to present health insurance card.

In case of emergency, health insurance participants can be examined and treated at any medical facility and must present their health insurance card along with their identification documents before being discharged from the hospital.

- 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 examination and treatment facility.

- In case of re-examination as required for treatment, health insurance participants must have a re-examination appointment paper from the medical examination and treatment facility.

- In cases beyond the technical expertise, the health insurance medical examination and treatment facility is responsible for promptly transferring the patient to another facility according to regulations on technical expertise referral.

Processing time: The decision of the Ministry of Health clearly states that the health insurance medical examination and treatment facility will process the case immediately after presenting the health insurance card and application documents.