Circular 18/2022/TT-BYT detailing Law on Social Insurance, Law on Occupational Safety and Health

CIRCULAR

Amending and supplementing a number of articles of Circular No. 56/2017/TT-BYT dated December 29, 2017, of the Minister of Health, detailing the implementation of the Law on Social Insurance and the Law on Occupational Safety and Health in health sector

Pursuant to the Law on Social Insurance dated November 20, 2014;

Pursuant to the Law on Occupational Safety and Health dated June 25, 2015;

Pursuant to the Government’s Decree No. 95/2022/ND-CP dated November 15, 2022, defining the functions, tasks, powers and organizational structure of the Ministry of Health;

At the proposal of the Director of the Department of Medical Service Administration, the Director of the Maternal and Child Health Department,

The Minister of Health promulgates the Circular amending and supplementing a number of articles of Circular No. 56/2017/TT-BYT dated December 29, 2017 of the Minister of Health, detailing the implementation of the Law on Social Insurance and the Law on Occupational Safety and Health in health sector.

Article 1. Amending and supplementing a number of articles of Circular No. 56/2017/TT-BYT dated December 29, 2017, of the Minister of Health, detailing the implementation of the Law on Social Insurance and the Law on Occupational Safety and Health in health sector (hereinafter referred to as Circular No. 56/2017/TT-BYT)

1. To amend Article 4 as follows:

“Article 4. Diseases eligible for a lump-sum social insurance allowance

Except for cases of suffering one of fatal diseases such as cancer, poliomyelitis, cirrhosis, leprosy, serious tuberculosis, HIV infection progressing into AIDS specified at Point c, Clause 1, Article 60 of the Law on Social Insurance, cases of suffering a working capacity decrease of 81% or more and inability to self-control or perform daily activities without having someone to monitor, assist, take care of are entitled to a lump-sum social insurance allowance.”

2. To amend Point d, Clause 1, Article 5 as follows:

“d) The original or a valid copy of the hospital discharge paper or the summary of the medical record specified in Appendix 3 and Appendix 4 issued together with this Circular. In case the employee does not undergo inpatient or outpatient treatment, he/she must have papers on an injury or disease examination and treatment suitable to the time of occurrence of the occupational accident and lesion that require to be assessed.

In case the assessed person is one of the subjects specified in Point c, Clause 1, Article 47 of the Law on Occupational Safety and Health: the medical record  summary must clearly state that the lesion resulting from the occupational accident fails to become stable after treatment.”.

3. To amend Clause 3, Article 5 as follows:

“3. Dossier of medical assessment to implement the retirement regime for employees:

a) An employer’s letter of introduction for assessment, according to the form prescribed in Appendix 1 issued together with this Circular, for employees currently paying compulsory social insurance premiums or a written request for medical assessment, according to the form specified in Appendix 2 issued together with this Circular, for employees who currently have their period of social insurance premium payment reserved or employees who have had a decision to quit their jobs pending the settlement of their retirement regime and monthly allowance and they clearly state in the written request for medical assessment of injuries and diseases;

b) The original or a valid copy of one of the following papers:

- The summary of medical record;

- The certificate of disability;

- The hospital discharge paper;

- The medical examination book;

- The medical examination sheet;

- The subclinical result sheet;

- The prescription of the medical examination and treatment establishment;

- The record of occupational disease;

- The latest written record of medical assessment in case the person has been assessed;

c) One of the papers specified at Point dd, Clause 1 of this Article.”.

4. To amend Point b, Clause 4, Article 5 as follows:

“b) The original or a valid copy of one of the following papers:

- The summary of medical record;

- The certificate of disability;

- The hospital discharge paper;

- The medical examination book;

- The medical examination sheet;

- The subclinical result sheet;

- The prescription of the medical examination and treatment establishment;

- The record of occupational disease;

- The latest written record of medical assessment in case the person has been assessed.”.

5. To amend Point b, Clause 5, Article 5 as follows:

“b) The original or a valid copy of one of the following papers:

- The summary of medical record;

- The certificate of disability;

- The hospital discharge paper;

- The medical examination book;

- The medical examination sheet;

- The subclinical result sheet;

- The prescription of the medical examination and treatment establishment;

- The record of occupational disease;

- The latest written record of medical assessment in case the person has been assessed.”.

6. To amend Point b, Clause 6, Article 5 as follows:

“b) The original or a valid copy of one of the following papers:

- The summary of medical record;

- The certificate of disability;

- The hospital discharge paper;

- The medical examination book;

- The medical examination sheet;

- The subclinical result sheet;

- The prescription of the medical examination and treatment establishment;

- The record of occupational disease;

- The latest written record of medical assessment in case the person has been assessed.”.

7. To amend Point c, Clause 2, Article 6 as follows:

“c) The original or a valid copy of the hospital discharge paper or the summary of the medical record as prescribed in this Circular or the record of occupational disease which states the occupational disease’s impairment is at the higher level. 

In case the assessed person is one of subjects prescribed at Point c, Clause 1, Article 47 of the Law on Occupational Safety and Health: The summary of the medical record must clearly state that the occupational disease cannot become stable after treatment.".

8. To amend Clause 1, Article 12 as follows:

"1. For cases of reassessment of occupational accidents and occupational diseases, employees are entitled to proactively take the medical assessment of their working capacity decrease and be paid fees for such medical assessment in case the assessment results are eligible for the increase of occupational accident and disease allowances”.

9. To amend and supplement Clause 4, Article 13 as follows:

“4. Contents of the medical assessment to enjoy the retirement regime, the survivorship allowance regime and to take leave due to postpartum incapacity to take care of children or to take maternity leave, to receive children through surrogacy, and contents of the medical assessment to enjoy a lump-sum social insurance allowance are pursuant to the papers specified in Clause 3 or 4, Article 5 and Clause 2, Article 12 of this Circular suitable to each case.

In case there are written records of assessment of occupational accidents, occupational diseases or war invalids or diseases, disabilities, deformities or malformations related to toxic chemicals, the reassessment of such disabilities and diseases shall not be carried out. The Medical Assessment Council shall combine the impairment ratings recorded in the previous written records of medical assessment with the ones being requested for medical assessment but not match recorded ones and determine the general impairment ratings.

In case of suffering one of fatal diseases such as cancer, poliomyelitis, cirrhosis, leprosy, serious tuberculosis, HIV infection progressing into AIDS, the consideration and settlement of the regime shall be based on the original or a valid copy of the hospital discharge paper or the summary of medical record.

In case of suffering other diseases entitled to a lump-sum social insurance allowance, the written record of medical assessment must clearly conclude the contents of the diseases and injuries causing a working capacity decrease of 81% or more and inability to self-control or perform daily activities without having someone to monitor, assist, and take care of.”.

10. To amend Point d Clause 5 Article 13 as follows;

“d) In case the subject has undergone medical assessment due to occupational accidents or occupational diseases twice or more, but the general impairment rating has not been determined:

- In case the written records of medical assessment record duplicate lesions in one or various organs, body parts, the Medical Assessment Council shall reassess all the lesions recorded in such written records of medical assessment (including both duplicate and non-duplicate lesions) and combine with the impairment rating recorded in the written record of medical assessment that does not have duplicate lesions as prescribed to issue a new written record of medical assessment;

- In case the subject has undergone medical assessment due to occupational accidents, occupational diseases twice or more and has a summary of the medical record or a hospital discharge paper or a record of occupational disease that records the state of lesions more or less serious than the one recorded in the written record of this medical assessment, the Medical Assessment Council shall perform a medical assessment of all lesions recorded in the written records of medical assessment in which the states of lesions are not the same and combine the impairment rating with the one recorded in the remaining written record of medical assessment as prescribed and issue a new written record of medical assessment;

- Except for above-mentioned cases, the Medical Assessment Council shall determine the general impairment rating from those assessment records according to the method specified in Joint Circular No. 28/2013/TTLT-BYT-BLDTBXH dated September 27, 2013 of the Minister of Health, the Minister of Labor, Invalids and Social Affairs, prescribing impairments ratings caused by injuries, diseases, disabilities and occupational diseases, and issue a new written record of medical assessment.”

11. To amend Clause 3, Article 15 as follows:

“3. In case patients are allowed to stay at commune-level health stations where the Department of Health allows to offer patient beds as prescribed at Point b, Clause 5, Article 4 of Circular No. 39/2018/TT-BYT dated November 30, 2018 of the Ministry of Health, unifying prices of medical examination and treatment services covered by health insurance among hospitals of the same class across the country and guidelines for applying prices and payment for medical services covered by health insurance in certain cases, they will be granted a certificate of leave under the social insurance regime according to the form prescribed in Appendix 7 issued together with this Circular, in which clearly states the number of days staying at the commune-level health station and the number of days off under the social insurance regime but not exceeding 30 days”.

12. To amend Clause 2, Article 20 as follows:

"2. Only one certificate of leave under the social insurance regime is granted each medical examination. In case the patient needs to take a leave longer than 30 days, when the leave period stated on the certificate of leave under the social insurance regime expires or is about to expire, the patient must conduct a follow-up examination so that the practitioner can consider and decide.

In case the employee undergoes medical examination at more than one department of different medical examination and treatment establishments at the same time and is granted more than one certificate of leave under the social insurance regime, he/she shall be only entitled to the certificate with the longest leave period.

In case the employee undergoes medical examination at various departments for different diseases on the same day at the one medical examination and treatment establishment, he/she shall be granted only one certificate of leave under the social insurance regime and shall be entitled to the social insurance regime for the disease with the highest regime.

In case the employee is treated for tuberculosis under the National Tuberculosis Program, the maximum leave period shall not exceed 180 days for a certificate of leave under social insurance regime.

In case the employee suffers a miscarriage, abortion, stillbirth with pregnancy of 13 weeks or more, the maximum leave period shall be pursuant to the Law on Social Insurance but not exceed 50 days for a certificate of leave under social insurance regime.”.

13. To add Article 20a after Article 20 as follows:

“Article 20a. Issuance of hospital discharge papers and certificates of leave under social insurance regime for COVID-19 patients treated at medical examination and treatment establishments as follows:

1. Subjects:

People infected with COVID-19 undergo inpatient or outpatient treatment at the following medical examination and treatment establishments:

a) Medical examination and treatment establishments established under the Law on Medical Examination and Treatment 2009;

b) COVID-19 treatment facilities established as prescribed at Point a, Clause 1, Article 1 of the Government’s Resolution No. 168/NQ-CP dated December 31, 2021 on a number of mechanisms and policies on COVID-19 prevention and control. To be specific:

- Field hospitals for the treatment of COVID-19;

- Hospitals for treatment of COVID-19;

- Hospitals for COVID-19 resuscitation & emergency;

- Intensive care centers for COVID-19 patients.

2. Authority to grant:

The heads of the establishments specified in Clause 1 of this Article or the persons authorized by the heads in accordance with the law provisions.

3. Regulations on the issuance of hospital discharge papers and certificates of leave under social insurance regime

a) After finishing treatment at a medical examination and treatment establishment, the patient is granted a hospital discharge paper and a certificate of leave under social insurance regime as prescribed in this Circular. In case the certificate issued before the effective date of this Circular does not conform to the form prescribed in Circular No. 56/2017/TT-BYT, the medical examination and treatment establishment shall re-issue it in accordance with this Circular. For hospital discharge papers, the dates of admission, discharge must be filled in according to the dates on the inpatient medical record, and the date above the signature of the practitioner must coincide with the date of issue;  

b) In case the employee has undergone a COVID-19 treatment but has not yet been granted a hospital discharge paper or a certificate of leave under social insurance regime, the medical examination and treatment establishment where the employee has been treated for COVID-19 shall, based on that person's request and medical record, issue the hospital discharge paper or the certificate of leave under social insurance regime. For hospital discharge papers, the dates of admission, discharge must be filled in according to the dates on the inpatient medical record, and the date above the signature of the practitioner must coincide with the date of issue;

c) In case the patient is discharged from hospital and the hospital discharge paper provides information about the period of continuing outpatient treatment or the period of isolation, the time off work shall be determined according to the time stated in the hospital discharge paper;

d) In case the patient is discharged from hospital and the hospital discharge paper does not provide information on the period of continuing outpatient treatment but the patient must be isolated according to regulations, the time off work shall be determined according to the isolation period specified in Appendix 9 to this Circular;

dd) In case the COVID-19 treatment facility has been dissolved, the medical examination and treatment establishment assigned to manage and operate the COVID-19 treatment facility as prescribed in Clause c, Section V of the Minister of Health’s Decision No. 4111/QD-BYT dated August 26, 2021, on promulgating the guidance for setting up the 3-storey tower COVID-19 treatment establishments, shall assume the responsibility for issuing or re-issuing hospital discharge papers and certificates of leave under social insurance regime;

e) The issuance and use of the form of the hospital discharge paper and the certificate of leave under social insurance regime must comply with the provisions in Appendix 3 and Appendix 7 issued together with this Circular.”.

14. To amend Article 21 as follows:

“Article 21. Forms of issuance of certificates of leave under social insurance regime and instructions to fill in papers certifying leave under social insurance regime

1. For the case of the employee or the employee's children under 07 years old undergoing inpatient treatment: the hospital discharge paper conforms to the form specified in Appendix 3 issued together with this Circular.

In case of hospital transfer during the course of treatment, a valid copy of the hospital transfer paper is required.

In case the patient dies at the medical examination and treatment establishment, the hospital discharge paper is not required. The implementation of the social insurance regime for the period of his/her treatment at the medical examination and treatment establishment before death is based on the time recorded on the death notice as prescribed in the Ministry of Health’s Circular No. 24/2020 /TT-BYT dated December 28, 2020, providing regulations on medical records of cause of death, grant of death notices and death statistics at medical examination and treatment establishments.

2. For the case of the employee or the employee's children under 07 years old undergoing outpatient treatment: the certificate of leave under social insurance regime must conform to the form specified in Appendix 7 issued together with this Circular.

In case the patient needs to rest for outpatient treatment after hospital discharge, the social insurance agency shall base on the number of days off stated in the notes section of the hospital discharge paper for payment of the social insurance regime as prescribed.

3. The form and method of filling in the certificate of leave under social insurance regime shall comply with the provisions in Appendix 7 issued together with this Circular.

a) The start date of time off work is the date the patient comes for medical examination and treatment;

b) The date, month and year above the practitioner's signature on the certificate of leave under social insurance regime shall be one of the following dates:

- The date, month, year the patient finishes medical examination and treatment;

- The date the medical examination and treatment establishment issues the certificate of leave under social insurance regime in case the employee requests for re-issuance according to the provisions of this Circular;

c) In case of re-issuance, the word "RE-ISSUANCE" must be shown on the certificate of leave under social insurance regime.

4. The disease code and the name of the disease requiring long-term treatment on the certificate of leave under social insurance regime, the hospital discharge paper must be filled in according to the provisions of the Minister of Health’s Circular No. 46/2016/TT-BYT dated December 30, 2016, on promulgating the List of diseases requiring long-term treatment.

In case the disease code on the certificate of leave under social insurance regime, the hospital discharge paper matches the one prescribed in Circular No. 46/2016/TT-BYT, but the name of the disease does not match the one prescribed in Circular No. 46/2016/TT-BYT, the patient’s regime will be settled according to the disease code prescribed in Circular No. 46/2016/TT-BYT".

15. To amend Clause 1, Article 25 as follows:

"1. Updating the conclusion of the written records of medical assessment on the national medical examination and treatment database to connect to the data system of the social insurance agencies.”.

16. To add Clause 6, Article 26 as follows:

“6. In case the employee has undergone a medical examination and treatment but has not been granted with the hospital discharge certificate, birth certificate, certificate of maternity leave, certificate of postpartum incapacity to take care of children, certificate of leave under social insurance regime, the medical examination and treatment establishment where the employee has undergone a medical examination and treatment shall base on the provisions of this Circular and that person's written request to issue the hospital discharge certificate, birth certificate, certificate of maternity leave, certificate of postpartum incapacity to take care of children, certificate of leave under social insurance regime, in which the date, month and year section above the signature of the practitioner coincides with the date of issue.”

17. To amend Appendices 1, 2, 3, 4 and 7 issued together with this Circular.

18. To add Appendix 9 issued together with this Circular.

Article 2. Effect

1. This Circular takes effect from February 15, 2023.

2. Appendix 4 and Appendix 5 issued together with Joint Circular No. 20/2016/TTLT-BYT-BLDTBXH dated June 30, 2016, of the Minister of Health and the Minister of Labor, Invalids and Social Affairs, guiding on medical assessment of diseases, disabilities, deformities and malformations related to exposure to toxic chemicals for resistance war activists and their biological children cease to be effective from the effective date of this Circular.

Article 3. Implementation responsibility

The Department of Medical Service Administration, the Director of the Department of Legal Affairs, the Director of the Maternal and Child Health Department, the Chief of the Ministry Office, the Chief of the Ministry Inspectorate, Directors, Directors General of Departments under the Ministry of Health, Heads of units under the Ministry of Health, relevant organizations and individuals shall assume the responsibility for implementing this Circular./.

* All Appendices are not translated herein.