Decree No. 102/2011/ND-CP dated November 14, 2011 of the Government on liability insurance in medical examination and treatment

DECREE

ON LIABILITY INSURANCE IN MEDICAL EXAMINATION AND TREATMENT 

THE GOVERNMENT

Pursuant to the December 25, 2001 Law on Organization of the Government;

Pursuant to the Law on Insurance Business dated December 09, 2000 and the law amending and supplementing some Articles of the Insurance Business Law dated November 24, 2010;

Pursuant to the Law on Medical Examination and Treatment dated November23, 2009;

At the proposal of the Minister of Finance,

DECREES:

Chapter 1.

GENERAL PROVISIONS

Article 1. Scopeof governing

This Decree provides for liability insurance in medical examination and treatment for the medical examination and treatment facilities.

Article 2. Subjects of application

1. The medical examination and treatment facilities licensed to operate in Vietnam and provide for services of medical examination and treatment.

2. The insurers licensed for implementation of liability insurance in accordance with the law regulations of Vietnam.

3. Involved organizations and individuals.

Article 3. Interpretation of terms

1. "The practitioner of medical examination and treatment", means the one who is certified to practice and perform medical examinations and treatment including:

a) Doctors, physicians.

b) Nurses.

c) Midwife.

d) Technician.

đ) Galenic physician.

e) Those that have traditional remedies or traditional healing methods.

2. "The practitioner in the medical examination and treatment facility" is the practitioner in the personnel; the practitioner having labor contract, the practitioner who is invited by a medical examination and treatment facility from other medical examination and treatment facility for professional support.

Chapter 2.

LIABILITY INSURANCE IN MEDICAL EXAMINATION AND TREATMENT

Article 4. Coverage

Insurance for complications in medical examination and treatment due to technical errors caused by negligence errors, carelessness of practitioners in the medical examination and treatment facilities to their patients. Other cases shall be agreed by medical examination and treatment facilities and insurers.

Article 5. The rates of insurance liability

1. Liability insurance rates for each complaint case of coverage is the maximum amount tht the insurer shall pay but not exceeding the total liability insurance rate for medical examination and treatment facility as agreed upon in the insurance contract. The rate of insurance liability includes legal expenses in case of medical examination and treatment required to pay in accordance with the law regulations.

2. Total insurance liability rate for medical examination and treatment facility is the total maximum amount the insurer required to pay as agreed in the insurance contract.

3. Insurers and medical examination and treatment facility are actively deal premium and the insurance liability rate on the basis of risk assessment of the medical examination and treatment facility and related factors.

Article 6. Principles of compensation

1. The insurers are liable to pay compensation for medical examination and treatment facilities on the basis of:

a) The written complaint of the patient or the legal representative of the patient sending to the medical examination and treatment facility.

b) Complication in medical examination and treatment occurs to patient within the insurance and insurance liability rate provided for in Article 4, Article 5 of this Decree.

c) Complication in medical examination and treatment occurs in the period of validity of the insurance contract. Other cases shall be agreed in the insurance contract by the medical examination and treatment facility and the insurer.

2. The insurer has no liability for paying compensation for the claims arising from other causes occurred before the effective term of the insurance contract or are being settled by other insurers except for otherwise agreed by the medical examination treatment facility and the insurer in the insurance contract.

3. The insurer may refuse to pay compensation all or part of the insurance liability in case of medical examination and treatment facility voluntarily negotiated and agreed to pay compensation for each claim under the insurance contract that has not been agreed in writing of the insurer unless specified at point d, clause 2 of Article 9 of this Decree.

4. Medical examination and treatment facility shall pay compensation to the patient or his/her legal representative. Where the medical examination and treatment facility is suspended or revoked the operating license or with other consents in writing between the medical examination and treatment facility and the insurer, the insurer shall directly pay compensation to patient or his/her legal representative.

Article 7. Claim dossier

Medical examination and treatment facility provides for the insurer 01 set of dossier including the following documents:

1. Notice of complication and claims of medical examination and treatment facility.

2. The written complaint of the patient or his/her legal representative sending to the medical examination and treatment facility.

3. Conclusions of the expertise Council. Where there is no conclusion of the expertise council, it must have medical records and documents to prove the cause of complications.

4. Copies of case history and other related documents for use as basis for paying compensation.

Article 8. Rights and obligations of the medical examination and treatment facilities

1. Rights of the medical examination and treatment facilities:

a) To select insurers to participate liability insurance for medical examination and treatment.

b) To require insurers to explain, provide for information related to insurance contracts.

c) To require insurers to reduce premiums for the remaining period of the insurance contracts in case of having a change of factors for use as a basis for calculating premiums leading to reduction of the risks covered.

d) To require insurers to pay compensation quickly, fully and timely according to the insurance contracts.

đ) To have the right to negotiate compensation agreement with patient as prescribed at point d, clause 2 of Article 9 of this Decree.

e) Other rights as prescribed by law.

2. Obligations of medical examination and treatment facilities:

a) To provide fully and truthfully contents as required by insurers as purchasing liability insurance for medical examination and treatment.

b) To create favorable conditions for insurers to check the status of medical examination and treatment facilities, equipment to practice before signing the insurance contract.

c) To pay the premiums in full and on time according to the agreed contracts.

d) Where there is a change of the factors for use as a basis for calculating premiums leading to increase and decrease of the risk covered, medical examination and treatment facilities must promptly notify the insurers to apply the appropriate premiums for the remaining period of the insurance contracts.

đ) To provide claim dossier under the provisions of Article 7 of this Decree.

e) Other obligations as stipulated by law.

Article 9. Rights and obligations of insurers

1. Rights of insurers:

a) To require medical examination and treatment facilities to provide complete and truthful information regarding the insured stated in the insurance contracts; review status of the medical examination and treatment facilities before signing the insurance contracts.

b) To require medical examination and treatment facilities to pay additional premiums for the remaining period of the insurance contracts, when there are changes of factors for use as a basic for calculating premiums leading to increase of the risk covered.

c) To require medical examination and treatment facilities to provide fully claim dossier as stipulated in Article 7 of this Decree.

d) To refuse to compensate for the cases not belonging to insurance liability under the provisions of this Decree and as agreed in the insurance contracts.

e) Other rights as prescribed by law.

2. Obligations of insurers:

a) To consult and provide for adequate information relating to insurance contracts and explain clearly the rules, terms and liability insurance premiums in medical examination and treatment for the medical examination and treatment facilities.

b) Where the insurers receive notice of the medical examination and treatment facilities on the changes of factors for use as the basis for calculating premiums leading to reduction of the risks covered, the insurers determine the reduction of the premiums for the remaining period of the insurance contracts and refund the difference to the medical examination and treatment facilities.

c) To pay compensation fully and timely under insurance contracts to the medical examination and treatment facilities.

d) Within 07 days after receiving complete claim dossiers under the provisions of Article 7 of this Decree, the insurers must give written approval or disapproval of the medical examination and treatment facilities’ negotiation and agreement upon compensation for patients. After 07 days if the insurers had no idea, the medical examination and treatment facilities have the rights to negotiate and agree upon compensation for patients.

đ) Within 15 days after receiving complete claim dossiers, the insurers must pay compensation to the medical examination and treatment facilities unless the medical examination and treatment facilities and the insurers have otherwise agreed.

e) The insurers shall deduct part of the revenue actually collected from the original premium of liability insurance for medical examination and treatment to set up databases of liability insurance for medical examination and treatment. Ministry of Finance guides the deduction level, the regime of management and use, payment and settlement of funds to set up databases of liability insurance for medical examination and treatment.

g) To make professional report regime under the guidance of the Ministry of Finance.

h) Other obligations as stipulated by law.

Article 10. Funding source to purchase liability insurance for medical examination and treatment

1. For the non-public medical examination and treatment facilities, funds to purchase liability insurance for medical examination and treatment shall be paid by medical examination and treatment facilities.

2. For the medical examination and treatment facilities as public service delivery units that business revenues cover all or part of the regular expenditure, funds to purchase liability insurance for medical examination and treatment shall be used in the business revenue source of the medical examination and treatment facilities.

3. For the medical examination and treatment facilities as public service delivery units having low business revenue source and the public service delivery units have not got revenue source ensured all regular expenditures by state budget, funds to purchase liability insurance for medical examination and treatment are used from funding granted by the state budget.

Chapter 3.

RESPONSIBILITIES OF THE MINISTRIES, BRANCHES AND PEOPLE’S COMMITTEES OF PROVINCES, CENTRALLY-RUN CITIES

Article 11. Responsibilities of the Ministry of Finance

1. Inspect and supervise the insurance enterprises in implementation of liability insurance in the medical examination and treatment under the provisions of this Decree and other provisions of concerned law.

2. Preside over and coordinate with the Ministry of Health to set up database on liability insurance in medical examination and treatment.

3. Coordinate with the Ministry of Health, ministries, concerned branches and the People s Committees of provinces and cities directly under the Central Government to propagate, disseminate the performance of insurance liability in medical examination and treatment.

Article 12. Responsibilities of the Ministry of Health

1. Organize the propagation and dissemination of the implementation of purchasing liability insurance for medical examination and treatment of the medical examination and treatment facilities.

2. Coordinate to handle the specialized contents related to complaints and disputes on liability insurance for medical examination and treatment at the request of the Court.

3. Coordinate with the Ministry of Finance to set up databases of liability insurance for medical examination and treatment.

4. Guide the prevention and limitation of errors in medical examination and treatment.

5. Define on the report regime for medical examination and treatment facilities participating in liability insurance for medical examination and treatment.

6. Inspect and supervise the participation and performance of liability insurance for medical examination and treatment of the medical examination and treatment facilities under the provisions of this Decree and other provisions of involved law.

Article 13. Responsibilities of the ministries, other ministerial-level agencies, governmental agencies

1. Organize the implementation, guide and supervise the participation and performance of liability insurance for medical insurance and treatment of the subordinate medical examination and treatment facilities under the provisions of this Decree.

2. Perform other duties as prescribed under the law.

Article 14. Responsibilities of People s Committees of provinces and cities directly under the CentralGovernment

1. Organize the implementation and guide this Decree, coordinate with the Ministry of Health to direct the application of measures to prevent and minimize errors in medical examination and treatment.

2. Direct the Departments of Health to inspect and guide the participation and performance of liability insurance for medical examination and treatment of the subordinate medical examination and treatment facilities under the provisions of this Decree; and annually synthesize and report to the Ministry of Health and Ministry of Finance.

Chapter 4.

IMPLEMENTATION PROVISIONS

Article 15. Effect

This Decree takes effect from January 01, 2012.

Article 16. Schedule to participate in liability insurance for medical examination and treatment

1. No later than December 31, 2015, all of the medical examination and treatment facilities operating in the form of organizations as hospitals, including general hospitals, specialized hospitals, traditional medicine hospitals must purchase liability insurance in medical examination and treatment.

2. No later than December 31, 2017, all of the medical examination and treatment facilities operating under other forms of organizations must purchase liability insurance in medical examination and treatment.

Article 17. Organization of implementation

1. Ministry of Finance, Ministry of Health shall coordinate with relevant agencies to guide the implementation of this Decree.

2. The ministers, heads of ministerial-level agencies, heads of governmental agencies, presidents of People s Committees of provinces and cities under central authority shall implement this Decree.