Circular 01/2025/TT-BYT detail Law on Health Insurance

CIRCULAR

Detailing and guiding the implementation of a number of articles of the Law on Health Insurance

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Pursuant to the Law on Health Insurance dated November 14, 2008; the Law Amending and Supplementing a Number of Articles of the Law on Health Insurance dated June 13, 2014, and the Law Amending and Supplementing a Number of Articles of the Law on Health Insurance dated November 27, 2024;

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 Health Insurance, the Ministry of Health,

The Minister of Health hereby promulgates the Circular detailing and guiding the implementation of a number of articles of the Law on Health Insurance.

Article 1. Scope of regulation

1. This Circular details and guides the implementation of a number of articles of the Law on Health Insurance No. 25/2008/QH12 dated November 14, 2008, which had a number of articles amended and supplemented under Law No. 32/2013/QH13, Law No. 46/2014/QH13, Law No. 97/2015/QH13, Law No. 35/2018/QH14, Law No. 68/2020/QH14, Law No. 30/2023/QH15 and Law No. 51/2024/QH15 (hereinafter referred to as the Law on Health Insurance), including:

a) Provisions on forms of organization of health divisions of agencies, units and organizations belonging to the primary medical care providers specified at Point c Clause 1 Article 22 of the Law on Health Insurance;

b) Provisions on procedures and cases of residence eligible for health insurance-covered medical care specified in Clause 3 Article 22 of the Law on Health Insurance;

c) Provisions on cases of definitive diagnosis and treatment of certain rare diseases, serious diseases, diseases requiring surgery or using advanced techniques specified at Point a Clause 4 Article 22 of the Law on Health Insurance;

d) Detailed provisions on registration for health insurance-covered primary medical care services and allocation of health insurance cards for the health insurance-covered primary medical care providers specified in Clauses 1 and 2 Article 26 of the Law on Health Insurance;

dd) Provisions on cases in which registration for health insurance-covered primary medical care services is allowed at medical care providers of intensive level specified in Clause 3 Article 26 of the Law on Health Insurance;

e) Provisions on patient transferal among medical care providers specified in Clause 1 Article 27 of the Law on Health Insurance;

g) Provisions on patient transferal to their health insurance-covered primary medical care providers for treatment, management, and monitoring of chronic diseases specified in Clause 2 Article 27 of the Law on Health Insurance;

h) Provisions on schedule for re-examination appointments to meet professional requirements in medical examination and treatment specified in Clause 2 Article 28 of the Law on Health Insurance;

e) Provisions on medical care provider transferal dossiers specified in Clause 3 Article 28 of the Law on Health Insurance.

2. To amend, supplement and annul provisions relating to line and level in a number of Circulars of the Minister of Health.

Article 2. Subjects and scopes of application

1. This Circular applies to persons participating in health insurance (hereinafter referred to the insured), health insurance-covered medical care providers and relevant agencies, organizations, and individuals, including:

a) Health insurance-covered medical care providers under the management of the Ministry of National Defence, the Ministry of Public Security that make registration for providing health insurance-covered primary medical care services for persons not under the management of the Ministry of National Defence, the Ministry of Public Security;

b) The insured under the management of the Ministry of National Defence, the Ministry of Public Security that register for health insurance-covered primary medical care services at health insurance-covered medical care providers not under the management of the Ministry of National Defence, the Ministry of Public Security;

c) The insured not under the management of the Ministry of National Defence, the Ministry of Public Security that register for health insurance-covered primary medical care services at health insurance-covered medical care providers under the management of the Ministry of National Defence, the Ministry of Public Security;

d) In case of patient transferal among health insurance-covered medical care providers under the management of the Ministry of National Defence, the Ministry of Public Security and health insurance-covered medical care providers not under the management of the Ministry of National Defence, the Ministry of Public Security.

2. This Circular does not apply to the following cases:

a) The registration for health insurance-covered primary medical care services of persons under the management of the Ministry of National Defence, the Ministry of Public Security at health insurance-covered medical care providers under the management of the Ministry of National Defence, the Ministry of Public Security;

d) Patient transferal under the management of the Ministry of National Defence, the Ministry of Public Security among health insurance-covered medical care providers under the management of the Ministry of National Defence, the Ministry of Public Security.

Article 3. Provisions on forms of organization of health divisions of agencies, units and organizations belonging to the primary medical care providers specified at Point c Clause 1 Article 22 of the Law on Health Insurance

Health divisions of agencies, units and organizations belonging to the primary medical care providers include health divisions of state agencies, non-business publics, production and business facilities, education institutions and other organizations and units organized in the form of health stations or clinics signing health insurance-covered medical care contracts.

Article 4. Procedures and cases of residence eligible for health insurance-covered medical care specified in Clause 3 Article 22 of the Law on Health Insurance

1. In cases of residence eligible for health insurance-covered medical care specified in Clause 3 Article 22 of the Law on Health Insurance where the insured having their places of residence changed less than 30 days has declared the residence information under the law on residence, include:

a) The insured on business trips to other provinces or centrally run cities (hereinafter referred to as provinces);

b) Students, pupils, and trainees studying in other provinces during summer, holiday, and Tet holidays at home or during practice, internship, or study in other provinces;

c) Workers in other provinces during their leave at home;

d) Mobile workers in other provinces;

dd) People going to other provinces to visit family members as prescribed in Clause 16 Article 3 of the Law on Marriage and Family.

2. Procedures for health insurance-covered medical care upon changing the places of residence or temporary residence are prescribed as follows:

a) The insured having the place of residence changed under Clause 1 of this Article and having the place of temporary residence changed shall carry out procedures specified in Article 28 of the Law on Health Insurance and Article 15 of the Government’s Decree No. 146/2018/ND-CP dated October 17, 2018, detailing, and guiding measures to implement, a number of articles of the Law on Health Insurance;

b) The insured having the place of residence changed under Clause 1 of this Article shall also carry out procedures specified in Clause 3 of this Article;

c) The insured having the place of temporary residence changed shall also carry out procedures specified in Clause 4 of this Article.

3. In case of changing the place of residence under Clause 1 of this Article, the insured shall present the following papers relating to the change of place of residence to the health insurance-covered medical care providers:

a) Documents on assignment for work and residence information updated on level-2 electronic identification account on the VNeID application for the case specified at Point a Clause 1 of this Article;

b) Student and trainee cards and residence information updated on level-2 electronic identification account on the VNeID application for the case specified at Point b Clause 1 of this Article;

c) Documents on leave confirmed by the agency or unit managing the insured and residence information updated on level-2 electronic identification account on the VNeD application for the case specified at Point c Clause 1 of this Article;

d) Documents on assignment or assignment of mobile work tasks by the agency or unit managing the insured and residence information updated on level-2 electronic identification account on the VNeID application for the case specified at Point d Clause 1 of this Article;

dd) Documents showing family member relationships as prescribed by the law on marriage and family and updated residence information on level-2 electronic identification account on the VNelD application for the case specified at Point d Clause 1 of this Article.

4. In case of changing the place of temporary residence, the insured shall present one of the papers proving the change of the place of temporary residence to the health insurance-covered medical care providers, including the receipt of the dossier for temporary residence registration, or a notice of the competent agency, issued to the registrant, on the updating of temporary residence registration information, or information on temporary residence registration on level-2 electronic identification account on the VNeID application.

Article 5. Cases of definitive diagnosis and treatment of certain rare diseases, serious diseases, diseases requiring surgery or using advanced techniques specified at Point a Clause 4 Article 22 of the Law on Health Insurance

1. To issue together with this Circular the List of rare diseases, serious diseases, diseases requiring surgery or using advanced techniques eligible for 100% of the benefits as prescribed at Point a Clause 4 Article 22 of the Law on Health Insurance as follows:

a) List of diseases to be examined and treated at intensive-level medical care providers in Appendix I;

b) List of diseases to be examined and treated at basic-level medical care providers in Appendix II.

2. The insured specified in Clause 1 of this Article is not required to follow the provisions on change of medical care providers.

3. The insured shall be entitled to benefits specified in Clauses 1 and 2 of this Article as follows:

a) Patients are entitled to benefits after being diagnosed by a medical care provider with a disease on the list specified in Clause 1 of this Article. In case the status and conditions column in the list of diseases in the Appendix to this Circular stipulates that the patient is entitled to benefits immediately during the medical examination and treatment session with a confirmed diagnosis of the disease, the patient is entitled to benefits immediately according to that provision.

- Example 1: In Appendix I, there is a malignant tumor in the pancreas with disease code C25, the patient is entitled to the following benefits:

Case 1: The patient is diagnosed with malignant neoplasm of pancreas - code C25 by hospital A, which belongs to primary or basic-level medical care providers, he/she will be entitled to the benefits prescribed in this Article when he/she comes to hospital B, which belongs to intensive-level medical care providers, for examination and treatment of malignant neoplasm of pancreas - code C25.

Case 2: The patient comes to hospital B, which belongs to intensive-level medical care providers, for examination and treatment and is diagnosed with malignant neoplasm of pancreas - code C25 by hospital B, the patient will be entitled to the benefits prescribed in this Article immediately during this examination and treatment at hospital B for examination, diagnosis and treatment of malignant neoplasm of pancreas - code C25.

- Example 2: A patient is diagnosed with malignant neoplasm of pancreas - code C25 by hospital A, which belongs to primary or basic-level medical care providers, then the patient goes to Hospital B at an intensive level for examination and treatment, he/she will be entitled to the benefits prescribed in this Article as follows:

Case 1: Hospital B at an intensive level examines and diagnoses the patient with malignant neoplasm of pancreas - code C25, then the patient is entitled to the benefits prescribed in this Article for examination and treatment of malignant neoplasm of pancreas - code C25 at Hospital B. During the examination and treatment of malignant neoplasm of pancreas - code C25 at Hospital B, if another disease or accompanying disease is detected, the patient will also be paid for the cost of examination and treatment of the other disease or accompanying disease detected according to the scope of benefits and the level of benefits prescribed by the law on health insurance for cases of examination and treatment in accordance with the order and procedures prescribed by the law on health insurance.

Case 2: If Hospital B which is an intensive level hospital examines and diagnoses the patient and determines that he or she does not have malignant neoplasm of pancreas - code C25, the patient will be still entitled to benefits as prescribed in this Article for that examination and diagnosis at Hospital B.

Case 3: When going to hospital B of intensive level for examination and treatment of malignant neoplasm of pancreas - code C25, if the patient also requests examination and treatment of other diseases, he/she will only enjoy the benefits prescribed in this Article for examination and treatment of malignant neoplasm of pancreas - code C25 at hospital B and will not enjoy the benefits prescribed in this Article for examination and treatment of other diseases at hospital B.

b) In case where the Appendices provide specific conditions or disease condition, only patients meeting such conditions or disease condition shall be entitled to benefits.

4. In case the name of the diagnosed disease does not completely match the name of the disease, disease group and cases specified in the Appendices to this Circular but the disease code is correct, the disease code shall be uniformly applied.

5. In case the patient has been treated stably or according to professional requirements, the disease condition, the medical care provider may transfer the patient to a primary or basic-level medical care provider for continued monitoring and treatment.

Article 6. Health insurance-covered primary medical care providers

1. Health insurance-covered primary medical care providers that may register for providing health insurance-covered primary medical care services for the insured under Clause 1 Article 7 of this Circular, include:

a) Health stations;

b) Health divisions of agencies licensed for provide medical care services in any of the forms specified at Points a, c, e, g, and h of this Clause;

c) General clinics;

d) Regional general clinics;

dd) District-level medical centers granted with medical examination and treatment operation licenses in the form of clinics under Point c or h of this Clause;

e) Family medicine establishments granted with medical examination and treatment operation licenses in the form of general clinics;

g) Medical doctor clinics or general practitioner clinics in communes in areas with particularly difficult socio-economic conditions;

h) Other medical care providers with internal medicine and at least 01 of the following specialties: surgery, pediatrics, obstetrics; not belonging to the following forms of medical care providers: specialized clinics, interdisciplinary clinics, dental and maxillofacial clinics, nutrition clinics, maternity hospitals, traditional medicine clinics, traditional medicine clinics, testing facilities, imaging diagnostic facilities, dental prosthetic facilities, rehabilitation facilities, blood filtration facilities, clinical psychology facilities, nursing service facilities, midwifery service facilities, palliative care facilities, out-of-hospital emergency facilities, and optical facilities that perform refractive measurement and testing.

2. Health insurance-covered medical care providers of basic level that may register for providing health insurance-covered primary medical care services for some insured under Clause 2 Article 7 of this Circular, include:

a) Medical care providers licensed to operate in the organization form of general hospitals;

b) Medical care providers granted with an operation license in any of the following forms: specialized hospitals, traditional medicine hospitals, or hospitals of odonto-stomatology. In the organizational structure of a medical care provider, there must be a specialized division in the form of department, or center or institute. This specialized division must have an internal medicine department and at least 01 of the following specialties: surgery, pediatrics, obstetrics.

3. Health insurance-covered medical care providers of intensive level that may register for providing health insurance-covered primary medical care services for some insured under Clause 3 Article 7 of this Circular, include:

a) Medical care providers specified at Points a and b Clause 2 of this Article, that have been determined as provincial- or district-level medical care providers or equivalent level medical care providers by competent agencies;

b) Medical care providers with the function of protecting the health of staff, medical care providers for leprosy, tuberculosis and lung diseases, mental illness, geriatrics, traditional medicine in the organizational structure with a specialized division in one of the following forms: department or center or institute. This specialized division must have an internal medicine department and at least 01 of the following specialties: surgery, pediatrics, obstetrics;

c) Other medical care providers according to the decision of the Ministry of Health, in the organizational structure with a specialized division in one of the following forms: department or center or institute. This specialized division must have an internal medicine department and at least 01 of the following specialties: surgery, pediatrics, obstetrics.

Article 7. Registration for health insurance-covered primary medical care services

1. The insured may select one of the health insurance-covered primary medical care providers under Clause 1 Article 6 of this Circular, that are near their place of residence, work, study and suitable to the response capacity of the medical care provider to register for health insurance-covered primary medical care services.

2. The insured may register for health insurance-covered primary medical care services at one of the health insurance-covered medical care providers at basic level under Clause 2 Article 6 of this Circular, that are near their place of residence, work, study and suitable to the response capacity of the medical care provider in the order of priority as follows:

a) Persons subject to health management and protection under Guidance No. 52 HD/BTCTW of the Party Central Committee's Organization Commission, dated December 2, 2005, on adjusting and supplementing subjects for medical examination and treatment at a number of central medical care providers; persons subject to health management and protection of provincial officers;

b) People with meritorious services to the revolution, veterans, people aged 75 and over;

c) Children;

d) The insured living in island communes and island districts may register for primary medical care services at the most convenient medical care provider on the mainland if there is no medical care provider specified in Clause 1 Article 6 of this Circular on the island communes and island districts;

dd) Students, pupils and trainees of universities, colleges and intermediate schools in the health sector may register for health insurance-covered primary medical care services at medical care providers with signed health insurance-covered medical care service contracts that meet the provisions in Clause 2 Article 6 of this Circular; employees of medical care providers are allowed to register for health insurance-covered primary medical care services at medical care providers where they work with signed health insurance-covered medical care service contracts that meet the provisions in Clause 2 Article 6 of this Circular;

e) Students, trainees, and trainees who are studying, practicing, or interning at a health insurance-covered medical care providers for 90 days or more may register for health insurance-covered primary medical care services at the health insurance-covered medical care providers where they are studying, practicing, or interning that have signed a health insurance-covered medical care service contract meeting the provisions of Clause 2 Article 6 of this Circular; employees who are on a business trip to a health insurance-covered medical care provider for 90 days or more may register for health insurance-covered primary medical care services at the health insurance-covered medical care provider where they are working that have signed a health insurance-covered medical care service contract meeting the provisions of Clause 2 Article 6 of this Circular;

g) Retired military and police personnel;

h) People with illnesses requiring long-term treatment according to the list of the Ministry of Health;

i) Civil servants, public employees, students, and pupils other than those specified at Point d of this Clause;

k) Other subjects.

3. The insured may register for health insurance-covered primary medical care services at one of the health insurance-covered medical care providers at intensive level under Clause 3 Article 6 of this Circular, that are near their place of residence, work, study and suitable to the response capacity of the medical care provider in the order of priority as follows:

a) Subjects under the management of the Politburo and the Secretariat;

b) Subjects specified at Point a Clause 2 of this Article;

c) People with meritorious services to the revolution, veterans, people aged 75 and over;

d) Persons specified at Points dd and e Clause 2 of this Article;

dd) Children aged under 6 years;

e) Retired military and police personnel;

g) People with diseases requiring long-term treatment according to the list of the Ministry of Health at one of the medical care providers specified at Point b Clause 3 Article 6 of this Circular;

h) Other subjects in necessary cases according to the characteristics of the medical care provider and actual requirements in the locality: The provincial-level Department of Health shall consult the social security office of the province where the medical care provider plans to sign a health insurance-covered medical care service contract, synthesize the dossiers and report to the Ministry of Health for consideration and decision.

4. In case the insured concurrently belongs to different prioritized groups specified in Clauses 2 and 3 of this Article, they may choose the appropriate one.

5. Retired military and police personnel may choose to register for primary medical care services at medical care providers managed by the Ministry of National Defence and the Ministry of Public Security according to regulations of the Minister of National Defence and the Minister of Public Security.

6. The primary registration place shall be changed as follows:

a) The insured may change their registered health insurance-covered primary medical care providers within the first 15 days of the quarter according to their places of residence, work or study;

b) Social security offices shall change the insured's registered health insurance-covered primary medical care providers on the health insurance card database. In case of difference between the information on the paper health insurance card and the electronic version, the information on the electronic health insurance card shall prevail.

Article 8. Allocation of health insurance cards to health insurance-covered primary medical care providers

1. The principle of allocating the number of health insurance cards to the health insurance-covered medical care providers must comply with Clause 2 Article 26 of the Law on Health Insurance, specifically as follows:

a) Ensuring balance and conformity with the health insurance-covered medical care needs of the people and the provisions of Article 7 of this Circular;

b) Consistent with the ability of the health insurance-covered medical care provider to provide primary health care, general medical care and initial emergency treatment, the number of medical examinations and treatment, transfers to medical examination and treatment facilities annually, the number of examinations per examination table per day, operating conditions regarding physical foundations, human resources, drug supply, equipment in accordance with the law on medical examination and treatment, the scale of hospital beds (if any) and the provisions of Article 6 of this Circular;

c) In accordance with the actual capacity of the locality, including: balancing the number of health insurance-covered medical care providers, between health insurance-covered medical care providers at each technical level and between technical levels in the locality; prioritizing the allocation of health insurance cards at primary level medical care providers; balancing and rationalizing the structure of the insured groups.

2. Responsibility of provincial-level Departments of Health:

a) To allocate health insurance cards to health insurance-covered primary medical care providers in the management area;

b) To review and adjust the number of health insurance cards of medical care providers and between medical care providers when necessary to ensure the provisions of this Circular or when the insured registers for new or request changes to the registration of health insurance-covered primary medical care providers;

c) To publicly announce the number of health insurance cards allocated to medical care providers on the provincial-level Departments of Health's websites.

3. Responsibility of social security offices:

a) Before October 31 of each year, the social security office shall provide information on the number and structure of the insured actually registered to the provincial-level Department of Health and medical care providers; information on the number of provision of health insurance-covered medical care services, and transfer of health insurance-covered medical care providers of health insurance-covered medical care providers in the province to the provincial-level Department of Health as a basis for considering and organizing the allocation of the number of health insurance cards to the health insurance-covered medical care providers in the management area;

b) To organize for the insured to register for health insurance-covered primary medical care services, and change the place of registration for health insurance-covered primary medical care at the health insurance-covered primary medical care provider under this Circular;

c) To periodically at the end of the first month of each quarter, the social security office shall notify the provincial-level Department of Health of the number of cards registered by subjects at medical care providers for timely review and adjustment of the number of health insurance cards of medical care provider and between medical care providers if necessary;

d) To publicly post information on the number and structure of the insured actually registered by medical care providers in the province on the social security offices’ websites.

4. The Ministry of National Defence and the Ministry of Public Security shall be responsible for synthesizing the needs and sending written notices to the provincial-level Department of Health and social security offices in the province to synthesize information and allocate in the cases specified at Points a, b and c Clause 1 Article 2 of this Circular.

Article 9. Patient transferal among health insurance-covered medical care providers

1. The patient transferal among health insurance-covered medical care providers must comply with the law on medical examination and treatment.

2. Cases of properly transferring patients between health insurance-covered medical care providers include:

a) Transferring patients between health insurance-covered medical care providers at the same level of medical examination and treatment, from primary medical care providers to basic-level medical care providers, from basic-level medical care providers to intensive-level medical care providers according to professional requirements, the patient's medical condition or beyond the response capacity of the medical care providers, other than the cases specified at Point d of this Clause and Article 5 of this Circular;

b) Transferring patients from primary medical care providers to intensive-level medical care providers in cases exceeding the response capacity of basic-level medical care providers in the province;

c) Transferring patients who have been treated stably from intensive-level medical care providers to basic-level or primary medical care providers, transferring patients from basic-level medical care providers to primary medical care providers for continued treatment and monitoring;

d) Transferring patients from intensive-level or primary medical care providers to health insurance-covered primary medical care providers for treatment, management and monitoring of chronic diseases as prescribed in Article 10 of this Circular;

dd) Transferring patients between medical care providers for patients with chronic diseases or long-term treatment according to the list of diseases prescribed in Appendix III to this Circular, the form of medical care provider transferal shall be valid for one year from the date recorded on the transferal form and shall be implemented in accordance with Point b Clause 3, Clause 4 and Clause 5 Article 5 of this Circular;

e) In case a person with a health insurance card goes to the medical care provider by himself/herself not in accordance with Article 26, Article 27 of the Law on Health Insurance and falls under the case prescribed by Points e, g, h (except for the case of enjoying 100% at Point e and Point h) Clause 4 Article 22 of the Law on Health Insurance, the medical care provider will then transfer the patient to another medical care provider according to professional requirements;

g) In case of emergency, after the emergency treatment phase, the patient will be transferred to inpatient treatment at the medical care provider that received the patient for emergency treatment or transferred to another medical care provider for continued treatment according to professional requirements or transferred back to the registered primary medical care provider if the patient becomes stable after treatment.

Article 10. Transferring patients to the registered health insurance-covered primary medical care providers for treatment, management and monitoring of chronic diseases

1. When becoming stable after treatment for chronic diseases according to the list in Appendix IV to this Circular, the medical care provider may transfer the patient to the registered health insurance-covered primary medical care provider for treatment, management and monitoring.

2. The health insurance-covered primary medical care provider registered by the patient shall treat, manage and monitor chronic diseases according to the professional guidance of the Ministry of Health and the following regulations:

a) Conducting medical examinations according to the guidance in the medical care provider transferal records; providing prescription drugs and medical equipment within the scope of payment of the Health Insurance Fund periodically according to the instructions in the medical care provider transferal records. The periodic medical examination specified at this Point is counted as one time of medical care service provision;

b) In case the patient develops diseases or symptoms that require medical examination, indication, technical service performance, prescription of drugs, and medical equipment indication, the patient’s registered health insurance-covered primary medical care shall provide medical care services according to the professional capacity, scope of professional activities, and list of technical services of the providers approved by the competent agency or transfer the patient to another health insurance-covered primary medical care provider in accordance with law.

3. The Health Insurance Fund shall pay for medical care costs, including medical examination fees, costs of drugs, medical equipment and technical services prescribed and indicated according to the professional capacity of the medical care provider managing and monitoring chronic diseases as prescribed in Clauses 1 and 2 of this Article, regulations on payment for drugs, medical equipment, technical services and other regulations on medical examination and treatment related to the scope of benefits and levels of enjoyment as prescribed by the law on health insurance.

4. The medical care provider managing chronic patients shall develop a plan, make purchases according to regulations or receive drugs and medical equipment issued or transferred from the medical care provider that transferred the patient, manage and summarize the costs of medical examination and treatment, drugs, medical equipment, technical services and settle with the social security office.

5. Health insurance-covered medical care providers that transfer patients to the patients’ registered health insurance-covered primary medical care providers shall have the following responsibilities:

a) Coordinating and exchanging information with the receiving medical care provider to ensure the supply of drugs and medical equipment and not affect the patient's treatment process;

b) Transferring drugs and medical equipment during the period on which the medical care provider receiving the patient does not have drugs and medical equipment available to provide to the patient.

Article 11. Re-examination appointment procedures

The patient shall be scheduled for a re-examination by the health insurance-covered medical care provider in case it is necessary to continue monitoring the patient's condition or to re-check the results of that examination and treatment as professionally required according to the following procedures:

1. The medical care provider records the content and schedule of the re-examination appointment in the re-examination appointment form (paper or electronic form) using the form provided in Appendix V to this Circular or in the prescription, hospital discharge papers (paper or electronic form) for the patient (hereinafter referred to as the re-examination appointment form).

2. The paper re-examination appointment form must bear the seal of the medical care provider on the upper left corner and the signature of the treating physician. The electronic re-examination appointment form must bear the digital signature of the treating physician. Each re-examination appointment form shall be used only 01 (one) time.

3. The medical care provider records the content and appointment schedule in the re-examination appointment book or on the electronic data of the medical care provider for monitoring and comparison when necessary.

4. The patient shall be responsible for arriving at the medical care provider on time as stated on the re-examination appointment form. In case the patient cannot arrive on time, he/she must contact the treating physician or the medical care provider to make another suitable appointment.

5. The number of re-examination appointments shall be made according to professional requirements after each medical examination and treatment. Only one re-examination appointment is allowed after the end of a treatment period.

Article 12. Medical care provider transferal records

1. In case of transferring health insurance-covered medical care providers according to professional requirements, the medical care provider transferring the patient must have a medical care provider transferal form, made according to the form provided in Appendix VI to this Circular in paper or electronic form. The medical care provider transferal form is valid for 10 working days from the date of signing.

2. The insured suffering from diseases, groups of diseases and cases specified in Appendix III to this Circular may use the medical care provider transferal form which is valid for 01 year from the date of signing. In case the medical care provider transferal form expires but the patient is still undergoing medical examination and treatment and needs to continue treatment at the medical care provider, the medical care provider transferal form is valid until the end of that treatment period.

3. In case the patient is transferred to a medical care provider with other accompanying diseases, diseases discovered or arising other than the diseases recorded on the medical care provider transferal form, the medical care provider that receives the patient shall provide medical care services for those diseases according to the patient's medical condition and the professional capacity and scope of medical examination and treatment activities of the provider.

4. In case the patient is transferred to a medical care provider and must undergo multiple treatment sessions according to professional requirements, the patient may continue to use the medical care provider transferal form until the end of treatment and after the first treatment session, each subsequent treatment session must have a re-examination appointment form from the medical care provider where the patient is transferred.

For example: A patient is transferred to a medical care provider for eye surgery but needs to perform 02 surgeries for each eye, the patient can use the medical care provider transferal form until the completion of 02 surgeries.

5. In case the patient is transferred to another medical care provider or the patient goes to a medical care provider other than the health insurance-covered medical care provider and is then transferred to another medical care provider, only the medical care provider transferal form from the medical care provider that directly transferred the patient is required.

Article 13. Amending and supplementing a number of provisions relating to line and level in the Minister of Health's Circulars

1. To amend and supplement a number of articles, clauses and points of Circular No. 09/2019/TT-BYT dated June 10, 2019, of the Minister of Health, on providing instructions for assessment of requirements for signing contracts for insured primary healthcare services, referral of sub-clinical services and certain cases of direct payment of insured healthcare service costs, as follows:

a) To replace the phrase “except self-referrals to other out-of-network healthcare establishments” specified at Point a Clause 1 Article 4 with the phrase “except for cases of self-examination and treatment in contravention of provisions of Articles 26 and 27 of the Law on Health Insurance”;

b) To replace the phrase "discharge from hospital, hospital transferal” specified at Point c Clause 1 Article 4 with the phrase “end of treatment, transferal of medical care provider”.

2. To replace the phrase “district level” in Article 1 of Circular No. 35/2021/TT-BYT dated December 31, 2021, of the Minister of Health, amending and supplementing Clause 1 Article 9 of Circular No. 30/2020/TT-BYT dated December 31, 2020, of the Minister of Health, detailing and guiding measures to implement a number of articles of Decree No. 146/2018/ND-CP dated October 17, 2018, of the Government, detailing, and guiding measures to implement, a number of articles of the Law on Health Insurance, with the phrase “basic-level medical examination and treatment”.

3. To amend and supplement a number of articles and clauses of Circular No. 36/2021/TT-BYT dated December 31, 2021, of the Minister of Health, regulating medical examination and treatment and payment of medical examination and treatment costs under health insurance related to tuberculosis examination and treatment as follows:

a) To replace the phrase “health insurance-covered treatment-line transfer” specified at Point c Clause 1 Article 2 to “health insurance-covered medical care provider transferal”;

b) To replace the phrase “transferring from higher levels” specified at Point b Clause 5 Article 14 to “transferring from basic- and intensive-level medical care providers”.

4. To add to the end of Point d Clause 1 Article 2 of Circular No. 20/2022/TT-BYT dated December 31, 2022, of the Minister of Health, on promulgation of list of pharmacochemical drugs, biological products, radioactive drugs and tracers covered by health insurance, insurance coverage ratio and payment conditions thereof, as follows:

“- In case a medical care provider is granted an operation license for the first time from January 1, 2025, and during the period of temporary classification as a basic level under Clause 7 Article 61 of Decree No. 96/2023/ND-CP, the regulations for class-II hospitals shall be temporarily applied until the Minister of Health issues a new document on the list of pharmacochemical drugs, biological products, radioactive drugs and tracers covered by health insurance, insurance coverage ratio and payment conditions thereof, which takes effect and replaces Circular No. 20/2022/TT-BYT dated December 31, 2022, of the Minister of Health.”.

Article 14. Responsibilities of implementation

1. The provincial-level Department of Health Insurance under the Ministry of Health shall assume the prime responsibility for, and coordinate with relevant agencies and units in, directing, guiding, organizing the implementation, and inspecting the implementation of this Circular nationwide; reviewing and proposing adjustments to the list of diseases in accordance with the capacity of technical expertise levels and practical requirements.

2. Provincial-level Departments of Health shall:

a) Direct, organize the implementation, guiding, inspect, and examine the implementation of this Circular for health insurance-covered medical care providers under the management;

b) Announce the list of health insurance-covered primary medical care providers in the locality, the number of health insurance cards allocated to health insurance-covered primary medical care providers, the list of medical care providers ranked by the provincial-level Departments of Health with the score on the provincial-level Departments of Health's websites and on the information system on management of medical care activities;

c) Advise the provincial-level People's Committees on ensuring resources and directing the connection and sharing of health insurance-covered medical care data, payment of health insurance-covered medical care costs of medical care providers in the locality and social security offices with the provincial-level Departments of Health in accordance with law;

d) Guide the transferal of patients between medical care providers for those who participate in health insurance in the province to ensure professional requirements, actual conditions of the locality and create convenience for patients.

3. Medical care providers shall:

a) Organize full and timely implementation of the provisions of this Circular;

b) Ensure full conditions for health insurance-covered medical care services according to the health insurance-covered medical care contract, this Circular and the law on medical examination, treatment and health insurance;

c) Publicize professional and technical classification results and the points on their websites and patient reception areas;

d) Provide advice and guidance to the insured on diseases that can be examined and treated at basic- and intensive-level medical care providers without having to go through the procedures to transfer to medical care providers in the list prescribed in this Circular when patients come to examine and treat themselves to ensure the rights of patients;

dd) Train, guide and thoroughly educate practitioners and medical staff to record disease codes and disease names in accordance with this Circular.

Article 15. Effect

1. This Circular takes effect from January 1, 2025.

2. The insured registered for health insurance-covered primary medical care services at medical care providers recorded on their health insurance cards before the effective date of this Circular may continue to receive primary medical care services at such providers until there are changes to the registered health insurance-covered primary medical care providers as guided in this Circular.

3. To annul the following documents and regulations from the effective date of this Circular:

a) Circular No. 40/2015/TT-BYT dated November 16, 2015, of the Minister of Health, guiding the registration for health insurance-covered primary medical care services, and health insurance-covered treatment-line transfer;

b) Article 6 of Circular No. 30/2020/TT-BYT dated December 31, 2020, of the Minister of Health, detailing and guiding measures to implement a number of articles of Decree No. 146/2018/ND-CP dated October 17, 2018, of the Government, detailing, and guiding measures to implement, a number of articles of the Law on Health Insurance;

c) Articles 3, 4 and Clause 2 Article 5 of Circular No. 36/2021/TT-BYT dated December 31, 2021, of the Minister of Health, regulating medical examination and treatment and payment of medical examination and treatment costs under health insurance related to tuberculosis examination and treatment.

4. In case any documents referred to in this Circular are amended, supplemented or replaced, the new ones shall prevail.

5. Transitional provisions:

a) The insured who comes for medical care services at health insurance-covered medical care providers before the effective date of this Circular and has his/her medical examination and treatment ended after the effective date of this Circular shall follow this Circular;

b) The allocation of health insurance cards to health insurance-covered medical care providers and the insured who have registered their health insurance-covered primary medical care providers before the effective date of this Circular shall continue to be implemented until the time the provincial-level Department of Health announce the number of health insurance cards for each health insurance-covered primary medical care provider. The provincial-level Departments of Health shall announce the expected number of primary registrations at each medical care provider no later than July 1, 2025. The change of the primary registration place of the insured for the above medical care provider shall be implemented until the end of December 31, 2025. For cases where the patient is being treated at the registered primary medical care provider, it shall be implemented until the end of that treatment period.

c) Re-examination appointment papers and transferal papers issued before the effective date of this Circular shall be used until the end of the validity period of the papers as prescribed in this Circular. In case the transferal paper in the calendar year expires from January 1, 2025, but the patient is still being treated at the medical care provider, the transferal paper shall be used until the end of the treatment period;

d) In case the disease code in the lists issued with this Circular is replaced by another document, the disease code specified in that new document shall apply, except in cases where the disease code is canceled without a corresponding replacement disease code;

dd) The forms of re-examination appointment and health insurance-covered medical care provider transferal as prescribed in Decree No. 146/2018/ND-CP, which was amended and supplemented under Decree No. 75/2023/ND-CP, shall continue to be used until the Vietnam Social Security and medical care providers complete the updating and sending of data on payment for health insurance-covered medical care costs according to the forms of re-examination appointment and health insurance-covered medical care provider transferal as prescribed in this Circular, but no later than December 31, 2025.

Any difficulties and problems arising in the course of implementation and organization should be promptly reported to the Ministry of Health for consideration and settlement./.

* All Appendices are not translated herein.