Circular No. 09/2019/TT-BYT dated June 10th, 2019 of the Ministry of Health on providing instructions for assessment of requirements for signing contracts for insured primary healthcare services, referral of subclinical services and certain cases of direct payment of insured healthcare service costs

This Circular provide for instructions on insured healthcare services with regard to:

1. Assessment of conformance of healthcare establishments to eligibility requirements for signing insured primary healthcare service contracts.

2. Referral of subclinical diagnostic tests, medical imaging and functional assessment services.

3. Direct payment of insured healthcare service costs made in other special cases defined in point c of clause 1 of Article 31 in the Law on Health Insurance amended and supplemented under the provisions of the Law No. 46/2014/QH13.


Accordingly, apart from the cases entitled to receive direct payment of medical costs under point a and point b Clause 2 Article 31 of the Law on Health Insurance, health insurance cardholders shall be directly paid medical and healthcare costs in the following cases:

+ A patient has participated in the health insurance plan for at least 5 consecutive years and has incurred total out-of-pocket medical cost within a year greater than total base pay amount received during 6 months (except self-referrals to other out-of-network healthcare establishments) which has not been made yet;

+ Health insurance card data are not provided or are provided inaccurately;

+ If the patient does not present his/her health insurance card prior to medical discharge, refer to another healthcare establishment within a day due to medical emergency, loss of consciousness, death or loss of the health insurance card without being not issued with another one yet.

This Circular takes effect from August 1st, 2019./.

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