Complaints, denunciations, disputes and dispute resolution about health insurance

1. Medical complaints

According to Article 47 of the Health Insurance Law 2014, regulations on complaints and denunciations about health insurance are as follows:

Complaints and settlement of complaints about administrative decisions and administrative acts on health insurance, denunciations and settlement of denunciations of violations of the law on health insurance are carried out in accordance with the provisions of law. Law on complaints and denunciations.

2. Disputes about health insurance

According to Article 48 of the Health Insurance Law 2014, regulations on health insurance disputes are as follows:

1. Dispute about health insurance is a dispute related to the rights, obligations and responsibilities of health insurance between the following subjects:

a) Persons participating in health insurance as prescribed in Article 12 of  Health Insurance Law 2014 representative of health insurance participants;

b) Organizations and individuals pay health insurance according to the provisions of Clause 1, Article 13 of  Health Insurance Law 2014.

c) Health insurance organization;

d) Medical examination and treatment facilities covered by health insurance.

2. Disputes over health insurance are resolved as follows:

a) The disputing parties are responsible for conciliating the content of the dispute themselves;

b) In case conciliation fails, the disputing parties have the right to sue in court according to the provisions of law.

3. Handling violations

According to Article 49 of the Health Insurance Law 2014, regulations on handling medical violations are as follows:

1. People who violate the provisions of this Law and other provisions of law related to health insurance will, depending on the nature and severity of the violation, be disciplined or fined for violations. or be prosecuted for criminal liability; if causing damage, compensation must be made according to the provisions of law.

2. Agencies and organizations that violate the provisions of this Law and other provisions of law related to health insurance shall be administratively sanctioned. If causing damage, they must compensate according to the law. provisions of law.

3. Agencies, organizations, and employers who are responsible for paying health insurance but do not pay or pay insufficiently as prescribed by law will be handled as follows:

a) Must pay the outstanding amount and pay an interest equal to twice the interbank interest rate calculated on the amount and time of late payment; If not done, at the request of the competent person, banks, other credit institutions, and the state treasury shall be responsible for deducting money from the deposit accounts of relevant agencies, organizations, and employers. Responsibility for paying health insurance to pay unpaid and late payments and interest on this amount to the health insurance fund account;

b) Must reimburse all expenses to the employee within the scope of health insurance benefits and benefits that the employee has paid while not having a health insurance card.