Responsibilities of organizations and individuals paying for health insurance and rights and responsibilities of health insurance organizations

According to the provisions of Article 39, Article 40, Article 41 LThe revised Health Insurance Law 2014 takes effect from January 1, 2015 and stipulates as follows:

The responsibilities of organizations and individuals paying health insurance according to Article 39 include:

1. Prepare an application for a health insurance card.

2. Pay health insurance in full and on time.

3. Deliver the health insurance card to the health insurance participant.

4. Provide complete and accurate information and documents related to the health insurance responsibilities of the employer and the representative of the health insurance participant when requested by the organization. health insurance agency, employee or employee representative.

5. Comply with inspection and examination of the implementation of legal regulations on health insurance.

The rights of health insurance organizations under Article 40 include:

1. Require employers, representatives of health insurance participants and health insurance participants to provide complete and accurate information and documents related to their responsibilities for carry health insurance.

2. Inspect and assess the implementation of medical examination and treatment covered by health insurance; revoke and temporarily hold health insurance cards for cases specified in Article 20 of the Health Insurance Law.

3. Request medical examination and treatment facilities covered by health insurance to provide records, medical records, and documents on medical examination and treatment to serve health insurance assessment work.

4. Refuse to pay medical examination and treatment costs covered by health insurance that are not in accordance with the provisions of the 2014 amended Health Insurance Law or that are not in accordance with the content of the medical examination and treatment contract covered by health insurance.

5. Request the person responsible for compensating the health insurance participant to reimburse the medical examination and treatment costs paid by the health insurance organization.

6. Propose to competent state agencies to amend and supplement policies and laws on health insurance and handle organizations and individuals that violate the law on health insurance.

The responsibilities of health insurance organizations according to Article 40 include:

1. Propagate and disseminate policies and laws on health insurance.

“2. Organize to the subjects specified in Clause 5, Article 12 of Health Insurance Law amended 2014 Conveniently pay family health insurance at a health insurance agent. Guide documents, procedures, where to register for health insurance and organize the implementation of health insurance regimes, ensuring quick, simple and convenient for health insurance participants. Review, synthesize and confirm the list of health insurance participants to avoid issuing duplicate health insurance cards to the subjects specified in Article 12 of this Law. Health Insurance Law amended 2014, except for subjects managed by the Ministry of National Defense and the Ministry of Public Security.”

3. Collect health insurance premiums and issue health insurance cards.

4. Management and use of health insurance fund.

5. Sign a health insurance medical examination and treatment contract with the medical examination and treatment facility.

6. Payment of medical examination and treatment costs covered by health insurance.

7. Provide information about medical examination and treatment facilities covered by health insurance and guide health insurance participants to choose the initial medical examination and treatment facility.

8. Check the quality of medical examination and treatment; Health insurance appraisal.

9. Protect the rights of health insurance participants; Resolve according to authority recommendations, complaints and denunciations regarding health insurance regimes.

“10. Store records and data on health insurance according to the provisions of law; Determine the time to participate in health insurance to ensure benefits for health insurance participants; Apply information technology in health insurance management, build a national database on health insurance.”

11. Organize the implementation of statistics, reports, and professional guidance on health insurance; Report periodically or unexpectedly when required on the management and use of health insurance funds.

12. Organize training, professional development, scientific research and international cooperation on health insurance.