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Page 1: 40/20 15/TT-BYT. GIAMDOC - soyte@binhduong.gov.vn

UBND TiNH BiNH DUONG CONG HOA xA HOI CHiJ NGHIA VIE.:TNAMsa Y Tit DQc I~p - T\I" do - H~nh plnic

sf>: 025oZG/SYT-NVVIv triSn khai Nghi dinh

146/2018/Nf}-CP

Binh Duong. ngay 01 thong 11nam 2018

Kinh grri: Cac co so kham chua benh tren dia ban tinh.

Ngay 17/10/2018, Chinh phu dil ban hanh Nghi dinh s6 146/2018/ND-CPQuy dinh chi ti~t va huong dfuI bien phap thi hanh mot s6 di8u cua Lu~t Baohiem y t~. Nghi dinh 146/20 18IND-CP co hieu hrc tir ngay 01112/2018.

M9t s6 van ban h~t hieu hrc, kS nr khi Nghi dinh 146/2018IND-CP cohieu hrc thi hanh:

- Nghi dinh s6 105/20141ND-CP (rieng quy dinh tai diSm b khoan 1 Di~u6, Di~u 8 ti~p tuc thirc hien d~n 31112/2018).

- Thong tu lien tich s6 4112014/TTLT-BYT-BTC (rieng cac guy dinh taiDi~u 11, khoan 2 DiSu 17, DiSu 18 tiSp tuc thuc hien d@nh~l ngay 31112/2018).

- Thong tu lien tich s6 16/2015/TTLT-BYT-BTC.- £>iSu8 va khoan 2 DiSu 9 Nghi dinh 15112016IND-CP.- Khoan 6 £>i~u 11, diSm c khocin 1 va khocin 2 £>i~u 12 Thong tu s6

40/20 15/TT-BYT.

Cac dan vi tciiNghi dinh 146/20 18/N£)-CP t;;tiwebsite S6 Y t~ v~ nghienClm triSn khai khi Nghi dinh co hi~u h,rc./~

Nui nh~n:- Nhu tren;- BHXH Binh Duong (Ph/H);- BGB SYT CBSL~c, BS Thu~n);- Website SYT;- Luu: VT, NV~

GIAMDOC

Page 2: 40/20 15/TT-BYT. GIAMDOC - soyte@binhduong.gov.vn

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JJA.; 7M--c QUY DINH CHI TrET vA HlJ6NG_ DAN: BIBN. pHAPTHI HANH MOT so DIEU CVAr:: LUATBAOHIEMYTE46-tl- Can cu Ludt t6 chuc Chfnh phu ngay I 9 thdng 6 ndm 2015;

Can cu Ludt bao hiem y d ngay 14 thdng 11ruim 2008 duac sua d6i, b6 sung mot s6 di~u~ _..If theo Ludt bao hi€m y d ngay 13 thang 6 ruim 2014;

~ Theo d~ nghi cua so truong so Y d;Chfnh phu ban hanh Nghi dinh quy dinh chi tidt va huang dJn bien phdp thi hanh mi)t s6 diJucua Ludt bao hidm y ti.Chuong IDOl TUONG THAM GIA BAo IDEM Y TEDi~u 1. Niu)m do nguot lao dQngva nguoi sir dung lao dQngdong1. Ngiroi lao dQnglam viec thea hQ'Pd6ng lao dQngkhong xac dinh thai han, hQ'Pd6ng laodQngco thoi han ill du 3 thang tro len; ngum quan ly doanh nghi~p, dan vi Sl,( nghi~p ngoaic6ng l~p va nguai quan ly diSu hclnhhQ'Ptac xa huang tiSn luang; can bQ, c6ng chuc, vienchuc.2. Ngum ho~t dQngkh6ng chuyen trach a xa, phuOng,thi trftnthea quy dinh cua phap l~t.Di~u 2. Nhom do CO' quan bao hi~m xii hQidong1.Nguai huang luang hUll,tr9' dp mit suc lao dQnghfuIgthang.2. Ngum dang huang tr9' dp bao hi~m xa hQihfuIgthang do bi tai n<;mlao dQng,b~nh nghSnghi~p; c6ng nhfulcao su dang huang tr9'cip hfuIgthang thea quy dinh cua Chinh phu.3. Ngum lao dQngnghi vi~c huang tr9' cip 6m dau do m~c b~nh thuQcDanh m\lCb~nh d.nchua tri delingay do BQY t~ban hanh.4. Can bQxa, phuOng,thi trftnda nghi vi~c dang huang tr9'dp bao hi~mxa hQihfuIgthang.5. Ngum lao dQngtrong thm gian nghi vi~c huang ch~ dQthai san khi sinh con ho~c nh~nu6i con nu6i.6. Ngum dang huang tr9' cip thit nghi~p.Di~u 3. Nbom do ngan sach nba nU'O'cdong1. Can bQxa, phuOng, thi trftn da nghl vi~c dang huang tr9' cip hfuIgthang illngful sach nhanu6c.2. Nguai da th6i huang tr9'dp mit suc lao dQngdang huang tr9' dp hfuIgthang tiI ngfulsachnhanu6c.3. NgU01co cong vrn each m<;mgthea quy dinh t~i Phap l~nh Uti dai nguCYico c6ng v6i cachm<;mg.4. Cl,(Uchi~n binh, g6m:a) Cl,(Uchi~n binh tham gia khang chi~n ti:r ngay 30 thang 4 nam 1975 tra v~ tru6c thea quydinh ~i khoan 1,2,3 va 4 DiSu2 Nghi dinh s6 150/20061ND-CP ngay 12 thang 12 nam 2006cua Chinh phu quy dinh chi ti€t va huang d§n thi hclnhmQts6 diSu cua Phap l~nh Cl,(Uchi€nbinh (sau day gQi t~t la Nghi dinh s6 150/20061ND-CP), du9'c sua d6i, b6 sung t~i khoan 1Di~u 1Nghi dinh s6 157/20161ND-CP ngay 24 thang 11 nam 2016 cua Chinh phu sua dai, basung Nghi dinh s6 150/20061ND-CP ngay 12 thang 12 nam 2006 cua Chinh phu quy diM chiti€t va huang d§n thi hclnhmQts6 diSu cua Phap l~nhCl,(Uchi~n binh (sau day gQit~t la Nghidinh s6 157/20161ND-CP).b) Cl,(Uchi~n binh tham gia khang ehi~n sau ngay 30 thang 4 nam 1975 quy dinh t~ khoan 5Di~u 2 Nghi dinh s6 150/20061ND-CP ngay 12 thang 12 nam 2006 cua Chinh phu quy dinhchi ti~t va huang dful thi hclnhmQts6 di~ueua Phap l~nhel,(UehiSnbinh va t~i khoan 1Di~u 1Nghi dinh s6 157120161ND-CPngay 24 thang 11 nam 2016 eua Chinh phu sua dai, b6 sungNghi dinh s6 150/20061ND-CP Clla Chinh phil, g6m:

CHiNHPHU

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bao hiem y tS thanh toan chi phi kham benh, chua benh trong pharn vi diroc hirong voi mirehuang nhir sau:a) 100% ,chi phi kham benh, chua benh d5i voi d5i tuong quy dinh tai cac khoan 3, 4, 8, 9, 11va 17 Dieu 3 Nghi dinh nay;b) ,100% chi p~ kham benh, chua benh va khong ap dung gioi han tY l~ thanh toan thuoc, hoachat, v~t til y te va dich vu ky thuat thee quy dinh cua BQtnrong BQY tS d5i voi:- Ngiroi hoat dQng each mang truce ngay 01 thang 01 nam 1945;- Ngiroi hoat dong each mang nr ngay 01 thang 01 nam 1945 d8n ngay khoi nghia thang Tamnam 1945;- Ba me Viet Nam anh hung;- Thuong binh, nguoi huang chinh sach nhir thuong binh, thuong binh loai B, benh binh suygiam kha nang lao dQng til 81% tro len;- Thuong binh, nguoi huang chinh sach nhu thuang binh, thuang binh 10(,liB, b~nh binh khidieu trt vet thuang, b~nh t~t tai phat;- Ngum hO(,ltdQng khang chi8n bi nhi~m ch~t dQc hoa hQc co ty l~ suy giam kha nang laodQng ti:r 81 % tra len;- Tre em du6i 6 tu6i.c) 100% chi phi kham b~nh, chua b~nh t(,lituy8n xa;d) 100% chi phi kham b~nh, chua b~nh d6i vm truang hQ'Pchi phi cho mQt lfuI kham b~nh,chua b~nh th~p han 15% muc luang co sa;d) 100% chi phi kham b~nh, chua b~nh khi ngum b~nh co thai gian tham gia bao hi~m y t8 05nam lien 1\lc tra len va co s6 ti~n cUng chi tra chi phi kham b~nh, chua b~nh trong nam 160han 06 thang luang co sa, tm truang hQ'Ptv di kham b~nh, chua b~nh kh6ng dUng tuy8n;e) 95% chi phi kham b~nh, chua b~nh d6i vm d6i tUQ'llgquy diM t(,likhoan 1 Di~u 2, khoan12 Di~u 3 va khoan 1 va 2 Di~u 4 Nghi dtnh mly;g) 80% chi phi kham b~nh, chua b~nh d5i vm cac d5i tUQ'llgkhac;h) Nguai b~nh duQ'c co sa kham b~nh, chua b~nh tuy8n tren chin doan, chi dinh di~u trt vachuy~n v~ d~ quan ly, thee dai, cAp phat thu5c t(,lico sa kham b~nh, chua b~nh tuy8n xa theequy dinh cua BQtruemg BQY t8 thi duQ'c quy bao hi~m y t8 chi tra trong ph~ vi duQ'c huemgva muc huang quy dinh t(,lidi~m a, b, d, e va g khoan 1 Di~u nay.2. TruOng hQ'PmQt ngum thuQc nhi~u d6i tuQ'llgtham gia bao hi~m y tS thj dUQ'chuemg quy~nlqi bao hi~m y t8 thee d5i tuQ'llg co muc huang cao nh~t quy dinh t(,likhoan 1 DiSu nay.3. Truang hQ'Pnguai co the bao hi~m y t8 tv di kham b~nh, chua b~nh khong dUng tuy8n, saudo duQ'cco sa noi ti8p nh~ chuy6n tuy8n d8n co sa kham b~nh, chua b~nh khac thi duQ'c quybao hi6m y t8 thanh toan chi phi kham b~nh, chua b~nh thee muc huang quy dinh t(,likhoan 3Di~u 22 cua L~t bao hi~m y t8, tm cac truOng hQ'P sau: c~p c(ru; dang di~u tri nQi trU duQ'cphat hi~n b~nh khac ngoru ph~ vi chuyen mon cua co sa kham b~nh, chua b~nh; tinh tr~gb~nh di~n bi8n vuqt qua kha nang chuyen mon eua co sa kham b~nh, chua b~nh.4. Ngum tham gia bao hi~m y t8 dang ky kham b~nh, chua b~nh ban dAut(,litr~ y t8 tuy8n xagiap ranh cua tinh giap ranh dUQ'cquy bao hi~m y tS thanh toan 100% chi phi kham b~nh,chua b~nh trong ph(,lIIJvi duQ'c hUOng va mue hu6ng quy dinh t(,likhocLn1 DiSu nay k_hid~nkham b~nh, chua b~nh t(,litr~ y t8 tuy8n xa giap ranh cua tinh giap ranh.5. TruOng hQ'Pchuy6n d6i mue huemg bao hiSm y t8 thi muc huemg bao hiSm y t8 mm duQ'ctinh til thai diSm the bao hi~m y tS m6i co gia tri sir d\lllg.Di~u 15. Thii tyc kham b~nh, chua b~nh bao hi~m y t~1. Ngum tham gia bao hiSm y t8 khi d8n kham b~nh, chua b~nh phai xuc1ttrinh the bao hiSm yt8 co anh; truang hQ'Pthe bao hi6m y tS chua co anh thi phai xu~t trinh mQt trong cac gic1ytoroy than co anh do ca quan, t6 chuc co thdm quyen cApho~c Gi~y xae nh~ eua Cong an c~pxa ho~c gi~y to khac eo xac nh~ cua co sa giao d\lc nm quan ly hQc sinh, sinh vien; cac gi~yto chUng minh nhan than hQ'Pphap khac.2. Tre em dum 6 tu6i dSn kham b~nh, chfra b~nh chi phai xuftt trinn the bao hi~m y t~. TruanghQ'Ptre chua dUQ'cc~p the bao hi~m y t8 thl phai xu~t trinh ban sao gi~y chUng sinh ho~c bansao gi~y khai sinh; truang hQ'Pphai diSu tri ngay sau khi sinh rna chua co gi~y chUng sinh thlthu truang co sa kham b~nh, chua b~nh va cha ho~c my ho~c ngum giam hQ cua tre ky xac

9

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d) ~anh muc dich vu ky thuat Y t~, danh muc thuoc, hoa ch~t, v~t tu Y t~ duoc c~p co thfunquyen phe duyet (bang van ban hoac ban dien nr),2. Truong hQ'Pco so kham benh, chua benh duoc co quan co tham quyen phe duyet b6 sungchirc nang, nhiem vu, pham vi chuyen mon, hang benh vien, co so kham benh, chua benh cotrach nhiem thon~ bao ~ho co quan bao hiem xa h('>id~ b6 sung vao hQ'Pd6ng kham benh,chua benh bao hiem y teoTrong thai han 10 ngay lam viec k~ tir ngay nhan diroc van ban pheduyet do co s6 kham benh chua benh gill d~n, co quan bao hiem xa h('>ico trach nhiem hoanthanh viec ky k~t b6 sung phu luc hQ'Pd6ng ho~c giao k~t hQ'Pd6ng moiDi~u 17. NQi dung hQ'P dAng, di~u ki~n kY hQ'P dAng kham b~nh, chua b~nh bao hiim yt~ dai VOl cO'SO' kham b~nh, chua b~nh1. N(,>idung hQ'Pd6ng kham b~nh, chua b~nh bao hi~m y t~ duQ'c l~p thea Mftu s6 7 Ph\ll\lcban hanh kern thea Nghi dinh nay. Tily thea di~u ki~n cua cO's6 kham b~nh' chua b~nh, cO'quan bao hi~m xa h('>iva cO's6 kham b~nh' chua b~nh thfmg nh~t b6 sung n('>idung trong hQ'Pd6ng nhung khong trai quy dinh cua phap lu~t v~ bilOhi~m y t~.2. Di~u ki~n d~ ky hQ'Pd6ng kham b~nh, chua b~nh bao hi~m y t~ d6i vai cO's6 kham b~nh,chua b~nh g6m:a) Co du di~u ki~n ho~t d('>ngkham b~nh, chua b~nh thea quy dinh cua phap lu~t v~ khamb~nh, chua b~nh va da duQ'CcO'quan co th~m quy~n c~p gi~y phep ho~t d('>ngkham b~nh,chua b~nh;b) Dam bao vi~c cung lIng thu6c, hoa ch~t, v~t tu Yt~ phil hQ'Pvm ph~ vi ho~t d('>ngchuyenmon cua cO's6 kham b~nh' chua b~nh.Di~u 18. Ky hQ'PdAng kham b~nh, chfra b~nh bao hiim y t~1. TruOng hQ'Pky hQ'Pd6ng kham b~nh, chua b~nh lk d~u:a) CO's6 khcim b~nh, chua b~nh gui 01 b('>h6 sO'thea quy dinh t~i Di~u 16Nghi dinh nay d~ncO'quan bao hi~m xa h('>i;b) Trong thm h~ 30 ngay, k~ tir ngay nh~ du h6 sO'hQ'Pl~ (theo ngay ghi tren d~u cong vand~n), cO' quan bao hi~m xa h('>iphai th\l'c hi~n xong vi~c xem xet h6 sO' va ky hQ'P d6ng.TruOng hQ'Pkhong d6ng y kY hQ'Pd6ng kham b~nh, chua b~nh bao hi~m y t~ thi phai co vanban tra 1m va neu r5ly do.2. Thm h~ co hi~u h,rcClla hQ'Pd6ng khcim b~nh, chua b~nh bao hi~m y t~:a) Thai h~ cua hQ'Pd6ng tir ngay 01 thang 01 d~n h~t ngay 31 thang 12 cua nam, t6i dakhong qua 36 thang;b) D6i vai hQ'Pd6ng ky lk d~u, thai h~ cua hQ'Pd6ng duQ'c tinh k~ tir ngay ky d~n h~t ngay31 thang 12 cila nam thm h~ hQ'Pd6ng h~t hi~u h,rc, t6i da khong qua 36 thang;c) TruOng hQ'Pky hQ'Pd6ng kham b~nh, chua b~nh bao hi~m y tS hfuIg nam, cO's6 kham b~nh,chua b~nh va cO'quan bao hi~m xa h('>ihoan thanh vi~c ky hQ'Pd6ng nam sau truac ngay 31thang 12 Cllanam do.Tnr6e khi hQ'Pd6ng hth hieu h,re 10 ngay, n~u cO'sa kham b~nh, chua b~nh va cO'quan baohi~m xa h('>ithoa thu~ gia h~ va thoa thu~ ti€p wc thl,l'chi~n hQ'Pd6ng bfuIg m('>tph\l l\lchQ'Pd6ng thi ph\ll\lc do co gia tri phap ly, tm khi co thoa thu~ khac.3. Cae khoim chi phi kham b~nh, chera b~nh d6i vai trtrOng hQ'Pnguai tham gia bao hi~m y t~d~n kham b~nh, chua b~nh truac ngay 01 thang 01 nhung ra vi~n k~ tiI ngay 01 thang 01 thithl,l'chi~n nhu sau:a) TruOng hQ'PcO's6 kham b~nh, chua b~nh ti€p wc ky hQ'Pd6ng kham b~nh, chua b~nh baohi~m y t~ thi tinh vao chi phi kham b~nh, chua b~nh nam sau;b) TruOng hQ'PcO' s6 kham b~nh, chua b~nh khong ti~p wc ky hQ'Pd6ng kham b~nh, chuab~nh bao hi~m y tS thi Hnh vao chi phi kham b~nh, chua b~nh nam do.4. HQ'Pd6ng kham b~nh, chua b~nh baa hi~m y t€ phai quy dinh ro phuang thuc thanh toanchi phi kham b~nh, chua b~nh bao hi€m y t~ phil hQ'Pvai di~u ki~n cua cO' s6 kham b~nh,chua benh.5. Cac 'ben co trach nhi~m bao dam quy~n 19i ctla ngum b~nh co the bao hiSm y t~ thea quydinh cua phap lu~t v~ bao hi~m y t~ va khong lam gian do~ vi~c kham b~nh, chua b~nh d6ivm ngum b~nh co the bao hi€m y t~.

11

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d) Gill d~ lieu dien tu v~ chi phi kham benh, chua benh bao hiem y t~ dS nghi thanh toancham nhat trong vong 07 ngay lam viec kS tu ngay k~t thuc viec kham benh, chua benh d6ivoi ngiroi benh thea quy dinh cua BQtnrong BQY t~.Di~u 22. Sila d6i, b6 sung hC}'Pdang1. Trong qua trinh thtrc hien hop d6ng kham benh, chua benh bao hiem y tS, neu ben nao coyeu d.u sua d6i, b6 sung noi dung hop d6ng thi phai thong bao bang van ban cho ben kia bi~ttruce it nhat 30 ngay vS nhtrng nQi dung can sua d6i, b6 sung tai hop d6ng kharn benh, chuabenh bao hiem y t~.2. Trong tnrong hop hai ben thea thuan diroc nQi dung sua d6i, b6 sung hop d6ng kham benh,chua benh bao hiSm y tS thi viec sua d6i, b6 sung hop d6ng duqc thvc hi~n bling vi~c Icy k~tph\ll\lc hqp d6ng hofLcgiao kSt hqp d6ng mm.3. Trong truOng hqp hai ben khong th6a thu~ duqc vi~c sua d6i, b6 sung nQi dung hqp d6ngthi ti~p t\lCthvc hi~n hqp d6ng dli giao k~t.Di~u 23. Cae tnrimg hQ1>ehim dU1 hQ1>dang1. CO' sa kham b~nh, chua b~nh ch~ dm ho:;ttdQng, giai thS, pha san hofLcbi thu h6i Gi~yphep ho:;ttdQng.2. Hai ben th6a th$ th6ng nh~t ch~ dm hqp d6ng kham b~nh, chua b~nh bao hiSm y tSthea quy dinh cua phap l~t.3. Trong qua trinh thvc hi~n hqp d6ng kham b~nh, chua b~nh bao hiSm y t~, cO'quan baohiSm xli hQi hofLccO'quan, dan vi, t6 chuc va ca nhan phat hi~n cO'sa kharn b~nh, chua b~nhco hanh vi vi ph:;tmhqp d6ng kharn b~nh, chua b~nh bao hi~rn y tS thi thong bao cho Sa Y t~d6i v6i truOng hqp cO'sa kham b~nh, chua b~nh thuQc ph:;tm vi quan ly clla Sa Y t~ hofLcBQY tS d6i vm tfUOngh9'P cO's6 kham b~nh, chua b~nh thuQc ph:;tmvi quan ly cua BQY tS hofLccO'quan quan ly y t~ Clla bQ nganh d6i vm tfUang hqp cO' s6 kharn b~nh, chua b~nh thuQcph:;tmvi quan ly cua bQ, nganh (sau day gQi tAt la cO'quan quan IY).Trong thm h:;tn05 ngay lam vi~c kS ill ngay nh~n duqc thong bao, cO'quan quan ly co trachnhi~m co van ban dS nghi cO's6 kham b~nh, chua b~nh giai trinh bling van ban cac nQi dunglien quan d~n ki~n nghi vS hanh vi vi ph:;tm.Sau khi nh~n duqc van ban dS nghi giai trinh cua cO'quan quan ly, cO's6 kham b~nh, chuab~nh co trach nhi~rn gUi van ban giai trinh cho cO'quan quan ly kern thea cac bfuIg chUngchUng minh (n~u co).Sau khi nh~ duqc van ban giai trinh cua cO' s6 kham b~nh, chua b~nh, cO'quan quan ly cotrach nhi~rn ph6i hqp vm cO'quan bao hiSm xli hQi cu.ng c~p xem xet, t6 chuc xac minh va kStlu~ d6i v6i kiSn nght vS hanh vi vi ph:;tm.N<)i dung k~t lu~ phai neu ro cO'sa kham b~nh,chua b~nh co hofLckhong co hanh vi vi ph:;tmva bi~n phap kh~c ph\lc h~u qua (nSu co).4. Trong qua trinh thvc hi~n hqp d6ng kham b~nh, chua b~nh bao hiSm y tS cO'quan, dan vi.t6 chuc va ca nhan phat hi~n cO'quan bao hi~rn xli hQi co hanh vi vi ph:;trn hqp d6ng khamb~nh, chua b~nh bao hiSrn y tS thi thong bao eho cO'quan quan IY.Trong thm h:;tn05 ngay lam vi~c kS ill ngay nh~ duqc thong bao, cO'quan quan ly co trachnhi~rn co van ban dS nghi cO'quan bao hiSrn xli hQi giai trinh bling van ban cac nQi dung lienquan d~n ki~n nghi vS hanh vi vi ph~rn.Sau khi nh~ duqc van ban dS nghi giai trinh cua cO'quan quan ly, cO'quan bao hiSrn xli hQi cotrach nhi~m gui van ban giai trinh cho cO'quan quan ly kern theo cac bftng chUng chUng rninh(nSu co).Sau khi nh~ duqc van ban giai trinh cua cO'quan bao hiSrn xli hQi, cO'quan quan ly co trachnhi~rn ph6i hqp vm cO'quan bao hiSrn xli hQi cling c~p (tfUang hqp cO'quan bao hiSm xli hQicling dp la cO'quan bi kiSn nghi thi rnai cO'quan bao hiSrn xii hQi dp tren) xem xet, t6 chucxac minh va kSt lu~.n d6i v6i kiSn nghi v~ hanh vi vi phC;lIIl.NQi dung ket lu~ phai neu ro cO'quan bao hiSrn xli hQi co hofLckhong co hanh vi vi ph:;tmva bi~n phap kh~c ph\lc h~u qua (n~uco).

ChlfO'Dg VI

13

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THANH ToAN em rnt KHAM B¢NH, cmr A B¢NHGIUA co QUAN BAo HIEMxA HQI vA co sa KHAMB¢NH, cmr A B¢NHDiiu 24. Thanh toan theo gia djch vy.1. Thanh toan thea gia dich vu la phuong thirc thanh toan chi phi kham benh, chua benh tr~nco sa gia dich vu kham benh, chua benh do e<lpc6 thfun quyen quy dinh va chi phi ve thuoc,h6a chAt, v~t tu y tS, mau, chS pham mau chua duoc tinh vao gia dich vu duoc sir dung chonguoi benh tai co sa kham benh, chua benh. .2. Thanh toan thea gia dich vu kham benh, chua benh diroc ap dung de thanh toan chi phikham benh, chua benh bao hiem y tS, tnr chi phi cua cac dich vu y t~ da duoc thanh toan theaphirong thirc khac.3.~guyent~cthanhtoan:a) Gia dich vu kham benh, chua benh bao hiem y tS ap dung thong nhAt d6i vm cac b~nh vi~ncling hCJ.llgtren toan qu6c;b) Chi phi thu6c, h6a chAt, v~t tu y t~ chua tinh vao gia dich Vl,l kham b~nh, chua b~nh thithanh toan thea gia mua thea quy dinh cua phap lu~t v~ dAuthftu;c) Chi phi mau va ch~ phAmmau thanh toan thea huang dful cua BQtruang BQY tS.4. Tfmg muc thanh toan chi phi kham b~nh, chua b~nh bao hi~m y t~ cho co sa kham b~nh,chua b~nh hang nam dUQ'ctinh thea cong thuc sau:T= [Tn-IX k] thu6c, h6a chftt + [Tn-IX k] v~t tu y te + [Tn-I] mau, che phdm milU +[T n-l] dich VII kMm b~nh, chua benh

+CnTrong d6:a) T la t6ng muc thanh toan chi phi kham b~nh, chua b~nh bao hi~m y tS t<;tico sa bkg t6ngmuc thanh toan chi phi kham b~nh, chua b~nh nQi tm va t6ng muc thanh toan chi phi khamb~nh, chua b~nh ngo<;titn};b) Tn_Ila chi phi kham b~nh, chua b~nh bao hi~m y t~ nam truac li~n k~ t<;tico sa da duQ'Ccoquan bao hi~m xa hQi thfun dinh quySt toan;c) k Ia h~ s6 di~u chinh do bi~n dQng v€ gia thu6c, h6a chAt, v~t tu y tS t<;tico sa kham b~nh,chua b~nh tuong lIng cua timg ySu t6 thu6c, h6a chAt, v~t tu y t~ chua duQ'c tinh vao gia dichV\l, khong bao g6m cac chi phi da duQ'ctinh trong Cn.d) Cn la phftn chi phi phat sinh tang hol[tcgiam trong nam t<;tico sa do cac nguyen nhan: apdl)Ilg dich Vl,l ky thu~t mai; b6 sung thu6c, h6a chAt mai, v~t tu y t~ mai; ap d\lllg gia dich Vl,lkham b~nh, chua b~nh bao hi~m y t~ mm; gia mau, chS phfun mau mm; di~u chinh hCJ.llgb~nhvi~n; d6i tUQ'llgngum c6 the bao hi~m y ts; thay d6i phCJ.ffivi ho<;ttdQng Clla co sa kham b~nh,chua b~nh thea quy~t dinh cua cApc6 thfun quy~n (n~u c6); thay d6i mo hinh b~nh t~t; s6 luQ'tkham b~nh, chua b~nh. Chi phi nay duQ'c t6ng hqp vao chi phi tht;rCt~ d~ lam co s6 tinh t6ngmuc thanh toan chi phi kham b~nh, chua b~nh bao hi~m y tS cho co sa kham b~nh, chua b~nh.5. Quy bao hi~m y t~ thanh toan chi phi kham b~nh, chua b~nh thea bao cao quySt toan namcua C(J sa kham b~nh, chua b~nh da dUQ'cthAm dinh nhung khong vuQ't t6ng muc thanh toanchi phi kham b~nh, chua b~nh bao hi~m y t~ duQ'c xac dinh thea quy dinh t~i khoan 4 f)i~unay.6. HfuIg nam, can cll chi s6 gia ella timg y~u t6 thu6c, h6a chAt,v~t tu y tS do T6ng C\lCTh6ngke cong b6, BQY t~ thong bao M s6 k sau khi th6ng nhAtvm BQTai chinh.Di~u25. Thanh toan theo dinh suit1. Thanh toan thea dinh suAt duQ'c ap dl)Ilg d6i vai co sa kham b~nh, chua b~nh c6 khamb~nh, chua b~nh bao hi~m y tS ngo<;titm.2. PhCJ.ffivi thanh toan thea dinh suAt, bao g6m chi phi trong phCJ.ffivi duQ'c huang va muchuang cua nguCric6 the bao hi~m y tS dang ky kham b~nh, chua b~nh ban dftu t~i co s6 khamb~nh, chua b~nh va nguai c6 the bao hi~m y te dang ky kham b~nh, chua b~nh ban ddu tCJ.icacco s6 kharn b~nh, chua b~nh khac dSn kham b~nh, chua b~nh t<;tico s6 kham b~nh, chua b~nhd6.3. Cac b~nh, nh6m b~nh, dich V\l y t~, chi phi khong thuQc phCJ.ffivi thanh toan theo dinh suAtdo BQtruang BQY tS quy dinh.4. Quy dinh suAt giao cho co sa kham b~nh, chua b~nh bao hi~m y tS hfuIg nam phai bao damtrong ph~ vi quy dinh suAt giao cho tinh va trong ph~ vi quy dinh suAt toan qu6c.

14

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3. Thanh toan chi phi kham benh, chua benh d6i voi nguoi benh co thoi gian tham gia baohiem y t~ 05 nam lien tuc tro len va co s6 tien cling chi tra chi phi kham benh, chua benhtrong nam Ian han 06 thang luang co sa thee quy dinh tai diSm d khoan 1 DiSu 14 Nghi dinhnay: , , " ,a) Truong hQ'Pngiroi benh co so tien cling chi tra tai mot Ian hoac nhieu lful kham benh, chuabenh tai cling co sa kham benh, chua benh do Ian han 06 thang luang co sa thi co sa khambenh, chua benh khong thu s6 tien cling chi tra Ian han 06 thang luang co sa cua nguoi benh.Co sa kham benh, chua benh co trach nhiem cung dp hoa dan thu d6i voi s6 tien cung chi tradll 06 thang luang co sa d~ ngiroi benh co din cir dS nghi co quan bao hiem xa hQi xac nhankhong phai cung chi tra trong nam do;b) Truong hQ'Pnguoi benh co s6 tiSn cling chi tra liiy k~ trong nam tai chinh t~i cac co sakhfun b~nh, chua b~nh khac nhau ho~c tC;licling mQt co sa khfun b~nh, chua b~nh Ian han 06thang luang co sa th1 nguai b~nh mang chUng tir d6n co quan bao hi€m xa hQinai d.p the baohi€m y t6 d€ thanh toan s6 tiSn cling chi tra Ian han 06 thang luang co sa va nh~n gi~y xacnh~ khong phai cling chi tra trong nam do;c) TruOng hQ'Pngum b~nh co s6 tiSn cling chi tra vuQi qua 06 thang luang co sa duQ'c tinh illngay 01 thang 01, quy bao hi€m y t6 thanh toan tOO% chi phi khfun b~nh chua b~nh trongph~ vi quySn IQ'iclla ngum b~nh k~ tir thm di~m ngum b~nh tham gia du 05 nam lien t\lcd6n h6t ngay 31 thang 12 clla nam do.4. TruOng hQ'Pchuy€n tuy6n khfun b~nh, chua b~nh d6i v6i nguai b~nh dn phai co nhan vieny t6 di kern va co su d\lng thu6c, v~t tu y t6 thee yeu cAu chuyen mon trong qua trinh v~chuy€n, thi chi phi thu6c, v~t tu y t6 duQ'c t6ng hQ'Pvao chi phi di€u tn cua co sa khfun b~nh,chua b~nh chi dinh chuy~n tuy6n.5. TruOng hQ'Pngum b~nh sau khi da di~u tri nQi trU 6n dinh nhung ck phai ti6p t\lc su dl,lllgthu6c sau khi ra vi~n thee chi diM clla co sa khfun b~nh, chua b~nh thee quy diM clla BQtruang BQY t6, quy bao hi€m y t6 thanh toan chi phi thu6c trong ph~ vi dUQ'chuang va muchuang thee ch6 dQ quy dinh. Co sa kham b~nh, chua b~nh t6ng hQ'Pkhoan chi thu6c nay vaochi phi khfun b~nh, chua b~nh cua nguai b~nh tru6c khi ra vi~n.6. TruOng hQ'Pco sa khfun b~nh, chua b~nh khong thl,Ic hi~n duQ'c xet nghi~m c~ lam sang,chfuI doan hinh anh, tham do chuc nang va phai chuy€n ngum b~nh ho~c m~u b~nh phfun d6nco sa khfun b~nh, chua b~nh bao hi€m y t6 ho~c co sa duQ'c c~p co thfun quy~n phe duy~t dlldi€u ki~n thl,Ichi~n d~ thl,Ic hi~n cac dich Vl,l do, thi quy bao hi€m y t~ thanh toan chi phi thl,Ichi~n dich Vl,l trong ph~ vi duQ'c huang va muc huang theo quy dinh cho co sa khfun b~nh,chua b~nh nai chuy~n nguai b~nh, m~u b~nh phfun. Co sa khfun b~nh, chua b~nh chuy€nngum b~nh ho~c m~u b~nh phfun co tnich nhi~m thanh toan chi phi cho co sa kham b~nh,chua b~nh ho~c dan vi thl,Ic hi~n dich Vl,l, sau do t6ng hQ'Pvao chi phi kham b~nh, chua b~nhcua nguai b~nh d~ thanh toan v6i co quan bao hi~m xa hQi.BQ truang BQ Y t6 quy dinh nguyen t~c, danh m\lc xet nghi~m cQ.nlam sang chfuI doan hinhanh, tham do chuc nang duQ'c chuy~n d~n co sa khfun b~nh, chua b~nh ho~c dan vi thl,IChi~ndich Vl,l.7. Thanh toan chi phi khfun b~nh, chua b~nh d6i v6i cac dich Vl,l ky th~t do nhful vien clla cosa khfun b~nh, chua b~nh chuy~n giao kY thu~t thl,Ic hi~n thee chuang trinh chi d~o tuy6n, d~an nfulg cao nang ll,Ic chuyen mon cho co sa khfun b~nh, chua b~nh nh~ chuy~n giao kythu~t, hQ'Pd6ng chuy~n giao ky thu~t thee quy diM clla BQtruang BQY t6:a) TruOng hQ'Pdich Vl,l kY thu~t da duQ'c dp co thfun quySn phe duy~t cho co sa khfun b~nh,chua b~nh nh~ chuy~n giao ky thu~t, quy bao hi~m y t6 thanh tOM thee muc gia dich Vl,l dadUQ'cphS duy~t;b) Truang hQ'Pdich Vl,l k-y thu~t chua duQ'c dp co thfun quySn phS duy~t cho co sa khfunb~nh, chua b~nh nh~ chuy~n giao kY thu~t, co sa kham b~nh, chua b~nh nh~ chuy~n giaoky thu~t co trach nhi~m thong bao bfuIg van ban cho co quan bao hi~m xa hQi ky hQ'Pd6ngkhfun b~nh, chua b~nh bao hi~m y t6 v~ cac dich V\l ky thu~t duQ'c thl,Ic hi~n thee chuangtrinh, d~ an, hQ'Pd6ng d~ lam co sa thanh toan, d6ng thai trinh c~p co thAm quy~n phS duy~tdanh ml,lc ky thu~t d~ lam co sa thl,Ichi~n khi ti~p nh~ ky thu~t Y t~ nay;

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- Mbaohiem y te: Mire d6ng bao hiem y t~ ap dung d6i voi d6i nrong tre em duoi 6 tu6i hoac hocsinh, sinh vien thea quy dinh tai khoan 1 Di~u 7 Nghi dinh nay.- Lea sa: Mire luang co sa tai thai di~m d6ng bao hiem y t~.- Th: S6 thang d6ng bao hiem y t~.Dinh ley 03 thang hoac 06 thang hoac 12 thang, co quan bao hiem xa hoi c6 trach nhiemchuyen s6 tien quy dinh tai diem nay cho co sa giao due hoac co sa giao due ngh~ nghiep vat6ng hop vao quyet toan quy kham benh, chua benh bao hiem y t~.b) 1% tinh tren s6 ti~n d6ng bao hiem y t~ hfuIg thang cho nguoi lao dong tai co sa giao duehoac co sa giao due nghe nghiep, co quan bao hiSm xa hoi c6 trach nhi~m thanh toan khoanchi nay ngay sau khi nh~n duQ'c ti~n d6ng bao hi~m y t~ cua ca sa giao dl,lc ho~c ca sa giaod\lc ngh~ nghi~p.2. S6 ti~n trich d~ l?i cho ca quan, t6 chuc, doanh nghi~p c6 du di~u ki~n thea quy diM t?ikhoan 1 Di~u 34 Nghi dinh nay bing 1% tinh tren s6 ti~n d6ng bao hi~m y t~ hkg thang chongum lao dong t?i ca quan, t6 chuc, doanh nghi~p. Ca quan bao hi~m xa hOi c6 trach nhi~mthanh toan khoan chi nay ngay sau khi nh~ duQ'c tiSn d6ng bao hi~m y t~ cua ca quan, t6chuc, doanh nghi~p.3. S6 tiSn trich d~ l?i cho ngum lam vi~c tren tau daub b~t xa ba:a) Muc chi bkg 10% s6 thu bao hi~m y t~ tinh tren s6 ngum lam vi~c tren tau c6 tham giabao hi~m y t~ d~ mua ill thu6c, thu6c, v~t tu y t~ ph\lc Vl,l sa cc1pcUu, xu tri ban dfru, congthuc tinh nhu sau:S6 ti~n trich = 10% x (Nsf,nguai X Mbaohiem y te x Lea sa x Th)Trongd6:- Nsf,nguai: S6 ngum tham gia bao hi~m y t~ lam vi~c tren tau danh b~t.- Mbaohiem y te: Muc d6ng bao hi~m y t~ d6i vo; ngum thu nh~t trong ho gia dinh thea quy dinht?i di~m e khoan 1 Di~u 7 Nghi dinh nay.- Lea sa: Muc luang ca sa t<,tithm di~m d6ng.- Th: S6 thang d6ng bao hi~m y t~.b) Chu tich Uy ban nhan dan cc1ptinh t6 chuc mua va cc1pcho cac chu tau daub b~t xa ba illthu6c, thu6c, v~t tu y t~. Ca quan bao hi~m xa hoi trich chuy~n s6 ti~n quy dinh t<,tidi~m akhoan nay cho ca quan, t6 chuc duQ'c Chu tich Uy ban nhan dan cfrp tinh giao mua ill thu6c,thu6c, v~t tu y t~; t6ng hqp s6 tiSn da trich chuy~n vao quy~t toan quy kham b~nh, chua b~nh.4. Can cu vao nhu cAuthvc t~ va kha nang can d6i quy bao hi€m y t~, Bo truang Bo Y t~ trinhChinh phu diSu chinh muc trich chuy€n kinh phi chi kham b~nh, chua b~nh trong cong taccham s6c suc khoe ban dfru.Di~u 34. Diiu ki~n, n(H dung chi, thanh quy~t toan kinh phi kham b~nh, chua b~nhtrong cong tac cham soc s....c khoe ban dAu1. Ca sa giao d\lc ho~c ca sa giao dl,lcngh~ nghi~p, ca quan, t6 chuc, doanh nghi~p quy dinht?i di€m b khoan 1 Di~u 31 Nghi dinh m'ty (tm ca sa giao d\lc ho~c ca sa giao dl,lc ngh~nghi~p, ca quan, t6 chuc, doanh nghi~p da ky hQ'Pd6ng kham b~nh, chua b~nh bao hi~m y t~theo quy dinh t?i f)i~u 19 Nghi dinh nay) duQ'c cc1pkinh phi illquy bao hi€m y t~ d€ thvc hi~nkham b~nh, chua b~nh trong cham s6c slre khoe ban d§u khi e6 dtl cac di~u ki~n sau day:a) C6 it nhfrt mot ngum c6 du diSu ki~n hanh nghS kham b~nh, chua b~nh thea quy diM cuaphap l~t vS kham b~nh, chua b~nh lam vi~c chuyen trach ho~c kiem nhi~m trong cong taccham s6c suc khoe ban dfru;b) C6 phong y t~ ho~c phong lam vi~c rieng d€ thvc hi~n vi~c sa cc1pcUu, xU tri ban dfru chocac d6i tuqng do ca sa giao d\lc ho~c ca sa giao d\lc ngh~ nghi~p, ca quan, t6 chuc, doanhnghi~p quan ly khi bi tai n?ll thuang tich, cac b~nh thong thuang trong thai gian hQc t~p, lamvi~c ~i co sa giao d\lc ho~c ca sa ghio d\lc nghe nghi~p, C(J quan, to chuc, doanh nghi~p.2. NOi dung chi:a) Chi mua thu6c, v~t tu y t~ ph\lc V\l sa cc1pcUu, xu tri ban dfru cho tre em, hQc sinh, sinhvien, cac d6i tu<:mgdo co quan, tA chuc, doanh nghi~p quan 1ykhi hi tai n?n thuang tich ho~ccac truang hQ'Pb~nh thong thuang trong thm gian hQc, lam vi~c t?i ca sa giao dl,lcho~c ca sagiao dl,lcnghS nghi~p, ca quan, t6 chuc, doanh nghi~p;

19

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b) Chi mua sam, sua chua trang thiet bi y t~ thong thuong phuc vu cham soc s~c khoe band~u, til tai li~u quan ly h6 so sire khoe tai co sa giao due hoac co sa giao due nghe nghiep, coquan, t6 chirc, doanh nghiep;c) Chi mua van phong pham phuc vu hoat dl)ng kham benh, chua benh trong cong tac chamsoc sire khoe ban d~u.3. Thanh toan, quyet toan kinh phi:a) D6i voi co sa giao due hoac co sa giao due ngh~ nghiep cong l~p thirc hien hach toan cackhoan chi kham benh, chua benh trong cong tac cham soc sire khoe ban d~u vao chi phi thuchien cong tac y t~ tai co sa va quyet toan voi dan vi quan ly dp tren thee quy dinh hien hanh;b) D6i voi co So' giao due hoac co So' giao due nghe nghiep ngoai cong l~p thuc hien h~ch toancac khoan chi kham b~nh, chua b~nh trong cong tac cham soc suc kh6e ban d~u vao chi phicua co So' va quy~t toan vOi dan vi dp tren (n~u co);c) D6i v6i doanh nghi~p, t6 chuc kinh t~ th\fc hi~n rna s6 k~ toan rieng d~ phan anh vi~c ti~pnh~ kinh phi, su dl,lllgkinh phi, khong t6ng hqp vao quySt toan chi phi cua doanh nghi~p, t6chuc kinh t~;d) D6i vOi co quan, dan vi khac thlJc hi~n h~ch toan cac khoan chi kham b~nh, chua b~nhtrong cham soc suc kh6e ban d~u vao chi phi thlJc hi~n cong tac y t~ cua co quan, dan vi vaquySt toan vOi co quan, dan vi quan ly dp tren t[lJC thul)c (n~u co) ho~c co quan tai chinhcling dp thee quy diM hi~n hanh.4. Co sa giao d\lc ho~c co So' giao d\lc ngh~ nghi~p, co quan, t6 chuc, doanh nghi~p duQ'c dpkinh phi chi cho kham b~nh, chua b~nh trong cham soc suc kh6e ban d~u thee quy dinh t~iNghi dinh nay co trach nhi~m su dl,lllg cho cong tac cham soc suc kh6e ban d~u, khong duQ'c~~~~~~~~~~~~~~~~~~~~chuy~n ngu6n sang nam sau ti~p t\lC su dl,lllg,khong phai quy~t toan v6i co quan bao hi~m xiihl)i.Di~u35. QUaD Iy va sir d\lDg quy d.., phODg1. Ngu6n hinh thanh quy dlJ phong:a) S6 ti~n duQ'c trich h~ng nam thee quy dinh t~i di~m b khoim 2 Di~u 31 Nghi dinh nay vadi~m a khoan 3 Di~u 35 Clla Lu~t bao hi~m y t~;b) Cac khoan thu ch~ dong, tr6n dong bao hi~m y t~;c) Ti~n sinh 1m cua ho~t dl)ng d~u tu illquy bao hi~m y t~;d) Ti~n liii ch~ dong, tr6n dong bao hi~m y tS.2. NQi dung su dl,lllgquy dlJ phong:a) B6 sung kinh phi kham b~nh, chua b~nh bao hi~m y tS cho cac tinh, thanh ph6 trong tru<'mghqp s6 thu bao hiSm y t~ danh cho kham b~nh, chua b~nh thee quy dinh t~i khoan 1 f)i~u 31Nghi dinh nay nh6 han s6 chi kham b~nh chua b~nh trong nam. Sau khi th~ dinh quy~t toan,bao hiSm xii hQi Vi~t Nam co trach nhi~m b6 sung toan bQ ph~n kinh phi chenh l~ch nay tirngu6n quy d\f phong.b) Hoan tra ngan sach nha nu6c kinh phi dp trUng the bao hiSm y tS.3. TruOng hQ'Pquy d\f phong khong du d~ b6 sung kinh phi kham b~nh, chua b~nh cho cactinh, thanh ph6 thee quy dinh t?i diSm a khoan 2 £)i~u nay, Bao hiSm xii hQi Vi~t Nam baocao HQi d6ng quan ly Bao hiSm xii hl)i Vi~t Nam phuang an giai quy~t tru6c khi bao cao BI)Y tS, BQTai chinh.BI) Y t~ chu tri, ph6i hQ'Pv6i BQ Tai chinh trinh Chinh phu cac bi~n phap giai quySt d~ baodam du va kip thai ngu6n kinh phi cho kham b~nh, chua b~nh bao hiSm y t~ theo quy dinh.Di~u36. L~p k~ho~ch tai chiDh va quyit toaD1. H~g nam, Bao hiSm xii hQiVi~t Nam l~p k~ ho~ch tai chinh v~ thu, chi quy bao hi~m y t€;chi phi quan ly quy bao hi~m y tS va d~u tu tir s6 ti~n t~ thm nhan r6i cua quy bao hiSm y t~.B9 Tai chinh chu tri, ph6i hQ'PvOi BQY t~ xem xet, t6ng hQ'Ptrinh Thu tu6ng Chinh phu giaoke ho~ch tru chinh.2. H~g ham, tru6c ngay 01 thang 10"Bao hi~m xii hQi Vi~t Nam co trach nhi~m t6ng hQ'Pva1~~bao ~ao quy~t toan quy bao hi~m y t~ nam tru6c thee quy dinh t~i f)i~u 32 cua Lu~t baohiem y teoChU'ongIX

20

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a) Chi dao co quan bao hiern xa hoi cac cap ky hop d6ng VO; cac co sa kham b~OO,chua benhco du di~u kien theo quy dinh tai Nghi dinh nay;b) Chi dao bao hiem xa h<)icac tinh, thanh ph6 chu tri phoi hop voi Sa Y t~, Sa Tai chinh vacac co sa kham benh, chua benh bao hiem y t~ tren dia ban, dia ban giap ranh va cac co quanlien quan giai quyet theo thfun quyen hoac ki~n nghi dp co tham quyen xem xet, xu ly kipthoi cac virong mac phat sinh;c) Chi dao bao hiem xa h<)icac dp cung cap bieu miu, huang din cho Uy ban nhan dan c~pxa trong viec l~p danh sach, quan ly danh sach tham gia bao hiem y t~ theo hQgia dinh;d) Hoan thien M thong cong nghe thong tin dap irng viec tiep nhan, giam dinh va phan h6i kipthai cho co sa kham b~nh, chua b~nh v~ du li~u kham b~nh, chua b~nh bao hi~m y t~; dambao chinh xac, an toan, bao m~t thong tin va quy~n lqi cua cac ben lien quan;d) T6ng hgp, bao cao diM leY, hfuIg nam ho~c bao cao dQt xu~t theo yeu d.u cua co quan quanly nha nuac v~ tinh hinh th\lc hi~n ch~ dQ, chinh sach bao hi~m y t~; tinh hiOOthu, chi, quanly va su d\lI1gquy bao hi~m y t~ va gUi B<)Y t~, BQ Tai chinh d~ t6ng hgp theo quy dinh t~Nghi dinh nay;e) Quy dinh thfun quy~n ky hgp d6ng kham b~nh, chua b~nh bao hi~m y t~ cua co quan baohi~m xa hQi vo; co sa kham b~nh, chua b~nh bao dam phil hgp chuc nang, nhi~m V\l, quy~nh~n va co c~u t6 chuc cua Bao hi~m Xa hQi Vi~t Nam;g) Ch~ nh~t d€n ngay 01 thang 01 nam 2020, co quan bao hi~m xa hQi phai th\lc hi~n phathanh the bao hi~m y t€ di~n tU cho nguai tham gia bao hi~m y t~.6. Uy ban nhan dan tinh, thanh ph6 trlJCthuQc trung uang co trach nhi~m triOOHQi d6ng nhandan cling dp bao dam kinh phi dong bao hi~m y t€ cho cac d6i tugng duqc ngan sach nhamrac dong, h6 trq dong bao hi8m y t~ theo quy dinh hi~n hanh.Di~u 43. Trach nhi~m thi himhCac BQtruang, Thu truang co quan ngang BQ, Thu twang co quan thuQc Chinh phu, Chu tichUy ban nhan dan cac tinh, thanh ph6 trlJc thuQCTrung uang chiu tnich nhi~m thi hanh Nghidinh nay.!.

TM. CHiNH PHUTHUTUONGNoi nhq.n:

- Ban Bi thlETrung 1I0llg Dang;- Thu tu6'ng, cac Pho Thil tu6'ng Chinh phu;- Cac BQ, co quan ngang BQ, co quan thuQc Chinh phil;- HE>ND, UBND cae tinh, thanh ph6 tn,rc thuQc Trung uOllg.- Vl1nphong Trung UOllgva cac Ban cua Dang;- Vl1nphong T6ng Bi thu;- Vlin phong Chu tjch nuoc;- HQi d6ng Dan tQc va cac Oy ban cila Qu6c h(ii;- Vl1nphOng Qu6c Mi;- Toa an nhiin diin t6i eao;- Vi~n Kiem sat nhiin diin t6i cao;- Uy ban GIiim sat tai chinh Qu6c gia;- Kiem toan Nha nuoc;- Ngiin hang Chinh sach Xli hQi;- Ngan hang Phat trien Viet Nam;- Uy ban Trung uOllgMl!t tr<inT6 qu6c Viet Nam;- Co quan Trung uO'Ilgcua cac doan th~;- VPCP: BTCN, cae PCN, Trq Iy TTg, TO£) C6ng TT£)T,cac V\l, C\lC, dOll vj IIVCthuQc, C6ng bao;- Luu: VT, KOVX (3b).

Nguy~n Xuan Phtic

PHVLVC(Kem thea Nghj ajnh so 146120181ND-CP ngay 17 thang 10 niim 2018 eua Chinh phu)

Miu s6 1 !Bang tong hqp doi tugng va kinh phi do ngan sach nha nuac dong, h6 trqkiong bao hi~m y t~

Miu s6 2 lOanh sach d6i tugng tham gia bao hiem y teMiu s6 3 lDanh sach thanh vien hQgia dinh. tham gia bao hiem __y_ teMiu s6 4 Giay tiep nh~ h6 so va hyn tra ket qua cap, cap l~i va d6i the bao hiem y

23

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eMdu so 5 Giay hen kham laiMi1uso 6 Giay chuyen tuyen kham benh, chua benh bao hi em y teMdu so 7 Hgp dong kham benh, chua benh bao hiem y te

Mdu s6 8Danh sach ngiroi tham gia bao hiem y te dang ky kham benh, chua benhban dAu

BHXH .M§u s81

eONG HOA xA H(H cnuNGHiA VI¥T NAMDQcl~p - TV do - Hanh phuc

BANG TONG HOP DOl Tl.)ONG vA KINH PHi DONGAN SACH NHA xtroc. DONG, HO TR<}DONG BAo HIl~M Y TE

Nam 20 ...,

So ti~ndong S8 ti~n S8 ti~n S8 ti~n coBHYT se ti~n A

DAinrong tham gia bao ss the ngan quan taidnh do sach co'quan

sA hi~m y t~ (BHYT) dU'qc BHYT theo nguoi nha tai chinh, chinh, laoTT ngan sach nha nU'(Ycdong, di phat lao dQng dQng con

b6trq hanb mire tham mnrc di phaidong gia dong dong,h6 ;I. chuyenquy trq chuyen

dinhA B 1 2 3 4=2-3 5 6=4-5

Tone sA1 Tre em diroi 6 tuoi2 Nguoi thuoc hQgia dinh

~gheo3 ~ guoi thuoc hQgia dinh c?n

pgheoDoi nrong diroc iNSNN h6ro 100% mire dong- Doi nrong diroc NSNN h6ro ...% muc dong

4 H9C sinh, sinh vien5 Nguai thuQc hQgia dinh lam

pong nghi~p, lam nghi~p,~gu nghi~p va diem nghi~p~o muc s6ng trung binh

6 ........

(Don vi tinh: The' Dong)

NGUm L~P BIEU PHl} TRAeH KIt ToAN ... ngay .... thimg. ...nam 20.../K' h' - h 'A, 1 /K' h' - h 'A, 1 GIAM DOC\' y,g Iro 9vaten/ \' y,g lro 9vaten/ (K' h' Nh A ';I' d~,ly, giro 9, ten va uong au/

Ghi chu: Truang hgp ca nhan, t6 chuc trong ho~c ngoai nu6c h6 trQ'them muc dong chonguai tham gia duQ'cNSNN h6 trQ'mQt ph§n muc dong BHYT, thi phfin kinh phi h6 trQ'CUaca nhan, t6 chuc duQ'c t6ng hgp VflO cQt 3 "S6 ti~n do ngum tham gia BHYT dong".

BHXH .M§u sA2

eONG HOA xA HOI eHU NGHiA VI~T NAM24

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Di)c l~p - Tl}' do - Hanh phuc

DANH sAcH DOl TUQ'NG THAM GIA BAo IDEM Y TENam20 ...

(Kem thea cong van s6 / ngay thdng nam cua BHXH ).... ... ... ... ... ...Ngay Sathe Noi dangMasa thang BHYTdaSTT HQ va ten GiOl Dfa chi kYKCBBHXH nam phathanh ban diusinh trona nam

1 ~guy~n VarrA23...

xctrot L~ BIEU(Ky, ghi rii ho va ten)

... ngay .... thdng. ...nam ....GIAMDOC

(Ky, ghi ro hi) va ten)

Miu sa3DANH sxcn THANH VlEN HQ GIA DiNH

THAM GIA BAo HIEM Y TEH '" hf hd ;.,." .;..,9 v,aten c,u 9: ; So dH;n thoai (neu co) ..So so h<)khau (hoac so tarn tru): .Dia chi: Then (ban, t6 dan ph6) Xa (phuong, thi tran) .Huyen (quan, thi xa, TP thuoc tinh): Tinh (TP): .

Ngay, saCMNDI

STT HQ va ten ~athe thang, GiOl Noi dp gi§y Mai quan h~ The can GhiBHYT nam tinh khai sinh vrri chu hi) cU'tYclHi) chu

sinh chi~uA B 1 2 3 4 5 6 71234...

(Ghi chu: Ngiroi ke khai co the tra ciru Ma s6 bao hiem y te va Ma h<)gia dinh tai dia chi:http://baohiemxahoi.gov.vn )

Toi cam doan nhfrng n<)idung ke khai 1adUng va chiu tnich nhi~m tru&c phap 1u~t

v~ nhUng n<)idung da kS khai...... , ngay .... thang .... nam ....

NGUm KE KHAI(Ky, ghi ro hi) ten)

Miu sa 4CQNG HOA xA HQI CHU NGHiA VI:tJ:TNAM

D(}c l~p - Tlf do - H~nh phucBAo HIEM xA HOI TlNH

PHONG ....IBHXH HUY.~N ....

S6: ..../TNHS ...., ngay .... thang .... nam ....

25

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GIAy TIEP NHAN HO so VAH~N TRA KET QuA cAp, cAp L~I VA DOl THE. BAo HIEM Y TE

Ngiroi nop h6 sa: .Ten dan vi (neu la dai dien cho ~an vi ~<)ph6 sa): Ma dan vi: ·H 't~ ,·th . b' hiem t~~ va, e~ ng:r?1 cur gia ao ie y e: .Ma the bao hiem y te: ..Noi dang ky kham benh, chua benh bao hiSm y t~ ban d~u: ..Dia chi: .S6 dien thoai lien h~: .Email (neu co) .Noi dung yeu c~u giai quyet: .

2. Thai han giai quy~t ho sa thea quy dinh: ngay3. Thai gian nhan h6 sa: ngay ..... thang .... nam .4. Thai gian tra k~t qua giai quyet h6 sa: ngay thang .... nam ....5. Dang ky nhan k~t qua tai:- B<)phan ti~p nhan h6 sa va tra k~t qua D

- 9ua ~ich~V\l~uu c~inh DDia ChInhan ket qua: .6. D6i voi k~t qua la tien giai quyet ch~ d<),dS nghi nhan tai:- Co quan BHXH D

- Nhan qua tai khoan DSo tai khoan: Ngan hang .Ten chu tai khoan: .

NGUm NQP HO SO NGUm TIEP NH~N HO SODil nh9n kit qua giai quyit vao ngay ..... thcmg..... nam .....

NGUmNH~N(Ky va ghi ro h()ten)

HtrO'ng dan:1.Gi~y ti~p nh~n h6 sa va hyn tn\ k~t qua duQ'Cl~p thanh 02 lien, m<)tlien giao ch.o ca nhan,t6 chilc n<)ph6 sa, m<)tlien chuySn cUng h6 sa ch.oB<)ph~ nghi~p V\l sau do luu t~ B<)ph~ti~p nh~ va tra k~t qua.2. Gi~y ti~p nh~ h6 sa va hyn tra k~t qua duQ'Cl~p cho timg 10~ih6 sa theo tirng thu 11,1Chanhchinh (vi d\l: m<)tdan vi n<)p3 lo~i h6 sa khac nhau thi se co 3 gi~y ti~p nh~ h6 sa va hyn trak~t qua).3. T~i ph~ll n<)idung yeu du giai quy~t: Ghi tom tit yeu du giai quy~t thu tl,lchanh chinh.M(Jt s6 truerng h(lJJ cdn luu y:a) Truang hqp ca nhan yeu du c&pl~i, g<)p,d6i, diSu chinh thong tin da ghi tren the bao hiSrny t~: vien chile B<)ph~n ti~p nh~n h6 sO'va tra k~t qua ghi d~y du n<)idung rna ca nhan yeuc~u giai quy~t; d6ng thai ghi ma the bao hiJm y Ii cil dJ sir d{lngPhiiu hfn thay thi the baohiJm y ti khi di kham brnh, chira brnh;b) Truang hqp dan vi yeu c~u c&pl~i, g<)p,d6i, diSu chinh thong tin da ghi tren the bao hiemy t~: vien chilc B<)ph?n ti~p nh~ h6 sa va tra k~t qua kiem tra tinh d~y du, hqp l~ cua h6 sakern thee Ta khai cung c&pva thay d6i thong tin nguai tham gia bao hiem y t~.c) Truang hqp ngum tham gia bao hiSm y t~ dS nghi c&pGi~y chUng nh~ khong cung chi tratrong nam co thai gian tham gia ba.o hiSrn y t~ (y nhiSu nai khac nhau ghi 0\1 th~ ten dan vitham gia bao hi~m y t~, bao hi~rn xa h<)itinhlthanh ph6 nai da dong bao hiSm y t~.

26

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4. Ca nhan dang ky nhan k~t qua tnrc ti~p tai co quan bao hiem xa he>i,khi d~n nhan k~t quala ti~n giai quyet ch~ de>bao hiem y t~, vien chirc be>phan ti~p nhan h6 sa va tra k~t quahu6ng dful ca nhan nhu sau:a) Nguoi huong ch~ de>true tiep nhan: cung cftp gi~y hen va chirng minh nhan dan.b) Ngiroi khac nhan thay:- N~u la than nhan cua nguoi hirong ch~ de>:cung cap gi~y hen, chirng minh nhan dan giay to'clnrng minh la than nhan cua ngiroi huong bao hi~m y t~ (ban sao s6 he>khau hoac gifty khaisinh hoac gifty chimg sinh hoac gifty dang ky k~t hon ...)- N~u la ngiroi giam he>:cung cftp giay hen, clnrng rninh nhan dan gifty to' clnrng rninh la giamhe>duong nhien clla ngu0'i hUOngbao hi~m y t~ (ban sao s6 he>kh§.uhoi)c gifty khai sinh hoi)cgifty chUng sinh hoi)c gifty dang ky k~t hon ...). Trong truang hqp khong co ngu0'i giam he>duang nhien thea quy dinh Cllaphap 1u~tthi cung cftp gifty hyn, chUng minh nhan dan, quy~tdinh cong nh~ vi~c giam he>cua cftp co thftm quy~n.- N~u khong phai la than nhan hoi)c ngu0'i giam he>neu tren: cung cftp gifty hyn, chUng minhnhan dan, gifty uy quy~n thea quy dinh cua phap lu~t hi~n hanh./.

co QUAN Cm) QuAN(ByT/SyT/ ....)

TEN CO Sa KHAM BENHcHfJ' A B"t:NH .

Miu sa 5CQNG HOA xA HQI CHiT NGIDA VI"t:T NAM

Dc}cI,p - Tl! do - H~nh phuc

S6: .

GIAy m:N KHAM L~IHe;> ten ngum b~nh: Nam 0 Nii 0Sinh ngay: .1 I .Dia chi: .S6 the bao hi~m y t~ :I I I IH~ sir d\lllg: Til ...1.. .1 D~n ...I...!....Ngay kham b~nh: ...1.. .1 .Ngay vaG vi~n: ...I...!. Ngay ra vi~n: ...1.. .1 .Ch§.n doan: .

Benh kem thea: .H~n kham l~i VaGgi0' ngay thang nam ,ho~c d~n bAtky thm gian nao truacngay hyn kham l~i n€u co dftu hi~u (tri~u chUng) bftt thuang.Gifty hyn kham l~i chi co gia tri Slr d\lllg 01 1fintrong thm h~ 10 ngay lam vi~c, k~ til ngayhyn kham l~i'/'

BAc si, y si KHAM B"t:NH(Ky ten)

"'" ngay .., thimg .... nam ..,DAI DIEN CO Sa KHAM BENH cHfJ' A. . ~

BENH(Ky ten, ·dong ddu)

Miu sa 6co QUAN CHU QuAN

(BYT/SYT..)TENco soKIIAMB~NH, CHUA B~NlI

S6: .....I20...IGCT

CONG HOA xA HOI CHU NGHiA Vn:T NAMf)qc I~p - Tl! do - H~nh phuc

~ ~So Ho sO': .Vito sa chuy~n tuySn~so: .....

GIAy CHUYEN TUYEN KHAM B"t:NH, CHit A B"t:NH BAo HIEM y TE

27

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" Kinh giri: .Co sa kham benh, chua benh: tran trong gi6,i thieu:- HQva ten nguoi benh: Nam!Nu: Tuoi: .- Dia chi: .- D§.u tQc: Quoc tich: .N h~ hie N . l' .~_ g eng ¥p: en am Vl¥C .S6 the:I IHan su dung: .Da duoc kham benh/dieu tri:+ Tai: · (Tuyen ) Tir ngay I ./ d~n ngay ./ ./ .+ Tai: (Tuyen ) Tir ngay .l .1 d~n ngay .1 .1 .TOMTATB~NHAN- Dftu hieu Him sang: .........................................................................................................................................................................................................................................................................................

J.. ?, ..... "1~ ,- Ket qua xet nghiem, C;;tnam sang: · .................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................- Chc1ndoan: ·.·····················································

- Phuong phap, thu thuat, kY thuat, thuoc da su dung trong di~u tri: ..·························..·..·............................................................................................................................................

.............................................................................................................................................

.............................................................................................................................................

.............................................................................................................................................- Tinh trang nguoi benh luc chuyen tuyen: ........................................................................................................................................................................................................................................................................................................................................................................................................................................-Li do chuyen tuyen: Khoanh trim vao ly do chuyen tuyen phil hop sau day:1. Du di~u kien chuyen tuyen.2. Theo yeu du cua nguoi benh hoac nguoi dai dien hQ'Pphap cua ngum b~nh.- Huang di~u tri: .....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

A :..).,. ., " , .....- Chuyen tuyen hot: gw phut, ngay thang nam 20 .- Phu~g ti~? v~ chu~~n: .~ : : : ,..: : ~ ;0 .

- HQ ten, chuc danh, tnnh dQchuyen mon cua nguen hQ tong: .............................................................................................................................................

Y, BAc si KHAM, DIEU TRJ(Ky va ghi ro h9 ten)

Ngay .... thang .... niim 20...NGuffi CO THAM QUYEN CHUYEN

TUYEN(Ky ten, dong ddu)

- "Mau so 7CONG HOA xA HOI cHiJ NGHiA VI~T NAM

DQc l~p - TV do - H,nh phuc

HC}PDONG KHAM B~NH, CHUA B~NH BAo HIEM Y TE28

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4. Trong thai gian tranh chap, hai ben vin phai bao dam khong lam gian doan viec kharnbenh, chua benh cua nguoi tham gia bao hiem y t6.5. Truong hop co thay d6i hoac cham dirt hop d6ng thirc hien thea quy dinh tai di~m e khoan2 Di~u 25 cua Luat bao hiem y t6, Di~u 22 va 23 Nghi dinh s6 ....l2018/ND-CP.Di~u 8. Cam k~t chung1. Hai ben cam k~t thirc hien dung cac di~u khoan thea thuan trong hop d6ng va cac quy dinhcua phap luat,2. Cac thong bao va thea thuan duoc thuc hien bang van ban gui qua biru dien hoac thu diennr thea dia chi neu trong Hop d6ng nay.3. Hai ben thong nhAtph6i hop trong viec ling dung cong nghe thong tin d~ tao thuan loitrong giam dinh va thanh quyet toan chi phi kham benh, chua benh bao hiem y t6.4. Cac ben khong duQ'c cung cApho~c dua thong tin lam anh hucmg d6n uy tin va quy~n lQ'icua cac ben, anh hUCmgdSn chinh sach, phap lu~t v~ bao hi~m y t6.5. Khi th\Ic hi~n cong tac kiSm tra, ben A phai thong bao cho ben B tru6c v~ thai gian, n<)idung ki~m tra.6. Cac thea thu~ khac (n6u co) phai duQ'c hai ben ghi nh~ thanh cac Ph\ll\lc cua Hqp d6ngnay nhung khong trai quy dinh cua phap lu~t.Hqp d6ng nay duQ'c l~p thanh 04 ban co gia tri nhu nhau, m6i ben giu 02 ban. Hqp d6ng cohi~u l\Ic kS illngay hai ben kY k6t va k6t thuc khi hai ben dii th\Ic hi~n xong nghla V\lva thanhtoan cho ben B.

D~I DI~N BEN A(Ky, ghi ro h() va ten, dong ddu) (Ky, ghi ro h() va ten, dong ddu)

Ghi chu:(1): s6 hqp d6ng dUQ'cdanh thea s6 thu tlJ hqp d6ng trong m<)tnam, bftt dllu ill s6 01 vao ngaydllu nam va kch thuc vao ngay 31 thang 12 nam k6t thuc hqp d6ng.(2): ghi thea Quy~t dinh thanh l~p don vi ho~c QuySt dinh phe duy~t ph~m vi chuyen man cuadan vi.(3): ghi theo QuySt dinh thanh l~p dan vi.(4), (5): ghi trong truOng hQ'Phai ben cll' d~i di~n cho Giam d6c ky HQ'Pd6ng.l.Tuy thea di~u ki~n cua co sa kham b~nh, chua b~nh, co quan bao hiSm xii h<)iva co sa khamb~nh, chua b~nh th6ng nhAt b6 sung n<)idung trong hqp d6ng nhung khong trai quy dinh cuaphap lu~t v~ bao hi~m y tS.I.

- .(Miu so 8BAo HIEM xA HOI VIl~:TNAMBAo IDEM xA HQI tinh/huy~n ...

DANH SACH NGUm THAM GIA BAo HIEM Y TIt DANG lIT KHAM B~NH,CHUA BENH BAN DAu TAL .. (Ten co sa kham chua benh). .

STT Hq va tenTuoi Dia chi Mii the BHYT

Ghi chuNam Nil

123456...

Ngay ..... thimg ..... niim .....(Ky, h() va ten, dong ddu)

Ghi chu: Danh sach thea mfiu nay dUQ'cchuySn d8n co sa kham b~nh, chua b~nh bftng filedi~n illho~c ban co ky ten dong dAucua co quan BHXH.

31


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