CU HI N THI V AP N Phn Chnh sch Bo him y t (BHYT) Cu 1.

Hy nu khi nim v Bo him y t, Qu BHYT, ngun hnh thnh qu BHYT ti Vit Nam? Tr li: Khi nim: Bo him y t l hnh thc bo him c p dng trong lnh vc chm sc sc khe, khng v mc ch li nhun, do Nh nc t chc thc hin v cc i tng c trch nhim tham gia theo quy nh ca Lut ny. Qu BHYT, ngun hnh thnh: Qu bo him y t l qu ti chnh c hnh thnh t ngun ng bo him y t v cc ngun thu hp php khc. Cu 2. Lut BHYT quy nh vic s dng Qu BHYT nh th no? Tr li: Qu BHYT c s dng chi tr chi ph khm bnh, cha bnh cho ngi tham gia bo him y t, chi ph qun l b my ca t chc bo him y t v nhng khon chi ph hp php khc lin quan n bo him y t. Cu 3. Chnh sch bo him y t ti Vit Nam c thc hin da trn cc nguyn tc no? Tr li: Nguyn tc bo him y t 1. Bo m chia s ri ro gia nhng ngi tham gia bo him y t. 2. Mc ng bo him y t c xc nh theo t l phn trm ca tin lng, tin cng, tin lng hu, tin tr cp hoc mc lng ti thiu ca khu vc hnh chnh (sau y gi chung l mc lng ti thiu). 3. Mc hng bo him y t theo mc bnh tt, nhm i tng trong phm vi quyn li ca ngi tham gia bo him y t. 4. Chi ph khm bnh, cha bnh bo him y t do qu bo him y t v ngi tham gia bo him y t cng chi tr. 5. Qu bo him y t c qun l tp trung, thng nht, cng khai, minh bch, bo m cn i thu, chi v c Nh nc bo h. Cu 4. Lut BHYT ti Vit Nam c ban hnh khi no? C quan no thc hin chc nng qun l nh nc v BHYT? C quan no c chc nng t chc thc hin chnh sch BHYT? Tr li: Lut BHYT c Quc hi nc Cng ho x hi ch ngha Vit Nam thng qua ngy 14/11/2008 v c hiu lc thi hnh t ngy 01/7/2009. C quan qun l nh nc v bo him y t 1. Chnh ph thng nht qun l nh nc v bo him y t.
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2. B Y t chu trch nhim trc Chnh ph thc hin qun l nh nc v bo him y t. 3. B, c quan ngang b trong phm vi nhim v, quyn hn ca mnh phi hp vi B Y t thc hin qun l nh nc v bo him y t. 4. U ban nhn dn cc cp trong phm vi nhim v, quyn hn ca mnh thc hin qun l nh nc v bo him y t ti a phng. Cc c quan c chc nng t chc thc hin chnh sch BHYT: 1. B Y t 2. B Ti chnh. 3. U ban nhn dn cc cp. 4. T chc Bo him y t. Cu 5. Chc nng qun l nh nc v BHYT ca B Y t bao gm nhng ni dung g? Tr li: Trch nhim ca B Y t v bo him y t Ch tr, phi hp vi cc b, c quan ngang b, c quan, t chc c lin quan thc hin nhim v sau y: 1. Xy dng chnh sch, php lut v bo him y t, t chc h thng y t, tuyn chuyn mn k thut y t, ngun ti chnh phc v cng tc bo v, chm sc v nng cao sc khe nhn dn da trn bo him y t ton dn; 2. Xy dng chin lc, quy hoch, k hoch tng th pht trin bo him y t; 3. Ban hnh danh mc thuc, vt t y t, dch v k thut thuc phm vi c hng ca ngi tham gia bo him y t v cc quy nh chuyn mn k thut lin quan n khm bnh, cha bnh bo him y t; 4. Xy dng v trnh Chnh ph cc gii php nhm bo m cn i qu bo him y t; 5. Tuyn truyn, ph bin chnh sch, php lut v bo him y t; 6. Ch o, hng dn t chc trin khai thc hin ch bo him y t; 7. Thanh tra, kim tra, x l vi phm v gii quyt khiu ni, t co v bo him y t; 8. Theo di, nh gi, tng kt cc hot ng trong lnh vc bo him y t; 9. T chc nghin cu khoa hc v hp tc quc t v bo him y t. Cu 6. B Ti chnh c trch nhim nh th no trong qun l nh nc v BHYT? Tr li: Trch nhim ca B Ti chnh v bo him y t
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1. Phi hp vi B Y t, c quan, t chc c lin quan xy dng chnh sch, php lut v ti chnh lin quan n bo him y t. 2. Thanh tra, kim tra vic thc hin cc quy nh ca php lut v ch ti chnh i vi bo him y t, qu bo him y t. Cu 7. Trch nhim ca y ban nhn dn cc cp i vi BHYT? Tr li: Trch nhim ca U ban nhn dn cc cp v bo him y t 1. Trong phm vi nhim v, quyn hn ca mnh, U ban nhn dn cc cp c trch nhim sau y: a) Ch o t chc trin khai thc hin chnh sch, php lut v bo him y t; b) Bo m kinh ph ng bo him y t cho cc i tng c ngn sch nh nc ng hoc h tr theo quy nh ca Lut ny; c) Tuyn truyn, ph bin chnh sch, php lut v bo him y t; d) Thanh tra, kim tra, x l vi phm v gii quyt khiu ni, t co v bo him y t. 2. Ngoi vic thc hin trch nhim theo quy nh trn , U ban nhn dn tnh, thnh ph trc thuc trung ng cn c trch nhim qun l, s dng mt phn ngun kinh ph kt d theo quy nh ca Lut BHYT. Cu 8. Trch nhim ca BHXH Vit Nam trong t chc v thc hin chnh sch BHYT? Tr li: Trch nhim ca t chc bo him y t 1. T chc bo him y t c chc nng thc hin ch , chnh sch, php lut v bo him y t, qun l v s dng qu bo him y t. 2. Chnh ph quy nh c th v t chc, chc nng, nhim v v quyn hn ca t chc bo him y t. Cu 9. Hy nu quyn hn ca BHXH Vit Nam ca t chc thc hin chnh sch bo him y t ? Tr li: Quyn ca t chc bo him y t 1. Yu cu ngi s dng lao ng, i din ca ngi tham gia bo him y t v ngi tham gia bo him y t cung cp y , chnh xc thng tin, ti liu c lin quan n trch nhim ca h v vic thc hin bo him y t. 2. Kim tra, gim nh vic thc hin khm bnh, cha bnh bo him y t; thu hi, tm gi th bo him y t i vi cc trng hp quy nh ti iu 20 ca Lut ny.

3. Yu cu c s khm bnh, cha bnh bo him y t cung cp h s, bnh n, ti liu v khm bnh, cha bnh phc v cng tc gim nh bo him y t. 4. T chi thanh ton chi ph khm bnh, cha bnh bo him y t khng ng quy nh ca Lut ny hoc khng ng vi ni dung hp ng khm bnh, cha bnh bo him y t. 5. Yu cu ngi c trch nhim bi thng thit hi cho ngi tham gia bo him y t hon tr chi ph khm bnh, cha bnh m t chc bo him y t chi tr. 6. Kin ngh vi c quan nh nc c thm quyn sa i, b sung chnh sch, php lut v bo him y t v x l t chc, c nhn vi phm php lut v bo him y t. Cu 10. Hy nu cc hnh vi nghim cm trong hot ng BHYT Tr li: Cc hnh vi b nghim cm 1. Khng ng hoc ng bo him y t khng y theo quy nh ca Lut ny. 2. Gian ln, gi mo h s, th bo him y t. 3. S dng tin ng bo him y t, qu bo him y t sai mc ch. 4. Cn tr, gy kh khn hoc lm thit hi n quyn, li ch hp php ca ngi tham gia bo him y t v ca cc bn lin quan n bo him y t. 5. C bo co sai s tht, cung cp sai lch thng tin, s liu v bo him y t. 6. Li dng chc v, quyn hn, chuyn mn, nghip v lm tri vi quy nh ca php lut v bo him y t. Cu 11. Hy nu cc nhm i tng c trch nhim tham gia BHYT theo qui nh ca Lut BHYT? Tr li: i tng tham gia bo him y t 1. Ngi lao ng lm vic theo hp ng lao ng khng xc nh thi hn, hp ng lao ng c thi hn t 3 thng tr ln theo quy nh ca php lut v lao ng; ngi lao ng l ngi qun l doanh nghip hng tin lng, tin cng theo quy nh ca php lut v tin lng, tin cng; cn b, cng chc, vin chc theo quy nh ca php lut (sau y gi chung l ngi lao ng). 2. S quan, h s quan nghip v v s quan, h s quan chuyn mn, k thut ang cng tc trong lc lng Cng an nhn dn. 3. Ngi hng lng hu, tr cp mt sc lao ng hng thng.

4. Ngi ang hng tr cp bo him x hi hng thng do b tai nn lao ng, bnh ngh nghip. 5. Ngi thi hng tr cp mt sc lao ng ang hng tr cp hng thng t ngn sch nh nc. 6. Cn b x, phng, th trn ngh vic ang hng tr cp bo him x hi hng thng. 7. Cn b x, phng, th trn ngh vic ang hng tr cp t ngn sch nh nc hng thng. 8. Ngi ang hng tr cp tht nghip. 9. Ngi c cng vi cch mng. 10. Cu chin binh theo quy nh ca php lut v cu chin binh. 11. Ngi trc tip tham gia khng chin chng M cu nc theo quy nh ca Chnh ph. 12. i biu Quc hi, i biu Hi ng nhn dn cc cp ng nhim. 13. Ngi thuc din hng tr cp bo tr x hi hng thng theo quy nh ca php lut. 14. Ngi thuc h gia nh ngho; ngi dn tc thiu s ang sinh sng ti vng c iu kin kinh t - x hi kh khn, c bit kh khn. 15. Thn nhn ca ngi c cng vi cch mng theo quy nh ca php lut v u i ngi c cng vi cch mng. 16. Thn nhn ca cc i tng sau y theo quy nh ca php lut v s quan Qun i nhn dn, ngha v qun s, Cng an nhn dn v c yu: a) S quan, qun nhn chuyn nghip thuc Qun i nhn dn ang ti ng; h s quan, binh s ang phc v trong Qun i nhn dn; b) S quan, h s quan nghip v v s quan, h s quan chuyn mn, k thut ang cng tc trong lc lng Cng an nhn dn; h s quan, chin s Cng an nhn dn phc v c thi hn; c) S quan, qun nhn chuyn nghip ang lm cng tc c yu ti Ban C yu Chnh ph v ngi ang lm cng tc c yu hng lng theo bng lng cp bc qun hm s quan Qun i nhn dn v bng lng qun nhn chuyn nghip thuc Qun i nhn dn nhng khng phi l qun nhn, cng an nhn dn. 17. Tr em di 6 tui. 18. Ngi hin b phn c th ngi theo quy nh ca php lut v hin, ly, ghp m, b phn c th ngi v hin, ly xc. 19. Ngi nc ngoi ang hc tp ti Vit Nam c cp hc bng t ngn sch ca Nh nc Vit Nam. 20. Ngi thuc h gia nh cn ngho. 21. Hc sinh, sinh vin.
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22. Ngi thuc h gia nh lm nng nghip, lm nghip, ng nghip v dim nghip. 23. Thn nhn ca ngi lao ng quy nh ti khon 1 iu ny m ngi lao ng c trch nhim nui dng v sng trong cng h gia nh. 24. X vin hp tc x, h kinh doanh c th. 25. Cc i tng khc theo quy nh ca Chnh ph. Cu 12. Hy nu trch nhim v quyn hn ca ngi s dng lao ng v thc hin ch BHYT i vi ngi lao ng? Tr li: Quyn ca t chc, c nhn ng bo him y t 1. Yu cu t chc bo him y t, c quan nh nc c thm quyn gii thch, cung cp thng tin v ch bo him y t. 2. Khiu ni, t co hnh vi vi phm php lut v bo him y t. Trch nhim ca t chc, c nhn ng bo him y t 1. Lp h s ngh cp th bo him y t. 2. ng bo him y t y , ng thi hn. 3. Giao th bo him y t cho ngi tham gia bo him y t. 4. Cung cp y , chnh xc thng tin, ti liu c lin quan n trch nhim thc hin bo him y t ca ngi s dng lao ng, ca i din cho ngi tham gia bo him y t khi c yu cu ca t chc bo him y t, ngi lao ng hoc i din ca ngi lao ng. 5. Chp hnh vic thanh tra, kim tra v vic thc hin cc quy nh ca php lut v bo him y t. Cu 13. Hy nu trch nhim v quyn hn ca ngi tham gia BHYT? Tr li: Quyn ca ngi tham gia bo him y t 1. c cp th bo him y t khi ng bo him y t. 2. La chn c s khm bnh, cha bnh bo him y t ban u theo quy nh ti khon 1 iu 26 ca Lut ny. 3. c khm bnh, cha bnh. 4. c t chc bo him y t thanh ton chi ph khm bnh, cha bnh theo ch bo him y t. 5. Yu cu t chc bo him y t, c s khm bnh, cha bnh bo him y t v c quan lin quan gii thch, cung cp thng tin v ch bo him y t. 6. Khiu ni, t co hnh vi vi phm php lut v bo him y t. Ngha v ca ngi tham gia bo him y t 1. ng bo him y t y , ng thi hn.
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2. S dng th bo him y t ng mc ch, khng cho ngi khc mn th bo him y t. 3. Thc hin cc quy nh ti iu 28 ca Lut ny khi n khm bnh, cha bnh. 4. Chp hnh cc quy nh v hng dn ca t chc bo him y t, c s khm bnh, cha bnh khi n khm bnh, cha bnh. 5. Thanh ton chi ph khm bnh, cha bnh cho c s khm bnh, cha bnh ngoi phn chi ph do qu bo him y t chi tr. Cu 14. Cn c vo mc lng no qui nh mc ng BHYT bt buc v BHYT t nguyn? Tr li: Tin lng, tin cng, tin tr cp lm cn c ng bo him y t 1. i vi ngi lao ng thuc i tng thc hin ch tin lng do Nh nc quy nh th cn c ng bo him y t l tin lng thng theo ngch bc, cp qun hm v cc khon ph cp chc v, ph cp thm nin vt khung, ph cp thm nin ngh (nu c). 2. i vi ngi lao ng hng tin lng, tin cng theo quy nh ca ngi s dng lao ng th cn c ng bo him y t l tin lng, tin cng thng c ghi trong hp ng lao ng. 3. i vi ngi hng lng hu, tr cp mt sc lao ng, tr cp tht nghip hng thng th cn c ng bo him y t l tin lng hu, tr cp mt sc lao ng, tr cp tht nghip hng thng. 4. i vi cc i tng khc th cn c ng bo him y t l mc lng ti thiu. 5. Mc tin cng, tin lng ti a tnh mc ng bo him y t l 20 ln mc lng ti thiu. Cu 15. Hin ti, i tng no phi thc hin mc ng BHYT bng 4,5% mc tin lng, tin cng hng thng ca ngi lao ng? Trch nhim ng ca cc nhm i tng ny c quy nh nh th no? Tr li: Hin ti, cc i tng sau phi thc hin mc ng BHYT bng 4,5% mc tin lng, tin cng hng thng ca ngi lao ng. 1. Ngi lao ng lm vic theo hp ng lao ng khng xc nh thi hn, hp ng lao ng c thi hn t 3 thng tr ln theo quy nh ca php lut v lao ng; ngi lao ng l ngi qun l doanh nghip hng tin lng, tin cng theo quy nh ca php lut v tin lng, tin cng; cn b, cng chc, vin chc theo quy nh ca php lut (sau y gi chung l ngi lao ng). 2. S quan, h s quan nghip v v s quan, h s quan chuyn mn, k thut ang cng tc trong lc lng Cng an nhn dn.
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Trch nhim ng bo him y t c quy nh nh sau: Ngi s dng lao ng ng 2/3 v ngi lao ng ng 1/3. Trong thi gian ngi lao ng ngh vic hng ch thai sn khi sinh con hoc nui con nui di 4 thng tui theo quy nh ca php lut v bo him x hi th ngi lao ng v ngi s dng lao ng khng phi ng bo him y t nhng vn c tnh vo thi gian tham gia bo him y t lin tc hng ch bo him y t; Cu 16. Hin ti, i tng no phi thc hin mc ng BHYT bng 4,5% mc lng ti thiu? Tr li: Hin ti, cc i tng sau phi thc hin mc ng BHYT bng 4,5% mc lng ti thiu 1. Ngi ang hng tr cp bo him x hi hng thng do b tai nn lao ng, bnh ngh nghip. 2. Ngi thi hng tr cp mt sc lao ng ang hng tr cp hng thng t ngn sch nh nc. 3. Cn b x, phng, th trn ngh vic ang hng tr cp bo him x hi hng thng. 4. Cn b x, phng, th trn ngh vic ang hng tr cp t ngn sch nh nc hng thng. 5. Ngi c cng vi cch mng. 6. Cu chin binh theo quy nh ca php lut v cu chin binh. 7. Ngi trc tip tham gia khng chin chng M cu nc theo quy nh ca Chnh ph. 8. i biu Quc hi, i biu Hi ng nhn dn cc cp ng nhim. 9. Ngi thuc din hng tr cp bo tr x hi hng thng theo quy nh ca php lut. 10. Ngi thuc h gia nh ngho; ngi dn tc thiu s ang sinh sng ti vng c iu kin kinh t - x hi kh khn, c bit kh khn. 11. Thn nhn ca ngi c cng vi cch mng theo quy nh ca php lut v u i ngi c cng vi cch mng. 12. Thn nhn ca cc i tng sau y theo quy nh ca php lut v s quan Qun i nhn dn, ngha v qun s, Cng an nhn dn v c yu: a) S quan, qun nhn chuyn nghip thuc Qun i nhn dn ang ti ng; h s quan, binh s ang phc v trong Qun i nhn dn;

b) S quan, h s quan nghip v v s quan, h s quan chuyn mn, k thut ang cng tc trong lc lng Cng an nhn dn; h s quan, chin s Cng an nhn dn phc v c thi hn; c) S quan, qun nhn chuyn nghip ang lm cng tc c yu ti Ban C yu Chnh ph v ngi ang lm cng tc c yu hng lng theo bng lng cp bc qun hm s quan Qun i nhn dn v bng lng qun nhn chuyn nghip thuc Qun i nhn dn nhng khng phi l qun nhn, cng an nhn dn. 13. Tr em di 6 tui. 14. Ngi hin b phn c th ngi theo quy nh ca php lut v hin, ly, ghp m, b phn c th ngi v hin, ly xc. 15. Ngi nc ngoi ang hc tp ti Vit Nam c cp hc bng t ngn sch ca Nh nc Vit Nam. 16. Ngi thuc h gia nh cn ngho. 17. Cc i tng khc theo quy nh ca Chnh ph nh: Cng nhn cao su ang hng tr cp hng thng; Thanh nin xung phong thi k khng chin chng Php; Ngi lao ng c hng ch m au theo quy nh ca php lut; Ngi hot ng khng chuyn trch x, phng, th trn... Cu 17. Mc ng BHYT hin ti ca ngi hng lng hu, tr cp mt sc lao ng hng thng; ngi hng tr cp tht nghip; Hc sinh, sinh vin c quy nh nh th no? Tr li: Mc ng ca i tng hng lng hu, tr cp mt sc lao ng bng 4,5% mc tin lng hu, tr cp mt sc lao ng hng thng v do t chc bo him x hi ng. Mc ng ca i tng hng tr cp tht nghip bng 4,5% mc tr cp tht nghip. Mc ng ca i tng hc sinh, sinh vin bng 3% mc lng ti thiu. Cu 18. Nu cc nhm i tng c ngn sch nh nc h tr 100% mc ng BHYT Tr li: Cc nhm i tng c ngn sch nh nc h tr 100% mc ng BHYT 1. Cn b x, phng, th trn ngh vic ang hng tr cp t ngn sch nh nc hng thng. 2. Ngi c cng vi cch mng. 3. Cu chin binh theo quy nh ca php lut v cu chin binh. 4. Ngi trc tip tham gia khng chin chng M cu nc theo quy nh ca Chnh ph.
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5. i biu Quc hi, i biu Hi ng nhn dn cc cp ng nhim. 6. Ngi thuc din hng tr cp bo tr x hi hng thng theo quy nh ca php lut. 7. Ngi thuc h gia nh ngho; ngi dn tc thiu s ang sinh sng ti vng c iu kin kinh t - x hi kh khn, c bit kh khn. 8. Thn nhn ca cc i tng sau y theo quy nh ca php lut v s quan Qun i nhn dn, ngha v qun s, Cng an nhn dn v c yu: a) S quan, qun nhn chuyn nghip thuc Qun i nhn dn ang ti ng; h s quan, binh s ang phc v trong Qun i nhn dn; b) S quan, h s quan nghip v v s quan, h s quan chuyn mn, k thut ang cng tc trong lc lng Cng an nhn dn; h s quan, chin s Cng an nhn dn phc v c thi hn; c) S quan, qun nhn chuyn nghip ang lm cng tc c yu ti Ban C yu Chnh ph v ngi ang lm cng tc c yu hng lng theo bng lng cp bc qun hm s quan Qun i nhn dn v bng lng qun nhn chuyn nghip thuc Qun i nhn dn nhng khng phi l qun nhn, cng an nhn dn. 9. Tr em di 6 tui. 10. Ngi hin b phn c th ngi theo quy nh ca php lut v hin, ly, ghp m, b phn c th ngi v hin, ly xc. Cu 19. Nu cc nhm i tng c ngn sch nh nc h tr mt phn mc ng BHYT? Tr li: Cc nhm i tng c ngn sch nh nc h tr mt phn mc ng BHYT: 1. Ngi thuc h gia nh cn ngho. 2. Hc sinh, sinh vin. 3. Ngi thuc h gia nh lm nng nghip, lm nghip, ng nghip v dim nghip (c mc sng trung bnh). Cu 20. Trng hp no c gim tr mc ng BHYT v gim tr nh th no? Tr li: Trng hp i tng l ngi thuc h gia nh cn ngho, ngi thuc h gia nh lm nng nghip, lm nghip, ng nghip v dim nghip tham gia BHYT theo h gia nh bao gm ton b ngi c tn trong s h khu v ang sng chung trong mt nh v i tng l thn nhn ca ngi lao ng m ngi lao ng c trch nhim nui dng v sng trong cng h gia nh c t hai thn nhn tr ln tham gia, mc ng cc thnh vin nh sau: a. Ngi th nht ng bng mc quy nh
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b. Ngi th hai, th ba, th t ng ln lt bng 90%, 80%, 70% mc ng ca ngi th nht. c. T ngi th nm tr i ng bng 60% mc ng ca ngi th nht. Cu 21. Lut BHYT quy nh nh th no v vic cp th BHYT v thi hn s dng th BHYT? Tr li: Cp th BHYT: 1. H s cp th bo him y t bao gm: a) Vn bn ng k tham gia bo him y t ca c quan, t chc c trch nhim ng bo him y t quy nh ca Lut BHYT; b) Danh sch ngi tham gia bo him y t do c quan, t chc c trch nhim ng bo him y t quy nh ca Lut BHYT hoc ngi i din ca ngi t nguyn tham gia bo him y t lp; c) T khai ca c nhn, h gia nh tham gia bo him y t. 2. H s cp th bo him y t i vi tr em di 6 tui bao gm: a) Bn sao giy chng sinh hoc bn sao giy khai sinh. Trng hp tr em cha c bn sao giy chng sinh hoc bn sao giy khai sinh th phi c giy xc nhn ca U ban nhn dn x, phng, th trn ni c tr ca cha, m hoc ngi gim h; b) Danh sch hoc giy ngh cp th bo him y t ca U ban nhn dn x, phng, th trn ni tr em c tr. 3. Trong thi hn 10 ngy lm vic, k t ngy nhn h s , t chc bo him y t phi cp th bo him y t cho ngi tham gia bo him y t. Thi hn s dng th: Thi im th bo him y t c gi tr s dng c quy nh nh sau: a) i vi ngi tham gia bo him y t t nguyn ng bo him y t lin tc k t ln th hai tr i hoc ngi tham gia bo him y t bt buc th th bo him y t c gi tr s dng k t ngy ng bo him y t; b) i vi ngi tham gia bo him y t t nguyn ng bo him y t ln u hoc ng bo him y t khng lin tc th th bo him y t c gi tr s dng sau 30 ngy, k t ngy ng bo him y t; ring i vi quyn li v dch v k thut cao th th bo him y t c gi tr s dng sau 180 ngy, k t ngy ng bo him y t; c) i vi tr em di 6 tui th th bo him y t c gi tr s dng n ngy tr 72 thng tui. Cu 22. Hy nu cc quy nh v i, cp li th BHYT Tr li: Cp li th bo him y t 1. Th bo him y t c cp li trong trng hp b mt.
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2. Ngi b mt th bo him y t phi c n ngh cp li th. 3. Trong thi hn 7 ngy lm vic, k t ngy nhn c n ngh cp li th, t chc bo him y t phi cp li th cho ngi tham gia bo him y t. Trong thi gian ch cp li th, ngi c th vn c hng quyn li ca ngi tham gia bo him y t. 4. Ngi c cp li th bo him y t phi np ph. B trng B Ti chnh quy nh mc ph cp li th bo him y t. i th bo him y t 1. Th bo him y t c i trong trng hp sau y: a) Rch, nt hoc hng; b) Thay i ni ng k khm bnh, cha bnh ban u; c) Thng tin ghi trong th khng ng. 2. H s i th bo him y t bao gm: a) n ngh i th ca ngi tham gia bo him y t; b) Th bo him y t. 3. Trong thi hn 7 ngy lm vic, k t ngy nhn h s , t chc bo him y t phi i th cho ngi tham gia bo him y t. Trong thi gian ch i th, ngi c th vn c hng quyn li ca ngi tham gia bo him y t. 4. Ngi c i th bo him y t do th b rch, nt hoc hng phi np ph. B trng B Ti chnh quy nh mc ph i th bo him y t. Cu 23. Th bo him y t b thu hi, tm gi trong cc trng hp no? Tr li: Thu hi, tm gi th bo him y t 1. Th bo him y t b thu hi trong trng hp sau y: a) Gian ln trong vic cp th bo him y t; b) Ngi c tn trong th bo him y t khng tip tc tham gia bo him y t. 2. Th bo him y t b tm gi trong trng hp ngi i khm bnh, cha bnh s dng th bo him y t ca ngi khc. Ngi c th bo him y t b tm gi c trch nhim n nhn li th v np pht theo quy nh ca php lut. Cu 24. Hy nu phm vi quyn li ca ngi tham gia BHYT? Tr li: Phm vi c hng ca ngi tham gia bo him y t 1. Ngi tham gia bo him y t c qu bo him y t chi tr cc chi ph sau y:

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a) Khm bnh, cha bnh, phc hi chc nng, khm thai nh k, sinh con; b) Khm bnh sng lc, chn on sm mt s bnh; c) Vn chuyn ngi bnh t tuyn huyn ln tuyn trn i vi i tng l ngi c cng vi cch mng; Ngi thuc din hng tr cp bo tr x hi hng thng theo quy nh ca php lut; Ngi thuc h gia nh ngho; ngi dn tc thiu s ang sinh sng ti vng c iu kin kinh t - x hi kh khn, c bit kh khn. Tr em di 6 tui; Ngi thuc h gia nh cn ngho trong trng hp cp cu hoc khi ang iu tr ni tr phi chuyn tuyn chuyn mn k thut. Cu 25. Cc trng hp khng thuc phm vi quyn li ca ngi tham gia BHYT? Tr li: Cc trng hp khng c hng bo him y t 1. Chi ph trong trng hp khm cha bnh, vn chuyn ngi bnh c ngn sch nh nc chi tr. 2. iu dng, an dng ti c s iu dng, an dng. 3. Khm sc khe. 4. Xt nghim, chn on thai khng nhm mc ch iu tr. 5. S dng k thut h tr sinh sn, dch v k hoch ha gia nh, no ht thai, ph thai, tr trng hp phi nh ch thai nghn do nguyn nhn bnh l ca thai nhi hay ca sn ph. 6. S dng dch v thm m. 7. iu tr lc, cn th v tt khc x ca mt. 8. S dng vt t y t thay th bao gm chn tay gi, mt gi, rng gi, knh mt, my tr thnh, phng tin tr gip vn ng trong khm bnh, cha bnh v phc hi chc nng. 9. Khm bnh, cha bnh, phc hi chc nng i vi bnh ngh nghip, tai nn lao ng, thm ha. 10. Khm bnh, cha bnh trong trng hp t t, t gy thng tch. 11. Khm bnh, cha bnh nghin ma ty, nghin ru hoc cht gy nghin khc. 12. Khm bnh, cha bnh tn thng v th cht, tinh thn do hnh vi vi phm php lut ca ngi gy ra. 13. Gim nh y khoa, gim nh php y, gim nh php y tm thn. 14. Tham gia th nghim lm sng, nghin cu khoa hc. Cu 26. Hy nu khi nim v cng chi tr chi ph khm cha bnh. Mc ng chi tr chi ph KCB c quy nh nh th no? Tr li:
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Cng chi tr tc l ngi tham gia BHYT khi i khm cha bnh ti cc c s y t phi b ra mt khon tin cng thanh ton cc khon chi ph khm v iu tr bnh. Mc ng chi tr c Nh nc quy nh t l theo tng nhm i tng tham gia BHYT. Cu 27. Trng hp no c qu BHYT thanh ton 100%, 95%, 80% chi ph khi s dng cc dch v KCB thng thng? Tr li: Ngi tham gia bo him y t khi i khm bnh, cha bnh c qu bo him y t thanh ton chi ph khm bnh, cha bnh trong phm vi c hng nh sau: a) 100% chi ph khm bnh, cha bnh i vi i tng l S quan, h s quan nghip v v s quan, h s quan chuyn mn, k thut ang cng tc trong lc lng Cng an nhn dn; Ngi c cng vi cch mng; Tr em di 6 tui. b) 100% chi ph khm bnh, cha bnh i vi trng hp chi ph cho mt ln khm bnh, cha bnh thp hn mc do Chnh ph quy nh v khm bnh, cha bnh ti tuyn x; c) 95% chi ph khm bnh, cha bnh i vi i tng l ngi hng lng hu, tr cp mt sc lao ng hng thng; Ngi thuc din hng tr cp bo tr x hi hng thng theo quy nh ca php lut; Ngi thuc h gia nh ngho; ngi dn tc thiu s ang sinh sng ti vng c iu kin kinh t x hi kh khn, c bit kh khn. d) 80% chi ph khm bnh, cha bnh i vi cc i tng tham gia BHYT khc. Cu 28. Hy nu phm vi c hng ca ngi c th BHYT khi s dng dch v k thut cao, chi ph ln: Tr li: Ngi c th BHYT khi i khm cha bnh ng tuyn c s dng dch v k thut cao, chi ph ln th c qu BHYT thanh ton chi ph trong phm vi c hng nh sau: a. 100% chi ph i vi i tng l Tr em di 6 tui v i tng l ngi hot ng cch mng t 1/1/1945 n trc tng khi ngha 19/8/1945; B m Vit Nam anh hng; thng binh, ngi hng chnh sch nh thng binh, thng binh loi B, bnh binh b mt sc lao ng t 81% tr ln; thng binh, ngi hng chnh sch nh thng binh, thng bnh loi B, bnh binh khi iu tr vt thng, bnh tt ti pht; b. 100% chi ph i vi i tng l S quan, h s quan nghip v v s quan, h s quan chuyn mn, k thut ang cng tc trong lc lng Cng an nhn dn nhng khng vt qu 40 thng lng ti thiu cho mt ln s dng dch v k thut ; phn cn li do ngn sch ca c quan, n v qun l i tng chi tr.
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c. 100% chi ph i vi i tng l Ngi c cng vi cch mng tr cc i tng nu ti im a nu trn, nhng khng vt qu 40 thng lng ti thiu cho mt ln s dng dch v k thut ; d. 95% chi ph i vi i tng l Ngi hng lng hu, tr cp mt sc lao ng hng thng; Ngi thuc din hng tr cp bo tr x hi hng thng theo quy nh ca php lut;Ngi thuc h gia nh ngho; ngi dn tc thiu s ang sinh sng ti vng c iu kin kinh t - x hi kh khn, c bit kh khn, nhng khng vt qu 40 thng lng ti thiu cho mt ln s dng dch v k thut ; . 80% chi ph i vi cc i tng khc nhng khng vt qu 40 thng lng ti thiu cho mt ln s dng dch v k thut . Cu 29.Th no l c s khm bnh, cha bnh bo him y t? Nu cc loi c s khm cha bnh BHYT? Tr li 1. C s khm bnh, cha bnh bo him y t l c s y t c k hp ng khm bnh, cha bnh vi t chc bo him y t. 2. C s khm bnh, cha bnh bo him y t bao gm: a) Trm y t x v tng ng, nh h sinh; b) Phng khm a khoa, chuyn khoa; c) Bnh vin a khoa, chuyn khoa Cu 30. Hy nu nhng quy nh ca Lut BHYT v trch nhim v quyn hn ca c s khm bnh, cha bnh BHYT? Tr li: Quyn ca c s khm bnh, cha bnh bo him y t 1. Yu cu t chc bo him y t cung cp y , chnh xc cc thng tin c lin quan n ngi tham gia bo him y t, kinh ph khm bnh, cha bnh cho ngi tham gia bo him y t ti c s khm bnh, cha bnh. 2. c t chc bo him y t tm ng kinh ph v thanh ton chi ph khm bnh, cha bnh theo hp ng khm bnh, cha bnh k. 3. Kin ngh vi c quan nh nc c thm quyn x l t chc, c nhn vi phm php lut v bo him y t. Trch nhim ca c s khm bnh, cha bnh bo him y t 1. T chc khm bnh, cha bnh bo m cht lng vi th tc n gin, thun tin cho ngi tham gia bo him y t. 2. Cung cp h s bnh n, ti liu lin quan n khm bnh, cha bnh v thanh ton chi ph khm bnh, cha bnh ca ngi tham gia bo him y t theo yu cu ca t chc bo him y t v c quan nh nc c thm quyn. 3. Bo m iu kin cn thit cho t chc bo him y t thc hin cng tc gim nh; phi hp vi t chc bo him y t trong vic tuyn truyn, gii thch v ch bo him y t cho ngi tham gia bo him y t.
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4. Kim tra, pht hin v thng bo cho t chc bo him y t nhng trng hp vi phm v s dng th bo him y t; phi hp vi t chc bo him y t thu hi, tm gi th bo him y t i vi cc trng hp quy nh ti iu 20 ca Lut ny. 5. Qun l v s dng kinh ph t qu bo him y t theo ng quy nh ca php lut. 6. T chc thc hin cng tc thng k, bo co v bo him y t theo quy nh ca php lut. Cu 31. Hy nu cc quy nh ca Lut BHYT v ng k khm cha bnh ban u i vi ngi tham gia BHYT? Tr li: ng k khm bnh, cha bnh bo him y t 1. Ngi tham gia bo him y t c quyn ng k khm bnh, cha bnh bo him y t ban u ti c s khm bnh, cha bnh tuyn x, tuyn huyn hoc tng ng; tr trng hp c ng k ti c s khm bnh, cha bnh tuyn tnh hoc tuyn trung ng theo quy nh ca B trng B Y t. Trng hp ngi tham gia bo him y t phi lm vic lu ng hoc n tm tr ti a phng khc th c khm bnh, cha bnh ban u ti c s khm bnh, cha bnh ph hp vi tuyn chuyn mn k thut v ni ngi ang lm vic lu ng, tm tr theo quy nh ca B trng B Y t. 2. Ngi tham gia bo him y t c thay i c s ng k khm bnh, cha bnh ban u vo u mi qu. 3. Tn c s khm bnh, cha bnh bo him y t ban u c ghi trong th bo him y t. Cu 32. Th tc khm cha bnh BHYT c quy nh nh th no? Tr li: Th tc khm bnh, cha bnh bo him y t 1. Ngi tham gia bo him y t khi n khm bnh, cha bnh phi xut trnh th bo him y t c nh; trng hp th bo him y t cha c nh th phi xut trnh th bo him y t cng vi giy t chng minh v nhn thn ca ngi ; i vi tr em di 6 tui ch phi xut trnh th bo him y t. 2. Trng hp cp cu, ngi tham gia bo him y t c khm bnh, cha bnh ti bt k c s khm bnh, cha bnh no v phi xut trnh th bo him y t cng vi giy t quy nh ca Lut BHYT trc khi ra vin. 3. Trng hp chuyn tuyn iu tr, ngi tham gia bo him y t phi c h s chuyn vin ca c s khm bnh, cha bnh. 4. Trng hp khm li theo yu cu iu tr, ngi tham gia bo him y t phi c giy hn khm li ca c s khm bnh, cha bnh. Cu 33. Hy nu cc phng thc thanh ton chi ph khm bnh, cha bnh bo him y t?
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Tr li: Phng thc thanh ton chi ph khm bnh, cha bnh bo him y t 1. Vic thanh ton chi ph khm bnh, cha bnh bo him y t c thc hin theo cc phng thc sau y: a) Thanh ton theo nh sut l thanh ton theo nh mc chi ph khm bnh, cha bnh v mc ng tnh trn mi th bo him y t c ng k ti c s khm bnh, cha bnh bo him y t trong mt khong thi gian nht nh; b) Thanh ton theo gi dch v l thanh ton da trn chi ph ca thuc, ha cht, vt t, thit b y t, dch v k thut y t c s dng cho ngi bnh; c) Thanh ton theo trng hp bnh l thanh ton theo chi ph khm bnh, cha bnh c xc nh trc cho tng trng hp theo chn on. 2. Chnh ph quy nh c th vic p dng phng thc thanh ton chi ph khm bnh, cha bnh bo him y t quy nh ca Lut BHYT. Cu 34. Theo Lut BHYT, thanh ton chi ph KCB BHYT c cc hnh thc no? Tr li: Thanh ton chi ph khm bnh, cha bnh bo him y t 1. T chc bo him y t thanh ton chi ph khm bnh, cha bnh bo him y t vi c s khm bnh, cha bnh theo hp ng khm bnh, cha bnh bo him y t. 2. T chc bo him y t thanh ton chi ph khm bnh, cha bnh bo him y t trc tip cho ngi c th bo him y t i khm bnh, cha bnh. Cu 35. Th no l thanh ton trc tip chi ph KCB? Nhng trng hp no c c quan BHYT thanh ton trc tip? Tr li: Thanh ton trc tip chi ph KCB l hnh thc: t chc BHYT thanh ton nhng chi ph khm, cha bnh bng tin mt cho ngi c th bo him y t theo mc quy nh ( nhng chi ph ny ngi bnh cha c hng ti c s khm, cha bnh). Ngi c th BHYT c thanh ton trc tip trong cc trng hp sau: a) Khm cha bnh ti c s khm bnh, cha bnh khng c hp ng khm bnh, cha bnh bo him y t; b) Trng hp khm bnh, cha bnh khng ng quy nh ca Lut BHYT. c) Ti nc ngoi; d) Mt s trng hp c bit khc do B trng B Y t quy nh. - B Y t ch tr, phi hp vi B Ti chnh quy nh th tc, mc thanh ton i vi cc trng hp thanh ton trc tip.
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- T chc bo him y t thanh ton chi ph khm bnh, cha bnh trn c s vin ph theo quy nh ca Chnh ph. Cu 36. Khi thanh ton trc tip chi ph KCB, ngi ngh cn c nhng giy t g? Tr li: Khi thanh ton trc tip chi ph KCB, ngi ngh cn c nhng giy t sau: a. Giy ngh thanh ton ca ngi bnh c th BHYT theo mu ca BHXH Vit Nam. b. Th BHYT bn sao. c. Giy ra vin hoc h s bnh n (bn chnh hoc bn sao). d. cc chng t hp l (n thuc, s y b, ha n mua thuc, ha n thu vin ph v cc chng t lin quan khc); . Trng hp i khm cha bnh nc ngoi, ngoi cc giy t trn, phi c kin ca mt c s y t tuyn tnh hoc tuyn Trung ng xc nhn v tnh trng bnh v hng iu tr; e. Trng hp c c i cng tc hoc hc tp nc ngoi, ngoi cc giy t trn phi c quyt nh cu cp c thm quyn c i cng tc hoc hc tp nc ngoi. Trng hp h s chng t vit bng ngn ng nc ngoi, phi dch sang ngn ng Vit Nam c cng chng. Cu 37. Ngi c th BHYT i khm cha bnh ng quy nh phi t thanh ton vi bnh vin chi ph no? Tr li: Ngi c th BHYT i khm cha bnh ng quy nh phi t thanh ton vi bnh vin chi ph khm cha bnh : khon cng chi tr theo nhm i tng v theo t l quy nh ca Lut BHYT v nhng khon chi ph khm, cha bnh ngoi quy nh (dch v k thut cao...). Cu 38. Gim nh BHYT l g? Hy nu ni dung ca cng tc gim nh BHYT theo quy nh ca Lut BHYT? Tr li: Gim nh bo him y t l hot ng chuyn mn do t chc bo him y t tin hnh nhm nh gi s hp l ca vic cung cp dch v y t cho ngi tham gia bo him y t, lm c s thanh ton chi ph khm bnh, cha bnh bo him y t. Ni dung gim nh bo him y t bao gm: a) Kim tra th tc khm bnh, cha bnh bo him y t; b) Kim tra, nh gi vic ch nh iu tr, s dng thuc, ha cht, vt t, thit b y t, dch v k thut y t cho ngi bnh; c) Kim tra, xc nh chi ph khm bnh, cha bnh bo him y t.
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- Vic gim nh bo him y t phi bo m chnh xc, cng khai, minh bch. - T chc bo him y t thc hin vic gim nh bo him y t v chu trch nhim trc php lut v kt qu gim nh. Cu 39. Qu khm bnh, cha bnh do Bo him x hi tnh qun l c s dng nh th no? Tr li: Qu bo him y t c s dng cho cc mc ch sau y: a) Thanh ton chi ph khm bnh, cha bnh bo him y t; b) Chi ph qun l b my t chc bo him y t theo nh mc chi hnh chnh ca c quan nh nc; c) u t bo ton v tng trng qu bo him y t theo nguyn tc an ton, hiu qu; d) Lp qu d phng khm bnh, cha bnh bo him y t. Qu d phng ti thiu bng tng chi khm bnh, cha bnh bo him y t ca hai qu trc lin k v ti a khng qu tng chi khm bnh, cha bnh bo him y t ca hai nm trc lin k. - Trng hp cc tnh, thnh ph trc thuc trung ng c s thu bo him y t ln hn s chi khm bnh, cha bnh bo him y t th c s dng mt phn kt d phc v khm bnh, cha bnh bo him y t ti a phng. - Chnh ph quy nh c th v s dng qu BHYT. Cu 40. Hy nu cc tranh chp v cch thc gii quyt cc tranh chp v BHYT? Tr li: 1. Tranh chp v bo him y t l tranh chp lin quan n quyn, ngha v v trch nhim bo him y t gia cc i tng sau y: a) Ngi tham gia bo him y t theo quy nh ca Lut BHYT, ngi i din ca ngi tham gia bo him y t; b) T chc, c nhn ng bo him y t theo quy nh ca Lut BHYT; c) T chc bo him y t; d) C s khm bnh, cha bnh bo him y t. 2. Tranh chp v bo him y t c gii quyt nh sau: a) Cc bn tranh chp c trch nhim t ha gii v ni dung tranh chp; b) Trng hp ha gii khng thnh th cc bn tranh chp c quyn khi kin ti Ta n theo quy nh ca php lut.
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