BAO IDEM xA HOI VItT NAM CQNGHOA xA HOI CmJ NGHiA vrsr NAMI>QcI~p - TV do - H3nh phuc

S5:,;1-ggIBHXH-BT Ha N9i, ngayoZ.-S thdng 6 ruim2017VIv hoan thien, cAp rna s6 BHXH cho

ngiroi tham gia BHXH, BHYT

Kinh giri: Bao hiem xa hQicac tinh, thanh ph5 tnrc thuoc Trung uong.

Thuc hien Quyet dinh s5 595/QD-BHXH ngay 14/4/2017 cua T6ng Giamd5c BHXH Vi~t Narn ban hanh quy trinh thu bao hiem xa hQi (BHXH), baohiem y t~ (BHYT), bao hiem th~t nghiep, bao hiem tai nan lao dQng- benh nghenghiep; qulin Iy s6 BHXH, the BHYT; de dap img yeu cfiu v~ quan Iy co sa dfrlieu t~.Ptrung toan q!l5c, ~~t n5i lien thong dfr lieu HGB va b,Qcong cu quan !ythu, so the, giai quyet che dQBHXH, BHYT thong qua rna so BHXH duoc capduy nh~t cho ngiroi tharn gia, BHXH Vi~t Narn huang d§n viec hoan thien, c~prna s5 BHXH cho nguoi tham gia BHXH, BHYT nhu sau:

1. Bao hi~m xii hQi cAp dnh1.1. B5i v&inguai dang tharn gia BHXH, BHYT chua c6 rna s5 BHXH:

th\lC hi~n thea -huOngd§n ~i cac Ph\! 11,lC1, 2, 3;4, 5, 6 Cong van nay, hoanthanh tru&cngay 31112/2017. Khi c6 phat sinh tang, di~u chinh, cApm&i,c~p ll:iis6 BHXH, the BHYT: th\lChi~n theo hu6ng d§n tl:iiPh\ll\lc 8 Cong van nay.

1.2. B5i v&inguai tharn gia BHXH, BHYT duQ'ccAprna s5 BHXH thvchi~n c~p d6i the BHYT thea rna s5BHXH tl:iiPh\ll\lc 7 kern thea Cong van nay.

1.3. Xay dvng lQtrinh c~p d6i the BHYT cho nguai tharn gia BHXH,B!1YT thea rna s6 BHXH; phArrd~u d~n 3016/2018 ho~ thanh xong vi~c c~pdoi the BHYT thea rna so BHXH. Uu tien ~p trung doi the BHYT cho doitugng la hQc sinh, sinh vien; d5i tugng c6 the BHYT h~t hl:illtru&c 31/12/2017.Pharr cong trach nhi~m cho lanh dl:io,can bQhu&ngd§n dan vi, nguai tham giaBHXH, BHYT ke khai, b6 sung thong tin tren Ta khai tham gia, di6u chinhthong tin BHXH, BHYT (M§u TKI-TS) theo cac Ph\l h,lc dam bao ch~t IUQllgva tien dQ.Kielitl'~ r~.soat thong tin M§u TKl- TS v&ica sa dfr li~u da c~pnh~tdam bao cWnh':tacva (tiy,du thong tin.

1.4. T6 chuc thong tin, tuyen truy~n cao di~m v~ m\lC dich, y nghia cuarna s5 BHXH va nhUngdi~rn rnai v~ quy trinh quan ly thu, c~p s6 BHXH, theBHYT tren cac phuong tien thong tin dl:iichUnglien tl,lctUnay d~n 3016/2018 vagiri Thu ng6 (Mftukern theo) d~n tUngnguai tham gia BHXH, BHYT.

1.5. Ph5i hgp vai Buu di~n nh~n, tni h6 sa, s6 BHXH, the BHYT cho donvi va nguai tharn gia BHXH, BHYT.

1.6. Kip thai thao ~anhUng kh6 khan, vuOng rn~c cho dan vi va nguaitham gia trong qua trinh to chirc thvc hi~n.

2. Cae dan vi true thuoe Bso hi~m xii hoi Viet Nam... . .2.1. Trung tam Cong ngh~ thong tin- Xay dvng cac chirc nang, huang d§n sir d\mg phfin rn~rn, dap (rug yeu

cfiu,nhi~rn V\ltheo quy trinh cac buac duQ'chu&ngdftntl:iiCong van nay.

1

- ~arn bao dirong truyen, ha tAng cong nghe thong tin hoat dQng lien tuc,thong suet. .

2.2. Ban Thu: Ki~rn tra, don d6e, giam sat viec e~p rna 86 BHXH thea quydinh. Kip thai bao cao, ph6i hop cac don vi thao go nhUng kh6 khan, vuong mactrong qua trinh t6 chirc thirc hien.

2.3. Ban 86 - The: Ki~m tra, don d6c, giam sat viec c~p d6i the BHYTthea rna s6 BHXH thea quy dinh. Kip thoi ba~ cao, ph6i hQ'Pcac don vi thao gonhttng kh6 khan, vuong mac trong qua trinh to chirc thuc hien,

2.4. V\1Tai chinh - Ke toan: CIDletc quy trinh cac buoc tai Cong VIDl nay,xay dung dinh mire va huang dAnBHXH cac tinh quan ly, sir dung kinh phi.

2.5. V\1Thi dua - Khen thirong- Phat dQng phong trao thi dua hoan thanh viec c~p rna 86 BHXH, c~p d6i

the BHYT cho nguoi tham gia thea hu6ng dan tai Cong van nay.- Ph6i hQ'Pcac dan vi xay dung tieu chi, d€ xu~t khen thuong t6 chirc, ca

nhan c6 sang kien, va hoan thanh nhi~rn Vl,l diM ky 3 thang 1 lfuI.2.6. Cae dan vi trge thUQCkhac can eu ehuc nang, nhi~rn V\1 ph6i hgp

thl!c hi~n.

3. T6ngCong ty BlfUd.i~nVi~t Nam. . ..... . .. ,_.,~:'.' ..3'.1. Chi -d~oBUll di~ri cac tinh, tharJi~pfi6-ph6i hgp ~h~t che ~ai BHXH

cae tinh, thanh ph6 d~ nh~, tra h6 sa thea trinh t\l t~ cac buac trong cae Ph\1l\1ckern thea Cong van nay eho dan vi va nguCritham gia BHXH, BHYT.

3.2. ChufuJ bi dAy dli dieu ki~n v€ may tinh, dUOng truyen, nhan I\lc choBuu di~n van h6a xa tra Cll thong tin rna 86 BHXH cua nguCritham gi~.

Yeu cAu BHXH cac tinh, thanh ph6 tr\lc thuQc Trung uang, cac dan vitrge thuQc BHXH Vi~t Narn t6 ch{rc tri~n khai th\lc hi~n. Trong qua trinh th\Ichi~n n~u c6 vuOng mdc, kip thai bao cao BHXH Vi~t Nam (T6 cong tae - BanThu) d~ nghien cUu, giai quy~t<tAt/

Noi nhlj.n:- NhlItren;- T6ng Giam d6c (de b/c);- Cae Ph6 TOD (de p/h chi df;io);- TCT Buu di~n Vi~tNam;- Cac don vi tn,rc thu9c;- LIIU: VT, BT.y

KT. TONG GIAM DOCPRO TONG GIAM DOC

2

Quy trinh bB sung tY:D1lr_i.( -cap rna s

(Ban hann k

LUCI.~ m gia, di~u chinh thong tin BHXH, BHYT;u g cimg tharn gia BRXH, BRYT~ 6.~9/BHXH-BT ngay.J.S./ ...S.l2017

'-=&ua..Bd~ im xii h9i n«Nam)

I. B6 SUNG THONG TIN T(J KHAI THAM GIA, DIED cHiNH THONG TIN BHXH, BHYT

1. Doi vOi co quan BHXH1.1. Phongna Quan ly thu

In Danh sach nguoi tharn gia BHXH, BHYT chua co rna so BHXH (M~u

Bucc 1MS 1) va TO'khai tharn gia, di~u chinh thong tin BHXH, BHYT (M~u TK1-TS)cua nguoi lao d¢ng co ten trong M~u MS1 chuyen Phongff6 TN & TKQTIRC.

Buoc 2 Nhan M~u MS1 va M§:u TK1-TS dll duoc bo sung thong tin tir Phong/ ToTN & TKQ TTHC.

Buoc 3 To chirc c~p nh~t hoac to chirc thue khoan c~p nh~t dfr lieu M~u TK1-TSda b6 sung thong tin.

Buoc 4 Ra soat, kiem tra va nghiem thu dfr lieu dll c~p nh~t thong tin bo sung tirM§:u TK 1-TS voi co sa dfr lieu dam bao chinh xac, dAydu thong tin.

Butrc 5 Chuyen M~u MSLva Mall TKI-TS den Phong/To QU8.n1y ho sa d~ thuchien hru trU thea quy dinh.1.2. PhonKITfj TN & TKQ TTHC

- Nhan M~u MS 1, Mau TK1- TS illPhong/ To QU8.nly thu.

Buae 1 - Chuy€n M~u MS1, M~u TK1-TS dinh kern Thu ng6 cua T6ng Giam d6cBao hi€rn xa h¢i Vi~t Nam (Thu ng6 do co quan BHXH tn,rc tiep ho~c ph6ihqp BUll di~n in) den dan vi sir d\).Ilg lao dQI!&thong qua Buu di~n.

Buae 2 Nh~ l~i Mftu MS 1, M~u TK 1-TS da bo sung thong tin illdan vi sir d\lIlglao d¢ng chuy€n den thong qua Buu di~n d€ chl!Y_€nPhon_g/T6 Quan ly thu.

2. Dai vOi dO'Dvi sir dung lao dong ~

Buac 1 Nh~ Mftu MS1, Mftu TKI-TS va Thu ng6 til' co quan BHXH chuyen den I~thong qua Buu di~n.

';t.

Buae 2 Chuyen M~u TK 1-TS, Thu ng6 va huang d~ nguO'i lao d¢ng ke khai bosung chinh xac, dAydu thong tin vao M~u TKI-TS.

Nh~ l~i day du Mau TKI-TS da bo sung thong tin tlr nguO'i lao d¢ng vaBuac3 ki€rn tra, ra soat l~i thong tin dUQ'cke khai tren to' khai, huang d~n nguai lao

d¢ng hi~u chinh l~ neu phM hi~n ra sai sot.- Chuyen M~u MSI va M~u TKI-TS cua nguai lao dQng dll ke khai bo

sung thong tin den co quan BHXH thong qua Buu di~n.Luu y: TruOng hqp thvc hi~n giao dich di~n ill:c~p nh~t chinh xac, d~y du

Buac4 thong tin cua nguO'i lao d¢ng b6 sung tren M~u TK1- TS vao phArrrn~m ke khaih~~c ke khai trvc tuySn t~i C6ng thong tin di~n ill BHXH Vi~t Nam ho~c quaTo_chuc I-VAN; giri dfr li~u di~n illthea quy diM; d6ng thai, giri Mftu MSI vaMau TK 1-TS de!l co _quan BHXH thong_g_uaBuu di~n.

3. Doi vOi nglfOi lao dong

Buac 1 Nh~n M~u TK 1-TS va Thu ng6 do co quan BHXH chuyen den thong quadan vi.

Buac2 K€ khai b6 sung chinh xac, day du thong tin con thieu vao M~u TKI-TS.Buac3 Chuyen Mftu TKl- TS sau khi dll ke khai bo sung thong tin cho dan vi.

£,~

1

II. cAPso BHXH, TIIit BHYT CHO TRUONG H<}PcAPTRUNG so so BHXH1. B6i v6i CO' quan BHXH

1.1. Phong/To Qulin lj ThuInDanh sach nguoi tham gia BHXH, BHYT chua co rna s6 BHXH (Mdu

MS 1) va Ta khai tharn gia, diau chinh thong tin BHXH. BHYT (Mdu TKl- TS)

Buac 1 cua nguoi lao dQng co ten trong Mdu MSI chuyen Phong/Tc 1N & TKQTTHC.

Luu y: nguoi dang tham gia da co rna s6 BHXH nhimg cap trung s6 s6BHXH v!n thuc hi~n in Mdu TKl- TS.

Buoc Z ' Nhan l':1d';l MS 1 va Mdu TKl- TS da:duoc bo sung thong tin va so BHXHcap trung so so ill Phong/ T6 1N & TKQ TfHC.

Buoc B To chirc ~p ~t hoac to chirc thue khoan c~p nhat dfr li~u Mdu TKI-TSda b6 sung thong tin.

Bube4 Ra soat, kiem tra va nghiem thu dfr lieu da c~p nhat thong tin b6 sung tirMdu TKI-TS voi co sa dfr li~u dam bao chinh xac, dAyd1ithong tin.

- Doi voi ngiroi lao dQng chua co rna s6 BHXH: cap rna s6 BHXH vachuyen du lieu dp lai s6 BHXH, the BHYT theo rna s6 BHXH kern theo s6BHXH thu h6i, Mdu MSI va Mdu TKI-TS den Phong/ T6 cAp s6, the.

Bube5 - D6i vai nguai lao dQng dang tham gia da co rna s6 BHXH nhung cAptrimg s6 s6 BHXH: chuy~n dfr li~u cAp l~i s6 BHXH, the BHYT theo rna s6

, BHXH eta co kern theo sa BIDLq thu· h6i va<Mdu MS 1, Mdil TKl -TS deu~ .r.. ' .-

Phong/ To cap so, the.1.2. PhongIT8 Cap sa, thi

Nl$l va ki~rn tra Mdu MSl, Mdu TKI-TS, so BHXH cap trimg va dfr li~uBube1 c~p s6 BHXH, the BHYT thea rna s6 BHXH ill Phong/ T6 Quan ly thu chuy~n

den.

Bube2 Th\IC hi~n cac nghi~p Vl,l thea quy dinh d~ cap so BHXH, the BHYT theornas6BHXH.

- Chuy~n so BHXH, the BHYT, Mau D09a-TS, Mau DIOa-TS den Phong/

Bube3 T6 1N & TKQ TIRC.- Chuy~n Mdu MSl, Mdu TKI-TS d€n Phong/ T6 Quan ly h6 sa d~ thl,tc

hi~n luu trU theo _guy dlnb.1.3. PhonglTo TN & TKQ TTHC

N1$lMauMS1, Mdu TK1-TS illPhong/To Quan lythu va dinhkern theoBube 1 Thu ng6 Clla T6ng Gi1im d6c Bao hi~rn xa hQi Vi~t Nam vao Mdu TKI-TS

chuy~n den dan vi sir d\ll1g lao dQng thong qua Buu di~n.

Bube2 Nh~ so BHXR, the BHYT, Mdu D09a-TS, Mdu DIOa-TS illPhong/ TocAp s6, the chuy~n den dan vi su d\lI1g lao dQng thong qua BUll di~n.

2. B<Ynvi sir dung lao dong

Bubel Nh~ Mdu MS1, Mdu TKI-TS va Thu ng6 ill cO'quan BHXH chuy~n denthong qua Buu di~n.

- Chuyen M~u TKI-TS, Thu ng6 va huang d!n nguai lao dQng k€ khai boBube2 sung chinh xac, dAydu thong tin vao Mdu TK~-TS. ,

- Thong baocho ngum lao.dQng nQp l~i so BHXH cap trUng..- Nh~ l~i day du M~u TKI-TS d~ bo sung thong tin tU nguaiNlao dQng va

Bube3ki~rn tra, ra soat l~i thong tin dugc ke khai tren ta khai, huang dan nguai laodQng hi~u chinh l~i n€u pM.t hi~n ra sai s6t.

- Nhans6 BHXH cAptrimg illnguai lao dQng

Bubc4Chuy~n M~u MS 1 va Mdu TK 1-TS cua ngum lao dQng dii k8 khai bo sung

thong tin va s6 BHXH dp trling den cO'quan BHXH thong_qua Buu di~n. Jv2

Buac5 Nhan so BHXH, the BHYT, Mau D09a-TS, Mftu D1Oa-TS til co quanBHXH chuyen d~nthong qua BUlldi~n de tra cho nguoi lao dQng.

3. B8i v6i nguOi lao dQng

Buac I Nh~ MftuTKI-TS va Thir ngo do co quan BHXH chuyen den thong quadan vi.

Buac2 Ke khai bo sung chinh xac, day dli thong tin con thieu vao Mau TKI-TS.

Buac3 - Chuyen MftuTKI-TS sau khi da k8 khai bB sung thong tin cho don vi.- NQps6 BHXH cAptrung cho dan vi.

Buac4 Nhan lai so BHXH, the BHXH thea rna so BHXH. 'j'V

3

;-n~~2Quy trinh b6 sung thong di~u chinh thong tin BHXH, BHYT;" N" .... x.cap ma so B do to clnrc BHXH dong

(Ban hcmhkern the'l!\.<e~~~/iU~~.'fl(B'HXH-BT ngay.~~/..B.'/2017iEfrn h(ji n«Nam)

1.Dai vOi co' quan BIIXH1.1.Phong/To Qulin lj thu

InDanh sach nguoi tham gia BHXH, BHYT chua c6 rna so BHXH (MauButrc 1 MS 1) va To' khai tham gia, di~u chlnh thong tin BHXH, BHYT (Mau TK 1-TS)

cua ngiroi tham gia c6 ten trong Mau MS 1 chuyen Phong/Td TN & TKQTTHC.

Buoc 2 Nhan Mau MS1 va M§:uTK1-TS da diroc bo sung thong tin illPhong/ ToTN & TKQ TTIIC.

Butrc 3 To clnrc c~p nh~t hoac to chirc thue khoan c~p nh~t dfr li~u Mau TK1-TSda bd sung thong tin.

Butrc 4 Ra soat, kiem tra va nghiem thu dfr li~u da c~p nh~t thong tin bo sung illM§:uTK 1-TS voi co sa dfr li~u dam bao chlnh xac, d~y du thong tin.

Buoc 5 Chuyen Mau MSI va Mau TK1-TS den Phong/Te Quan ly h6 sa de thtrchi~n luu trU thee quy dinh,

, ,'".,,-- , ".....1.2. Ph(;n~l'l'o TN & 11IQTTHC ." .... ,-,-

B'tfac 1 Nhan Mdu MS 1,Mdu TKl- TS tir Phong/ To Qulm ly thu. r

Chuyen Mdu MSl, Mau TKI-TS dinh kern Thu ng6 cUa Tong GiAm docBao hi€rn xa h9i Vi~t Nam (Thu ng6 do ca quan BHXH trvc ti6p ho~c ph6ihqp Buu di~n in) d6n:

- Buu di~n d6i v6i d6i tUQ'IlgduQ'c chi tra qua Buu di~n (bao g6rn nguaiB'tfac 2 duQ'cchi tra tr\lC ti6p, ngum huang luang qua A1M, ngum duQ'cuy quy~n linh

thay va nguai huang thuang xuyen khong c6 rn~t t?i nm cu trU) d~ Buu di~nhu6ng d§:nngum huang ke khai b6 sung thong tin M§:uTKI-TS.

- Tn..rc ti6p cho ngum huang d6i v6i d6i tuQ'Ilg duQ'c chi tra t?i ca quanBHXH va huang ddn ngum huang ke khai bd sung thong tin Mfiu TKl- TS deduQ'Cca quan BHXH cgp rna s6 BHXH thee quy dinb.

Buac 3 Nh~ l?i Mau MS1, Mdu TKI-TS da bo sung thong tin tu Buu di~nchuy~n d6n de chuy~n Phong/ Td Qulm ly thu.

2. Delivo; BU'udienB'tfac 1 Nh~ M§:uMS 1, Mfiu TK 1-TS va Thu ng6 illca quan BHXH chuyen den.B'tfac 2 Chuyen Mau TKI-TS, Thu ng6 va hu6ng ddn ngum tharn gia ke khai bo

sung chinh xac, dAydu thong tin vao Mdu TKI-TS.Nh~ l?i day du Mfiu TKI-TS da b6 sung thong tin illngum tham gia va

B'tfcYc3 kiern tra, ra soat l?i thong tin duQ'c ke khai tren ta khai, huang ddn nguai tharngia hi~u chinh l?i n6u phat hi~n ra sai s6t.

Btrac 4 Chuy§n Mau MSI va M§:uTKI-TS cua nguai tham gia da ke khai bo sUngthOng tin d6n ca quan BHXH.

3. Delivo; ngllOi tham ltia - .. -

Btrac 1 Nh~ Mau TKI-TS va Thu ngo do ca quan BHXH chuyen den thong quaB11Udi~n ho~c tn..rcti6p (n6u dugc chi tra t?i ca quan BHXH).

B'tfac 2 Ke khai bo sung chinh xac, day du thong tin con thieu vao Mfiu TK 1-TS.Buac3 Chuyen Mau TKI-TS sau khi da ke khai bo sung thong tin cho Buu di~n

ho~c tr1.1Cti6p cho ca quan BHXH (n6u duQ'c chi tra t?i ca quan BHXH). ~4NV

Quy trlnh b6 sung thongcip ma ~~r;,Ja.

(Ban hanh kern th

1.DoivOi cooquan BHXH1.1. PhongIT6 Quiin Ij thu

In Danh sach ngiroi tham gia BHXH, BHYT chua co rna so BHXR (Mftu

Buac I MS1) va To khai tharn gia, diSuchinh thong tin BHXH, BHYT (MftuTK1-TS)cua tre em dum 6 tu6i co ten trong Mdu MS1 chuyen Phong/T6 TN & TKQTTHC.

- Nh~ MduMS1vaMdu TK1-TS da duqc bo sung thong tin til Phong/ ToTN & TKQ TIRC chuyen den.

Buae2 - Nhan Mdu TK1-TS cua tre em duoi 6 tu6i di kham, chua benh khong cothe BHYT da diroc ke khai thong tin til PhongIT6 TN & TKQ TIRC chuyenden.

Buoc S To chirc c~p nh~t hoac to chirc thue khoan c~p nh~t du lieu Mdu TK1-TSda b6 sun_g_thon_g_tin.

Buae4 Ra soat, kiem tra va nghiem thu du lieu da c~p nh~t thong tin b6 sung tilM!u TKl- TS voico sa du li~udam bao chinh xac, dAydli thong tin.

Buoc 5 Chuyen Mau MS1 va Mdu TKI-TS den Phong/To Quan ly ho so de thirchi~n luu trU thea_quydiuh.

Thong bao den UBND xa nm dang kY khai sinh Cllatre em dum 6 tuoi diBuae6 kham, chua b~nh khong co the BHYT (sau khi c~p ~t Mdu TK 1-TS) d€ cftp

the BHYT theoguy diuh.1.2. Phon_g_1T6TN & TKQ TTHC

- N~ MauMSl, MftuTKI-TS tilPhong/T6 Quan lythu.- Chuy€n MduMS1,MftuTKl- TS dinh kern Thu ngo CllaT6ng Gifunddc

Bao hi€m xa hQiVi~t Nam (Thu ngo do co quan BHXH trgc tiep ho~c phdiBuae 1 hqp Buu di~n in) den UBND xa thong qua Buu di~n.

- ~n Mdu TK1-TS cua tre em du6i 6 tu6i di kham, chUa b~nh khong cothe BHYT da duqc ke khai thong tin illPhong/T6 Giam dinh BHYT (ho~c tilco_quanBHXH nm kMc) chuy€n den.

- Nh~n l~i Mftu MS1, Mftu TK 1-TS da b6 sung thong tin til UBND xaBuae2 chuy€n den thong qua Buu di~n d€ chuy€n Phong/ T6 Quan ly thu.

- Chuy€n MftuTKI-TS Cllatre em du6i 6 tu6i di kham, chua b~nh khongco the BHYT da duqe ke khai thong tin den Phong/ T6 Quan ly thu.1.3. PhonglTa Gidm dinh BHYT t{li cO'sUKCB (chi thlJChi~n doi v6i truanghQ'Ptre em du6i 6 tu6i di kharn, chua b~nh khong co the BHYT)

Khi nh~n duqc thong bao tre em dum 6 tuoi den kham, chua b~nh khongco the BHYT cua co sa KCB, ph6i hqp ngay v6i co s6 KCB chuy€n Thu ngo

Buael cua T6ng Giarn d6c Bao hi€rn xa hQi Vi~t Nam dinh kern Mdu TKI-TS vahuang dftn chal rn~1nguai giarn hQke khai ehinh xac, dAydu thong tin eua treem dum 6 tu6i VaGMftuTKI-TS.

Buae2 Nh~ Mftu TK1-TS da:duqc ke khai chinh xac, day du thong tin eua tre emdu6i 6 tu6i.

Chuyen MftuTKI-TS da:dUQ'cke khai thong tin cua tre em du6i 6 tu6i denBuae3 Phong/ T6 Quan 1;' thu (ho~c cC!quan BHXH noi tre em du6i 6 tu6i cApgifty

khai sinh) d€ ra soat, e~pnh~t, cap the BHYT thea rna s6 BHXH.l~

1

2. D6i v6'i UBND xi noi l~p danh sach cip the BHYT

Butrc I Nhan Mdu MSl, Mdu TKI-TS va Thu ngo tir cc quan BHXH chuyen denthong qua Bun di~n.

Bu&c2 Chuyen M!u'TKI-TS, Thtr ngova hu~g ddn cha/ mr;! ngiroi giam h9 kekhai b6 sung chinh xac, dAydu thong tin treem dtroi 6 tu6i vao M!u TKI-TS.

Nh~ lai day du Mdu TKl- TS da bo sung thong tin cua tre em diroi 6 tu6iButrc S va ki~m tra, ra scat lai thong tin dUQ"cke khai tren to khai, huang ddn chaJ my!

nguoi giam h9 hieu chinh lai n€upMt hi~n ra sai s6t.- Chuyen Mdu MS 1 va Mdu TKl- TS cua tre em dum 6 tuoi da ke khai bo

sung thong tin d~n CCYquan BHXH thong qua Bun di~n.Luu y: Truong hQP thuc hien giao dich di~n ill:~p nh~t chinh xac, dAydu

Bu&c4 thong tin b6 sung cua tre em dum 6 tu6i tren Mdu TKl- TS vao phArrm€m kekhai ho~c ke khai trl,lc tuy€n t~i C6ng thong tin di~n illBHXH Vi~t Nam ho~cqua T6 chuc I-VAN; gui du li~u di~n tU thee quy dinh; dang thai, gUi MduMS 1 va M!u TKl- TS d€n CCYquan BHXH thong qua Bun di~n.

Thl,lChi~n cap the BHYT doi vm tre em duai 6 tu6i di kham, chua b~nhBu&c5 khong c6 the BHYT thea quy dinh khi nh~ dUQ"cthong bao cua CCYquan

BHXH.3. Deli vo; chal mel n~Oi giam hQ

Bu&el Nh~ Mdu TKI-TS va Thu ngo do cO'quan BHXH chuyen den thong quaUBNDxa.

Bu6-c2 c- - Ke khaiho:sUng:hlnh xac, daydtithongnn COilthi~u vao Mau TKI-TS.- Chuy~n Mdu TKI-TS sau khi da ke khai bo sung thong tin cho UBND

xa.Bu&e3 - Chuy~n M!u TKl- TS sau khi da ke khai chinh xac, ddy du thong tin cho

PhongIT6 Gicim dinh BHYT t~i co sa KCB dBi vm truOng hQP tre em duai 6Ir~tu6i di kham chua b~nh khong c6 the BHYT.

2

C4, di~u chinh thong tin BHXH, BHYT;xi l,p danh sach cAp the BHYT

'l3HXJf-BT ngay.,JE.I..B. ..l2017~-wJJ:'tllJfJJ.e1~r.yn9i n« Nam)

1.nAi vOi CC1 quan BHXH1.1. PhonglTJ Quiin lY thu

In Danh sach nguoi tham gia BHXH, BHYT chua c6 rna so BHXH (Mau

BU[Jc 1MS1)va To khai tham gia, ai~u chlnh thong tin BHXH, BHYT (Mau TKl- TS)cua nguoi tharn gia c6 ten trong Mau MS1 chuyen Phongff6 TN & TKQTIRC.

BU[Jc 2Nhan Mau MS1 va Mau TKl- TS aa duoc bo sung thong tin tir Phong/ To

TN & TKQ TIRC.

BU[Jc 3 To clnrc c~p nh~t ho~c to chirc thue khoan c~p nh~t dft lieu Mau TKI-TSaa b6 sung thong tin.

BU[JC 4Ra soat, kiem tra va nghiem thu dft lieu aa c~p nh~t thong tin bo sung ill

Mau TK1-TS voi co sa dfrlieu dam bao chinh xac, a~y au thong tin.

BU[JC 5 Chuyen Mau MS1 va Mau TK1-TS aen Phong/To Quan ly ho sa ae thuchien hru trii thee quy dinh.

- 1.2. PhonglTD TN & TKQ TTHC _- Nhan Mau MSl, Mau TKI-TS ttr Phong/ TAQulin ly thu. r

BU[Jc 1 - Chuyen Mau MSl, Mau TK1-TS dinh kern Thu ngo cua T6ng Giam aocBao hi~m xa hQi Viet Nam (Thu ng6 do co quan BHXH trt,rctiep ho~c ph6ihgp Buu aien in) aen UBND xa thong qua Buu dien.

BU[Jc 2Nh~ l~i Mau MSl, Mau TK1-TS aa be, sun~ thong tin tir UBND xa

chuy€n den thong qua Buu ai~n a~ chuy~n Phong/ To Qulin ly tim.2. Dai vo; UBND xi noi Hipdanh sach cip the BHYT

BU[JC 1 Nh~ Mau MS1, Miu TKI-TS va Thu ng6 til co quan BHXH chuyen aenthong qua Buu di~n.

Buo-c2Chuyen Mau TK1-TS, Thu ng6 va hu6ng dan nguai tham gia ke khai bo

sung chinh xac, d~y au thongtin vao Mau TKI-TS.Nh~ l~ aay au Mau TKl- TS da bo sung thong tin illnguai tham gia va

BU[JC 3 ki8rn tra, ra soat l~i thong tin dugc ke khai tren ta khai, hu6ng din nguai thamgia hi~u chlnh l~ineu phat hi~n ra sai s6t.

- Chuyen Mau MS1 va Mau TK1-TS cua nguai tham gia aa ke khai bosung thong tin den co quan BHXH thong qua Buu ai~n.

Luu y: Truang hgp th1,l'Chi~n giao dich ai~n tU: c~pnh~t chinh xac, a~y aliBU[JC 4 thong tin cua nguai tharn gia b6 sung tren Mau TKl- TS vao phk rn€rn ke khai

hoi;icke khai trl,Ictuyen t~i C6ng thong tin ai~n tU BHXH Vi~t Nam hoi;icquaT6 chilc I-VAN; gui dft li~uai~n ill thee quy diM; a6ng thai, gfriMau MSI vaMau TKl- TS aen co quan BHXH thong qua Buu ai~n.

3. DBivo; nglfOi tham gia

BU[Jc 1 Nh~n Mau TKI-IS va Thu ng6 do co quan BHXH chuyen aen thong quaUBNDxa.

BU[Jc 2 Ke khai bo sung chinh xac, a~y au thong tin con thieu vao Mau TK1-TS.BU[Jc 3 Chuy~nMau TKl- IS sau khi da ke khai bo sung thong tin cho UBND xa. ~i

"V

1.D8i v6i co_quanBHXH'1.1. Phonf!/TIJ Qulin LVthu

Buirc 1InDanh sach ngiroi tham gia BHXH, BHYT chua c6 rna so BHXH (Mfiu

MS1) va To khai tham gia2dieu chinh thong tin BHXH, BHYI (MfiuTK.1-IS)cua HSSV c6 ten trong Mau MS1 chuyen PhongIT6 TN & TKQTIRC.

Butrc 2 Nhan MfiuMSl va Mau TK.l-TS da dtroc bo sung thong tin tlr Phong/ ToTN & TKQ TIRC.

Butic 3 To chile c~p nh~t hoac to clnrc thue khoan c~p nhat dfr li~uMfiuTKl-TSda:b6 sung thong tin.

Buac 4 Ra soat, kiem tra va nghiem thu dfr li~u da:c~p nhat thong tin bo sung tirMdu TKl- TS voi co sa dfr lieu dam bao ehinh xac, dfiydu thong tin. .

Bucc 5 Chuyen Mdu MSl va Mau TK1-TS den Phong/To Quan Iy he so de thirchien hru trfrthea quy dinh,1.2. Phonf!/TIJ TN & TKQ TTHC! - Nl1~nMauMSl, IvffiuTl(l~TSfuPhoifglTo Quan ly tbu.. ,-,.: r; - ,-'

Buac 1 - Chuyen Mdu MS1, MfiuTK1-TS dinh kern Thtr ngo cua T6ng Giam d6cBao hi~m xa hQiVi~t Nam (Thu ng6 do cO'quan BHXH trgc ti€p ho~c ph6il!2P.BUlldi~n in) d€nNha trilang thong qua BUlldi~n.

Buac 2 Nh?o l~ Mfiu MS1, Mfiu TK1-TS da bo sung thong tin tlr Nha truOngchuy~nd€n thong qua BUlldi~nde chuy~nPhong/ T6 QuAnly thu.

2. Doi v6i Nha truimg noi HQcsinh, sinh vien theo dang theo hQcBuac 1 Nh?o MfiuMS1, Mfiu TKl-TS va Thu ng6 tir cO'quan BHXH chuyen den

thong qua BUlldi~n.

Buac 2 Chuyen Mfiu TK1-TS, Thu ng6 va hu6ng dfin HSSV ke khai b6 sungchinh xac, dfiydu thong tin VaGM§;uTKl-TS.

Nh?o l~i day du Mau TKl-TS da bo sung thong tin tir HSSV va kiern tra,Buac 3 ra soat l~i thong tin duQ'cke khai tren ta khai, hu6ng dfinHSSV hi~u chinh l~i

n~u phat hi~n ra sai s6t.- Chuyen MfiuMSl va Mdu TK1-IS cua HSSV da ke khai bo sung thong

tin d€n co quan BHXH thong qua BUlldi~n.Luu y: TruOnghQ'Pthl,lchi~n giao dich di~n ill: c~I?nh~t chinh xac, dfiydu

Buac 4 thong tin eua HSSV b6 sung tren Mfiu TKl-IS VaGphan mam ke khai ho~c kekhai trgc tuy~n ~i C6ng thong tin di~n tU BHXH Vi~t Nam ho~c qua T6 chucI-VAN; girl dfr li~u di~n tU thea quy dinh; d5ng thai, girl MfiuMSl va MfiuIKl- IS d€n cO'quan BHXH thong quaBuu di~n.

3. Dai v6i HQcsinh, sinh vien

Buac 1 Nh?o Mau IKl- IS va Thu ng6 do co quan BHXH chuy~n den thong quaNha truOng.,-

Ke khai bo sung chinh xac, day du thong tin con thieu VaGMau TKI-TS.Buac 2

Buac 3 Chuy6n Mfiu TKI-TS sau khi da ke khai bo sung thong tin cho NhatruOng.

~

Quy trinh b8 sung ~"''U'''''&I'''_''

dp rna s6BHXH cho(Ban hanh kern thld;.~n~mAsc~M1W

p'~"I''''Ih_'di~u chinh thong tin BHXH, BHYT;

HGB va tham gia BHXH tv nguy~n-BT ngay~ .8./ ..8.,/2017

(!1)ltI....'ff,a() ..fIllem:a~ah9i Vi?tNam)

1.D6i v6i co quan BHXH1.1. Phonl!lTo Qulin Iv thu

InDanh sach ngiroi tham gia BHXH, BHYT chua co rna so BHXH (M~u

Buac 1 MS1) va To khai tham gia, di~uchinh thong tin BHXH, BHYT (M~u TK1-TS)cua nguoi tham gia c6 ten trong M~u MS1 chuyen PhOngfT6TN & TKQTIRC.

Buoc 2 Nhan Mau MS 1 va Mau TK1-TS da duoc bo sung thong tin til Phong/ To1N & TKQ TIRC.

Bucc 3 To chtrc c~p nh~t hoac ta chirc thue khoan c~p nh~t dfr lieu M~u TK1-TSda b6 sung thong tin.

Bucc 4 Ra soat, kiem tra va nghiem thu dfr lieu da c~p nh~t thong tin bo sung tirM~u TK1-TS voi co sa dfr lieu dam bao chinh xac, d~ydli thong tin.

Buirc 5 Chuyen M~u MS1 va M~uTK1-TS den Phong/To Quan ly ho sa de thirchi~n hru trfr tfeo q~~d~.

•......."'c ...•__ ,..1.2. Pho1!l!/To TN & TKQ TTHC

- Nh§.nM~uMS 1,MfiuTK1-TS til Phong! To Quan ly thu.Buac 1 - Ch~y~nM~u MS1, M~uTK1-TS dinh kern Thu ng6 cua T6ng Giam d<1c

Bao hi~m xa hQi Vi~t Nam (Thu ng6 do ca quan BHXH tn,rc tiap ho~c ph6i~ Buu di~n in) dan f)'ilily thu thong qua Buu di~n.

Bttac 2 Nh~ l'iliMau MS1, Mau TK1-TS da b6 sung thong tin til D'ili ly thuchuy~n dan thong qua Buu di~nd~ chuy~n Phong! T6 Quan ly thu.

2. Doi vOiDai Iv thuBttac 1 Nh~ M~u MS1, M~u TK1-TS va Thu ngo tir ca quan BHXH chuyen den

thong qua Buu di~n.

Bttac 2 Chuyen M~u TK1-TS, Thu ng6 va huang d~ nguai tham gia ke khai bosung chinh xac, d§.ydu thong tin vao M~u TKI-TS.

~ l'iliday du Mau TK1-TS da bo sung thong tin til nguai tham gia vaBttac 3 kiSm tra, ra soat l'ilithong tin dugc ke khai tren ta khai, huang d~n ngum tham

gia hi~u chinh l'ilinau phat hi~nra sai s6t.- Chuyen Mfiu MS1 va M~u TK1-TS cua ngum tham gia da ke khai bo

sung thong tin dan co quan BHXH thong qua Buu di~n.Lzro y: Truang hqp thl,rchi~n giao djch di~n ill: c~p nh~tchinh xac, dAydu

Bttac 4 thong tin cua nguai tham gia b6 sung tren M~ti TK1-TS vao phk m~m ke khaiho~c ke khai tn,rc tuyen t'iliC6ng thong tin di~n tU BHXH Vi~t Nam ho~c quaT6 chuc I-VAN; gfri dfr li~u di~n tir theo quy dinh; d6ng thai, giriM~u MS1 vaM~uTK1-TS den ca quan BHXH thong qua Buu di~n.

3. B8i vOi ngU'o;tham gia

Bttac 1 Nh~n M~u TK1-TS va Thu ngo do co quan BHXH chuyen den thong quaD'ilily thu.

Buac 2 Ke khai bo sung chinh xac, day du thong tin con thieu vao M~uTK 1-TS.Buac 3 Chuyen M~u TKI- TS sau khi da ke khai bo sung thong tin cho f)'ili ly thu.

~

tl7m gist' BHYT dii co rna sa BHXH

J"m1l1XJ +-lr ngayJ.: 8.1...8..12017Vi~.tNam)

- Thirc hi~n cap doi va in the BHYT theo mau quy dinh tai Cong van soButrc 1 33401BHXH-ST ngay 08/8/2017 cua BHXH Vi~t Nam v~ viec c§.ps6 BHXH,

the BHYT theo rna s6 BHXH.- In Danh sach cd the BHYT du D 1Oa-TS).

so, thi

Buac 2 Chu en the BHYT, M~uD10a-TS den Phon To TN & TKQ TIRC.

Chuyen M~u D 1Oa-TS, the BHYT dinh kern Thir ngo cua Tong Giam docBuoc 2 Bao hi~rn xa hQi Vi~t Nam (Thir ngo do co quan BHXH tnrc ti~p ho~c phdi

hop Bini di~n in) den tirng co quan, dan vi sir dung lao dQnglUBND xa/ Dai Iythu, ... ( oi t~t la Dan vi) va n uoi tham ia then ua Btru di~n.

2. Bai vOi Bon viBu:ac 1 Nh~ Mau DlOa- TS, The BHYT vaThu ngo til co quan BHXH chuyen

I· " . d6n thon aua Buudi~n. . ~.'~' - _" ...: ..~~ ,< - ;";,'.; .- .Butte 2 Chu en The BHYT va Thir n 6 den n um tham ia.

Butrc 1 Nhan The BHYT va Thu ngo do co quan BHXH chuyen den thong quaDan vi.

Sir dung the BHYT theo rna so BHXH moo de di kham, chua b~nh. DongBuoc 2 thoi ghi nho rna sd BHXH do co quan BHXH cdp (10 sd cudi cua rna sd ghi

tren the BHYT).Thirc hien viec tra cUu thong tin 4ti cong thong tin cila BHXH Vi~t Nam

(t~ dia chi https:llbaohiemxahoLgov.vn) d~ bi~t v~ qua trinh th~ ~ia BHXH,Bu:ac 3 BHYT, BRTN cila minh da duqc co quan BHXH ghi nh~ va de biet thong tin

ia tri sir dl,1Il cila the BHYT.

~--~1. f>ai vOi ngrrOl tham ~a

Bubel Ke khai chinh xac, day du thong tin vao To khai tham gia, dieu chinhthong tin BHXH, BHYT (M~uTK1-TS).

Nhan so BHXH, the BHYT va Thir ngo do ca quan BHXH chuyen de,nBuac Z thong qua ca quan, dan vi S11 dung lao dQng/UBND xal Dai Iy thu, ... (goi tat

IaDan vi).S11dung the BHYT thea rna so BHXH moi de di kham, chtra benh, Bong

Buoc s thai ghi rilia rna s6 BHXH do co quan BHXH dp (10 s5 cu5i cua ma s6 ghitren the BHYT).

Thirc hien viec tra ciru thong tin tai cong thong tin cua BHXH Vi~t Nam

Bucc s (tai dia chi https://baohiemxahoi.gov.vn) d€ bi6t v6 qua trinh tham gia BHXH,BHYT, BHTN cua minh da diroc co quan BHXH ghi nh~n va d€ bi6t thong tingia tri S11 dung cua the BHYT.

2. Bai vOi Don viI ~Huang d~ ngtrci tham gia ke khai chinh xac, day du thong tin vao Miiu I

I Bubel TK1-TS.- Nhan M~u TK1-TS cua nguoi tham gia,L~pho sa thea quy dinh tai Quyet dinh so 595/QB-BHXH ngay 14/4/2017

Bube2 cua T5ng Giam d6c BHXH Vi~tNam ban hanh quy trinh thu BHXH, BHYT,BHTN, BHTNLB, BNN; quan ly 86 BHXH, the BHYT kern thea M~u TK1-TS (triJ: wang hqp bao giam nghi vi~c cMrn d(rt HBLD).

Bube3 NQPcho ca quan BHXH thong qua Buu di~n ho~c thong qua hinh th(rcgiao dich di~n illtheo quy diM.

Bube4 Nh~ so BHXH, the BHYT, M~u D09a-TS, M~u DIOa-TS va Thu ngo illca quan BHXH chuyen d~nthong qua Buu di~n.

Bube5 Tra so BHXH, the BHYT va Thu ngo cho nguai tham gia.3. Bai v6'i cO'quan BHXH

3.1. PltbnglTo TN & TKO TTHC

Bubel Nh~ ho sa thea quy diM tir nguai tham gia, Dan vi nQPcho ca quanBHXH d~ chu_y_~nd~n cae Phong/ T6 nghi~p VI,l.

Nh~n va tra ket qua thu tl,lchanh ehinh thea quy diM dinh kern Thu ngoBube2 cua T6ng Giam d6c Bao hi6rn xa hQiVi~t Nam (Thu ng6 do ca quan BHXH

trY'cti6p ho~c ph6i hgp BUlldi~n in) d5i vai nguai tharn gia mai dugc dp maso BHXH cho Dan vi, nguai tham gia.3.2. PltbnglTo Quan Ii tIm

Bube 1 Nh~ ho sa thu t\lChanh chinh thea quy dinh tir Phong/ To TN & TKQTTHC ho~e thong qua hinh thuc giao dich di~n ill.

Thvc hi~n c~c t;ghi~p V\l phat sinh thea huang d~n tl;liQuyet diM so595/QD-BHXH de cap so BHXH, the BHYT va lUll y:

Bube2 1.D6i vai h6 sa gi§.y:- T6 chuc c~p nh~t ho~c t6 chuc thue khoan e~p nh~t dfr li~uM~uTKI-TS

tU dan vi chuy~n d~n. Vi~c giao, nh~n va c~p nh~t M~u TKI-TS khong qua 1ngay. 'yri_.......

1

Bttac 2

- Kiem tra dit li~u M~u TKl- TS da c~p nh~t, cap rna so BHXH, ghi rna sovito cac bieu rn~u wang (mg.

- Ki~rn tra rna s6 BHXH do dan vi ke khai tren cac bieu mdu. Truong hQPdo dan vi ke khai sai rna s6 BHXH cua ngiroi tharn gia thi tra Iai d6 dan viki~rn tra, ke khai M~u TKI-TS. .

2. D6i voi h6 sa giao dich di~n ill:- Ki6rn tra dit li~u M~u TKI-TS da c~p nhat, dp rna s6 BHXH, ghi rna s6

vito cac bieu rndu wang (mg.- Ki~rn tra rna s6 BHXH do dan vi ke khai tren cac bi6u rndu:+ Truong hop do dan vi ke khai sai rna s6 BHXH cua ngiroi tharn gia thi

tra lai de dan vi kiern tra, ke khai Mdu TKI-TS.+ Tnrong hop c~p nh~t thong tin tren Mdu TKI-TS trung khop voi thong

tin ngiroi tham gia da diroc cdp rna s6 BHXH thi ghi rna s6 BHXH vito dit li~udi~n ill do dan vi I~p, khong thirc hien nh~p thong tin rndu TKI-TS vao co sadii li~u.3.3. PhonglTa cap sa, thi

Bttac 1Nh~ ho sa thu tuc hanh chinh theo quy dinh ill Phongl T6 TN & TKQ

TIRe ho?c thong qua hinh thuc giao dich di~n ill va illPhongl T6 Quan Iythu.

Th\!'c hi~n cac nghi~p V\l pMt sinh theo huang ddn tCjliQuyet dinh s6595/QD-BHXH d€ cdp s6 BHXH, the BHYT theo rna s6 BHXH.

BuacJI

2

.1ell uuu V!. ~Vl1!5 Ly .ll''U.l.l1. v ..... UyU ,",uvu5 !UUyL ,UJ'-'

se dinh danh: YNOO11NDia chi:

J",l,II" iY..c..,.1

(Banhanh kem thea Cong van s6:~!fBHXH-BT ngayJ31B 12017cuaBHXH Vi?( Nam)

DANH sxca NGUm THAM GIA BHXH, BHYT CHUA CO MA so BHXH

Ngay thang Gi6iS6CMNDI Ngu'Oi giam

STT HQ va ten s6 the BHYT Dja chi The elin cu'6'c/ Mli phOng ban Ghi chiinlim sinh tinh Ho chi~u

hl}

A B C 1 2 3 4 5 6 7

I.DANH SACH NGlJOI THAM GIA BHXH cmrA CO MA so BHXH

1 Nguy€n Thj Nhtr Lan DT20 10118000001 02/03/1989 Ncrsa 13, Phuong cAu Den, Quan Hai Ba Tnmg, Tp 0135xxx69 Xmmg mayHaNoi

...

II. DANH SACH NGlfCH DANG THAM GIA BHXH cAp TRUNG so so BHXH

sa 18, Phuong Bl;iiKim, Qu~ Hoang Mai, Tp HaThu hoi so

Nguy8n Viin Hung DT20 10 118000002 03/0211990 Nam NQi i o13572xxx Thi~t k~ BHXHs6

1, 011358xxx9

L""(..

NGU(1!L~P BrEU

Ha N9i, ngay thang nam2017co QUANBHXH

(kf, dong ddu)

C9t A: ghi s6 thu t¥ tic 1din hit ngzro-ilao d(jng chua duvc d6ng b9CQ!B: ghi ro h9 fen cua nguai tham giaCQtC: ghi s6 the BHYT eua nguai tham gia tlii tlu(1CCCl quan BHXH cdpCi)( 1:ghi ngay. (hang. nam sinh nhu trong gicy khai sinh ho¢e chUng minh nhtin dan, h9 ehiiu. the can ewe.CQ(2: ghi gilli linh cua cae Ihcmh vien Irong h9 (niu la nam thi ghi tic "nam" ho¢e niu la nu thi ghi tic "nu"),C(jt 3: ghi d/a chi lien h? cua nguai tham gia.Ci)t 4: s6 chWzg minh nhtin danlHQ ehiiuIThe din ewc (niu co): ghi s6 chung minh nhdn dan ho¢c ghi s6 M.:t,iiu ho¢c ghi s6 The can ewe.C(jt 5: ghi h() ten nguo-i giam h(j d6i Vi;,itruimg hr;p Ire em duai 6 !U6iC(jt 6: ghi Mil phdng ban eua dan vi (niu co)C{5t7: ghi "Thu h6i s6 BHXH va s6 s6 kem theo" va ghi nhilng n(5idung cdn ghi eM.

Phuong phtip flip:Ten dan vi: Ghi len dan vi dang tham gia BRXH, BRIT86 dinh danh: Ghi md dan vi do ca quan BHXH cdpDia chi: Ghi dia chi dan vi dang IcY nhdn h6 sa* Chi lieu thea hang:_Chi day d(, thong tin ngutr!tham gia BHXll, BHYT chua co 1'1111s6BJ-L¥Hva nguai dang thamgia BHXlJ cap Irimg s6 s6BHXH_Chi in hang tieu thux: cua M~ICJ va M~leII tlti voi dan vi szr dyng lao tI{5ngco ngucJi dang tham gia BHXH cdp triing s6 s6 BHXH

* Chi mu thea c(jt:

r,

BAo HIEM xX H(H VI~T NAM

(Ban hanh kem thea QE> sO: 595/QE>-BHXHngay 14/412017 cua BHXHVietNam)

CC)NGHoA xX HQI cHi] NGmA vrsr NAMD.QcIi-p- TV do --H\lnb phuc

TOKHAITHAM GIA, BIEU CHiNH THONG TIN BAo HIEM xA HOI,BAo HIEM Y TE

Kinh glii: .

L Phftn ke khai bit bUQc[01]. HQva ten (viet chit in hoa): ..

[02]. Ngay, thang, nam sinh: .1 .1 [03]. Gioi tinh: ..[04]. QuActich [05]. Dan tQC ..[06]. Noi dang Icy giAykhai sinh: [06.1]. Xa (phuong, thi ttin): ~ ..[06.2]. Huyen (quan, thi x~ Tp thuQc tinh): [06.3]. Tinh (Tp): .[07]. Dja chi nh~nhe so: [07.1]. s6 nha, duong ph6, thon xom: ..[07.2]. Xli (phtrong, th] trdn): [07.3] Huyen (quan, thi x~, Tp thuQc tlnh):

.................................................................. [07.4].Tinh (Tp): .[08]. HQ ten cha/ mr;/ nguoi giam he;> (a6i-v61 tre em dWi6 tu6i): ~~ .

. .:.-_.:, .,.~Il. Phin ke kbai chung - . ---,

[09]. Ma s6 BHXH (da cdp):.. .. .. .. .. .. [09.1]. s6 di~ thoai lien h~: .[09.2]. s6 CMND/ HQ chi~U/ The can circe: .[10]. Mli s6 he;>gia dlnh (da cAp): ..(truUng hap chua co mil h9 gia amh thi Ire khai b6 sung Ph¥ i{lC (flnh kem tu khai)

[11]. Muc ti~n dong: [12]. Phuong thuc dong: ..[13]. NO'i dang Icy kham b~nh, chua b~nhban dAu: '" .[14]. NQi dung thay dAi, yeu cAu:..... ~ , .[15]. H6 sO'kern thea (n~u c6): ..............................................................................................................................................

TOi cam doan nhilng nQidung ke khai IAdUng vAchiu trach nhi~m truac phapIu~t v~ nhltng nQidung dil ke khai

.........., ngay thang nam ..Ngu'Oi ke khai(Ky, ghi ro h(Jten)

PhtrO'ng phdp lQ-p:Ghi ady au thOngtin con thiiu VaGcac chi lieu tren Ta khai (khongpha; ke khai cac chi lieu [10], [11], [12],[13J, [14], [15]). Lim Y m9t s6 chi lieu sau:

[06). Nai aang 10/ GiOykhai sinh: ghi ro ten xa (phuOng, thi tran), huy¢n (qu~n, thi xii, thanh ph6 thu9c tinh), tinh, thcmhpM aa aang 10/ giOykhai sinh Truang h9]J chua xci.:ainh au(J'crlO'i cdp giay-khai sinh ltin adu thi ghi nguyen qu(m (trwng h9Psat.nh~p, chia tach a/a giai hanh chinh thi ghi theo ten a/a danh t{li thd1 aiim ke !chai)hogc ghi theo ncriaang 10/ M!chau thuangtrU hogc t{lmtrU.

[09). Ma s6 BHXH: Trttang h9P c6 s6 s6 BHXH hoi;1cs6 the BHYT thi ghi s6 s6 BHXH ho(jc s6 the BHYT.Sau khi hoan tat vi¢c ke khai, nguai ke khai 10/ ghi ro h() tenrJJ'

Phu luc: Thanh vien hQ gia dlnhHQ va ten chu he): sa dien thoai (neu co): .

sa s6 hQ khAu (hoac s6 tarn tru): Dja chi: Thon (ban, t6 dan ph6) ' Xa (phirong, th] trdn): .Huyen (qu~n, th] xii, Tp thu{)c tlnh): '" Tinh (Tp): , .

,Stt HQva t@n MllsaBHXH Ngay, thang, GiO·j

Noi cap gi§y kha] sinh M6i quan h~ Sa CMNDI The canGhi chtinam sinh Hob v6'i chu hO Clr(J'c/H6 chi@uA B 1 2 3 4 5 6 7

1

-2 ,

3

-4

...

Phuong pluip l{ip: ,

* Phan thong tin chung: ghi iJay iJiIho va ten chit h9; ghi s6 s6 h9 khtiu (ho(ic s6 s6 tam troy; s6 iJl?"!thoai lien h¢ (niu co); ghi ro iJia chi: than (bim, t6 dan ph6);xii (phrrc1ng.thi tran); huyfn (qu(in. thi xii, thanh ph6 thu9C tinh); tlnh (tht1nhph6).

Tru&ng h(yp h9 gia iJinh chi co giciy t(lm lro thi van thl,rCht?n ke khat nhrrng ghi ro Cl,ImtU "giciy tt;lmtru" VaG c9t ghi eM.* Chi lieu theo C91:- CQtA: ghi s6 tM tl,rtU 1iJin hit cac thOnh vien trong M gia tlinh.- CQ!B: ghi iJay du /1(J va ten c1ia timg ngWi trong s6 h9 khdu (trir nhiing ngrrai t(lm vcing) holjc s6 t(lm tru (bao g6m chu Mva cae thcmh vien trong M).- C911:ghi ma s6 BHXH a6i ViyitUng thanh vien h9 gia i1lnh iJa iJU(1cC(7quan BllXH cap; truangtrwng h(iJJchrra xac iJinh iJu(1cmii s6 BHXH thi ngrrai ke khai

co 1M tra cUu mii sJ BllXH tt;liaia chi: http://baohiemxahoi.gov.vn (niu au ai€u ki?n).- Cpt 2: ghi ngay. thang. nam sinh nhrr trong giciy khai sinh ho(ic chUng minh nhtin dan. h9 chiiu. the can eWc.- CQt3:ghi giai tinh cua cac thanh vien trong h9 (niu la nam thi ghi tU "nam" ho(ic niu ia nii thi ghi fir "nii").- CQI4: ghi ro ten xii (phwng. thi tran); huy¢n (qu(in. thi xii, thcmh pM thU9Ctinh); tinh, thanh phd iJii cap giciy khai sinh.

• Truirng h9]l chrra xac afnh au(J'cnai ct1p~iciy khai sinh thi ghi nguyen quan (truirng h9]l sat nh(ip, chia tach ala giai hcmh chinh thi ghi thea ten ala danh t(Ii thataiem ke /chat) ho(ic ghi theo nai aang kY h9 khau thuang tru holjc t(Im tru.

- Ci)t 5: ghi m6i quan h¢ vai chit h9 (/a V(7, ch6ng, con, chau ...).- Cpt 6:S6chUng minh nhan danlH(J chiduirhe can cu6'c (niu c6): ghi s6 chung minh nhtin dan holjc ghi s6 h9 chiiu ho(ic ghi s6 The can eWc.- Cl)t 7: ghi nhiing n(Ji dung can ghi chu.Sau khi hoan tat vi?c ke khai, ngrrai ke khai IcY ghi ro h9 ten~

Tlli cam doan nhilng nQi dung k8 khai hl dungva chiu trach nhiem truce phap lu~t ve nhtrng n/)i dung dii ke khai

........... ngay thdng ndm ..NgtfiYj ke khai

BAomtM xx HQIvq:T NAM

THUNGO

Tham gia chinh sach bao hiembao an sinh xii hQi dai voiam dau, thai san, tai nan l~9.iJ.(l,!;mg~'::~.~~I1J1,kham benh, ch rasnennling dungphu vatham giaph~

bao hiem y t8 (BHYT) la damcUQcsang cua nguoi dan hie

~~~~ khi nghi huu va dinhan dan d8 dua

~J.<"'''''LL hang cuaco quan BHXH,

buu di~n van hoa xii, .~ai~(:i~~+~~DI~§Ja1~tGi~rj~thu noi tham gia BHXH,BHYT, cosa KCB BHYT dS rlfrqcgiai

Xin tran trong cam an!