National Health Insurance Act
2023-06-28
手機睡眠
語音選擇
Chapter 1 General Principles
Article 1
This Act is enacted to promote the health of all nationals, administer National Health Insurance (hereinafter referred to as “this Insurance”), and provide health services.
This Insurance is compulsory social insurance. Benefits shall be provided during the insured term under the provisions of this Act in case of illness, injury, or maternity that occurred to the beneficiary.
This Insurance is compulsory social insurance. Benefits shall be provided during the insured term under the provisions of this Act in case of illness, injury, or maternity that occurred to the beneficiary.
Article 2
Terms used in this Act are defined as follows:
1. Beneficiary: refers to the insured and his/her dependents.
2. Dependents:
(1) The insured ’s spouse who is not employed.
(2) The insured ’s lineal blood ascendants who are not employed.
(3) The insured’s lineal blood descendants within the second degree of kinship who are either minor and not employed or majority but incapable of making a living, including those who are in school without employment.
3. Premium withholder: Refers to the individual from whom the premium is withheld according to the Income Tax Act.
4. Benefit payments: refers to the remainder of total medical benefit payments minus the self-bearing medical fees of the beneficiary based on this Act.
5. Insurance budget: Refers to the insurance benefit payments and reserve funds that shall be established or added.
6. Medical Visit Advice: Refers to understanding the beneficiary’s medical visit practices, providing appropriate medical and health education, as well as arranging and assisting with medical visits when the beneficiary has been found to duplicate medical visits, undergo repetitive visits, and use inappropriate treatment.
1. Beneficiary: refers to the insured and his/her dependents.
2. Dependents:
(1) The insured ’s spouse who is not employed.
(2) The insured ’s lineal blood ascendants who are not employed.
(3) The insured’s lineal blood descendants within the second degree of kinship who are either minor and not employed or majority but incapable of making a living, including those who are in school without employment.
3. Premium withholder: Refers to the individual from whom the premium is withheld according to the Income Tax Act.
4. Benefit payments: refers to the remainder of total medical benefit payments minus the self-bearing medical fees of the beneficiary based on this Act.
5. Insurance budget: Refers to the insurance benefit payments and reserve funds that shall be established or added.
6. Medical Visit Advice: Refers to understanding the beneficiary’s medical visit practices, providing appropriate medical and health education, as well as arranging and assisting with medical visits when the beneficiary has been found to duplicate medical visits, undergo repetitive visits, and use inappropriate treatment.
Article 3
The government shall bear no less than 36% of the total annual insurance budget after deducting statutory revenue for this insurance program each year.
If the government’s budgetary allocation as stipulated by law falls short of covering 36% of the annual insurance budget after deducting statutory revenue, the Competent Authority shall allocate a budget to cover the shortfall.
If the government’s budgetary allocation as stipulated by law falls short of covering 36% of the annual insurance budget after deducting statutory revenue, the Competent Authority shall allocate a budget to cover the shortfall.
Article 4
The Competent Authority of this Insurance shall be the Ministry of Health and Welfare.
Article 5
The National Health Insurance Committee (hereinafter referred to as the “NHIC”) shall be in charge of the following tasks:
1. Review of insurance premiums;
2. Review of the scope of benefits;
3. Coordination of drafting and allocation of medical benefit payments;
4. Study and interpretation of insurance laws and policies;
5. Other supervisory functions pertaining to insurance matters.
When the review and coordination done by the NHIC in the preceding paragraph find a reduction in insurance revenues or increase in insurance expenditures, it shall ask the Insurer to present a proposal for resource allocation and financial balance to be reviewed or coordinated jointly.
When the NHIC reviews and coordinates matters relevant to this Insurance, it shall make its agenda public seven days before the meeting and the meeting minutes within ten days after the meeting. Before reviewing and coordinating major matters, it shall gather information on public opinion and organize related activities involving the public if necessary.
The NHIC is made up of insureds, employers, insurance medical service providers, experts, reputable public figures, and representatives from relevant agencies. Representatives from premium payers shall not be less than one-half of the total number of NHIC members, while representatives from the insureds shall not be less than one-third.
The Competent Authority shall determine the number of members, how they are selected, meeting regulations, self-disclosure of the representative’s interest, and disclosure to the public.
Matters reviewed and coordinated by the NHIC shall be approved by the Competent Authority or presented to the Executive Yuan for approval. Matters approved by the Executive Yuan shall be sent to the Legislative Yuan for future reference.
1. Review of insurance premiums;
2. Review of the scope of benefits;
3. Coordination of drafting and allocation of medical benefit payments;
4. Study and interpretation of insurance laws and policies;
5. Other supervisory functions pertaining to insurance matters.
When the review and coordination done by the NHIC in the preceding paragraph find a reduction in insurance revenues or increase in insurance expenditures, it shall ask the Insurer to present a proposal for resource allocation and financial balance to be reviewed or coordinated jointly.
When the NHIC reviews and coordinates matters relevant to this Insurance, it shall make its agenda public seven days before the meeting and the meeting minutes within ten days after the meeting. Before reviewing and coordinating major matters, it shall gather information on public opinion and organize related activities involving the public if necessary.
The NHIC is made up of insureds, employers, insurance medical service providers, experts, reputable public figures, and representatives from relevant agencies. Representatives from premium payers shall not be less than one-half of the total number of NHIC members, while representatives from the insureds shall not be less than one-third.
The Competent Authority shall determine the number of members, how they are selected, meeting regulations, self-disclosure of the representative’s interest, and disclosure to the public.
Matters reviewed and coordinated by the NHIC shall be approved by the Competent Authority or presented to the Executive Yuan for approval. Matters approved by the Executive Yuan shall be sent to the Legislative Yuan for future reference.
Article 6
The beneficiary, the group insurance applicant, the premium withholder, and the contracted medical care institution shall apply for a review to settle disputes against the Insurer. They may file an administrative appeal or administrative lawsuit if they disagree with the review results.
The National Health Insurance Dispute Mediation Committee shall review such disputes.
The Competent Authority shall determine the scope of the abovementioned disputes, application for review, or deadline for submission of documents, procedures, as well as the review methods and process.
The National Health Insurance Dispute Mediation Committee shall periodically publicize the dispute review results via the publication of a government gazette, Internet, or other proper methods.
The publication of the dispute review results referred to in the preceding paragraph shall be made only after the information of individuals, juridical persons, or groups has been de-identified through coding, anonymizing, masking part of the information or other methods, and no longer identifiable.
The National Health Insurance Dispute Mediation Committee shall review such disputes.
The Competent Authority shall determine the scope of the abovementioned disputes, application for review, or deadline for submission of documents, procedures, as well as the review methods and process.
The National Health Insurance Dispute Mediation Committee shall periodically publicize the dispute review results via the publication of a government gazette, Internet, or other proper methods.
The publication of the dispute review results referred to in the preceding paragraph shall be made only after the information of individuals, juridical persons, or groups has been de-identified through coding, anonymizing, masking part of the information or other methods, and no longer identifiable.
Chapter 2 The Insurer, The Beneficiary, and The Group Insurance Applicant
Article 7
The Insurer of this Insurance shall be the National Health Insurance Administration, Ministry of Health and Welfare, which will administer the insurance business.
Article 8
Any national of the Republic of China must meet one of the following requirements in order to become the beneficiary of this Insurance:
1. Those who have previously subscribed to this Insurance within the last two years and have a registered domicile in Taiwan or have established a registered domicile for at least six consecutive months in the Taiwan area prior to subscription of this Insurance;
2. The following individuals who have established a registered domicile in the Taiwan area at the time of becoming a subscriber:
(1) Civil servants or full-time and regularly paid personnel in governmental agencies and public/private schools;
(2) Employees of publicly or privately owned enterprises or institutions;
(3) Employees other than the insured prescribed in the preceding two items but are otherwise employed by particular employers;
(4) Newborns in the Taiwan area;
(5) Spouse and offspring of government officials assigned abroad.
Individuals who had previously subscribed to this Insurance and had gone abroad before this revision was promulgated on January 4, 2011, shall immediately establish residency and subscribe to this Insurance the first time they return to the country one year after the revision has been implemented. They will not be subject to the six-month restriction of Subparagraph 1 of the preceding paragraph.
1. Those who have previously subscribed to this Insurance within the last two years and have a registered domicile in Taiwan or have established a registered domicile for at least six consecutive months in the Taiwan area prior to subscription of this Insurance;
2. The following individuals who have established a registered domicile in the Taiwan area at the time of becoming a subscriber:
(1) Civil servants or full-time and regularly paid personnel in governmental agencies and public/private schools;
(2) Employees of publicly or privately owned enterprises or institutions;
(3) Employees other than the insured prescribed in the preceding two items but are otherwise employed by particular employers;
(4) Newborns in the Taiwan area;
(5) Spouse and offspring of government officials assigned abroad.
Individuals who had previously subscribed to this Insurance and had gone abroad before this revision was promulgated on January 4, 2011, shall immediately establish residency and subscribe to this Insurance the first time they return to the country one year after the revision has been implemented. They will not be subject to the six-month restriction of Subparagraph 1 of the preceding paragraph.
Article 9
With the exception of individuals mentioned in the preceding article, any person who has an alien resident certificate in the Taiwan area must meet one of the following requirements in order to become the beneficiary of this Insurance:
1. Those who have established a registered domicile in Taiwan for at least six months.
2. Those with a regular employer.
3. Newborns in the Taiwan area.
1. Those who have established a registered domicile in Taiwan for at least six months.
2. Those with a regular employer.
3. Newborns in the Taiwan area.
Article 10
The insured shall be classified into the following six categories:
1. Category 1
(1) Civil servants or full-time and regularly paid personnel in governmental agencies and public/private schools;
(2) Employees of publicly or privately owned enterprises or institutions;
(3) Employees other than the insured prescribed in the preceding two items but are otherwise employed by particular employers;
(4) Employers or self-employed owners of business;
(5) Independently practicing professionals and technicians.
2. Category 2
(1) Members of an occupational union who have no particular employers or who are self-employed;
(2) Seamen serving on foreign vessels, who are members of the National Seamen’s Union or the Master Mariners’ Association.
3. Category 3
(1) Members of the Farmers’ Association or the Irrigation Association, or workers aged over fifteen who are actually engaged in agricultural activities;
(2) Members of category A of the Fishermen’s Association who are either self-employed or have no particular employers or workers aged over fifteen who are actually engaged in fishery activities.
4. Category 4
(1) Military servicemen whose compulsory service terms are over two months or who are summoned to serve in the military for more than two months, military school students who receive grants from the government, military servicemen’s dependents who lost their support recognized by the Ministry of National Defense, and military decedent’s families who are receiving pensions due to the death of their decedents.
(2) Men at the age of enlisting in the military, who are currently in substitute services.
(3) Those who are serving sentences in correctional institutions or receiving rehabilitative or reformatory measures. However, this is not applicable to those who are serving sentences of less than two months or are under parole.
5. Category 5
Members of low-income households, as defined by the Public Assistance Act.
6. Category 6
(1) Veterans, household representatives of survivors of veterans;
(2) Representatives or heads of household other than the insured or his/her dependents prescribed in Subparagraphs 1 to 5 and the preceding item of this subparagraph.
The standard for identification and qualification of the workers actually engaged in agricultural activities under Item (1) of Subparagraph 3 and the workers actually engaged in fishery activities under Item (2) of Subparagraph 3 shall be established jointly by the central agricultural competent authority and the Competent Authority.
1. Category 1
(1) Civil servants or full-time and regularly paid personnel in governmental agencies and public/private schools;
(2) Employees of publicly or privately owned enterprises or institutions;
(3) Employees other than the insured prescribed in the preceding two items but are otherwise employed by particular employers;
(4) Employers or self-employed owners of business;
(5) Independently practicing professionals and technicians.
2. Category 2
(1) Members of an occupational union who have no particular employers or who are self-employed;
(2) Seamen serving on foreign vessels, who are members of the National Seamen’s Union or the Master Mariners’ Association.
3. Category 3
(1) Members of the Farmers’ Association or the Irrigation Association, or workers aged over fifteen who are actually engaged in agricultural activities;
(2) Members of category A of the Fishermen’s Association who are either self-employed or have no particular employers or workers aged over fifteen who are actually engaged in fishery activities.
4. Category 4
(1) Military servicemen whose compulsory service terms are over two months or who are summoned to serve in the military for more than two months, military school students who receive grants from the government, military servicemen’s dependents who lost their support recognized by the Ministry of National Defense, and military decedent’s families who are receiving pensions due to the death of their decedents.
(2) Men at the age of enlisting in the military, who are currently in substitute services.
(3) Those who are serving sentences in correctional institutions or receiving rehabilitative or reformatory measures. However, this is not applicable to those who are serving sentences of less than two months or are under parole.
5. Category 5
Members of low-income households, as defined by the Public Assistance Act.
6. Category 6
(1) Veterans, household representatives of survivors of veterans;
(2) Representatives or heads of household other than the insured or his/her dependents prescribed in Subparagraphs 1 to 5 and the preceding item of this subparagraph.
The standard for identification and qualification of the workers actually engaged in agricultural activities under Item (1) of Subparagraph 3 and the workers actually engaged in fishery activities under Item (2) of Subparagraph 3 shall be established jointly by the central agricultural competent authority and the Competent Authority.
Article 11
The insured classified in Category 1 may not opt for classification in Category 2 or Category 3. The insured classified in Category 2 may not opt for classification in Category 3. The insured classified in Categories 1 to 3 may not opt for classification in Categories 4 to 6. However, Members of Category A of the Fishermen’s Association who hire 10 or less than 10 laborers for ocean fishing and are actually engaged in fishery activities starting from January 21, 2002, shall be classified as Category 3.
Those who qualify as the insured shall not subscribe to this Insurance as dependents.
Those who qualify as the insured shall not subscribe to this Insurance as dependents.
Article 12
The dependents of the insured in Article 2 shall subscribe to or withdraw from this Insurance together with the insured. However, this rule shall be inapplicable to situations including but not limited to domestic violence, which the Competent Authority recognizes as difficult for dependents to subscribe to or withdraw from this Insurance together with the insured.
Article 13
The following persons are not covered by this Insurance and shall be withdrawn from it if they have subscribed to this Insurance:
1. Those who have been missing for six months or more;
2. Those who are not qualified under Articles 8 or 9.
1. Those who have been missing for six months or more;
2. Those who are not qualified under Articles 8 or 9.
Article 14
The commencement of the insurance shall take effect from the date of occurrence of such qualifications specified in Articles 8 or 9.
The termination of the insurance shall take effect from the date of occurrence of the preceding article.
The termination of the insurance shall take effect from the date of occurrence of the preceding article.
Article 15
The group insurance applicants for the different Categories of the insured are as follows:
1. For the insured in Categories 1 and 2, the group insurance applicants shall be the agencies, schools, enterprises, institutions, or employers in which they work for or unions where they hold membership. Nonetheless, the group insurance applicants that cover the insured in the Ministry of National Defense shall be designated by the Ministry of National Defense.
2. For the insured in Category 3, the group insurance applicants shall be the lowest-level Farmer’s Association, Irrigation Association, or Fishermen’s Association to which they belong or located at the place where the insured have their household registered.
3. For the insured in Category 4, the group insurance applicants are as follows:
(1) For the insured in Item 1, Subparagraph 4, Paragraph 1, Article 10, the group insurance applicants shall be designated by the Ministry of National Defense.
(2) For the insured in Item 2, Subparagraph 4, Paragraph 1, Article 10, the group insurance applicants shall be designated by the Ministry of Interior.
(3) For the insured in Item 3, Subparagraph 4, Paragraph 1, Article 10, the group insurance applicants shall be designated by the Ministry of Justice and by the Ministry of National Defense.
4. For the insured in Categories 5 and 6, the group insurance applicants shall be the village (township, municipal, district) administration offices of their registered domiciles; provided, however, the public or private social welfare service institutions may be the group insurance applicants for the insured who lives therein.
The insured prescribed in Item 2, Subparagraph 6, Paragraph 1 of Article 10, and his/her dependents may, upon the consent of the group insurance applicants of the insured in another category who live together with the above insured and his/her dependents, use such units as their group insurance applicants, provided that the insurance premium shall be calculated separately according to the provision of Article 23.
The group insurance applicants prescribed in Subparagraph 4, Paragraph 1 of this Article shall set up special units or agents to administer relevant matters of this Insurance.
For anyone who is covered under Category 6 and undergoing vocational training or exam-taking training at a government-registered institution, such training institution or agency shall be the group insurance applicant.
If the group insurance applicant has failed to make the insurance premium payments for more than two months, the Insurer may contact another group insurance applicant to administer matters related to this Insurance.
The group insurance applicants shall subscribe to the Insurer for coverage within three days from the date on which a beneficiary meets the conditions of this Insurance and shall withdraw from the coverage within three days from the date of occurrence of the cause of the withdrawal.
1. For the insured in Categories 1 and 2, the group insurance applicants shall be the agencies, schools, enterprises, institutions, or employers in which they work for or unions where they hold membership. Nonetheless, the group insurance applicants that cover the insured in the Ministry of National Defense shall be designated by the Ministry of National Defense.
2. For the insured in Category 3, the group insurance applicants shall be the lowest-level Farmer’s Association, Irrigation Association, or Fishermen’s Association to which they belong or located at the place where the insured have their household registered.
3. For the insured in Category 4, the group insurance applicants are as follows:
(1) For the insured in Item 1, Subparagraph 4, Paragraph 1, Article 10, the group insurance applicants shall be designated by the Ministry of National Defense.
(2) For the insured in Item 2, Subparagraph 4, Paragraph 1, Article 10, the group insurance applicants shall be designated by the Ministry of Interior.
(3) For the insured in Item 3, Subparagraph 4, Paragraph 1, Article 10, the group insurance applicants shall be designated by the Ministry of Justice and by the Ministry of National Defense.
4. For the insured in Categories 5 and 6, the group insurance applicants shall be the village (township, municipal, district) administration offices of their registered domiciles; provided, however, the public or private social welfare service institutions may be the group insurance applicants for the insured who lives therein.
The insured prescribed in Item 2, Subparagraph 6, Paragraph 1 of Article 10, and his/her dependents may, upon the consent of the group insurance applicants of the insured in another category who live together with the above insured and his/her dependents, use such units as their group insurance applicants, provided that the insurance premium shall be calculated separately according to the provision of Article 23.
The group insurance applicants prescribed in Subparagraph 4, Paragraph 1 of this Article shall set up special units or agents to administer relevant matters of this Insurance.
For anyone who is covered under Category 6 and undergoing vocational training or exam-taking training at a government-registered institution, such training institution or agency shall be the group insurance applicant.
If the group insurance applicant has failed to make the insurance premium payments for more than two months, the Insurer may contact another group insurance applicant to administer matters related to this Insurance.
The group insurance applicants shall subscribe to the Insurer for coverage within three days from the date on which a beneficiary meets the conditions of this Insurance and shall withdraw from the coverage within three days from the date of occurrence of the cause of the withdrawal.
Article 16
The Insurer must produce and distribute a National Health Insurance (NHI) Card with an electronic information processing function to store and send information to the beneficiary. However, the card may not store any information not used for medical care purposes or those unrelated to the beneficiary receiving insurance medical services.
The Insurer may charge a reasonable administrative fee for the reissuance and replacement of the preceding NHI Card. The methods governing the production, issuance, reissuance, replacement, data access, transmission, content utilization, usage management, and other related matters shall be drafted by the Insurer and submitted to the Competent Authority for approval and promulgation.
The Insurer may charge a reasonable administrative fee for the reissuance and replacement of the preceding NHI Card. The methods governing the production, issuance, reissuance, replacement, data access, transmission, content utilization, usage management, and other related matters shall be drafted by the Insurer and submitted to the Competent Authority for approval and promulgation.
Chapter 3 Insurance Finance
Article 17
The Central Government, the group insurance applicant, and the beneficiary shall jointly bear the insurance budget after promulgated revenues have been deducted.
Article 18
The insurance premium payable by the insured in Categories 1 to 3 and his/her dependents shall be calculated according to the insured payroll-related amount and the insurance premium rate of the insured. The insurance premium rate shall be set at a maximum of 6 percent.
The insurance premium payable by the dependents articulated in the preceding paragraph shall be paid by the insured. When the number of dependents exceeds three, the insurance premium shall be calculated on the basis of only three dependents.
The insurance premium payable by the dependents articulated in the preceding paragraph shall be paid by the insured. When the number of dependents exceeds three, the insurance premium shall be calculated on the basis of only three dependents.
Article 19
The insured payroll-related amount for the insured in Categories 1 to 3 shall be subject to a grading table drafted by the Competent Authority and be reported to the Executive Yuan for approval.
The minimum in the said Grading Table of insured payroll-related amount shall be equal to the basic wage/minimum wage promulgated by the central competent authority in charge of labor affairs. Upon adjustment of the basic wage/minimum wage, such minimum shall be adjusted accordingly.
The insured payroll-related amount of the top level of the Grading Table of insured payroll-related amount has to be kept fivefold higher than the amount in the bottom level, and the said Grading Table has to be revised in one month after the basic wage/minimum wage is adjusted. In case the number of the insured applicable to the highest level of insured payroll-related amount exceeds three percent of the total number of the insured for twelve consecutive months, the Competent Authority shall readjust the Grading Table of insured payroll-related amount to advance a higher level starting from the following month.
The minimum in the said Grading Table of insured payroll-related amount shall be equal to the basic wage/minimum wage promulgated by the central competent authority in charge of labor affairs. Upon adjustment of the basic wage/minimum wage, such minimum shall be adjusted accordingly.
The insured payroll-related amount of the top level of the Grading Table of insured payroll-related amount has to be kept fivefold higher than the amount in the bottom level, and the said Grading Table has to be revised in one month after the basic wage/minimum wage is adjusted. In case the number of the insured applicable to the highest level of insured payroll-related amount exceeds three percent of the total number of the insured for twelve consecutive months, the Competent Authority shall readjust the Grading Table of insured payroll-related amount to advance a higher level starting from the following month.
Article 20
The insured payroll-related amount for the insured in Categories 1 and 2 is determined on the following basis:
1. Employees: the payroll;
2. Employers and self-employed owners of business: the business income;
3. Self-employed individuals and independently practicing professionals and technicians: the income from professional practice.
If the insured prescribed in Categories 1 and 2 has no stable income, the insured shall select the proper insured payroll-related amount from the Grading Table of insured payroll-related amount, and such insured payroll-related amount shall be examined by the Insurer, who may adjust at its own discretion if the insured payroll-related amount is found inappropriate.
1. Employees: the payroll;
2. Employers and self-employed owners of business: the business income;
3. Self-employed individuals and independently practicing professionals and technicians: the income from professional practice.
If the insured prescribed in Categories 1 and 2 has no stable income, the insured shall select the proper insured payroll-related amount from the Grading Table of insured payroll-related amount, and such insured payroll-related amount shall be examined by the Insurer, who may adjust at its own discretion if the insured payroll-related amount is found inappropriate.
Article 21
In case the income of the insured in Categories 1 and 2, as prescribed in the preceding article, is adjusted between February and July of the current year, the group insurance applicants shall notify the Insurer the adjusted insured payroll-related amount by the end of August of the same year, or notify the Insurer by the end of February of the following year if the adjustment is made between August of the current year and January of the following year, which shall become effective on the first day of the following month after notification.
Unless the insured payroll-related amount, as prescribed in the preceding paragraph, has reached the highest level of this Insurance, such amount shall not be lower than the monthly labor pension reserve deposit or the insured salary of other social insurance schemes to which the insured subscribes. In case the insured payroll-related amount of this Insurance is lower, the group insurance applicant shall at the same time notify the Insurer to adjust accordingly, or the Insurer may also make adjustments at its own discretion.
Unless the insured payroll-related amount, as prescribed in the preceding paragraph, has reached the highest level of this Insurance, such amount shall not be lower than the monthly labor pension reserve deposit or the insured salary of other social insurance schemes to which the insured subscribes. In case the insured payroll-related amount of this Insurance is lower, the group insurance applicant shall at the same time notify the Insurer to adjust accordingly, or the Insurer may also make adjustments at its own discretion.
Article 22
The insured payroll-related amount applicable to the insured in Category 3 shall be the average amount for those specified under Items 2, 3 of Subparagraph 1, and Subparagraph 2 of Paragraph 1, Article 10, provided that the Insurer may adjust the level of insured payroll-related amount according to the financial viability of the insured and his/her dependents.
Article 23
The insurance premium of a beneficiary in Categories 4 to 6 shall be calculated according to the averaged actuarial insurance premium based on the total number of beneficiaries in accordance with Article 18.
The insurance premium of the dependents stated in the preceding paragraph shall be paid by the insured. When the number of dependents exceeds 3, the payment shall be calculated on the basis of only three dependents.
The insurance premium of the dependents stated in the preceding paragraph shall be paid by the insured. When the number of dependents exceeds 3, the payment shall be calculated on the basis of only three dependents.
Article 24
The insurance premium rate for the insured and each of his/her dependents specified in Article 18 shall be proposed by the Insurer for deliberation within one month after the NHIC negotiates and determines the total medical benefit expenditure. However, if the insurance premiums collected based on the maximum rate fail to balance with the total medical benefit expenditure agreed upon for that year, the total medical benefit expenditure shall be renegotiated.
Before the review from the preceding paragraph, the NHIC shall invite actuaries, insurance and finance experts, economists, and reputable public figures to provide opinions.
The deliberation referred to in the first paragraph shall be completed one month prior to the start of the fiscal year based on the total medical payment amount stipulated in the agreement in order to finalize the revenue and expenditure balance rate review for that year. The result shall be submitted to the Competent Authority, which will forward them to the Executive Yuan for approval, after which the Competent Authority shall make a public announcement. If the deliberation cannot be completed within the specified timeframe, the Competent Authority shall directly submit the matter to the Executive Yuan for approval and subsequent announcement.
Before the review from the preceding paragraph, the NHIC shall invite actuaries, insurance and finance experts, economists, and reputable public figures to provide opinions.
The deliberation referred to in the first paragraph shall be completed one month prior to the start of the fiscal year based on the total medical payment amount stipulated in the agreement in order to finalize the revenue and expenditure balance rate review for that year. The result shall be submitted to the Competent Authority, which will forward them to the Executive Yuan for approval, after which the Competent Authority shall make a public announcement. If the deliberation cannot be completed within the specified timeframe, the Competent Authority shall directly submit the matter to the Executive Yuan for approval and subsequent announcement.
Article 25
The Insurer shall make the actuarial process at least once every five years for the insurance premium finance, with each such actuarial process covering a period of 25 years.
Article 26
Upon the occurrence of any of the following events in this Insurance, the Insurer shall readjust the insurance premium rate and present it to the NHIC, which shall report it to the Competent Authority and then to the Executive Yuan for approval, after which the Competent Authority shall make the public announcement:
1. The reserve fund for this Insurance drops below the total insurance benefit amount for a month.
2. Any addition to or reduction in benefit items, contents, or payment schedules that affects the financial balance of this Insurance.
1. The reserve fund for this Insurance drops below the total insurance benefit amount for a month.
2. Any addition to or reduction in benefit items, contents, or payment schedules that affects the financial balance of this Insurance.
Chapter 4 Collection and Calculation of insurance Premiums
Article 27
This Insurance’s contribution rates specified in Articles 18 and 23 shall be calculated according to the following provisions:
1. For the insured in Category 1:
(1) The insured and his/her dependents, referred to in Item 1, Subparagraph 1, Paragraph 1 of Article 10, shall pay 30 percent of the insurance premium, with the other 70 percent of it paid by the group insurance applicants. Nonetheless, for the insurance premium charged for the employees of private schools, the insured and his/her dependents shall pay 30 percent of the insurance premium, with 35 percent of them paid by their schools, and the central government shall subsidize the remaining 35 percent.
(2) The insured and his/her dependents referred to in Items 2 and 3 of Subparagraph 1, Paragraph 1 of Article 10 pay 30 percent of the insurance premium, the group insurance applicants pay 60 percent of them, and the central government shall subsidize the remaining 10 percent.
(3) The insured and his/her dependents referred to in Items 4 and 5 of Subparagraph 1, Paragraph 1 of Article 10 shall pay the full insurance premium.
2. The insured and his/her dependents in Category 2 pay 60 percent of the insurance premium, with the other 40 percent subsidized by the central government.
3. The insured and his/her dependents in Category 3 pay 30 percent of the insurance premium, with the other 70 percent subsidized by the central government.
4. For the insured in Category 4:
(1) For the insured in Item 1, Subparagraph 4, Paragraph 1 of Article 10, the institutions to which they belong shall subsidize their insurance premium in full.
(2) For the insured in Item 2, Subparagraph 4, Paragraph 1, Article 10, the central military training administrative authority shall subsidize the insurance premium in full.
(3) For the insured in Item 3, Subparagraph 4, Paragraph 1 of Article 10, the central correctional authority and the Ministry of National Defense shall subsidize the insurance premium in full.
5. For the insured in Category 5, the central competent authority in charge of social welfare shall subsidize the insurance premium in full.
6. The insurance premium payable by the insured referred to in Item 1, Subparagraph 6, Paragraph 1 of Article 10 shall be subsidized by the Veterans Affairs Council, Executive Yuan. Whereas 30 percent of the insurance premium of the insured dependents shall be self-covered and 70 percent subsidized by the Veterans Affairs Council, Executive Yuan.
7. The insured and his/her dependents referred to in Item 2, Subparagraph 6, Paragraph 1 of Article 10 shall pay 60 percent of the insurance premium, and the central government shall subsidize 40 percent.
1. For the insured in Category 1:
(1) The insured and his/her dependents, referred to in Item 1, Subparagraph 1, Paragraph 1 of Article 10, shall pay 30 percent of the insurance premium, with the other 70 percent of it paid by the group insurance applicants. Nonetheless, for the insurance premium charged for the employees of private schools, the insured and his/her dependents shall pay 30 percent of the insurance premium, with 35 percent of them paid by their schools, and the central government shall subsidize the remaining 35 percent.
(2) The insured and his/her dependents referred to in Items 2 and 3 of Subparagraph 1, Paragraph 1 of Article 10 pay 30 percent of the insurance premium, the group insurance applicants pay 60 percent of them, and the central government shall subsidize the remaining 10 percent.
(3) The insured and his/her dependents referred to in Items 4 and 5 of Subparagraph 1, Paragraph 1 of Article 10 shall pay the full insurance premium.
2. The insured and his/her dependents in Category 2 pay 60 percent of the insurance premium, with the other 40 percent subsidized by the central government.
3. The insured and his/her dependents in Category 3 pay 30 percent of the insurance premium, with the other 70 percent subsidized by the central government.
4. For the insured in Category 4:
(1) For the insured in Item 1, Subparagraph 4, Paragraph 1 of Article 10, the institutions to which they belong shall subsidize their insurance premium in full.
(2) For the insured in Item 2, Subparagraph 4, Paragraph 1, Article 10, the central military training administrative authority shall subsidize the insurance premium in full.
(3) For the insured in Item 3, Subparagraph 4, Paragraph 1 of Article 10, the central correctional authority and the Ministry of National Defense shall subsidize the insurance premium in full.
5. For the insured in Category 5, the central competent authority in charge of social welfare shall subsidize the insurance premium in full.
6. The insurance premium payable by the insured referred to in Item 1, Subparagraph 6, Paragraph 1 of Article 10 shall be subsidized by the Veterans Affairs Council, Executive Yuan. Whereas 30 percent of the insurance premium of the insured dependents shall be self-covered and 70 percent subsidized by the Veterans Affairs Council, Executive Yuan.
7. The insured and his/her dependents referred to in Item 2, Subparagraph 6, Paragraph 1 of Article 10 shall pay 60 percent of the insurance premium, and the central government shall subsidize 40 percent.
Article 28
Before the promulgation of this amendment on January 4, 2011, every level of government that has been unable to appropriate funds to pay the Insurer in accordance with Article 29 (pre-amendment) shall present a payback plan to the Insurer. The time frame for the payback shall not exceed eight years, and the Insurer shall request interest payments in accordance with Article 30 (pre-amendment).
Article 29
The number of dependents in Items 1 to 3 of Category 1, for whom the group insurance applicants or the government subsidize premium, shall be the average number of the dependents that the insured in Items 1 to 3 of Category 1 actually have.
Article 30
The insurance premium of this Insurance shall be paid monthly according to the following provisions in Articles 18 and 23:
1. The insurance premium to be contributed by the insured in Category 1 shall be deducted from the payroll and paid by the group insurance applicants to the Insurer, together with the group insurance applicant’s contributions, by the end of the following month.
2. The insurance premium to be contributed by the insured in Categories 2, 3, and 6 shall be paid monthly to the group insurance applicants to which they belong, and the group insurance applicants shall forward the accumulated insurance premiums to the Insurer no later than the end of the following month.
3. The insurance premium payable by the insured in Category 5 shall be paid by the central competent authority regarding social welfare to the Insurer no later than the fifth day of the current month.
4. For the beneficiary in Categories 1 to 4 and 6, the insurance premiums shall be partly subsidized by the various levels of government. They shall be paid in advance to the Insurer twice a year by the end of January and of July. The account shall be settled at the end of the year.
The insurance premium of this Insurance for the month in the preceding paragraph when the insured subscribes to coverage shall be fully paid, and the month when the insured withdraws from coverage shall be exempted.
1. The insurance premium to be contributed by the insured in Category 1 shall be deducted from the payroll and paid by the group insurance applicants to the Insurer, together with the group insurance applicant’s contributions, by the end of the following month.
2. The insurance premium to be contributed by the insured in Categories 2, 3, and 6 shall be paid monthly to the group insurance applicants to which they belong, and the group insurance applicants shall forward the accumulated insurance premiums to the Insurer no later than the end of the following month.
3. The insurance premium payable by the insured in Category 5 shall be paid by the central competent authority regarding social welfare to the Insurer no later than the fifth day of the current month.
4. For the beneficiary in Categories 1 to 4 and 6, the insurance premiums shall be partly subsidized by the various levels of government. They shall be paid in advance to the Insurer twice a year by the end of January and of July. The account shall be settled at the end of the year.
The insurance premium of this Insurance for the month in the preceding paragraph when the insured subscribes to coverage shall be fully paid, and the month when the insured withdraws from coverage shall be exempted.
Article 31
For beneficiary individuals in Categories 1 to 4 and Category 6, supplementary insurance premiums shall be calculated and collected based on the prescribed supplementary insurance premium rates for the following types of income. The premium withholder the payment shall deduct the supplementary insurance premium at the time of payment and remit it to the insurer by the end of the month following the payment date. However, no deduction is required for portions of a single payment exceeding NT$10 million or for amounts below a specified threshold:
1. Accumulated annual bonus is given by group insurance applicants in excess of four times the monthly insurance premium ratable wages.
2. Salary earnings outside of those from the group insurance applicant. However, this is not applicable to the salary earnings of Category 2 individuals.
3. Income from professional practice. However, income from professional practice designated by
Article 20 as an insured payroll-related amount is not to be included in the calculation of insurance premium ratable wages;
4. Dividends income. However, this is not applicable to insurance premiums already included in the insurance premium ratable wages;
5. Interest income;
6. Earnings from rentals.
The premium withholder shall pay first if he is unable to deduct within the specified time.
The Competent Authority shall determine the amount referred to in Paragraph 1, the method of deduction and payment of supplementary insurance premium, and other relevant matters.
1. Accumulated annual bonus is given by group insurance applicants in excess of four times the monthly insurance premium ratable wages.
2. Salary earnings outside of those from the group insurance applicant. However, this is not applicable to the salary earnings of Category 2 individuals.
3. Income from professional practice. However, income from professional practice designated by
Article 20 as an insured payroll-related amount is not to be included in the calculation of insurance premium ratable wages;
4. Dividends income. However, this is not applicable to insurance premiums already included in the insurance premium ratable wages;
5. Interest income;
6. Earnings from rentals.
The premium withholder shall pay first if he is unable to deduct within the specified time.
The Competent Authority shall determine the amount referred to in Paragraph 1, the method of deduction and payment of supplementary insurance premium, and other relevant matters.
Article 32
Those who are not eligible, have lost their eligibility, or are deemed as not requiring premium withholder to deduct supplementary insurance premium shall notify the premium withholder prior to receiving benefit payments so that no supplementary insurance premium will be deducted.
Article 33
The supplementary insurance premium rates of Article 31 shall be calculated at 2 percent one year after the implementation of the amendment of this Act on January 4, 2011. In the second year, it shall be adjusted in accordance with the growth rate of the insurance premium rate, which shall be announced by the Competent Authority.
Article 34
For the group insurance applicant of Items 1 to 3 of Category 1, when the total amount of salary paid exceeds the insured payroll-related amount for that month, supplementary insurance premium shall be calculated based on the difference as well as the rate in the preceding article and paid jointly per month in accordance with the payment structure in Article 27.
Article 35
A grace period of fifteen days shall be allowed in case the group insurance applicants, the beneficiary, or the premium withholder do not pay the insurance premium during the period provided in this Act. If payment is not made by the end of the grace period, a belated surcharge of 0.1 percent of the amount payable shall be levied for each day of delay after the expiry day of the said grace period until the insurance premium is fully paid up with the maximum amounts as follows:
1. 15 percent of the payment to be made by the group insurance applicant and premium withholder.
2. 5 percent of the payment to be made by the beneficiary.
The belated surcharge mentioned in the preceding paragraph may be waived if it is less than the amount to be fixed by the Competent Authority.
If the insurance premium and the belated surcharge referred to in Paragraph 1 payable by the group insurance applicant/premium withholder remains unpaid for thirty days, the Insurer may refer the case to the court for administrative execution under the law; the same shall apply to the beneficiary [who has failed to pay either the insurance premium or the belated surcharge] for one hundred and fifty days.
1. 15 percent of the payment to be made by the group insurance applicant and premium withholder.
2. 5 percent of the payment to be made by the beneficiary.
The belated surcharge mentioned in the preceding paragraph may be waived if it is less than the amount to be fixed by the Competent Authority.
If the insurance premium and the belated surcharge referred to in Paragraph 1 payable by the group insurance applicant/premium withholder remains unpaid for thirty days, the Insurer may refer the case to the court for administrative execution under the law; the same shall apply to the beneficiary [who has failed to pay either the insurance premium or the belated surcharge] for one hundred and fifty days.
Article 36
Those who are unable to pay the insurance premium, belated surcharge, or full self-covered premium due to economic difficulties shall apply for installment payments with the Insurer or apply for loans or subsidies according to Article 99. The Insurer shall assist and, if necessary, work with social agencies or relevant private professional groups to look for assistance within the society.
The Insurer shall determine the conditions of applications, review procedures, installment payment schedule, and other relevant matters in the preceding paragraph and report to the Competent Authority for approval and announcement.
The Insurer shall determine the conditions of applications, review procedures, installment payment schedule, and other relevant matters in the preceding paragraph and report to the Competent Authority for approval and announcement.
Article 37
The Insurer may temporarily suspend benefits for those group insurance applicants or those beneficiary who have been proven to have the ability to pay the insurance premium and the belated surcharge through investigation and supervision but have chosen not to do so. However, such restrictions do not apply to the portion of the insurance premium payable withheld by or paid to the group insurance applicants, those approved by the Insurer as having to be paid in installments according to the preceding article, or the premium payable during the period the beneficiary is receiving protection under the Domestic Violence Prevention Act.
The insurance premium during the temporary suspension of benefits shall still be collected.
The insurance premium during the temporary suspension of benefits shall still be collected.
Article 38
Whenever the group insurance applicants or premium withholder owe insurance premium or the belated surcharge but have no property for execution or do not have a property to pay off their debts, the persons in charge or the persons dealing with the businesses shall be responsible for clearing the debts.
Article 39
Insurance premiums and belated surcharges for this Insurance shall take precedence over general claims.
Chapter 5 Insurance Benefits
Article 40
When the beneficiary experience illness, injury, or childbirth, the contracted medical care institutions providing beneficiary medical services shall comply with the medical regulations established under Paragraph 2, as well as the provisions of Paragraphs 1 and 2 of Article 41, including the Fee Schedule and Reference List for Medical Services as well as the drug dispensing items and fee schedule.
The Competent Authority shall determine the procedure of medical visits, medical visit advice, provision of insurance medical services, and other regulations concerning medical services of the preceding paragraph. If the beneficiary is in a correctional facility, the restrictions on treatment schedule and venue, as well as matters relating to guarding, transferring, and method of providing insurance medical services, shall be determined jointly by the Competent Authority and the Ministry of Justice.
The Competent Authority shall determine the procedure of medical visits, medical visit advice, provision of insurance medical services, and other regulations concerning medical services of the preceding paragraph. If the beneficiary is in a correctional facility, the restrictions on treatment schedule and venue, as well as matters relating to guarding, transferring, and method of providing insurance medical services, shall be determined jointly by the Competent Authority and the Ministry of Justice.
Article 41
The Fee Schedule and Reference List for Medical Services shall be established jointly by the Insurer and the relevant agencies, experts, beneficiaries, employers, and contracted medical care providers and reported to the Competent Authority for approval.
The drug dispensing items and fee schedule shall be established jointly by the Insurer and the relevant agencies, experts, beneficiaries, employers, and contracted medical care providers; drug providers and relevant experts, as well as patients, shall also be invited to voice their opinions and reported to the Competent Authority for approval.
The drafting of the two abovementioned standards shall be in accordance with the medical needs of the insured as well as the quality of medicine. The meeting shall be accurately recorded; self-disclosure of the representatives’ interests and other relevant information shall be made public. The results of the Insurer’s medical technology evaluation shall be made public before the drafting process begins.
The joint drafting of the procedures in Paragraphs 1 and 2, as well as the drawing up of the list of representatives, its selection process, term of office, disclosure of interests, and other relevant information, shall be determined by the Competent Authority.
The drug dispensing items and fee schedule shall be established jointly by the Insurer and the relevant agencies, experts, beneficiaries, employers, and contracted medical care providers; drug providers and relevant experts, as well as patients, shall also be invited to voice their opinions and reported to the Competent Authority for approval.
The drafting of the two abovementioned standards shall be in accordance with the medical needs of the insured as well as the quality of medicine. The meeting shall be accurately recorded; self-disclosure of the representatives’ interests and other relevant information shall be made public. The results of the Insurer’s medical technology evaluation shall be made public before the drafting process begins.
The joint drafting of the procedures in Paragraphs 1 and 2, as well as the drawing up of the list of representatives, its selection process, term of office, disclosure of interests, and other relevant information, shall be determined by the Competent Authority.
Article 42
The Fee Schedule and Reference List for Medical Services described in the preceding paragraph shall follow the principle of “equal payment for the same nature of illness,” and the relative points shall reflect the cost of each medical service. It shall be drafted taking into account volume, cases, quality, individuals, and number of days.
The Insurer may first conduct a medical technology evaluation before drafting the Fee Schedule and Reference List for Medical Services in the preceding paragraph, and then consider human health, medical ethics, the cost-effectiveness of the treatment, and the finances of the Insurance. The same applies to the drafting of the drug dispensing items and fee schedule.
Medical services and drugs are expensive and pose great danger to inappropriate users, which must be presented to the Insurer for review and approval before use, except in emergencies.
The review items before use, as well as the definition and review of emergencies, standards, and other relevant Fee Schedule and Reference List for Medical Services, shall be drafted for the medical service items and fee schedule as well as the drug dispensing items and fee schedule. 14
The Insurer may first conduct a medical technology evaluation before drafting the Fee Schedule and Reference List for Medical Services in the preceding paragraph, and then consider human health, medical ethics, the cost-effectiveness of the treatment, and the finances of the Insurance. The same applies to the drafting of the drug dispensing items and fee schedule.
Medical services and drugs are expensive and pose great danger to inappropriate users, which must be presented to the Insurer for review and approval before use, except in emergencies.
The review items before use, as well as the definition and review of emergencies, standards, and other relevant Fee Schedule and Reference List for Medical Services, shall be drafted for the medical service items and fee schedule as well as the drug dispensing items and fee schedule. 14
Article 43
A beneficiary is required to pay 20 percent of the expenses of either ambulatory or emergency care and 5 percent of home nursing care expenses; 30 percent, 40 percent, and 50 percent of the expenses if they visit outpatient departments of district hospitals, regional hospitals, and medical centers respectively directly without referral.
The insured in areas with inadequate medical resources will be exempted from paying self-bearing expenses.
When deemed necessary by the Competent Authority, the expenses to be borne by the individual as stipulated in the first paragraph may be collected as a fixed amount based on the average outpatient costs of clinics and hospitals of all levels from the previous year and the ratio specified in the first paragraph. This amount shall be announced annually.
The implementation of the referral procedure and regulations in Paragraph 1, as well as the conditions for areas with inadequate medical resources in Paragraph 2, shall be regulated by the Competent Authority.
The insured in areas with inadequate medical resources will be exempted from paying self-bearing expenses.
When deemed necessary by the Competent Authority, the expenses to be borne by the individual as stipulated in the first paragraph may be collected as a fixed amount based on the average outpatient costs of clinics and hospitals of all levels from the previous year and the ratio specified in the first paragraph. This amount shall be announced annually.
The implementation of the referral procedure and regulations in Paragraph 1, as well as the conditions for areas with inadequate medical resources in Paragraph 2, shall be regulated by the Competent Authority.
Article 44
To promote preventive medicine, implement the referral system, and improve the quality of medicine and treatment, the Insurer shall draft the family physicians system.
The benefits of the family physicians system shall be paid out on a per-person basis; annual benefit payment shall be based on the patient’s age, gender, illness, and other individual expenses after correction.
The Competent Authority shall determine the implementation regulations and schedule of the family physicians system in Paragraph 1.
The benefits of the family physicians system shall be paid out on a per-person basis; annual benefit payment shall be based on the patient’s age, gender, illness, and other individual expenses after correction.
The Competent Authority shall determine the implementation regulations and schedule of the family physicians system in Paragraph 1.
Article 45
The Insurer shall fix a maximum amount for special materials as well as the maximum amount charged by contracted medical care institutions as a difference. The Insurer shall pay the same amount for special materials of the same functional type.
The beneficiary shall choose the special material designated by the Insurer as the maximum benefit when deemed necessary by the physician from the contracted medical care institutions and pay for the difference.
For the special material items, in which the beneficiary pays the difference, the permit holder shall apply to the Insurer and, upon agreement of the Insurer, present jointly with implementation date to the NHIC for discussion before submission to the Competent Authority for approval.
The beneficiary shall choose the special material designated by the Insurer as the maximum benefit when deemed necessary by the physician from the contracted medical care institutions and pay for the difference.
For the special material items, in which the beneficiary pays the difference, the permit holder shall apply to the Insurer and, upon agreement of the Insurer, present jointly with implementation date to the NHIC for discussion before submission to the Competent Authority for approval.
Article 46
The Insurer shall adjust drug prices based on prevailing market conditions; prices for drugs with patents, which have expired for a year, shall start being lowered; gradual adjustment to reasonable prices shall be made within five years based on prevailing market conditions.
The Competent Authority shall determine the operating procedure for the adjustment in the preceding paragraph as well as the relevant rules.
The Competent Authority shall determine the operating procedure for the adjustment in the preceding paragraph as well as the relevant rules.
Article 47
The ratio of hospitalization expenses to be borne by a beneficiary is as follows:
1. Acute care wards: Within 30 days, 10%; from over 30 days to 60 days, 20%; beyond 60 days, 30%.
2. Chronic care wards: Within 30 days, 5%; from over 30 days to 90 days, 10%; from over 90 days to 180 days, 20%; beyond 180 days, 30%.
For a beneficiary hospitalized in acute care wards for 30 days or less, or in chronic care wards for 180 days or less, the maximum amount of expenses to be personally borne per hospitalization for the same illness as well as the cumulative maximum amount of expenses to be personally borne annually shall be announced by the Competent Authority.
1. Acute care wards: Within 30 days, 10%; from over 30 days to 60 days, 20%; beyond 60 days, 30%.
2. Chronic care wards: Within 30 days, 5%; from over 30 days to 90 days, 10%; from over 90 days to 180 days, 20%; beyond 180 days, 30%.
For a beneficiary hospitalized in acute care wards for 30 days or less, or in chronic care wards for 180 days or less, the maximum amount of expenses to be personally borne per hospitalization for the same illness as well as the cumulative maximum amount of expenses to be personally borne annually shall be announced by the Competent Authority.
Article 48
In case of the following circumstances, a beneficiary shall be exempted from payment of the expenses prescribed in Article 43 and the preceding article:
1. Major illness and injury;
2. Child delivery;
3. Receiving medical care in mountain regions and outlying islands.
The rules relating to the exemption from the payment of expenses as well as major illnesses and injuries referred to in the preceding paragraph, the procedure for applying for proof of major illness and injury, and other relevant regulations shall be determined by the Competent Authority.
1. Major illness and injury;
2. Child delivery;
3. Receiving medical care in mountain regions and outlying islands.
The rules relating to the exemption from the payment of expenses as well as major illnesses and injuries referred to in the preceding paragraph, the procedure for applying for proof of major illness and injury, and other relevant regulations shall be determined by the Competent Authority.
Article 49
In the case where the low-income households eligible under the Public Assistance Act make medical visits, the central competent authority in charge of social affairs shall prepare a budget to pay for that, according to Articles 43 and 47. However, those who do not abide by referral provisions shall not receive subsidies except for those in special situations.
Article 50
A beneficiary shall pay the contracted medical care institutions for the self-bearing expenses prescribed in Articles 43 and 47.
The Insurer shall be notified in cases where a beneficiary fails to pay the expenses according to the preceding paragraph after being notified and duly demanded by the contracted medical care institutions; the Insurer may suspend benefits to the beneficiary when necessary and when it has been determined, through investigation and supervision, that the beneficiary is capable of paying but is unwilling to pay insurance premiums. However, this is not applicable to individuals who are under protection in accordance with the Domestic Violence Prevention Act.
The Insurer shall be notified in cases where a beneficiary fails to pay the expenses according to the preceding paragraph after being notified and duly demanded by the contracted medical care institutions; the Insurer may suspend benefits to the beneficiary when necessary and when it has been determined, through investigation and supervision, that the beneficiary is capable of paying but is unwilling to pay insurance premiums. However, this is not applicable to individuals who are under protection in accordance with the Domestic Violence Prevention Act.
Article 51
Expenses arising from the following service items are not covered by this Insurance:
1. Medical service items on which the expenses shall be borne by each level of government according to other laws or regulations;
2. Immunization and other medical services on which the expenses shall be borne by the government;
3. Treatment of drug addiction, cosmetic surgery, non-post-traumatic orthodontic treatment, preventative surgery, artificial reproduction, and gender conversion surgery;
4. Over-the-counter drugs and non-prescription drugs which shall be used under the guidance of a physician, pharmacist, or assistant pharmacist;
5. Services provided by specially designated physicians, specially registered nurses, and professional registered nurses;
6. Blood, except for the blood transfusion necessary for emergent injury or illness according to the diagnosis by the physician;
7. Human-subject clinical trials;
8. Hospital daycare, except for psychiatric care;
9. The difference in meal costs beyond tube feeding nutrition and ward fees;
10. Transportation, registration fee, and certificate for the patient;
11. Dentures, artificial eyes, spectacles, hearing aids, wheelchairs, canes, and other treatment equipment not required for positive therapy;
12. Other treatments and drugs as stipulated by the Insurer, reviewed by the NHIC, and promulgated by the Competent Authority.
1. Medical service items on which the expenses shall be borne by each level of government according to other laws or regulations;
2. Immunization and other medical services on which the expenses shall be borne by the government;
3. Treatment of drug addiction, cosmetic surgery, non-post-traumatic orthodontic treatment, preventative surgery, artificial reproduction, and gender conversion surgery;
4. Over-the-counter drugs and non-prescription drugs which shall be used under the guidance of a physician, pharmacist, or assistant pharmacist;
5. Services provided by specially designated physicians, specially registered nurses, and professional registered nurses;
6. Blood, except for the blood transfusion necessary for emergent injury or illness according to the diagnosis by the physician;
7. Human-subject clinical trials;
8. Hospital daycare, except for psychiatric care;
9. The difference in meal costs beyond tube feeding nutrition and ward fees;
10. Transportation, registration fee, and certificate for the patient;
11. Dentures, artificial eyes, spectacles, hearing aids, wheelchairs, canes, and other treatment equipment not required for positive therapy;
12. Other treatments and drugs as stipulated by the Insurer, reviewed by the NHIC, and promulgated by the Competent Authority.
Article 52
This Insurance shall not apply to a contingency incurred by war, riot, or major plague and act of God, such as severe earthquake, wind storm, flood, or fire that has been identified by the Executive Yuan and provided by all levels of the government with special aids.
Article 53
No insurance benefits shall be paid by the Insurer for any one of the following events:
1. Excessive hospitalization after being notified of discharge from the hospital but refused to do so;
2. Expenses incurred from inappropriate repetitive medical visits or other improper use of medical resources; undergo treatment in contracted medical care institutions not designated by the Insurer. This restriction does not apply in medical emergencies;
3. Treatment and drugs that are not medically necessary according to the pre-examination;
4. Violating relevant medical procedures of this Insurance.
1. Excessive hospitalization after being notified of discharge from the hospital but refused to do so;
2. Expenses incurred from inappropriate repetitive medical visits or other improper use of medical resources; undergo treatment in contracted medical care institutions not designated by the Insurer. This restriction does not apply in medical emergencies;
3. Treatment and drugs that are not medically necessary according to the pre-examination;
4. Violating relevant medical procedures of this Insurance.
Article 54
If the Insurer determined medical services provided by the contracted medical care institutions to a beneficiary to be incompatible with the provisions of this Act, the expenses may not be charged to the beneficiary.
Article 55
The following may apply for reimbursement of self-advanced medical expenses from the Insurer:
1. Those within the Taiwan area who avail of medical visits from non-contracted medical care institutions due to emergency or childbirth;
2. Those outside of the Taiwan area who are afflicted with special illnesses as determined by the Insurer and requiring local medical care due to unforeseen illnesses or emergency childbirth. The reimbursement amount shall not be higher than the maximum amount set by the Competent Authority;
3. Those who received medical care services at contracted medical care institutions when their coverage was temporarily suspended but have already paid their insurance premium in full. Those who get medical visits in non-contracted medical care institutions shall fall under the preceding two subparagraphs;
4. Those who receive treatment or who give birth in contracted medical care institutions and have to self-advance medical expenses due to it being non-attributable to the beneficiary;
5. Those who have covered their own expenses according to Article 47, the annual accumulation of which has already exceeded the maximum amount set by the Competent Authority.
1. Those within the Taiwan area who avail of medical visits from non-contracted medical care institutions due to emergency or childbirth;
2. Those outside of the Taiwan area who are afflicted with special illnesses as determined by the Insurer and requiring local medical care due to unforeseen illnesses or emergency childbirth. The reimbursement amount shall not be higher than the maximum amount set by the Competent Authority;
3. Those who received medical care services at contracted medical care institutions when their coverage was temporarily suspended but have already paid their insurance premium in full. Those who get medical visits in non-contracted medical care institutions shall fall under the preceding two subparagraphs;
4. Those who receive treatment or who give birth in contracted medical care institutions and have to self-advance medical expenses due to it being non-attributable to the beneficiary;
5. Those who have covered their own expenses according to Article 47, the annual accumulation of which has already exceeded the maximum amount set by the Competent Authority.
Article 56
The beneficiary shall apply for reimbursement of self-advanced medical expenses according to the preceding article in the following deadlines:
1. Beneficiary under Subparagraphs 1, 2, or 4 must apply for reimbursement of medical expenses within six months from the day of emergency treatment, outpatient treatment, or discharge from the hospital. After the deadline, no application will be accepted. Sailors on an ocean-going fishing ship shall apply for reimbursement within six months from the date they come back from the sea.
2. Beneficiary under Subparagraph 3 shall apply for reimbursement within six months from the day relevant expenses are paid in full; this is applicable for cases within the last five years.
3. Beneficiary under Subparagraph 5 shall apply for reimbursement before June 30 of the following year.
The Competent Authority shall determine the documents required of beneficiary applying for reimbursement of self-advanced medical expenses, reimbursement standards and procedures, and other relevant matters.
1. Beneficiary under Subparagraphs 1, 2, or 4 must apply for reimbursement of medical expenses within six months from the day of emergency treatment, outpatient treatment, or discharge from the hospital. After the deadline, no application will be accepted. Sailors on an ocean-going fishing ship shall apply for reimbursement within six months from the date they come back from the sea.
2. Beneficiary under Subparagraph 3 shall apply for reimbursement within six months from the day relevant expenses are paid in full; this is applicable for cases within the last five years.
3. Beneficiary under Subparagraph 5 shall apply for reimbursement before June 30 of the following year.
The Competent Authority shall determine the documents required of beneficiary applying for reimbursement of self-advanced medical expenses, reimbursement standards and procedures, and other relevant matters.
Article 57
The beneficiary may not make a repetitive application or receive duplicated reimbursement of self-advanced medical expenses under this Insurance for the same incident.
Article 58
From the date of withdrawal, no benefits shall be payable for a beneficiary who withdraws from coverage according to Article 13; the Insurer shall return all extra insurance premiums. If the benefits have already been received, the beneficiary shall return them to the Insurer.
Article 59
The right of a beneficiary to receive cash reimbursement for self-advanced medical expenses shall not be assigned, offset, seized, or used as security.
Chapter 6 Payment of Medical Expenses
Article 60
The range of the total amount of the medical payment of this Insurance each year shall be proposed by the Competent Authority no later than six months prior to the commencement of the fiscal year and reported to the Executive Yuan for approval after consultation with the NHIC.
Article 61
The NHIC shall negotiate and reach the agreement on, no later than 3 months prior to the commencement of each fiscal year, the aggregate amount of the medical payment and the method of allocation within the range of the total amount of the medical payment approved by the Executive Yuan under the preceding article, and report to the Competent Authority for approval. The Competent Authority shall decide at its own discretion in case the NHIC does not reach an agreement in time.
The allotment for ambulatory care and hospitalization expenses of the budget for the aggregate payment described in the preceding paragraph may be specified by the district.
The allocation ratio and a system of separating accounts for medical and pharmaceutical expenses may be established in regard to the budget for payment of the ambulatory care described in the preceding paragraph, according to the ambulatory care services provided by physicians, doctors of Chinese medicine, and dentists, pharmaceutical services and expense of drugs.
After the benefit expense package in Paragraph 1 has been drafted, the Insurer shall ask insurance premium payer representatives, contracted medical care provider representatives, and experts to study and promote the global budget payment system.
The agenda for the study process in the preceding paragraph shall be announced seven days before, and the list of attendees and minutes of the meeting shall be made public within ten days after the meeting.
The scope of the district mentioned in Paragraph 2 shall be determined by the Insurer and submitted to the Competent Authority for approval.
The allotment for ambulatory care and hospitalization expenses of the budget for the aggregate payment described in the preceding paragraph may be specified by the district.
The allocation ratio and a system of separating accounts for medical and pharmaceutical expenses may be established in regard to the budget for payment of the ambulatory care described in the preceding paragraph, according to the ambulatory care services provided by physicians, doctors of Chinese medicine, and dentists, pharmaceutical services and expense of drugs.
After the benefit expense package in Paragraph 1 has been drafted, the Insurer shall ask insurance premium payer representatives, contracted medical care provider representatives, and experts to study and promote the global budget payment system.
The agenda for the study process in the preceding paragraph shall be announced seven days before, and the list of attendees and minutes of the meeting shall be made public within ten days after the meeting.
The scope of the district mentioned in Paragraph 2 shall be determined by the Insurer and submitted to the Competent Authority for approval.
Article 62
The contracted medical care institutions shall declare to the Insurer the points of the medical services rendered and the expense of drugs based on the Fee Schedule and Reference List for Medical Services as well as the drug dispensing items and fee schedule.
The contracted medical care institutions shall declare the medical expenses in the preceding paragraph within the first day of the month following the treatment to six months. However, if there are unavoidable circumstances, another six months after the fact will be provided.
The Insurer shall calculate the value of each point based on the budget allocated according to the preceding article and the total points of medical service as reviewed by the Insurer. The Insurer shall pay each contracted medical care institution according to the reviewed points.
The drug expenses shall be paid to the contracted medical care institutions after being examined by the Insurer. In case the payment of expense exceeds the preset total of drug expense ratio target, exceeding the targeted amount, the Insurer shall adjust the drug dispensing items and fee schedule for the following year. The amount in excess shall be deducted from the budget for the medical benefit payment for the current season and the payment to contracted medical care institutions according to expenditure targets.
The contracted medical care institutions shall declare the medical expenses in the preceding paragraph within the first day of the month following the treatment to six months. However, if there are unavoidable circumstances, another six months after the fact will be provided.
The Insurer shall calculate the value of each point based on the budget allocated according to the preceding article and the total points of medical service as reviewed by the Insurer. The Insurer shall pay each contracted medical care institution according to the reviewed points.
The drug expenses shall be paid to the contracted medical care institutions after being examined by the Insurer. In case the payment of expense exceeds the preset total of drug expense ratio target, exceeding the targeted amount, the Insurer shall adjust the drug dispensing items and fee schedule for the following year. The amount in excess shall be deducted from the budget for the medical benefit payment for the current season and the payment to contracted medical care institutions according to expenditure targets.
Article 63
The Insurer, in order to examine the item, quantity, and quality of the medical service of this Insurance provided by the contracted medical care institutions, shall appoint medical and pharmaceutical specialists who have clinical or relevant experiences to conduct the review, which shall be based on the approved payment; the review work shall be assigned to the relevant professional agency or group.
A review of the medical services in the preceding paragraph shall be done before, during, and after the matter; sampling or case analysis will be the methods used.
The Competent Authority shall establish the procedure and schedule for medical expense application and payment, as well as rules for reviewing medical services.
The Insurer shall be responsible for drafting the contract items of Paragraph 1, the contracted institutions, qualifications of the group, selection, and revision of procedure, supervision, and relevant pertaining to rights and responsibilities and reporting these matters to the Competent Authority for approval.
A review of the medical services in the preceding paragraph shall be done before, during, and after the matter; sampling or case analysis will be the methods used.
The Competent Authority shall establish the procedure and schedule for medical expense application and payment, as well as rules for reviewing medical services.
The Insurer shall be responsible for drafting the contract items of Paragraph 1, the contracted institutions, qualifications of the group, selection, and revision of procedure, supervision, and relevant pertaining to rights and responsibilities and reporting these matters to the Competent Authority for approval.
Article 64
In case a physician issues a prescription for dispensing, testing, examination, or treatment by another contracted medical care institution, and the Insurer denies payment due to reasons attributable to the physician, the associated costs shall be subtracted from the medical expenses submitted by the physician’s affiliated medical institution.
Article 65
Paragraph 3 of Article 61 and Paragraph 4 of Article 62 may be implemented in stages, with the respective implementation dates to be set by the Competent Authority. Before the implementation date, the amount of payment for each point in the Fee Schedule and Reference List for Medical Services shall be decided by the Competent Authority.
Chapter 7 Contracted Medical Care Institutions
Article 66
Medical care institutions shall apply to the Insurer to become contracted medical care institutions. The Competent Authority shall determine the qualifications, procedure, review standards, disqualification, resolution of violations, and other relevant matters pertaining to contracted medical care institutions.
The medical care institutions of the preceding paragraph are limited to those in Taiwan, Penghu, Kinmen, and Matsu.
The medical care institutions of the preceding paragraph are limited to those in Taiwan, Penghu, Kinmen, and Matsu.
Article 67
Provisions of a ward in a contracted hospital shall comply with the criteria for the establishment of the insurance ward. The criteria for the establishment of an insurance ward and the ratio of the insurance ward to the aggregate number of hospital wards shall be established by the Competent Authority.
Contracted hospitals shall announce the status of their insurance wards daily.
The Insurer shall announce the ratio of insurance wards monthly and conduct quarterly checks.
Contracted hospitals shall announce the status of their insurance wards daily.
The Insurer shall announce the ratio of insurance wards monthly and conduct quarterly checks.
Article 68
With regard to the medical benefit provided by this Insurance, unless provided otherwise by this Act, the contracted medical care institutions shall not make up items to charge a beneficiary.
Article 69
The contracted medical care institutions shall check the qualifications of the beneficiary when they visit, matching them to the information on the NHI Card. The Insurer may refuse to pay medical expenses for those who have not been checked and shall seek reimbursement if the medical expenses have been paid. This is inapplicable to matters not attributable to contracted medical care institutions.
Article 70
Upon the occurrence of an incident under coverage to the beneficiary, the contracted medical care institutions shall provide proper medical service based on their specialties and facilities or assist in referral without any unreasonable refusal due to the status of the beneficiary.
Article 71
Contracted medical care institutions shall give the beneficiary a prescription after treatment, which shall be according to the contracted medical care institutions’ dispensation, lab tests, and diagnostic examinations.
The beneficiary’s drug prescription from ambulatory treatment and major lab test items shall be stored in the NHI Card.
The beneficiary’s drug prescription from ambulatory treatment and major lab test items shall be stored in the NHI Card.
Article 72
To reduce cases of ineffective treatment and other inappropriate use of insurance medical resources, the Insurer shall draft an annual proposal for controlling inappropriate use of resources, present it to the NHIC for discussion, and submit it to the Competent Authority afterward for approval.
Article 73
Contracted medical care institutions that have received medical insurance payments in excess of a specific amount shall present to the Insurer financial reports signed by a CPA or reports from audit institutions on the National Health Insurance business, which the Insurer shall make public.
The Insurer shall draft the rules pertaining to the amount, deadline, procedure for providing financial reports, the format, and contents to be presented to the NHIC for discussion and submitted to the Competent Authority for approval afterward.
The financial report of Paragraph 1 shall at least include the following reports:
1. Asset-liability statement
2. Surplus balance sheet
3. Changes in net report
4. Cash flow report
5. Medical revenue schedule
6. Medical cost schedule
The Insurer shall draft the rules pertaining to the amount, deadline, procedure for providing financial reports, the format, and contents to be presented to the NHIC for discussion and submitted to the Competent Authority for approval afterward.
The financial report of Paragraph 1 shall at least include the following reports:
1. Asset-liability statement
2. Surplus balance sheet
3. Changes in net report
4. Cash flow report
5. Medical revenue schedule
6. Medical cost schedule
Article 74
The Insurer and the contracted medical care institutions shall regularly make public information pertaining to the quality of care of this Insurance.
The methods governing the scope and content of the medical quality information mentioned in the preceding paragraph, the manner of its disclosure, and other matters to be complied with shall be drafted by the Insurer, discussed by the NHIC, and submitted to the Competent Authority for approval and promulgation.
The methods governing the scope and content of the medical quality information mentioned in the preceding paragraph, the manner of its disclosure, and other matters to be complied with shall be drafted by the Insurer, discussed by the NHIC, and submitted to the Competent Authority for approval and promulgation.
Article 75
When drug expenses applied for by contracted medical care institutions exceed the amount designated by the Competent Authority, contracts for all transactions with pharmaceutical firms shall be signed to define rights and responsibilities, except if the purchase of drugs is for rare diseases or other special cases.
The Competent Authority shall meet with the Fair Trade Commission, Executive Yuan, to draft the standard contracts for the written contract in the preceding paragraph and other recorded or unrecorded matters.
The Competent Authority shall meet with the Fair Trade Commission, Executive Yuan, to draft the standard contracts for the written contract in the preceding paragraph and other recorded or unrecorded matters.
Chapter 8 Reserve Fund and Administrative Expenses
Article 76
In order to balance the insurance finances, this Insurance shall set aside a reserve fund from the following sources:
1. Surplus from each fiscal year;
2. Belated surcharge of this Insurance;
3. Profits generated from the management of the reserve fund.
4. Social health and welfare surcharge on tobacco and alcoholic products imposed by the government.
5. Incomes from sources with statutory grounds other than this Act.
Deficiency in the balance of this Insurance revenue and expenditure of each fiscal year shall be recovered by the reserve fund first.
1. Surplus from each fiscal year;
2. Belated surcharge of this Insurance;
3. Profits generated from the management of the reserve fund.
4. Social health and welfare surcharge on tobacco and alcoholic products imposed by the government.
5. Incomes from sources with statutory grounds other than this Act.
Deficiency in the balance of this Insurance revenue and expenditure of each fiscal year shall be recovered by the reserve fund first.
Article 77
The funds of this Insurance may be managed in the following ways:
1. To invest in government bonds, treasury bills, and corporate bonds;
2. To deposit in government-owned banks or financial institutions designated by the Competent Authority;
3. To invest in any other program that is beneficial to this Insurance and as approved by the Competent Authority.
1. To invest in government bonds, treasury bills, and corporate bonds;
2. To deposit in government-owned banks or financial institutions designated by the Competent Authority;
3. To invest in any other program that is beneficial to this Insurance and as approved by the Competent Authority.
Article 78
In principle, the aggregate amount of the reserve fund shall be equal to the aggregate amount of benefit payments in the most recent one to three months based on actuarial principles.
Chapter 9 Collecting and Gathering of Relevant Information and Documents
Article 79
The Insurer may require relevant agencies to provide the necessary information it needs to carry out the business of this Insurance, which the agencies may not refuse.
The information obtained by the Insurer in accordance with the preceding paragraph shall be handled responsibly and prudently. The storage and use of relevant information shall be carried out according to the Personal Data Protection Act.
The information obtained by the Insurer in accordance with the preceding paragraph shall be handled responsibly and prudently. The storage and use of relevant information shall be carried out according to the Personal Data Protection Act.
Article 80
The Competent Authority may, to review insurance disputes or for administrative reasons, ask the beneficiary, the group insurance applicants, the premium withholders, and contracted medical care institutions to provide relevant documents, such as account records, receipts, medical records, diagnosis records, or cost of medical expenses, and other documents or relevant information. The beneficiaries, the group insurance applicants, premium withholders, and contracted medical care institutions shall not elude, reject, obstruct, misrepresent, misreport, or misstate.
The Competent Authority shall determine the scope, accessing procedure, and rules for interviewing and inquiry pertaining to the relevant information in the preceding paragraph.
The Competent Authority shall determine the scope, accessing procedure, and rules for interviewing and inquiry pertaining to the relevant information in the preceding paragraph.
Chapter 10 Penal Provisions
Article 80-1
A person who compromises the normal operation of any equipment or any computer room of the core information and communication system used in connection with the underwriting of this Insurance by the Insurer or the medical services provided by the Insurer under this Insurance (the “CICS”) by means of theft, destruction, or any other unlawful means shall be subject to imprisonment for not less than one year but not more than seven years and may also be fined not more than NT$ 10,000,000.
A person who intends to endanger national security or the stability of the society and commits an offense prescribed in the preceding paragraph shall be subject to imprisonment for not less than three years but not more than ten years and may also be fined not more than NT$ 50,000,000.
A person who causes a catastrophe as a result of his commission of any of the offenses prescribed in any of the preceding two paragraphs shall be subject to one and a half of the sentence prescribed for such offense; a person who causes the death of another person as a result of his commission of any of the offenses prescribed in any of the preceding two paragraphs shall be subject to life imprisonment or imprisonment for not less than seven years and may also be fined not more than NT$100,000,000; a person who causes serious physical injury to another person as a result of his commission of any of the offenses prescribed in any of the preceding two paragraphs shall be subject to imprisonment for not less than five years but not more than twelve years and may also be fined not more than NT$80,000,000.
An attempt to commit any of the offenses prescribed in Paragraph 1 or Paragraph 2 is punishable.
A person who intends to endanger national security or the stability of the society and commits an offense prescribed in the preceding paragraph shall be subject to imprisonment for not less than three years but not more than ten years and may also be fined not more than NT$ 50,000,000.
A person who causes a catastrophe as a result of his commission of any of the offenses prescribed in any of the preceding two paragraphs shall be subject to one and a half of the sentence prescribed for such offense; a person who causes the death of another person as a result of his commission of any of the offenses prescribed in any of the preceding two paragraphs shall be subject to life imprisonment or imprisonment for not less than seven years and may also be fined not more than NT$100,000,000; a person who causes serious physical injury to another person as a result of his commission of any of the offenses prescribed in any of the preceding two paragraphs shall be subject to imprisonment for not less than five years but not more than twelve years and may also be fined not more than NT$80,000,000.
An attempt to commit any of the offenses prescribed in Paragraph 1 or Paragraph 2 is punishable.
Article 80-2
A person who compromises the normal operation of the CICS by any of the following means shall be subject to imprisonment for not less than one year but not more than seven years and may also be fined not more than NT$ 10,000,000:
1. Unauthorized access to any computer of or any equipment related to the CICS by entering the account code and password of the CICS, cracking any protective measure(s) preventing unauthorized access to a computer, or exploiting any loophole in a computer system;
2. Unauthorized interference with any computer or any equipment related to the CICS by any computer program or any other electromagnetic interferences; or
3. Unauthorized acquisition, deletion, or alteration of any magnetic records of, in, or on any computer of or any equipment associated with the CICS.
A person who makes any computer program solely for the commission of any offense prescribed in the preceding paragraph and makes such computer program available to himself or another person to commit such offense shall be subject to the same punishment prescribed in the preceding paragraph.
A person who intends to endanger national security or the stability of the society and commits any of the offenses prescribed in the preceding two paragraphs shall be subject to imprisonment for not less than three years but not more than ten years and may also be fined not more than NT$ 50,000,000.
An attempt to commit any of the offenses prescribed in any of the preceding three paragraphs is punishable.
1. Unauthorized access to any computer of or any equipment related to the CICS by entering the account code and password of the CICS, cracking any protective measure(s) preventing unauthorized access to a computer, or exploiting any loophole in a computer system;
2. Unauthorized interference with any computer or any equipment related to the CICS by any computer program or any other electromagnetic interferences; or
3. Unauthorized acquisition, deletion, or alteration of any magnetic records of, in, or on any computer of or any equipment associated with the CICS.
A person who makes any computer program solely for the commission of any offense prescribed in the preceding paragraph and makes such computer program available to himself or another person to commit such offense shall be subject to the same punishment prescribed in the preceding paragraph.
A person who intends to endanger national security or the stability of the society and commits any of the offenses prescribed in the preceding two paragraphs shall be subject to imprisonment for not less than three years but not more than ten years and may also be fined not more than NT$ 50,000,000.
An attempt to commit any of the offenses prescribed in any of the preceding three paragraphs is punishable.
Article 81
The person who applies for reimbursements or claims medical expenses through improper conduct or makes false certification, report, or misrepresentation shall be fined equivalent to two to twenty times the benefits or medical expenses received. If a criminal offense is involved, he/she shall also be referred to the court. Any medical expenses so received by contracted medical care institutions may be deductible from the expenses claimed or receivable by it.
If a contracted medical care institution behaves in the way mentioned in the preceding paragraph, the Insurer may announce the name of the institution, responsible medical personnel, or the name of the individual and the nature of the violation, depending on the severity of the situation.
If a contracted medical care institution behaves in the way mentioned in the preceding paragraph, the Insurer may announce the name of the institution, responsible medical personnel, or the name of the individual and the nature of the violation, depending on the severity of the situation.
Article 82
The contracted medical care institutions that violates the provision of Article 68 shall return the amount received and shall be fined five times the expenses received.
Article 83
When contracted medical care institutions violate Article 68 or act as described in Paragraph 1 Article 81, aside from the punishment provided for in Paragraph 1 Article 81, the Insurer must study the severity of the situation and decide whether to suspend the contract indefinitely or within a period of time.
Article 84
If a group insurance applicant fails to carry out a subscription to this Insurance pursuant to Article 15 for the insured or his/her dependents, it shall be penalized with an amount equivalent to two to four times the payable insurance premiums in addition to the unpaid insurance premium.
The preceding paragraph is not applicable if the failure is not attributable to the group insurance applicant.
If a group insurance applicant fails to pay the insurance premiums for the insured and his/her dependents, and the insurance premiums were paid by the insured, in addition to returning the insurance premiums paid, the group insurance applicant shall be penalized with an amount equivalent to two to four times of the payable insurance premiums.
The preceding paragraph is not applicable if the failure is not attributable to the group insurance applicant.
If a group insurance applicant fails to pay the insurance premiums for the insured and his/her dependents, and the insurance premiums were paid by the insured, in addition to returning the insurance premiums paid, the group insurance applicant shall be penalized with an amount equivalent to two to four times of the payable insurance premiums.
Article 85
If the premium withholder does not deduct supplementary insurance premium from the beneficiary according to Article 31, the Insurer shall impose a deadline for covering the payment as well as a fine that is double the deducted amount. Those who do not pay within the specified deadline will be fined three times the amount.
Article 86
If the contracted hospital fails to attain the criteria and the specified ratio of the insurance ward to the aggregate number of hospital wards as provided in Article 67, it shall be fined no less than ten thousand and no more than fifty thousand New Taiwan Dollars based on the inadequate number of beds and shall be ordered to improve within a given period of time. The Insurer shall make improvements within the specified time; the fine shall be continuously imposed for each violation if not improved within the time given.
Article 87
Contracted medical care institutions violating Paragraph 1 of Article 75, which have not signed contracts or have violated the rule set by the Competent Authority according to Paragraph 2 of Article 75 regarding what and what not to record shall be fined not less than twenty thousand and not more than one hundred thousand New Taiwan Dollars. The Insurer shall make improvements within the specified time; the fine shall be continuously imposed for each violation if not improved within the time given.
Article 88
If a beneficiary subscribes to this Insurance in violation of the provision of Article 11, he/she shall be subject to a penalty of no less than three thousand and no more than fifteen thousand New Taiwan Dollars in addition to the payment of insurance premium shortfall.
The payment of the insurance premium shortfall described in the preceding paragraph is limited to those payable within the most recent five years.
The payment of the insurance premium shortfall described in the preceding paragraph is limited to those payable within the most recent five years.
Article 89
In any of the following cases, a fine in the amount of two to four times the payment of different insurance premiums shall be imposed in addition to the payment of premium differential:
1. The insured payroll-related amount of the insured in Category 1 declared by the group insurance applicants for the insured is less than the regulated insured payroll-related amount;
2. The insured payroll-related amount of the insured in Categories 2 and 3 declared by the insured is less than the regulated, insured payroll-related amount.
1. The insured payroll-related amount of the insured in Category 1 declared by the group insurance applicants for the insured is less than the regulated insured payroll-related amount;
2. The insured payroll-related amount of the insured in Categories 2 and 3 declared by the insured is less than the regulated, insured payroll-related amount.
Article 90
Persons who violate the provisions of Article 70 or Paragraph 1 of Article 80 shall be subject to a fine of no less than twenty thousand and no more than one hundred thousand New Taiwan Dollars.
Article 91
If a beneficiary who, in violation of the provision of this Act, has not subscribed to this Insurance, he or she shall be subject to a fine of no less than three thousand and no more than fifteen thousand New Taiwan Dollars and shall subscribe to this Insurance retroactively from the date on which the beneficiary is qualified for insurance. The benefits shall be suspended before the fines and insurance premiums are fully paid.
Article 92
The fines prescribed in this Act shall be imposed by the Insurer.
Chapter 11 Supplementary Provisions
Article 93
The Insurer may apply for the provisional attachment of assets from the court and may be exempted from providing a security to group insurance applicants, beneficiary, or contracted medical care institutions that owe this Insurance relevant payments or are hiding or transferring assets or avoiding implementing matters.
Article 94
For those insured occupational accident insurance who are covered by occupational accident insurance, the medical expenses incurred from the occupational injury contingency shall be paid by occupational accident insurance.
The Insurer may, upon the entrustment of the Labor Insurance provider, handle matters related to medical benefits under occupational accident insurance.
The Competent Authority shall determine the scope, payment compensation, and other relevant regulations of the package and meet with the central labor competent authority for approval.
The Insurer may, upon the entrustment of the Labor Insurance provider, handle matters related to medical benefits under occupational accident insurance.
The Competent Authority shall determine the scope, payment compensation, and other relevant regulations of the package and meet with the central labor competent authority for approval.
Article 95
If the Insurer has paid insurance benefits to a beneficiary for any car traffic accident, the Insurer may claim against the insurer of the compulsory automobile liability insurance to recover the benefits paid.
If a beneficiary has an indemnity claim against a third party arising out of an incident covered by this Insurance, the Insurer of this Insurance may, after paying insurance benefits to the beneficiary, exercise the right of subrogation in accordance with the following subparagraphs:
1. Public safety incidents: The Insurer shall claim against the insurer of liability insurance, which is mandatorily required by law to be obtained from a third party. If the claim is not fully satisfied, a request may be made to the third party.
2. Other serious traffic accidents, public nuisance, or food poisoning incidents: When the third party has carried his liability insurance, the Insurer shall claim against the third party’s insurer. If there is any deficit in settlement or no such insurance being carried, the Insurer shall claim against the third party for the deficit amount or the indemnity.
The regulations governing the minimum compensation amount, the compensation scope, methods, and procedures of the public safety incidents, serious traffic accidents, public nuisance, or food poisoning incidents referred to in the preceding paragraph shall be prescribed by the Competent Authority.
If a beneficiary has an indemnity claim against a third party arising out of an incident covered by this Insurance, the Insurer of this Insurance may, after paying insurance benefits to the beneficiary, exercise the right of subrogation in accordance with the following subparagraphs:
1. Public safety incidents: The Insurer shall claim against the insurer of liability insurance, which is mandatorily required by law to be obtained from a third party. If the claim is not fully satisfied, a request may be made to the third party.
2. Other serious traffic accidents, public nuisance, or food poisoning incidents: When the third party has carried his liability insurance, the Insurer shall claim against the third party’s insurer. If there is any deficit in settlement or no such insurance being carried, the Insurer shall claim against the third party for the deficit amount or the indemnity.
The regulations governing the minimum compensation amount, the compensation scope, methods, and procedures of the public safety incidents, serious traffic accidents, public nuisance, or food poisoning incidents referred to in the preceding paragraph shall be prescribed by the Competent Authority.
Article 96
The revenues and expenditures of this Insurance shall be administered by the Insurer as an operation fund and incorporated into the annual fiscal budget.
Article 97
All account records, receipts, revenue, and expenditures under this Insurance shall be exempted from taxation.
Article 98
The belated surcharge, the temporary suspension of benefits, or the fines provided in Articles 35, 37, Paragraph 2 of Article 50, and Article 91 are not applicable to the beneficiary qualified as being in financial difficulty.
Article 99
The Competent Authority may work out a budget to establish a fund for the beneficiary, who have financial difficulty in paying insurance premiums, to apply for loans without interest in the amount of the insurance premiums of this insurance and the fees they have to pay.
The monthly repayment may not be higher than twice the personal insurance premium set at the time when the borrowers began applying for the loans unless the borrowers want to repay it earlier at their own will. The Competent Authority shall determine the loan application, conditions, loan repayment schedule, and methods, as well as other relevant matters of the reserve fund of this Insurance as referred to in Paragraph 1.
The monthly repayment may not be higher than twice the personal insurance premium set at the time when the borrowers began applying for the loans unless the borrowers want to repay it earlier at their own will. The Competent Authority shall determine the loan application, conditions, loan repayment schedule, and methods, as well as other relevant matters of the reserve fund of this Insurance as referred to in Paragraph 1.
Article 100
Standards for financial difficulties defined in the two preceding articles shall be interpreted by the Competent Authority in reference to relevant standards for social assistance.
Article 101
The Insurer shall check, on a regular basis, the ability to pay off the insured who has either applied for insurance premium payment postponement or loan clearing pursuant to Paragraphs 1 and 2 of Article 87-4 (prior to this Act’s amendment on January 4, 2011).
Article 102
All accumulated deficits incurred before the amendment of this Act on January 4, 2011, shall be shouldered by the central competent authority through annual incremental amounts in the national budget.
Article 103
The Competent Authority shall prepare the Enforcement Rules of this Act.
Article 104
The Executive Yuan shall decide upon the date of implementation of this Act.
The amendments to articles of this Act shall come into force as of the date of promulgation, with the exception that the implementation date of Article 11, amended on June 29, 2011, shall be determined by the Executive Yuan.
The amendments to articles of this Act shall come into force as of the date of promulgation, with the exception that the implementation date of Article 11, amended on June 29, 2011, shall be determined by the Executive Yuan.