Taiwan’s National Health Insurance(English)2014-2015 Handbook

7/21/2019 Taiwans National Health Insurance(English)2014-2015 Handbook

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Handbook of Taiwans National Health2014~2015


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Chapter 1: National Health Insurance: Protecting Your Right toHealth CareWhat is National Health Insurance?

Compulsory Enrollment

The National Health Insurance Card: Your Health Passport

Chapter 2: How to Enroll in the National Health InsuranceProgramTaiwanese Citizens Who Reside in Taiwan

Foreign Nationals from Hong Kong, Macau, China, or OtherCountries who Reside in Taiwan

Chapter 3: Special Circumstances

Loss of Insurance EligibilityRe-registering when Coverage Is Interrupted

Resuming Insurance after an Extended Stay Abroad

Going Abroad for More than Six Months

Enrollment of Inmates

Chapter 4: Premium CalculationsSources of Funding

How Premiums Are Calculated

General Premium Calculation PrinciplesSupplementary Premium Calculation Principles

Chapter 5: Premium CollectionsPremium Payments and Tax Deductibility

Premiums Payment Methods

What Happens If You Forget to Pay Your Premiums or YourAccount Is Short of Funds

Chapter 6: Medical Services Reimbursed by the National HealthInsurance ProgramOutpatient and Referral Services

How the Referral System Works

Co-payments for the Same Course of Treatment

Emergency Care

Hospitalization

Home Health Care

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Hospice Care

NHI Family Physician Integrated Care Project

Reimbursement Plans that Improve Health Care Quality

Home Health Care

Chapter 7: How to Get Health CareBring Your NHI Card when Visiting a Doctor

Pick Up Your Prescription after Seeing a Doctor

Referral Regulations

Co-payments

Receipts, Itemized Medical Expenses, Medication Lists

Doctors Should Notify Patients Beforehand of Out-of-pocketExpenses

Partial Coverage of Special Medical Devices

Filing a Complaint

Dispute Mediation Application

Chapter 8: NHI Card Functions, Renewals and SafekeepingDoes the NHI Card Have an Expiration Date?

NHI Card Functions

Can Private Medical Records Be Leaked through NHI Cards?

NHI Card KeepingWhat If the NHI Card Is Damaged or Lost, or the HolderWants to Change His/Her Name or Photo?

Chapter 9: Care for Special GroupsPatients with Chronic Diseases (Re ll Prescriptions)

Patients with Catastrophic Illnesses

Patients with Occupational Injuries or Diseases

Patients with Rare Diseases

Chapter 10: Facilitating Access to Health Care for DisadvantagedGroups

Premium Subsidies for the Disadvantaged

If You Are Unable to Pay Your Premiums or Co-payments

Access to Health Care Project

Reducing Co-payments for Speci c Patients

Active Investigation, Active Reinstatement

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Giving Disadvantaged Groups a Break on SupplementaryPremiums on Part-time Wages

Improvement Project for Regions Deficient in Medical

Resources

Chapter 11: Reimbursement for Prepaid Medical ExpensesApplication Deadline

Documents Needed

How to Apply

Reimbursement Caps

Appendix: T h e L i s t o f t h e N a t i o n a l H e a l t h I n s u r a n c eAdministration and its Regional Divisions

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National Heal th Insurance:Protecting Your Right to HealthCare

When you fall ill, you should remember that the NationalHealth Insurance (NHI) is there for you. Taiwans governmentlaunched the National Health Insurance program on March 1,1995, hoping to safeguard the right to health care for all of thecountry's residents.

Chapter 1

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What Is National Health Insurance?

The National Health Insurance program is compulsory forall citizens starting from birth. It is founded on the conceptof mutual assistance and depends on the insured paying their

premiums according to regulations. When people fall ill, thegovernment uses the premiums it receives to help patients

pay part of their medical and medication costs to contractedhealth care institutions. In this way, when we are ill, we canobtain appropriate medical care for a relatively small amount

of money and make a faster recovery.In other words, by paying your monthly National Health

Insurance premiums on time, you are not only helpingyourself but also are receiving help from other premium

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payers. When others become ill, they will also be receivinghelp from you.

Compulsory EnrollmentThe National Health Insurance program is a compulsory

social insurance program. By law, every Taiwanese citizenwith official residency or foreign national living in Taiwanwith an Alien Resident Certi cate (ARC), regardless of age,gender, or employment status, must enroll in the program.

Also, this insurance program lasts an entire lifetime. No onemay arbitrarily withdraw, except for those who lose theirinsurance eligibility (such as people who give up their Taiwancitizenship, move abroad, let their Alien Resident Certi cateexpire, or a person who goes missing).

The National Health Insurance Card: YourHealth Passport

When individuals enroll in the National Health Insurance program, they have to apply for a National Health InsuranceCard. The card is proof that a person enrolls in NationalHealth Insurance program, and it must be presented everytime you visit a clinic or hospital. Please keep it carefully.

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Chapter 2How to Enroll in the National

Health Insurance ProgramTaiwanese Citizens Who Reside in Taiwan

Any Taiwanese citizen whose household is registered inTaiwan must enroll in the National Health Insurance programwhen their six-month residency has been established. Thosewho are employed in Taiwan are not subject to the six-monthwait. Babies with Taiwanese citizenship born in Taiwan areenrolled in the program from the day they was born. The

National Health Insurance program classifies the insuredinto six categories depending on their employment status.Individuals who are residents of Taiwan but are unemployedor in between jobs must remain enrolled based on their currentstatus. They cannot interrupt their insurance coverage.

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Enrolling in the Proper Category

If you are eligible to register in category 1 or 2, youcannot choose category 3. If you are eligible to register incategory 3, you cannot choose category 4, and so on.1.If you work for a company, the government or any other

organization, you should be registered in the NationalHealth Insurance program through your employer (formallyknown as the insurance registration organization).

2.If you are the head of a company or corporation, youshould form an insurance registration organization to enrollyourself, employees, and their family members in the

National Health Insurance program.3.If you belong to a union, or a farmers or fishermen's

association, you should have your union or associationregister you in the National Health Insurance program. Ifyou simultaneously belong to a union and a farmers' or

shermen's association, you should have the union registeryou.

4.If you are unemployed but are a legal dependent of anemployed spouse or a direct blood relative, you should enrollthrough your spouse or relative's insurance registrationorganization (employer, union, etc.) as a dependent. If youqualify as a family dependent of two or more relatives, youshould enroll through the closest blood relative.

5.If you are unemployed, and cannot enroll as a legaldependent of a relative (i.e., parents, spouses, or children),then the administrative of ce of the village, township, cityor area where your household is registered is your insuranceregistration organization. Please enroll in the NationalHealth Insurance program through that of ce.

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If you reside abroad for more than two years withoutreturning, your household registration will be automaticallyterminated, and you will no longer be eligible to participatein the National Health Insurance program. You will also berequired to complete the necessary procedures to withdrawfrom the program. When you re-establish residency in Taiwanat a later date, you can apply for enrollment again.

Infants

Once newborns get a birth certi cate, they legally becomethe dependent of their father or mother (whoever is employed;if both are employed, either may be selected) and should beenrolled in the National Health Insurance program throughtheir father or mothers insurance registration organization.Taiwanese citizens born overseas can enroll in the programafter they have their household registration for a full sixmonths.

Students

1.With No OccupationStudents (de ned as individuals studying at an educationalinstitution approved by the Ministry of Education, and whoalso hold a valid student ID if they are over 20 years of age)who are not employed can enroll as a dependent throughthe parent of their choice. Those who cannot be a dependentof a parent can enroll as a dependent of their paternal ormaternal grandparent. If that is not an option, then theyshould enroll in the National Health insurance program attheir local village, township, city or area administrativeof ce where they have their household registered.

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2.Employed Part-time

Students with steady jobs should be registered in the program through their employers.

3.Seasonally EmployedFull-time students who only work during summer andwinter vacations for fewer than 3 months and return toschool when classes resume do not need to change theirenrollment statuses during the period of employment.

4.Vocational TrainingThose students in vocational training programs who workat factories on a rotating basis can have the factories, if theyare willing, continue to register them in the National HealthInsurance program when they return to class.

Insurance Renewal for Students Who Reach

the Age of 20 Students who have reached the age of 20 and areunemployed or have no way to support themselvesmust still rely on their parents or grandparents to becovered under the National Health Insurance system.The insurance registration organization responsible fortheir enrollment must submit an Insurance RenewalApplication Form by the end of the month in which theyturn 20. This form, along with documentation provingthey are students, should be submitted to the NationalHealth Insurance Administration regional division wherethey are registered to extend their insurance coverageafter they turn 20.

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The EmployedThose who are employed should enroll through their

company, rm, or af liated organization:

1.Company chairpersons/ownersThey can serve as their own insurance registration unit. Ifthey have other jobs, then they can be insured through theirmain employer.

2.Company employees with xed employersThey are enrolled through their employers.

3.Those employed, but without a xed employerIndividuals who are members of an occupational union ora farmers or fishermens association, or who are activelyengaged in farming- or fishing-related jobs, should enrollin the National Health Insurance program through theiroccupational union, or farmers or shermens association.

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4.Individuals working two jobs at the same time

They should be registered in the program through their mainemployer (determined by the place at which more hours areworked; if hours worked are similar, and then income can

be used as the deciding factor).

5.Individuals on unpaid leaveThey can have their employers, if they are willing, continueto register them using their original income basis.

6.Parents on unpaid parental leaveParents of newborn children who take unpaid parentalleave under the Gender Equality in Employment Act caneither continue to have their employers register them undertheir original income basis or be registered through theiremployed spouses.

The Unemployed1.Individuals who are unemployed and qualify as dependents

should be registered in the insurance program throughemployed spouses or direct blood relatives.

2.If individuals cannot be enrolled through spouses or direct blood relatives, or have retired from government agencies, public or private schools, or public enterprises but want toregister in the program independently, they should apply to

do so at the administrative office in the village, township,city or area where their household is registered.3.Veterans or dependents of deceased veterans can enroll in

the program through the administrative of ce in the village,township, city or area where their household is registered

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Foreign Nationals from Hong Kong,

Macau, China, or Other Countries whoReside in TaiwanThe National Health Insurance Act stipulates that foreign

nationals who are legal residents of Taiwan (including thosefrom Hong Kong, Macau and China) must either be registeredin the National Health Insurance program by their employerstarting the day they are employed or enroll in the NationalHealth Insurance program upon living in Taiwan for 6 months(6 months of continuous residence in Taiwan or with onetrip abroad not exceeding 30 days when the actual residency

period of 6 months is reached after the days abroad have beendeducted).1.Foreign students

Foreign students can apply to enroll in the program throughtheir school.

2.Those with xed employersThose with a steady job can register for the programthrough their employers.

3.Those who are unemployed but able to enroll as a dependentthrough a relative (i.e., parents, spouses, or children) could

par ticipate in the National Heal th Insurance programthrough a relative's insurance registration organization aftersix months continuous residence in Taiwan.

4.Those without a fixed employer or family members withwhom dependency can be claimed, must, after six months ofconsecutive residence, enroll through the local administrativeof ce where they reside.

5.Company chairpersons/ownersThey must enroll in the program through their companyafter six months of consecutive residence.

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Chapter 3Special CircumstancesLoss of Insurance Eligibility

People are not allowed to participate in the NationalHealth Insurance program and those already enrolledmust withdraw from the program under the followingcircumstances:1.They are missing for six months or more. If an individual

is missing because of a natural disaster, coverage can bewithdrawn from the day the disaster occurred.

2.They lose Taiwan citizenship, move overseas, or have anexpired Alien Resident Certi cate.

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Re-registering when Coverage Is

InterruptedIf your insurance coverage is interrupted as a result of

a change in jobs or insurance category, you will be requiredto pay health care expenses out of your own pocket. The

National Health Insurance Administration therefore suggeststhat you update your registration as quickly as possible. Here'show:1.If your coverage has been cut off and you are an employee of

a company or an organization, you should re-register in the National Health Insurance program through your employer.

2.If your coverage has been cut off and you are a member of aunion, or farmers or shermen's association, you should re-register in the National Health Insurance program throughyour union or association.

3.If your coverage has been cut off and you are unemployed but can be legally registered as a dependent of an employedrelative, you should enroll in the National Health Insurance

program though the insurance registration organization of yourspouse or blood relative as a dependent.

4.If your coverage has been cut off and you are unemployed andcannot be treated as a dependent of a spouse or direct bloodrelative, please enroll in the National Health Insurance programthrough your village, township, city or area administrativeof ce.

Resuming Insurance after an ExtendedStay Abroad

Under the new system implemented by the secondgeneration National Health Insurance system, those who donot have a record of being insured for two years prior to their

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return to Taiwan must establish their household registrationin Taiwan for 6 months before being able to join the NationalHealth Insurance program.1.Those who were abroad for less than two years are quali ed

for the National Health Insurance as long as they still havetheir household registration and must enroll in the NationalHealth Insurance program according to the regulations.

2.Those who left Taiwan with cancelled household registrationless than two years simply have to reestablish their householdregistration when they return to Taiwan in order to enroll backin the National Health Insurance program immediately.

3.Those who left Taiwan with cancelled household registrationand had their National Health Insurance cancelled formore than two years, a re-establishment of their householdregistration for 6 months upon returning to Taiwan is required

before being able to join the National Health Insurance program again.

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Going Abroad for More than Six Months

If you plan to go abroad for more than six months, youcan either maintain your National Health insurance or suspendyour coverage.

1.Continuing Coverage No application needs to be submitted. As long as the insuredcontinue paying their premiums while they are out of thecountry, they will be covered for emergency procedures or

child delivery abroad but must apply for reimbursement forexpenses they paid on their own. (To nd out how, pleasesee Chapter 11).

2.Suspending Coverage(1)Those who decide to suspend their insurance coverage

must submit an Insurance Suspension ApplicationForm before going abroad. While outside the country,these individuals do not have to pay premiums but willalso not be covered for medical care.

(2)Suspending your coverage means you do not have to pay premiums while abroad, but upon returning to Taiwan,you must remember to restore your coverage from theday of your return. Restoring coverage will ful ll yourobligation to enroll in the National Health Insurance

program. If you have suspended coverage but left thecountry for fewer than six months, you must void thesuspension and pay back premiums retroactively for the

period from when coverage was halted to the time youreturn to the country.

(3)Those who suspend coverage during their time abroadcan only suspend their insurance starting from the dayof the application rather than making it retroactive to

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the day they left the country. This group of people alsocannot apply retroactively to suspend their coverage afterreturning home or request a reimbursement of premiums

paid while they lived abroad. We suggest, therefore,that you complete any appropriate insurance procedures

before going overseas. Once you suspend coverage, youcannot restore coverage or request reimbursement ofmedical expenses while abroad. Only after returning toTaiwan and restoring coverage can you regain your rightto health care.

(4)Those who have already suspended coverage for theirtime abroad and those who choose to suspend theircoverage while abroad starting January 1, 2013 can onlysuspend their coverage again after they have returned toTaiwan and reinstated their coverage for three months.

Enrollment of Inmates

To improve health care for inmates, the second generation National Health Insurance program now enrolls inmates ofcorrectional facilities (this includes inmates serving prisonsentences, students, those subjected to discipline, defendants,

people receiving rehabi litat ion, and juvenile inmates atcorrectional facilities) in the National Health Insurance

program. Starting January 1, 2013, inmates are required bylaw to enroll in the National Health Insurance program. Asinmates in correctional facilities have restricted freedom whileincarcerated, the location and method which they receivemedical care must be restricted. Inmates should rst receivemedical treatment at clinics within the correctional facility. Ifthere is a need for transfer, inmates may undergo the processto seek medical care under security.

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Chapter 4Premium CalculationsSources of Funding

The National Health Insurance program is mainly nanced

by the premiums shared by the insured, employers and thegovernment. The premiums received by the National HealthInsurance Administration are used to help the insured pay fortheir health care expenses.

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We want to emphasize that National Health Insurance premiums only go toward defraying actual medical expenses.Employee salaries and administrative costs associated with the

National Health Insurance program itself are all paid by thegovernment and under no circumstances is premium revenueused to cover the costs of these items.

Government's nancial liabilityincreased from 34% to 36%

Government subsidiesand employercontributions paid bythe government

e.g. Tobacco health surcharge, LotterySurplus, late payment penalty

P r e mi um f un

d i n

g

( s t a t u t or yi n

c om e d e d u c t e d )

Employeecontribution

Employercontribution

Government

contributionOther Statutory income

Government employer

How Premiums Are Calculated

General Premium

National Health Insurance premiums for individuals incategory 1, 2, and 3 are calculated based on the monthlyincome they report to the National Health InsuranceAdministration. The premiums of individuals in categories4, 5, and 6 are based on the average premium of the peopleenrolled in category 1, 2, and 3.

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The formulas used to calculate premiums are as follows:Insured

Category Contributor Formula

WageEarners

The InsuredSalary Basis x Premium Rate Contribution Ratio (1 + Numberof Dependents)

InsuranceRegistrationOrganization

or the

Government

Category 1,Subcategories

1 to 3

Salary Basis x Premium Rate Contribution Ratio (1 + Average

Number of Dependents)

Category 2

and 3

Salary Basis x Premium Rate Contribution Ratio Actual

Number of People Insured

Non-wageEarning

Individuals

The InsuredAverage Premium ContributionRatio (1 + Average Number ofDependents)

GovernmentAverage Premium ContributionRatio Actual Number of PeopleInsured

Notes: 1. Salary Basis: The amount on which premiums are

calculated based on a payroll bracket table.2.Insurance Premium Rate: 4.91% since January 1, 2013.3.Contribution Ratio: Based on ratios set by National Health

Insurance Act.4. Number of Dependents: Maximum of three even if the

actual number of dependents is higher.5.Average Number of Dependents: Set at 0.7 as of January 1,

2007.6.Since October 1, 2009, the average monthly premium for

individuals in categories 4 and 5 has been NT$1,376, whichis entirely subsidized by the government.7.Since April 2010, the average premium for individuals in

Category 6 has been NT$1,249, with 60% paid for by theindividual(NT$749) and 40% by the government.

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Premium Contribution Ratios under NHI System

Classi cation of the InsuredContribution Ratio (%)

Insured RegistrationOrganization Government

Category1

Civil servants,volunteerservicemen, publicof ce holders

Insured anddependents 30 70 0

Private schoolteachers


Employees of public or privateowned enterprisesand organizations


EmployersSelf-employedIndependent

professionalsand technicalspecialists


Category2

Occupation unionmembersForeign crewmembers


Category3

Membersof farmers,

shermensand irrigationassociations


Category4

Military conscripts,alternative militaryservice, militaryschool studentson scholarships,widows of deceased

military personnelon pensions,inmates

Insured 0 0 100

Category5

Low-incomehouseholds

Householdmembers 0 0 100

Category6

Veterans and theirdependents

Insured 0 0 100Dependents 30 0 70

Other individuals Insured anddependents 60 0 40

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Payroll Brackets on which Premiums AreCalculated

BracketIncome

Differential

IncomeTier

SalaryBasis(Amount

on whichPremiumsCalculated)

(NT$)

Actual Monthly Salary(NT$)

Bracket 1 NT$900

1 19,273 Under 19, 273

2 20,100 19,274-20,100

3 21,000 20,101-21,000

4 21,900 21,001-21,900

5 22,800 21,901-22,800

Bracket 2 NT$1200

6 24,000 22,801-24,000

7 25,200 24,001-25,200

8 26,400 25,201-26,400

9 27,600 26,401-27,600

10 28,800 27,601-28,800

Bracket 3 NT$1500

11 30,300 28,801-30,300

12 31,800 30,301-31,800

13 33,300 31,801-33,300

14 34,800 33,301-34,800

15 36,300 34,801-36,300

Bracket 4 NT$1900

16 38,200 36,301-38,200

17 40,100 38,201-40,100

18 42,000 40,101-42,000

19 43,900 42,001-43,900

20 45,800 43,901-45,800

Bracket 5 NT$2400

21 48,200 45,801-48,200

22 50,600 48,201-50,600

23 53,000 50,601-53,000

24 55,400 53,001-55,40025 57,800 55,401-57,800

BracketIncome

Differential

IncomeTier

SalaryBasis(Amount

on whichPremiumsCalculated)

(NT$)

Actual Monthly Salary(NT$)

Bracket 6 NT$3000

26 60,800 57,801-60,80027 63,800 60,801-66,80028 66,800 63,801-66,80029 69,800 66,801-69,80030 72,800 69,801-72,800

Bracket 7 NT$3700

31 76,500 72,801-76,50032 80,200 76,501-80,20033 83,900 80,201-83,90034 87,600 83,901-87,600

Bracket 8 NT$4500

35 92,100 87,601-92,10036 96,600 92,101-96,60037 101,100 96,601-101,10038 105,600 101,101-105,60039 110,100 105,601-110,100

Bracket 9 NT$5400

40 115,500 110,101-115,500

41 120,900 115,501-120,90042 126,300 120,901-126,30043 131,700 126,301-131,70044 137,100 131,701-137,10045 142,500 137,101-142,50046 147,900 142,501-147,90047 150,000 147,901-150,000

Bracket 10 NT$6400

48 156,400 150,001-156,40049 162,800 156,401-162,80050 169,200 162,801-169,20051 175,600 169,201-175,600

52 182,000 Above175,601

Note: Tiers 1-47 follow the wage classification table formonthly contributions into the labor pension fund.

Took effect on July 1, 2014

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General Premium Calculation Principles

1.Premiums are calculated on a monthly basis. Therefore, themonth you join the program, regardless of which day youenroll, the National Health Insurance Administration willcollect a full months premium from you.

2.For the month you transfer your insurance status (exceptfor those persons transferring on the last day of the month),the insurance premium will be counted at new insuranceregistration organization (employer).

3.If you transfer your insurance status on the last day of themonth, you still have to pay your insurance premium for themonth through your original insurance registration organization(employer) because the effective day of transferring onesstatus is the first day of following month. Therefore, unlessthe original insurance registration organization (employer)noted that you did not receive a full months pay for themonth of the transfer, the effective day will still be the firstday of the following month. For example, if you transfer toa new employer on November 30, it will only take effect onDecember 1, so you still have to pay your premium for themonth of November through your original employer.

General Premium Calculation Examples

Example 1: Joe Smith works at company A and makes NT$35,000 per month. His wife is a full-time housewife,and his three children are still in school.

Calculation:1.All members of Joe Smiths family should be enrolled in

the health insurance program through company A. Thoughhe has four dependents, he does not have to pay premiums

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for any more than three dependents under existing NHIguidelines, so one dependent will be covered for free.

2.Based on Mr. Smiths salary, the monthly income used tocalculate his premium is NT$36,300 (i.e. level 15 in theincome bracket chart).

3.The amount Mr. Smith will pay from his own pocket forhis health insurance premium is:[NT$36,300 4.91% 30%] (amount rounded) (1 + 3)= NT$2,140

4.The amount company A will contribute to Mr. Smiths premium on a monthly basis is:[(NT$36,300 4.91% 60%) (1 + 0.7)] (amountrounded) = NT$1,818

5.The amount the government will contribute to Mr. Smiths premium on a monthly basis is:[(NT$36,300 4.91% 10%) (1 + 0.7)] (amountrounded) = NT$303

Note: 0.7 in the calculation formula in steps 4 and 5 re ectsthe standard average number of dependents.

Example 2: John Doe and his wife are insured at thedistrict of ce where their household registration is.

Calculation:

1.The amount John Doe will pay for his premium from hisown pocket is:[NT$1,249 60%] (amount rounded) (1 + 1) = NT$1,498

2.The amount the government will contribute to John Does premium each month is:[NT$1,249 40%] (amount rounded) (1 + 1) = NT$1,000

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Supplementary Premium Calculation PrinciplesIn addition to the basic premium, the insured will be

charged a 2% supplementary premium when receiving othertypes of income, including large bonuses, stock dividends,

part-time job income, interest income, income for professional practice, and rental income.

Employers will be also collected supplementary premium.The formulas to calculate supplementary premiums are asfollows.

Item DescriptionTax Code

(First 2 digits)Bonuses received duringthe year that exceed fourtimes the insureds monthlysalary basis

Any bonuses (such as year-end bonuses, festival allowances anddividends) not included in thecalculation of the insureds registered

income apply to this calculation. The portion of the total amount that exceedsfour times the insureds monthly salary

basis is subject to the supplementary premium.

50

Wage from part-time jobs Any wages or salary paid for part-timework (from organizations other thanthe one through which the individual isenrolled in the NHI program)

50

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Item DescriptionTax Code

(First 2 digits)

Ad hoc professional feesand income

Income paid to the insured for adhoc professional services ( beforededucting any necessary expenses orcosts)

9A9B

Dividends on stockholdings

Total dividends (stock and cashdividends) paid to shareholders of acompany (net dividends + deductibletax)

54

Interest incomeInterest earned on government bonds,corporate bonds, nancial bonds, short-term bills, savings accounts and loans.

5A5B5C52

Rental incomeRent paid to the insured (beforededucting any necessary losses andexpenses) 51

Supplementary Premium Calculation Examples[Interest Income]Example: Mr. Fu has a few time deposit accounts at bankB. Three of them expired on June 20, 2014 and paid Mr. Fu

NT$1,500, NT$25,000, and NT$1,800 in interest, respectively.How will bank B deduct Mr. Fus supplementary premium?Calculation: Supplementary premium = NT$25,000 2% =

NT$500.Note: Supplementary premiums are calculated based on theinterest paid on each time deposit account, not the combinedamount. Two of the accounts paid out less (NT$1,500 and

NT$1,800) in interest than the minimum amount of NT$5,000on which supplementary premiums are collected and aretherefore exempt from the supplementary premium deduction.Bank B is required to pay the NHIA the NT$500 deductedfrom Mr. Fus interest payment by July 31, 2014.[Bonus]Example: Mr. Wang is a computer software engineer

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employed by company C. His monthly salary basis for healthinsurance purposes is NT$150,000. He received a year-end

bonus of NT$450,000 in February 2014 and then a profit-sharing bonus of NT$600,000 in October.Calculation: Supplementary premium = NT$450,000 2% =

NT$9,000Explanation: Wangs bonus in February of NT$450,000 wasnot more than four times the amount of his monthly salary

basis (NT$600,000, or NT$150,000 4), so there was noneed to deduct a supplementary premium. When he receivedthe profit-sharing bonus of NT$600,000 in October, thecumulative bonuses came to a total of NT$1.05 million, whichexceeded four times his monthly salary basis by NT$450,000(NT$1.05 million NT$600,000). As a result, when companyC paid him the bonus in October, it was required to deductthe supplementary insurance premium of NT$9,000. Thecalculations are shown in detail in the following table:Payment Date Type of Bonus (A)

Monthly Salary Basis atTime Payment Made

(B=A4)

Four times the salarybasis (B=Ax4)

(C)

Amount paid

2014/02/01 Annual bonus NT$150,000 NT$600,000 NT$450,0002014/10/01 Pro t-sharing

bonus NT$150,000 NT$600,000 NT$600,000

Sub total

(D)

Cumulative total ofbonuses received

(E=D-B)

C u m u l a t i v e b o n u samount exceeding 4 timesthe salary basis

(F)

Amount on whichsupplementary premiumshould be collectedMin (C,E)

(G=F*2%)

Supplementary premiumowed

NT$450,000 -NT$150,000 0 0

NT$1,050,000 NT$450,000 NT$450,000 NT$9,000 NT$1,050,000 NT$9,000

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3. Types of Income Subject to Supplementary Premiums andthe Lower and Upper Limits on which Premiums Collected Note 1

Type of income Lower Limit Upper LimitAnnual bonuses exceeding fourtimes the insured`s monthlysalary basis

None NT$10 million more than fourtimes the salary basis for thatmonth, received in a single

paymentWages from part-time jobs B e f o r e A u g . 3 1 , 2 0 1 4 ,

NT $5 ,0 00 (r ec ei ve d in on e payment). After Sep. 1, 2014,an amount equal to the monthlyminimum wage (received in a

single payment) Note 2

.

NT$10 million (received in one payment)

Ad hoc professional fees NT$5,000 ( received in one payment)

Stock dividend income NT$ 5,0 00 (rec eiv ed in one payment) Note 3 .


Interest income NT$5,000 (received in one payment) Note 4 .


Rental income NT$5,000 (received in one payment)


Note: 1. When income subject to the supplementary premium

exceeds the minimum threshold, the supplementary premium is calculated based on the full amount ofincome. If it exceeds the upper limit for incomesubject to the supplementary premium, then the upperlimit amount is used to calculate the premium.

2.According to the provisions of Articles 4, 5, and 12in the Regulations Governing the Deduction andPayment of the Supplementary Insurance Premium of

the NHI Program, amended by the Ministry of Healthand Welfare on July 21, 2014, the minimum part-timeincome subject to the supplementary premium wasincreased to the monthly minimum wage (currently

NT$19,273, to be adjusted to NT$20,008 from July 1,2015 onward).

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3.For employers or people registered as self-employed,each dividend payment made to themselves thatexceeds the individuals salary basis by at least

NT$5,000 will be subject to the supplementary premium.

4.Units paying NT$20,000 or more in interest in a single payment must deduct the supplementary premiumat the time of payment; for interest payouts between

NT$5,000 and NT$20,000, if the interest -payingorganization does not deduct the supplementary

premium at the time of payment, it must submit adetailed list of unpaid supplementary premiums byJan. 31 of the following year to the NHIA, which willthen collect the premiums directly from the insured.

4. Supplementary Premium ExemptionsIndividuals holding any of the following supporting documentscan be declared exempt from having supplementary premiums

deducted from various kinds of non-salary income.Reasons for Exemption Income Exempt from Supplementary

PremiumRequired Documents

Individuals not eligible to be coveredunder NHI program

Al l s ix ca tegor ies o f incomenormally subject to supplementary

premiums.

After the individual te l ls theemployer he/she is not eligible forthe NHI program, confirmation ofthis by the employer with the NHIA

Insured individuals belongingto NHI Category 5 low-incomehouseholds

A low-income household certi cateissued by a social agency that wasvalid during the period the incomewas paid

Category 2 insured individuals Salary paid by sources other than theunit that has enrolled the recipient inthe NHI program

Proof of insurance or proof of payment issued by a union duringthe payment period.

Professionals and technicians in bus ine ss for thems elv es or thosewho are self-employed and insuredthrough a union (income from

professional practice considered to be the salary basis

Professional fees A. For persons enrolled in the NHI pr og ra m as a pr of es si on al ortechnician, proof of insurancei s s u e d b y t h e i n d i v i d u a l si n s u r a n c e r e g i s t r a t i o norganization.

B.For persons insured through aunion, proof of insurance or proofof payment issued by the union.

Documents must be valid for periodduring which income was paid.

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Reasons for Exemption Income Exempt from SupplementaryPremium

Required Documents

Children and teenagers Part-time wages received betweenJanuary 1, 2013 and August 31, 2014that were lower than the minimumwage

Identity documents.

Low-income households A low-income household certi cateissued by a social agency that wasvalid during the period the incomewas paid

Low-income senior citizens Eligibility approval letter issued by asocial administrative agency duringthe period of paymentRecipients of a disability livingallowance

People with disabilities whose salaryused for labor insurance purposes islower than the minimum wage

A disability card or certificate andlabor insurance certi cates that wereissued by a social administrativea g e n c y d u r i n g t h e p e r i o d o f

payment.Students in vocational colleges,un ive r s i ty s tuden t s s tudy ingf o r a b a c h e l o r s d e g r e e , o r

postgraduate master s or doctoral

degree candidates studying in thecountry who do not have full-timeemployment

School registration form or studentID card with a registration stampand a declaration that the applicantdoes not have a full-time job

I n d i v i d u a l s f a c i n g f i n a n c i a ldifficulties who meet the criteriaoutlined in Article 100 of the NHIAct

Documents o ffe r ing p roof o ffinancial difficulties during the

period payment received

5. Employer Supplementary Insurance Premiums

[Total salary paid monthly by the insurance registrationorganization (employer) minus the total combinedsalary basis reported to the NHIA for the organizationsemployees] x 2%. No upper limit After the employer calculates this premium each

month, it is paid along with its general healthinsurance obligations.

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Chapter 5Premium Collections

On the payment receipt sent to the insured or theirinsurance registration organization, there is a phone numberof the person in charge. If you have any questions about howyour premium was calculated, you can call the contact the

person for help.

Premium Payments and Tax DeductibilityAccording to Article 17 of the Income Tax Act, when

people fi le their income tax returns and choose to takeitemized deductions rather than standard deductions, theycan claim National Health Insurance premiums as an itemizeddeduction without limitation. Other insurance payments arealso tax deductible up to a certain limit, so insurance paymentscan be deducted from taxable income in two categories:

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1.National Health Insurance Premium Expenses

The total amount spent on National Health Insurance premiums by the individual taxpayer, his or her spouse andreported dependents can be listed as an itemized deduction,without any ceiling on the overall total. Thus, the moreyou pay in premiums, the more you can deduct from yourtaxable income and the less you'll have to pay in taxes.

2.Other Insurance Premium ExpensesPremiums paid for life insurance, personal injury insurance,national pension insurance, labor insurance, employmentinsurance, agricultural insurance, and military, publicservant and teachers insurance can be listed as itemizeddeductions. However, there is a ceiling on how much is taxdeductible per person per year.

Premium Payment Methods

1.Those insured through their employersEmployers will directly withhold from employees'

paychecks the amount the insured must contribute towardtheir insurance premium and pay it on their behalf to the

National Health Insurance Administration.

2.Those insured through unions and farmers' andshermen's associations

These individuals must pay the amount owed forthe premiums directly to their insurance registrationorganization, which then is required to transfer the sum tothe National Health Insurance Administration.

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3.Those who are unemployed and are insuredthrough local administrative of cesThe National Health Insurance Administration offers manyconvenient ways to pay premiums, as follows:(1)Bank transfer

You can go to a financial institution designated by the National Health Insurance Administration to set upan automatic transfer account from which monthly

premiums will automatically be deducted.

(2)In personYou can take your insurance bill to any bank authorized

by the National Health Insurance Administration tocollect premiums and pay it there.

(3)Convenience storesYou can take your insurance

bill to any 7-Eleven, Family

M a r t , H i - L i f e o r O Kconvenience store aroundthe country and pay i tthere. (A processing feewill be charged andonly payments ofunder NT$20,000 areaccepted.)

(4)Automated TellerMachines (ATMs)You can use anautomated tellermachine (ATM)with an automaticinterbank money

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transfer label to pay premiums. Those transferring moneyfrom one bank to another will be charged a transactionfee.

(5)Paying OnlineYou can pay your premium using a cash card byfollowing the instructions on the National HealthInsurance Administration's website at http: //www.nhi.gov.tw, the national pay website at http: //ebill.ba.org.tw, or the Bank of Taiwan's website at https: //ebank.

bot.com.tw. Those making transfers from one bank toanother will be charged a service fee.

To save time and avoid being fined for late payment because you forget to pay your premium, we suggest that youuse a designated savings account from which payments can bededucted and transferred automatically.

Setting up an Automatic Transfer Account

To set up an account to automatically pay your insurance premiums, you can contact a nancial institution that accepts payment for National Health Insurance premiums. Fill out a

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New (Cancellation) Agreement for Bank Transfers of NationalHealth Insurance Premiums Bank Transfer (with the premium

payment stub or copy of the receipt from the most recentmonth for reference) and submit it with your bank book,seal, ROC ID to a clerk at the counter. (If you do not have anaccount at the financial institution, you must first open onethere.) Once you have completed the application process,your remiums will begin to be deducted from the designatedaccount the following month.

What Happens If You Forget to Pay YourPremiums or Your Account Is Short ofFunds? (Calculating Fines for Late Payment)

Once your appl ica t ion to have your premiumsautomatically deducted from your account officially takeseffect, the authorized financial institution will debit youraccount on the 15th of each month. If your account lacks thenecessary funds, nancial institutions will no longer debit youraccount. Instead, the NHIA will send you the unsuccessfultransfer payment slip and ask you to pay the amount owedthrough another channel. Therefore, please make sure thatsufficient funds are in the account before the 15th of eachmonth so that the automatic deduction can be made.

No matter how you choose to pay, if you pay your premiums after the grace period (the 15th of the month afterthe payment period) has expired, the NHIA will count thenumber of days payment was late (from the day following theexpiry of the grace period the 16th of the month after the

payment period to the day before the payment was made)and will charge a penalty of 0.1% of the amount owed perday. The penalty cannot exceed 15% of the premiums owedfor insurance registration organizations and cannot exceed 5%of the amount owed for individuals.

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Supplementary Insurance PremiumsIndividual

:Supplementary premiums rely on withholding funds at thesource of income. Organizations paying people income in thesix categories withhold the premium at the time of payment

based on the supplementary premium rate. For example,for somebody who receives a lecture fee, the unit hiring thelecturer rst deducts the supplementary premium based on the

premium rate and then pays the balance owed to the speaker.Individuals who receive payment do not have to processanything.

If you have dividend income, the supplementary premiummight not be automatically deducted because of the amount ofthe imputation tax credit companies distribute can changeat the end of the year or there is no cash dividend from whichto deduct premiums on stock dividends. In those cases, theindividual will have to pay the supplementary premiumon his or her own. If an individual has received a singleinterest payment of between NT$5,000 and NT$19,999,and the organization paying the interest did not deduct thesupplementary premium, the NHIA will charge the recipientthe amount in the following year. Once the individual receivesthe bill, he or she can pay it at any authorized financialinstitutions or at a convenience store or make the transferusing an ATM machine or online.Employer :

Employer supplementary premiums, based on thedifference between the total monthly salary employers payand the total salary basis they report to the NHIA for theiremployees, are paid by employers together with the regularhealth insurance premiums they owe every month, keepingemployers operational burdens to a minimum.

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Chapter 6Medical Services Reimbursed bythe National Health InsuranceProgramOutpatient and Referral Services

When you visit a doctor, the National Health InsuranceAdministration will cover most of your examination andmedication costs. All you need to pay is a co-payment. (Fordetails on basic outpatient co-payments and medication co-

payments, please see Chapter 7)

1.Please visit a clinic rst; get a referral to a hospitalif necessary(1)To ensure that each level of health care institution can

provide patients with the most appropriate care, we

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suggest that you should seek outpatient treatment at alocal clinic and stick to one doctor to get basic care. If ahospital stay or a further procedure or test is necessary,the clinic will refer you to a hospital.

(2)The benefit of doing this is twofold: you can develop acomplete medical record at the clinic while receivingspecialized medical care and you can avoid wastingmoney and time running around to different health careinstitutions.

2.Visiting a hospital without a referral costs more(1)Under the referral system that took effect on July 15,

2005, the basic outpatient co-payment at clinics wasfixed at NT$50. If follow-up care is necessary, theclinics doctor can refer the patient to a regional hospitalor medical center. The rst visit to a hospital within onemonth of an outpatient or emergency procedure or ahospital stay, or a new mothers rst checkup within six

weeks after being discharged from the hospital, are alltreated as referral visits.(2)If individuals go directly to district hospitals, regional

hospitals or medical centers without a referral (except fordental care and traditional Chinese medicine therapy),the basic outpatient co-payment will be NT$30, NT$100,and NT$150 higher, respectively, than if they had areferral. There is no difference in the co-payment for

medication if you bypass clinics and go directly to ahospital for a checkup.

How the Referral System WorksYou only have to remember the following easy steps to

get a referral without any problems and save time and effort.

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Step 1: If you are not feeling well, visit a local clinicor family doctor and ask the attending physician for a

preliminary diagnosis and suggested course of treatment.Step 2: If you have to be hospitalized or need tests or

surgery, the doctor will give you a referral note and referyou to a hospital for follow-up treatment, including dateof visit, department, and registration assistance.

Step 3: Please visit the referral service counter orwindow at the designated hospital on the date of visiton the referral note and present your referral note forcon rmation.

Step 4: Once a hospital agrees to accept the referral,it must -- within three days of an outpatient visit orwithin 14 days of the patient being hospitalized -- informthe patient's original clinic of the treatment given, anysuggestions, or the hospital discharge summary. The

original clinic will be notified if the patient needs toremain in the hospital or if further treatment is needed.

Step 5: Patients who do not need to be further referredto a hospital or clinic for treatment but still require follow-up therapy should be referred back to their original clinicor hospital, or other suitable healthcare providers tocontinue their treatment.

Visiting ahospital ora clinic

A referralnote given

Referred toa hospitalor a clinic

A patient

Taking furthertreatments

The original hospital,clinic or other suitablehealthcare providers

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Notes: 1. Regardless of whether the referral is from hospital toclinic, clinic to hospital or between same-class healthcare institutions, transfers out and transfers back areall considered to be referrals.

2.All contracted hospitals and clinics can issue referralnotes and refer patients to any level of health careinstitution. A clinic, for example, can directly refera patient to a medical center without sending the

patient rst to a district hospital and then a regionalhospital.

Co-payments for the Same Course ofTreatment

Undergoing the special therapies listed below in responseto a medical condition is considered following the samecourse of treatment. Patients following the same course oftreatment only have to pay the basic outpatient co-payment

before their first outpatient visit and deduct one doctor visitfrom their allotted visits. Subsequent outpatient visits donot require co-payments and do not count against a patientsallotted visits. The only exceptions to this are patientsundergoing western medicine physical therapies (simpleor simple to moderate therapies) and traditional Chinesemedicine therapies. They will be required to pay a co-paymentof NT$50 for the second to the sixth outpatient visits relatedto the same course of treatment, but the visits will not bededucted from their allotted number. In all cases, patientsmust still present their NHI cards when getting outpatient carefor veri cation1.Western Medicine: From the rst day of treatment,

(1)Changing dressings within two days after being treatedfor a simple wound.

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(2)Getting the same injections not more than 6 timeswithin 30 days at a contracted clinic or hospital to treat acondition (chemotherapy excluded).

(3)Getting rehabilitation therapy not more than 6 timeswithin 30 days.

(4)Light therapy for skin disease, electrical stimulation forurinary incontinence, pelvic muscle biofeedback trainingnot more than 6 times within 30 days.

(5)Postoperative suture removal not more than 6 timeswithin 30 days.

(6)Pulmonary rehabilitation therapy not more than 6 timeswithin 30 days.

(7)Less than six rehabilitative therapy sessions for childrenunder nine years of age before the end of the followingmonth.

(8)Radiation treatment for cancer within 30 days.(9)Hemodialysis within 30 days.

(10)Hyperbaric oxygen treatments within 30 days.(11)Hyposensitization therapy within 30 days.(12)Home care within 30 days.(13)Psychiatric community rehabilitation sessions within

30 days.(14)Psychiatric activity therapy, occupational therapy, or

psychotherapy within 30 days.

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2.Dental Care: From the rst day of treatment,(1)Tooth extraction and related therapy not more than 6

times within 30 days.(2)Operative dentistry in the same part of the mouth not

more than 6 times within 30 days.(3)Therapeutic scaling not more than 6 times within 30

days.(4)Root canal in the same part of the mouth 60 days

constitutes one course of treatment.

3.Traditional Chinese medicine: From the first day oftreatment,(1)Six acupuncture sessions to treat the same condition

within 30 days.(2)Six dislocation rehabilitation therapy sessions to treat the

same condition within 30 days.(3)Six injury treatment sessions to treat the same condition

within 30 days.Undergoing the special therapies listed below in response toa medical condition is considered following the same courseof treatment. Patients following the same course of treatmentonly have to pay the basic outpatient co-payment before theirfirst outpatient visit and deduct one doctor visit from theirallotted visits. Subsequent outpatient visits do not require co-

payments and do not count against a patients allotted visits.

The only exceptions to this are patients undergoing westernmedicine physical therapies (simple or simple to moderatetherapies) and traditional Chinese medicine therapies.They will be required to pay a co-payment of NT$50 forthe second to the sixth outpatient visits related to the samecourse of treatment, but the visits will not be deducted fromtheir allotted number. In all cases, patients must present their

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National Health Insurance cards (NHI Cards) when gettingoutpatient care for veri cation.

Notes: 1. If the physician treating you for a condition providestreatments for other ailments during the same visit, itdoes not count against your total allotted visits.

2.If during a course of treatment your conditionchanges and the original treatment cannot becontinued because the attending physician issues anew diagnosis, then subsequent treatments cannot beconsidered part of the same course of treatment. The

patient must follow the normal procedure associatedw i t h a n ycheckup, namelyr e g i s t e r i n g ,seeing a doctor,and paying forthe visit.

Emergency CareThe National Health

Insurance Administrationcovers most emergencycare expenses, includingt r e a t m e n t , p h y s i c a lexaminations, lab tests,and medication costs.Patients only have to payan emergency care co-

payment. (For moredetails on emergencycare co-payments, pleasesee Chapter 7.)

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Hospitalization

When an insured individual needs to be hospitalized, the National Health Insurance Administration will fully coverthe cost of certain NHI beds (according to National HealthInsurance guidelines) and most hospitalization expenses,

please see Chapter 7 for details.

1.Hospital Room Fees(1)NHI beds refer to those in a hospital room with three

or more beds, or special beds, such as intensive care bedsand isolation beds. If you stay in a room with only oneor two beds, then you are required to pay the difference

between the actual cost and the amount covered by the National Health Insurance program for a NHI bed.

(2)Ward fees are calculated beginning the day a patientis hospitalized but the day the patient is discharged isnot included. In other words, the date of admittance

rather than the date of discharge is used in the ward feecalculation.

2.Hospitalization Fees(1)There is no arbitrary time limit on hospital stays. Length

of hospital stays are determined by patients needs. The National Health Insurance program will cover between70% and 95% of your hospitalization expenses dependingon the length of stay and whether your condition is acuteor chronic. You will only be responsible for 5% to 30%of the cost of your hospitalization. (For more details onhospitalization co-payments, please see Chapter 7.)

(2)If a physician determines that you no longer need to behospitalized, but you insist on continued inpatient care,you will be responsible for all additional hospitalizationexpenses.

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How to Apply:1.If a physician assesses that a hospital patient quali es

for home health care, the patient will be handed over tothe hospitals home care department or transferred to

(3)As for medication fees, some special medications areregulated and are only covered by the National HealthInsurance program if a doctor determines that themedication is appropriate for the medical condition.

Home Health CareHome health care is carried out in coordination between

doctors and nurses. Services offered at patients homesinclude: home visits, diagnosis and treatment, the provision of

medical supplies, and nurse-supervised catheter and ostomyservices for the respiratory, digestive and urinary systems.Other services include collecting tissue samples for testingand guiding family members and caregivers on how to helpcare for the patient.

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Patients Must Meet One of the Following Conditionsto Qualify for Home Health Care1.Patient is immobile and spends more than 50% of the

waking hours either in bed or in a chair.2.Patient has a clear need for medical or nursing services.3.A chronic disease patient who has need for long-term

nursing care or patient who needs follow-up nursing careafter being discharged from the hospital.

Related National Health Insurance Regulations1.Thirty days of home health care is considered as one course

of treatment. Only the rst visit of every month by a healthcare worker is deducted from the NHI Cards visit allotment.

2.In principle, home health care consists of two visits a month by a nurse and one visit every two months by a doctor.

3.The home health care patients co-payment is 10% of the

actual cost of each visit except for those who qualify forexemption from co-payments.

4.Transportation costs incurred by health care workers gettingto the patient.

another health care or nursing care institution that has a

home care department.2.If the patient has not been hospitalized, but the attending

physician nds he or she meets the conditions requiredfor home health care, the patient can apply directly forhome health care with a health care or nursing careinstitution that has a home care department.

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Hospice Care

The hospice and palliative care covered by the NationalHealth Insurance program is divided into three categories:hospice care in a hospital, home hospice care (includingcommunity hospice care), and hospice shared care. Patientsadmitted include various patients with terminal stage cancer,

patients with amyotrophic lateral sclerosis (ALS), and 8 typesof critically ill patients. These 8 types of critically ill patientsinclude patients with senile and presenile organic psychotic

conditions, other cerebral degenerations, heart failure,chronic airway obstruction (uncategorized), other pulmonarydisease, chronic liver disease and cirrhosis, acute renal failure(unspecified), and chronic renal failure and renal failure(unspeci ed).

Service Content1.Hospice Care in Hospital

As hospice beds are not available at all hospitals, youmay visit the website at http: //www.nhi.gov.tw/ formore information or call any National Health InsuranceAdministration regional division or liaison of ce to inquirewhich hospitals provide this before seeking medicalattention at these locations directly. After a doctors

professional diagnosis which meets the admittanceconditions, the doctor will arrange for your stay at a hospice

bed. A professionally trained team will offer a detailedexplanation regarding precautions such as signing a hospicecare agreement and refusing invasive medical procedures.

2.Home Hospice Care (Including CommunityHospice Care)

If you or your family member chooses to return home or

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go to a care facility closer to home to receive care, the National Health Insurance Administration also provideshome hospice care. A team of medical professionals (GroupA) will visit your home for visitation, regular diagnosis andtreatment, and care relating to the psychological, social,and spirituality issues of terminally ill patients and theirfamilies. With the introduction of community-orientedhome hospice care (Group B) in 2014, the norms formedical personnel involved in community hospice carewere eased so that primary care physicians could participatein the program, enabling hospice care to be deliveredinto communities and on outlying islands. To better serve

patients at home, medical facilities provide a 24 hour phoneconsultation service so you may call nursing staff to inquireabout any questions you may have regarding care. Pleasevisit the website at http: //www.nhi.gov.tw/ to look up 24hour consultation hotlines.

3.Hospice Shared Care

As not every hospital has hospice beds and some patientswho desire hospice and palliative care are unable toreceive this care due to the limited amount of hospice

beds, the National Health Insurance Administration beganimplementing the hospice shared care trial project inApril 2011. This allows patients in special beds such asacute beds, intensive care units, and respiratory care bedsthe chance to receive hospice care jointly from medical

professionals from their original medical team along with ahospice shared care medical team in the same hospital. Thehospice shared care team provides hospice and palliativecare services while the original medical team continues to

provide care services in hospital.

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NHI Family Physician Integrated Care

Project5 or more primary care clinics in the same region

cooperate with the regional hospital to form a communityhealth care group which uses its combined strength to care for

people in the community.

Service Content1.Community health care groups set up 24-hour health care

counseling hotlines that can immediately answer questionsand offer uninterrupted, complete health care.

2.Providing health management and health education to teachmembers correct health knowledge and fortify diseasescreening, vaccinations, and improve self-care capabilities.

3.If a patient needs to be further examined or treated at ahospital or referred to another specialist, your family doctorwill contact the partner hospital and help you transfer toits inpatient department. Your medical records will also besent to the partner hospital. The hospital, in turn, will reportthe results of the examination and tests immediately backto the clinic. The family doctors coordination helps you,the patient, go to the right department and find the rightspecialist, and will also avoid unnecessary examinationsand medications, reduce waiting time for a hospital bed anddecrease the confusion you may experience while seeking

health care at a major hospital.4.Once your condition stabilizes, you may return to your

original family physicians clinic to receive continuedtreatment.

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How to ParticipateThe National Health Insurance Administration analyzes

patient behavior from the previous years data of the outpatientdepartment (western medicine), lists qualified people and thenmatch them to the clinic they visit most frequently, which will

be regarded as this patients main healthcare provider. Oncethis clinic joins the project, the National Health InsuranceAdministration will provide the community health care clinicwith a roster to provide comprehensive care services to the public.

If you would like to find out which clinics around yourresidence are part of the community health care group, pleasecall NHI toll-free hotline at 0800-030-598 or inquire on thewebsite at http: //www.nhi.gov.tw/.

Reimbursement Plans that Improve HealthCare Quality

Prevention is better than a cure. When most diseasesfirst occur, if they are discovered at an early stage throughscreening and treated, chances for full recovery increasesignificantly. In addition, some patients with chronic orillnesses which require long term treatment can live normallives if they take their medication according to their doctorsorders and control their condition properly.

Based on the concept of purchasing health for the public, the National Health Insurance Administration hasselected a few common diseases to be handled under themedical benefits improvement plan. The National HealthInsurance Administration hopes that through certain paymentmethods, healthcare providers will be guided to provide

patients with comprehensive and continuous medical care. Italso hopes that by making health care quality and ef ciency

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the basis for payment, this scheme will become an innovativeway to purchase health.

Service ContentDiseases currently covered under the medical benefits

improvement plan include: diabetes, early stage chronickidney disease, asthma, chronic hepatitis B and C carriers,

breast cancer, schizophrenia, and etc. Because of the positiveimpact of the pay-for-performance plan in treating diabetes,it was instituted as the standard for all diabetes cases in

October 2012. To lower the incidence of dialysis treatment,the early chronic kidney disease medical bene t improvement plan was added in January of 2011. Hospitals reversed the previous situation of patients seeking out doctors to activelyassisting patients through disease management on a case basis.Treatment plans were planned with patients, with remindersfor patients to take their medication on time, follow up ontheir condition, and reminders for subsequent clinic visits, etc.

How to JoinSimply visit the website at http://www.nhi.gov.tw/ for

more information or call any National Health InsuranceAdministration regional division or liaison office to inquireabout hospitals that are participating in the medial benefitsimprovement plan. You may then directly seek medicalattention at these locations or visit after a referral.

If doctor diagnosis con rms that you are indeed sufferingfrom a disease designated by the plan, a professional medicalteam will aid in controlling your condition by setting acomplete treatment plan without need for you to submit anapplication. As a reminder, to ensure complete treatment andsubsequent follow up, it is best if you continue treatment atone hospital or clinic.

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Chapter 7How to Get Health CareBring Your NHI Card When Visiting a Doctor

Whether you are visiting a doctor, picking up medicine

or having a test done, you can bring your National HealthInsurance card (NHI card) to any contracted health careinstitution (identified by the National Health Insurance logoin their doorways) to be treated under the National HealthInsurance program. You will be required, however, to pay aregistration fee and co-payment.

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If you dont have your NHI card with you when visitingthe doctor, you must first pay all medical expenses out ofyour own pocket. But you can have the expenses, minus therequired co-payment, refunded if you bring your NationalHealth Insurance Card and receipt to the health care institutionwhere you were treated within 10 days.

Pick Up Your Prescription after Seeing a DoctorDoctors are responsible for treating patients and deciding

what medication they should take. Pharmacists then preparethe medication according to the doctors prescription andremind patients how to take it.

At the end of your visit with a doctor, the doctor may giveyou a prescription listing the types of medicine you need,dosages to be taken and how to use them. You should takethe prescription slip within three days of the visit (after threedays, the prescription is no longer valid) to a NHI-contracted

pharmacy to pick up your medicine. (If the hospital or clinicyou visited has a qualified pharmacist, you can have your prescription lled by the health care institutions pharmacy onthe spot.)A prescription should include the following information:1.The patients name and age (or date of birth)2.The diagnosis and physicians signature (or seal)3.The name of the hospital or clinic and its address and

telephone number 4.The name of the drug(s), its form (capsule, pill, liquid, etc.),

unit dosage content, quantity, dosage, and usage instructions(i.e., how long or when to take the medication, and othermedication precautions.)

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5.The date of the prescription has been issued, its refillinstructions (how many times the patient can refill the

prescription and the period of time between re lls).

Doctor Visit Flow Chart

Take prescriptionto NHI-contracted

pharmacy or hospitalclinic pharmacy

Pick upmedication

Take NHI card to healthcare institution and register

Get prescription

See doctor

Note: Registration fees are administrative fees and varydepending on the health care institution based on afee schedule approved by the Public Health Bureau ofthe county or city in which the institution is located.According to the National Health Insurance Act,registration fees are not covered by the National HealthInsurance program and are not collected by the National

Health Insurance Administration. If you have anyquestions regarding registration fees, please contact yourlocal Public Health Bureau.

Regular Prescription Rules When physicians prescribe medicine to a patient,they usually prescribe 7 days of medicine in principle.Based on physicians assessments of their patients, theyare allowed to prescribe up to seven days worth ofmedicine, and if a patient is diagnosed with a chronicailment, they can prescribe up to 30 days of medicine.(For more information on prescription re lls for chronic

patients, please see Chapter 9.)

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Referral RegulationsIf NHI-contracted hospitals and clinics are unable

to provide complete treatment due to limitations such as personnel, equipment, or specialization, they should assistyou with a referral to another medical facility with treatmentcapabilities. However, if your situation is critical, thecontracted hospital or clinic should provide the appropriateemergency procedures before making the referral. In addition,if your condition stabilizes after referral treatment and you nolonger need to continue treatment at the facility, the contractedfacility should aid you in transferring back to your originalfacility or another appropriate contracted facility to receivecontinued follow up treatment.

If you meet the aforementioned criteria for referral, yourfamily physician or contracted facilitys referral counterwill make appropriate referral arrangements for you. Thisincludes date of visit, treatment department, and registration

If the pharmacy does not have a particular drug listed

in the prescription, and the doctor did not specify that thespeci c drug has to be taken, the pharmacists can substituteanother drug from another pharmaceutical company thatis not more expensive and has the same composition, formand dosage. The substitute drug must also be covered underthe National Health Insurance program.

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assistance. You will not have to make graduated referrals froma small hospital to larger hospitals. Please communicate withyour doctor about the doctor you wish to be referred to whenyour referral note is being issued. As the referral is made asa professional medical arrangement after communication by

both parties, you must visit the speci ed contracted hospital,clinic, department listed on your referral note in order fordoctors to provide you with the most appropriate medical careand for the western medicine clinic basic co-payment to becharged according to referral regulations.

If you are unable to seek medical care on the date ofvisit specified on your referral note due to outstandingcircumstances, you can contact the referral counter at thecontracted facility accepting your referral directly to arrangean alternate visit date. (Please refer to Chapter 6 on how tomake referrals.)

Co-paymentsWhen local residents covered under the National Health

Insurance program visit a doctor, the system covers mostof the medical expenses, but patients are required to pay asmall portion of the cost, called a co-payment. The mainreason for requiring a co-payment is to remind the insuredthat medical resources are used to help people who are ill orinjured and should not be wasted under any circumstance.

In general, outpatients must pay a basic outpatient co- payment and a medication co-payment. If an outpatient wasgiven rehabilitation therapy or traditional Chinese medicinetherapy, then there will be an outpatient rehabilitation(including traditional Chinese medicine traumatology) co-

payment. If a patient is hospitalized, then he or she will haveto pay an inpatient co-payment when discharged.

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1.Basic Co-payments for Outpatient Visit underNHI System (NT$)

InstitutionClass

Basic Co-payments

Type ofInstitution

Western MedicineOutpatient Care Emergency

CareDentalCare

TraditionalChinese

MedicineWithreferral

Withoutreferral

MedicalCenters 210 360 450 50 50

RegionalHospitals

140 240 300 50 50

DistrictHospitals 50 80 150 50 50

Clinics 50 50 150 50 50

Notes: 1. Individuals classi ed as disabled pay co-payments of NT$50 for any medical care, regardless of the typeof medical institutions they visit.

2.Patients who return for their first checkup after anoutpatient or emergency procedure, or within 30 daysafter being discharged from the hospital, or within42 days after giving birth, pay the same co-paymentas if they were given a referral as long as they have a

hospital certi cate con rming the need for a follow-up visit.

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2.Medication Co-payments under NHI System(NT$)

Drug cost per prescription

Co-payment per prescription

Drug cost per prescription

Co-payment per prescription

under 100 0 601~700 120

101~200 20 701~800 140

201~300 40 801~900 160

301~400 60 901~1,000 180

401~500 80 1,001 andabove 200

501~600 100

3.Rehabilitation and Traditional Chinese MedicineCo-paymentsIf you are receiving physical therapy or traditional Chinesemedicine therapy (including traditional Chinese medicinetraumatology) on an outpatient basis, the Co-payment forfollow-up visits is uniformly NT$50 (except for moderateto complicated and complicated therapies).

4.Co-payments for Inpatient CareIf a patient is hospitalized in a NHI-contracted hospital, theinpatient co-payment -- the percentage of the overall cost ofthe stay to be covered by the patient -- depends on the type

of the ward (acute or chronic) and length of stay, as shownin the following table:

WardCo-payment Rates

5% 10% 20% 30%

Acute -- 30 days or less 31-60 days 61 days or more

Chronic 30 days or less 31-90 days 91-180 days 181 days or more

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Note: Co-payments for multiple acute ward stays of fewerthan 30 days and chronic ward stays of fewer than 180days for the same ailment are capped, with the ceilingsadjusted annually. For example, in the period fromJanuary 1, 2014 to December 31, 2014, caps on hospitalstay co-payments for acute ward stays of a total of fewerthan 30 days or chronic ward stays of fewer than 180days have been set at NT$32,000 for a single hospitalstay for a particular condition and at a cumulative

NT$53,000 for the entire calendar year. Those who

pay more than the established ceiling can apply for areimbursement before the end of June of the followingyear.

Applying for a refundPatients should ll out an Instructions for NHI Prepaid

Medical Expense Refund Application Form and preparecopies of their medical receipts and itemized expenses.These should then be submitted to a nearby National HealthInsurance Administration regional division. (The applicationforms can be picked up at any National Health InsuranceAdministration regional divisions.)

Who is Exempted from Paying Co-payments

1.Those Exempt from all Co-payments:A.Individuals suffering from a catastrophic illness, or living

and being treated in remote mountain areas or islandregions, or women giving birth.

B.Outpatients or emergency care patients from outlyingislands who have been referred to a health care facility onTaiwan.

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C.Veterans who have the symbol for veteran on their NHIcards and their dependents.

D.Members of low-income households.E.Children under three years of age.F.Registered tuberculosis patients who receive treatment at

speci ed contracted hospitals.G.Patients with labor insurance who are being treated for

occupational ailments.H.Patients suffering from PCB (polychlorinated biphenyl)

poisoning.I.Centenarians.J.Alternative servicemen who hold military service ID cards

(including general alternative servicemen and alternativeservicemen involved in rst- and second-stage R&D).

2.Those Exempt from Co-payments on Prescribedmedication:A.Patients with chronic illness refill prescriptions. The

National Health Insurance Administration has listed 100diseases as chronic illnesses, including hypertension anddiabetes.

B.Dental patients.C.Patients receiving care for one of the ailments covered

under the per case payment system.

3.Those Exempt from Physical Therapy Co-payments:

A.Patients undergoing moderate to complicated physicaltherapy, defined as undergoing three or more types ofmoderate therapy, such as electrical muscle stimulationand 13 other therapies, for a total of more than 50minutes.

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B.Patients undergoing complicated therapeutic treatmentrequiring specialized therapists, such as balance trainingand six other therapies. Limited to prescriptions issued byrehabilitation medicine specialists.

4.Regions De cient in Medical Resources:The co-payment amount of patients who receive clinic,emergency, or home care services in regions deficient inmedical resources will be reduced by 20%. The NationalHealth Insurance Administration will make annual

announcements regarding regions determined to be de cientin medical resources.

Receipts, Itemized Medical Expenses,Medication Lists

When you visit a doctor or are discharged from a hospital, please remember to get a receipt from the hospital or clinic as

well as an itemized list of medical expenses and an itemizedlist of medications prescribed.

1. Receipt(1)The receipt should include items covered by NHI and

out-of-pocket expense items along with the NHI Cardtreatment serial number. If you choose to itemize yourdeductions when ling personal income taxes, the receiptcan be used as an itemized tax deduction. The NHI Cardtreatment serial number tracks a patients number ofoutpatient visits for the year and prevents the NHI Cardfrom being mistakenly used.

(2)Some clinics and hospitals combine the receipt anditemized list of medical expenses on one receipt, whileothers separate them.

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2. Itemized List of Medical Expenses

(1)The itemized medical expense list for any doctors visitor hospital stay should include out-of-pocket expenses(including the registration fee, co-payments and otherexpenses), total medical expenses, t

Taiwan’s National Health Insurance(English)2014-2015 Handbook

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