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Copayments

When local residents covered under the National Health Insurance program visit a doctor, the system covers most of the medical expenses, but patients are required to pay a small portion of the cost, called a “co-payment.” The main reason for requiring a co-payment is to remind the insured that medical resources are used to help people who are ill or injured 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 was given rehabilitation therapy or traditional Chinese medicine therapy, then there will be an outpatient rehabilitation (including traditional Chinese medicine traumatology) co-payment. If a patient is hospitalized, then he or she will have to pay an inpatient co-payment when discharged.

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

Institution Class

Basic Co-payments

Type of Institution

Western Medicine Outpatient Care

Emergency Care

Dental Care

Traditional Chinese Medicine

With referral

Without referral

Medical Centers

210

360

450

50

50

Regional Hospitals

140

240

300

50

50

District Hospitals

50

80

150

50

50

Clinics

50

50

150

50

50

Notes:

  • Individuals classified as disabled pay co-payments of NT$50 for any medical care, regardless of the type of medical institutions they visit.
  • Patients who return for their first checkup after an outpatient or emergency procedure, or within 30 days after being discharged from the hospital, or within 42 days after giving birth, pay the same co-payment as if they were given a referral as long as they have a hospital certificate confirming the need for a follow-up visit.

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

Drug cost per prescription

Co-payment per prescription

under100

0

101~200

20

201~300

40

301~400

60

401~500

80

501~600

100

601~700

120

701~800

140

801~900

160

901~1,000

180

1,001 and above

200

3.Rehabilitation and Traditional Chinese Medicine Copayments

If you receive physical therapy or traditional Chinese medicine therapy for injuries (including traditional Chinese medicine traumatology) on an outpatient basis, the Co-payment for follow-up visits is uniformly NT$50 (except for “moderate to complicated” and “complicated” therapies).

4.Coinsurance for Inpatient Care

If a patient is hospitalized in a NHI-contracted hospital, the coinsurance rate -- the percentage of the overall cost of the stay to be covered by the patient -- depends on the type of the ward (acute or chronic) and length of stay, as shown in the following table:

Ward

Coinsurance 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

Note:
Coinsurance for multiple acute ward stays of fewer than 30 days and chronic ward stays of fewer than 180 days for the same ailment are capped, with the ceilings adjusted annually. For example, in the period from January 1, 2016 to December 31, 2016, caps on hospital stay coinsurance for acute ward stays totaling fewer than 30 days or chronic ward stays of fewer than 180 days during the year have been set at NT$36,000 for a single hospital stay for a particular condition, and at a cumulative NT$59,000 for the entire calendar year. Those who pay more than the established ceiling can apply for a reimbursement before the end of June of the following year.
(Note: The National Health Insurance Administration announces coinsurance ceiling on ward stay every year.)

Applying for a refund

1.Patients should fill out an “Instructions for NHI Prepaid Medical Expense Refund Application Form” and prepare copies of their medical receipts and itemized expenses. These should be filed at the National Health Insurance office closest to the hospital where treatment was initially sought.

2.You can go to an NHIA office or the NHIA website to download an application form.

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 island regions, or women giving birth.

B.Outpatients or emergency care patients from outlying islands who have been referred to a health care facility in Taiwan.

C.Veterans who have the symbol for “veteran” on their NHI cards and their dependents.

D.Members of low-income households.

E.Children under three years of age.

F.Registered tuberculosis patients who receive treatment at specified 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 alternative servicemen involved in first- and second-stage R&D).

2.Those Exempt from Co-payments on Prescribed medication:

A.Patients with chronic illness refill prescriptions. The National Health Insurance Administration has listed 100 diseases as chronic illnesses, including hypertension and diabetes.

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 Copayments:

A.Patients undergoing “moderate to complicated” physical therapy, defined as undergoing three or more types of “moderate” therapy, such as electrical muscle stimulation and 13 other therapies, for a total of more than 50 minutes.

B.Patients undergoing “complicated” therapeutic treatment requiring specialized therapists, such as balance training and six other therapies. Limited to prescriptions issued by rehabilitation medicine specialists.

4.Regions Deficient in Medical Resources:
The co-payment amount of patients who receive clinic, emergency, or home care services in regions deficient in medical resources will be reduced by 20%. The National Health Insurance Administration will make annual announcements regarding regions determined to be deficient in medical resources.

2017/01/26