Introduction of Reimbursement of Medical Expenses and Relevant Application Form

1. All regional divisions of the NHIA, MOHW:

Disclaimers: The contents of the followings are for the service of translation. If there is any conflict or discrepancy between laws/regulations/documents written in Chinese and English translations, the Chinese ones shall prevail.

2. An insured who meets any of the following situations may apply for the reimbursement of medical expenses according to the “Regulations for National Health Insurance Reimbursement of Medical Expenses.”

A. In Taiwan: Generally, the insured must receive medical treatment at an NHI contracted hospital or clinic. However, an insured who meets any of the following situations may submit relevant supporting documents to apply for a reimbursement of medical expenses at the regional division of the NHIA where the insured attended health care organization is located.

(1) Where an insured who receive medical treatment from non-NHI contracted medical institution due to an emergency or emergency childbirth, the itemized lists, the original receipts, medical diagnosis, and the application form shall be submitted to apply for a reimbursement.
(2) Where an insured was required to pay for medical expenses in advance due to having no insurance certificate when visiting a doctor, the insured shall submit the insurance certificate to the attended health care institution to apply for a reimbursement within 10 days from the date of seeing the doctor (not including public holidays). In case the insured fails to submit the preceding insurance certificate due to force majeure (such as typhoons) or caused by the NHIA or the insured units, the itemized list and the original receipt can be submitted to apply for a reimbursement.
(3) As for copayment for hospitalization in an acute ward within 30 days, or in a chronic ward within 180 days, the insured can file a claim for a return of the difference if their total expenses of copayment exceeded the annual accumulated amount determined by the MOH.  An application form and original copies of the medical receipts are required. However, the receipts may be exempted if the applicant agrees that the NHIA settles the reimbursement amount. The application shall be submitted before June 30 of the following year to apply for a reimbursement.
(4) Where the insured received medical care services when their coverage was temporarily suspended, the insured must pay the premium and other relevant expenses in full before the submission of the itemized statement of expenses, the original copies of the medical expense receipts, the diagnosis certificate, and the application form to apply for a reimbursement. The insured shall apply for reimbursement within 6 months from the day the relevant expenses were paid in full; and this is applicable for cases within the last 5 years.

B. Overseas: If the insured received medical treatments because of an unexpected disease, emergency injury or emergency childbirth in a foreign country or China, the insured may ask a reimbursement. They shall apply with the following supporting documents within six months from the day of the emergency treatment, or outpatient treatment, or a discharge from the hospital. The reimbursement amounts, based on receipts, will be decided according to the NHI fee schedule. The reimbursement ceiling is the average payment of the NHI-contracted hospitals and clinics.

(1) NHI Prepaid Medical Expense Refund Application Form.
(2) The original copy of the medical expense receipt and the itemized statement of expenses, a copy of the Chinese translation should be enclosed if the documents are not in Chinese or English.
(3) A copy of the Chinese translation shall be enclosed if the diagnosis certificate or supporting documents are not in Chinese or English (a discharge summary should be attached for cases of hospitalization).
(4) A copy of the exit-and-entry documents or proofs provided by the employer.

Reminder:
For reimbursements cases where the insured was hospitalized in China for 5 days and more (excluding the date of hospital discharge, i.e. hospitalized on January 1, 2014 and discharged on January 5, 2014, hospitalization for 4 days), the original copy of the medical expense receipt and the diagnosis certificate are required to be notarized by a notary public in China and verified by the Straits Exchange Foundation (contact number: 02-2533599) before the submission of an application

C. Application method: The insured (statutory agents, statutory heirs) or their authorized agents shall apply for the reimbursement with the respective regional division of the NHIA. In addition, the insured shall contact the regional joint service centers or liaison offices of the NHIA or submit the application by registered mail. For those who have not yet returned to the country shall entrust others to apply with a power of attorney.

D. Documents required for application: The NHI Prepaid Medical Expense Refund Application Form, the original copies of the medical expense receipts and the itemized statement of expenses, the diagnosis certificate, the discharge summary of hospitalization, and the exit-and-entry documents shall be enclosed.

3. The ceilings for annually-accumulated copayment and for copayment per hospitalization: