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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
ER Examination
With
referral
Without
referral
Level 1、2 Level 3 to 5
Medical
Centers
170 420 450 550 50 50
Regional
Hospitals
100 240 300 300 50 50
District
Hospitals
50 80 150 150 50 50
Clinics 50 50 150 150 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
Notes:
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
  • 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.
  • 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.