Article Content

  Chapter 2 Occupational Accident Insurance

   Section 4 Insurance Benefits

     Subparagraph 2 Medical Care Benefits

Article 48
When an insurer entrusts an NHI insurer (hereinafter referred to as the “NHI insurer”) to handle medical benefits by the provisions of Paragraph 2 of Article 38 of the Act, the contract of entrustment shall be prepared by the insurer with the NHI insurer, which shall be submitted to the central competent authority for approval with the central competent health and welfare authority.
When the insured attends the NHI hospital or clinic for medical treatment, the procedures for medical treatment, consultancy, the method of providing medical treatment, and other necessary matters for medical treatment shall be handled mutatis mutandis by the relevant provisions of the National Health Insurance, unless otherwise provided for in the Act and these Rules.
Article 49
When the insured applies for outpatient or inpatient treatment for occupational injuries and diseases, the insured shall submit the occupational injury and disease outpatient clinic or inpatient application form issued by the insured unit or the insurer, and submit the following documents for inspection:
1. Certificate of National Health Insurance (hereinafter referred to as the NHI card).
2. National Identity Card or other documents sufficient to prove the identity. However, if the NHI card is sufficient to identify the identity, the submission of the National Identity Card may be waived.
Those who fail to present the documents specified in the provisions of the preceding Paragraph shall be rejected to register for medical treatment as the insured of the insurance at the NHI hospital or clinic.
Article 50
If the insured fails to timely submit the occupational injury and disease outpatient application form, the application form for hospitalization, or the NHI card for inspection, the insured shall present the identification document to declare that he is the insured under the insurance and handle the registration for medical treatment; the NHI hospitals or clinics shall first provide medical treatment, and then collect medical treatment fees, and issue receipts based on the Enforcement Rules of the Medical Care Act.
If the insured receives medical treatment by the provisions of the preceding Paragraph, within 10 days from the date of the medical treatment (excluding holidays) or before discharge, if the insured submits additional documents, the NHI hospital or clinic shall refund the medical treatment fees collected.
Article 51
If due to reasons not attributable to the insured, which causes him to fail to submit additional documents within 10 days from the date of receiving medical treatment or before discharge by the provisions of the preceding Article, the insured may within six months from the date of receiving outpatient medical treatment or the date of discharge apply to the insurer for reimbursement of medical expenses.
Those applying for reimbursement of medical expenses by Paragraph 1 of Article 40 of the Act shall submit the following documents:
1. Occupational accident medical treatment fees reimbursement application form and the payment receipt.
2. Diagnosis certificate or supporting documents.
3. Receipts of medical expenses and details of the fees collected.
Article 52
After receiving the occupational injury and disease outpatient application form or the application form for hospitalization, the NHI hospital or clinic shall fill in the insured’s medical treatment information in detail, and attach the occupational injury and disease outpatient application form or the application form for hospitalization to the insured's medical record, and archive these documents at least seven years for future review.
The second copy of the occupational injury and disease outpatient application form in the preceding Paragraph shall be returned to the insured for reference after the diagnosis and treatment; the second copy of the application form for hospitalization shall be submitted to the insurer for review within ten days.
The insurer shall notify the NHI insurer, the NHI hospital or clinic, the insured unit, and the insured if the application form for hospitalization or outpatient treatment in the Preceding paragraph is verified as not conforming to definitions of occupational injury or disease.