Article 1
These Regulations are duly enacted pursuant to Paragraph 2 of Article 40 of the National Health Insurance Act (hereinafter referred to as “the Act”).

Article 2
The procedures of medical visit of beneficiaries, medical visit advice, methods of provision of the insurance medical services and other matters necessary for medical services under the National Health Insurance (hereinafter referred to as the “NHI”) shall be governed by these regulations.

Article 3
The following documents shall be provided if a beneficiary receives medical treatment or gives birth at a NHI contracted hospital, clinic or delivery institution:
1. The National Health Insurance Card (hereinafter referred to as the “NHI Card”);
2. The national identification card or any other appropriate identification document. Notwithstanding, the above document may be exempted if the NHI Card is sufficient to establish the beneficiary’s identity.
The document set forth in Subparagraph 2 of the preceding paragraph of a beneficiary under 14 years old may be replaced by a copy of the household registration certificate or household registration certificate transcription, or any other document which is sufficient to prove the beneficiary’s identity.
A beneficiary shall provide the prescription prescribed by the contracted hospital or clinic in addition to the documents listed in the Paragraph 1 when he or she visits a contracted medical care institution to receive medical service which is not listed in Paragraph 1.
Where a beneficiary requires home nursing care service, the beneficiary shall first be diagnosed and evaluated by a physician of a contracted medical care institution who should issue a home nursing care instruction order according to which the hospital or clinic shall directly make application to a contracted medical care institution which has home nursing service department or nursing institution.

Article 4
Where a beneficiary undertakes medical visit and fails to produce the NHI Card or identification document in a timely manner, the contracted medical care institution shall first provide medical service, charge the NHI medical expenses and issue a receipt in compliance with the Enforcement Rules of the Medical Care Act. The beneficiary shall submit the required document within ten days (excluding weekends and public holidays) from the date when he or she undertakes the medical visit in question or before he or she is discharged from the hospital. The contracted medical care institution shall reimburse the beneficiary the remainder between the NHI medical expenses and the co-payment made by the beneficiary.
In the event that a beneficiary who is unable to pay the insurance premium has one of the following circumstances during the period when the insurer suspends the benefit payment, the beneficiary may undertake medical visit in the capacity of beneficiary by presenting a low-income family certificate issued by the chief of Village (Neighborhood) where the beneficiary’s household is registered. Notwithstanding, if it is difficult to obtain a low-income family certificate due to a special circumstance, the contracted medical care institution which the beneficiary seeks medical service may provide medical treatment first:
1. The beneficiary needs to receive emergency or inpatient care due to injury or illness; or
2. The beneficiary suffers life-threating acute illness which requires immediate medical treatment, or major illness or injury under the NHI which requires outpatient medical care.

Article 5
Where a beneficiary fails to submit the supplementary supporting document(s) before the deadline set forth in the preceding article, which cannot be attributed to the beneficiary, the beneficiary may apply to the insurer for reimbursement of the self-advanced NHI medical expenses pursuant to Article 56 of the Act by submitting the itemized statement of medical expenses and receipt thereof issued by the contracted medical care institution.

Article 6
A contracted hospital or clinic shall pass the outpatient prescription to a beneficiary who has the right to decide whether to select the contracted hospital, clinic where he or she receives the current medical service or any other qualified contracted medical care institution to fill the prescription or conduct lab test or diagnostic examination.
Where a contracted hospital or clinic needs to transfer a beneficiary to another contracted medical care institution for the purpose of dosage dispensation, lab test or diagnostic examination due to its own specialty or limited facilities, its physician shall issue prescription to the beneficiary for the latter to receive medical service in another contracted medical care institution.
Referral form may be issued to a beneficiary for referral of ancillary service of lab test or diagnostic examination in the preceding paragraph, or, alternatively, outsourcing medical examination form may be issued whereby the collected clinical samples will be tested by an appointed outsourcee.

Article 7
Where a contracted medical care institution provides medical service for a beneficiary, it shall check the required document set forth in Paragraph 1 of Article 3. In the event of any discrepancy, the contracted medical care institution shall refuse to treat the patient in the capacity of beneficiary. Notwithstanding, a chronic patient who cannot physically pay the medical visit and requires long-term medication with any of the following special circumstances may authorize another person to state his or her medical condition to a physician, which shall be limited to refillable prescription. The physician shall only prescribe the same drug(s) after making sound judgment based on his or her expertise and fully grasping the state of the patient’s condition:
1. Immobility which is confirmed by a physician or supported by an affidavit provided by the person authorized by the beneficiary in question;
2. The person has already been on board due to his or her engagement in far sea fisheries or service on a vessel of international route, which is supported by an affidavit submitted by the person authorized by the beneficiary in question; or
3. Any other special circumstance approved by the insurer.

Article 8
Where a contracted medical care institution provides diagnostic and treatment services, such as outpatient, emergency or inpatient care, or re-checks the NHI Card, it shall return the NHI Card to the cardholder after recording the medical record and the medical visit category (hereinafter referred as the “MVC”) of cumulative medical-visit serial number (hereinafter referred as the “CMVSN”) into the NHI Card.
If the medical service in the preceding paragraph is given during the same course of treatment, it shall be recorded only once for the MVC of CMVSN. In addition, if the same physician simultaneously provides other treatments, the recording should not be duplicated.
The therapeutic course in the preceding paragraph refers to a course of continuous treatment which is given within a specific period of time with the items listed below:
1. Simple wounds: wound dressing change within 2 days.
2. The therapeutic course is within 30 days from the first day of treatment: Hemodialysis, community organization rehabilitation therapy for mental illness, psychotherapy for psychiatric illness, psychiatric activity therapy, psychiatric occupational therapy, cancer radiotherapy, hyperbaric oxygen therapy, chemotherapy, immunotherapy, home nursing or any other item designated by the insurer.
3. The therapeutic course has no more than six treatments, and is within 30 days from the first day of treatment: western medicine rehabilitation therapy, photodynamic therapy, simple change of wound dressings, the same injection of non-chemotherapy drugs, removal of tartar of the same tooth treatment, operative dentistry of the same tooth (tooth filling), same tooth extraction, removal of stitches after operation, electrical stimulation treatment for urinary incontinence, pelvic muscle physical therapy, pulmonary rehabilitation traditional Chinese medicine acupuncture, fractures, wounds and restoration of dislocated bone of the same diagnosis that needs continuous treatment, and any other item designated by the insurer;
4. The therapeutic course has no more than six treatments, and is from the first day of treatment to the end of next month: western medicine rehabilitation for children under 9 years old.
5. The therapeutic course is within 60 days from the first day of treatment: endodontic therapy of the same location.
Where the last day of treatment of the same therapeutic course is weekend or public holiday, the last day of treatment should be automatically extended to the next business day.

Article 9
The contracted medical care institution shall record the medical records in the NHI Card of a beneficiary which should exclude the MVC of CMVSN if the beneficiary has any of the following circumstances:
1. The beneficiary is discharged from hospital;
2. The beneficiary receives the second or subsequent treatment in the same therapeutic course;
3. The beneficiary receives the scheduled examination, scheduled lab test, scheduled treatment, scheduled surgery or referral medical examination; or
4. The beneficiary receives the medical service set forth in Paragraph 4 of Article 3.
If the related treatment is required during the scheduled examination, scheduled lab test, scheduled treatment, scheduled surgery or referral examination due to the need of the beneficiary’s medical condition, such treatment may be deemed as another diagnosis treatment and recorded as the MVC of CMVSN for one time.

Article 10
Except in the case of daytime hospitalization provided by the department of psychiatry, a contracted hospital shall retain the NHI Card of a beneficiary who undertakes hospitalization procedures and return the aforementioned card to the beneficiary when he or she is discharged from the hospital.
In the event that a beneficiary is admitted to a chronic hospital or psychiatry hospital and a physician determines that such beneficiary shall immediately receive certain treatment which the hospital does not have a proper department to provide due to the need to involve various medical departments in treating the beneficiary’s illness, the hospital may return the NHI Card to the beneficiary for him or her to seek outpatient care somewhere else. The same shall apply to the case where a physician confirms that a dialysis patient shall immediately undergo dialysis treatment during the patient’s hospitalization in a hospital which is unable to provide dialysis service.
A contracted hospital may not provide its medical service for a beneficiary who is hospitalized in such hospital by way of its outpatient care. Notwithstanding, if the hospital is unable to provide a complete lab test (examination), it may entrust another contracted medical care institution to provide the lab test (examination) by way of referral medical examination or outsourcing medical examination.

Article 11
Where a beneficiary has any of the following circumstances, a contracted hospital may not admit or continue to admit such beneficiary as an inpatient:
1. The beneficiary suffers from an injury or illness which can be treated with outpatient care; or
2. The beneficiary suffers from an injury or illness that no longer requires hospitalization after proper treatment.

Article 12
Where a beneficiary is diagnosed by a contracted hospital as fit to be discharged from the hospital, the hospital shall promptly notify such beneficiary. If the beneficiary refuses to be discharge from the hospital, all expenses arising therefrom shall be solely borne by the beneficiary.

Article 13
A beneficiary who is already hospitalized may not leave the hospital on his or her own discretion. Where the beneficiary has to leave the hospital due to any special circumstance, he or she shall first obtain the permission from the responsible physician who should record the reason and departure time in the beneficiary’s medical history before the beneficiary is allowed to leave the hospital by leave. The beneficiary is not allowed to stay overnight outside of the hospital.
A beneficiary who leaves the hospital without permission shall be automatically deemed as having discharged themselves from the hospital.

Article 14
In the event that a beneficiary suffers from a chronic illness and is diagnosed to require the same prescribed drugs for treatment for a long time, a physician may issue a refillable prescription for patients with chronic illnesses, except grade-one or grade-two controlled drug defined in the Statute for the Control of Controlled Substances.
The scope of chronic illnesses in the preceding paragraph is set forth in the attached table.
Each chronic disease is limited to one refillable prescription for patients with chronic illnesses only.

Article 15
Where a beneficiary is given prescription issued by a contracted hospital or clinic, the beneficiary shall have the dosage dispensed in such contracted hospital or clinic, or a contracted pharmacy of his or her choice. Notwithstanding, a beneficiary who is issued with refillable prescription for patients with chronic illnesses is unable to have the dosage dispensed in the hospital or clinic which issues the original prescription due to certain reason, and there is no contracted pharmacy locally, the beneficiary may have the dosage dispensed in another contract hospital or clinic.
Where the prescription set forth in the preceding paragraph is a combination of both common drugs and controlled drugs, the beneficiary shall hold two separate prescriptions at the same time.

Article 16
A contracted medical care institution shall inform a beneficiary prior to its provision of medical service if the beneficiary is required to solely bear all hospitalization expenses according to Article 47 of the Act or the beneficiary is to incur expenses arising from the item or circumstance which are not covered by the NHI pursuant to Article 51 or 52 of the Act.

Article 17
Where a beneficiary completes the therapeutic procedure, the contracted medical care institution shall collect the co-payment from the beneficiary according to the Act, and issue a receipt in compliance with the Enforcement Rules of the Medical Care Act and label the drug container(s) according to the Pharmaceutical Affairs Law. Where a drug container cannot be properly labeled, the contracted medical institution shall issue an itemized list of drugs.
Where a contracted hospital or clinic does not issue drug prescription or prescription for dosage, it may be exempted from issuing an itemized list of drugs.

Article 18
A beneficiary who seeks medical treatment from a contracted medical care institution shall comply with the following requirements:
1. Abide by all requirements imposed by the NHI;
2. Abide by all advices given by medical staff in relation to medical treatment;
3. Not arbitrarily demand medical examination (test), drug prescription or hospitalization;
4. Leave the hospital immediately upon receiving the discharge notice that he or she is no longer required to be hospitalized; and
5. Pay the co-payment in accordance with the relevant regulations.

Article 19
A beneficiary who needs blood transfusion and blood derivatives shall first use the blood and derivatives thereof denoted by his or her family members or relatives or provided by blood donation institutions.
In the event that a patient with emergent injury or illness needs blood transfusion and blood derivatives according to the diagnosis of a physician, but the blood donation institution is in short supply of the blood or derivatives thereof, the contracted hospital or clinic shall first secure blood and derivatives thereof from the blood donation institution of the blood bank of a hospital which has passed evaluation.

Article 20
A beneficiary who is hospitalized shall stay in the NHI ward. Where the grade of the ward which he or she temporarily stays is lower than that of the NHI ward, the beneficiary may not request compensation for the difference. Where a beneficiary stays in a ward whose grade is higher than that of the NHI ward, the beneficiary may not request subsidy for the difference.
A contracted hospital shall first offer the NHI ward to a beneficiary. Where the contracted hospital is unable to provide the NHI ward due to usage of the NHI ward, it shall obtain the consent from the beneficiary and inform the beneficiary the difference for which he or she has to pay before it arranges the beneficiary to stay in a non-NHI ward. If subsequently there is available bed in the NHI ward, the contracted hospital shall, without objection, transfer the beneficiary to the NHI ward upon the beneficiary’s request.
If a beneficiary refuses to pay for the difference of the ward, the contracted hospital shall transfer the beneficiary to another hospital, or schedule a NHI ward and notify the beneficiary to report to the hospital when the NHI ward is available

Article 21
The NHI ward expenses shall be calculated from the first day of hospitalization (including the first day) till the day of discharge (excluding the day of discharge).

Article 22
The dosage of NHI drug prescription, in principle, should not be given for more than seven days. Notwithstanding, a patient who is within the scope of chronic illnesses set forth in Paragraph 2 of Article 14 may be given dosage for less than 30 days as required by his or her medical condition.

Article 23
A NHI common prescription is valid for three days starting from the date when the prescription is issued (in the event of weekend or public holiday, it is automatically extended to the next business day). Refillable prescriptions for patients with chronic illnesses should be valid for at most 90 days according to the number of medication days specified in each prescription. A contracted medical care institution may not dispense dosage if the prescription thereof expires.
A refillable prescription for patients with chronic illnesses shall be dispensed in different dispensations with the dosage of each dispensation subject to the preceding Article.

Article 24
A beneficiary holding a refillable prescription for patients with chronic illnesses may request dosage dispensation by presenting the original prescription within 10 days before the expiration of the previous dosage dispensation.
In the event that a beneficiary is scheduled to go abroad, return to an outlying island, engage in far sea fisheries or service on a vessel of international route, or is a rare disease patient, he or she may submit an affidavit when requesting dosage dispensation in order to receive at once the total number of drugs prescribed in the refillable prescription for patients with chronic illnesses.

Article 25
Where a physician does not specify that the prescribed drug or medical device cannot be substituted in a prescription, a pharmacist (assistant pharmacist) may replace the drug with a drug of another brand with the same ingredients, dosage and contents at the same or lower price, or replace the medical device with specialty material of another brand of the same functional category, and inform the beneficiary.

Article 26
In order to safeguard a beneficiary’s drug safety, the drug container or packaging shall clearly specify the name and gender of the beneficiary, the name, quantity, number of medication days, and the method of use of the drug(s), the place and name of dispensation, the name of the dispenser and the date of dispensation.

Article 27
Where a beneficiary conducts repetitive medical visits or improperly uses medical resources, the insurer shall provide guidance service for such beneficiary by understanding the beneficiary’s medical visit practices, providing adequate medical and health education, arranging medical visit and offering necessary assistance to the beneficiary. The insurer may request the beneficiary to receive medical service in a contracted medical care institution designated by the insurer as his or her medical condition requires.
Where the beneficiary in the preceding paragraph fails to pay medical visit to the contracted medical care institution designated by the insurer, the beneficiary is not entitled to benefit payment, except in the case of emergencies.
The guidance in Paragraph 1 may be conducted by way of caring letter, telephone interview, home visit or utilization of relevant social resources.

Article 28
These Regulations shall come into force on January 1, 2013, except Articles 6, 7, 10 and 24 which shall come into force from the date of promulgation.
The amended articles of these Regulations shall come into force from the date of promulgation.