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With Effect from May 1, 2022, Workers Covered by Occupational Accident Insurance May Claim Reimbursement when they Choose to Use National Health Insurance Partially Covered Special Materials

With effect from May 1, 2022, the implementation date of the Labor Occupational Accident Insurance and Protection Act, further protection will be provided to for the medical benefit rights and interests of the workers suffering from occupational injury/disease. If, due to injury/disease caused by occupational reasons, the insured person is identified as having medical needs by the doctors in the NHI-designated hospitals or clinics and such insured person selects partially covered special materials and items specified in the National Health Insurance Act, he/she may, after having settled the partial out-of-pocket payment, apply to the BLI for the reimbursement of such payment.

The BLI expressed that, in order to protect the rights and interests of the workers suffering from occupational accidents and ensure the effective utilization of insurance resources, after deducting the copayment by NHI, the difference paid by the workers for the special material will be covered by the Occupational Accident Insurance in future. For example, Mr. A has, due to an occupational accident, received a surgery on June 10, 2022 for the replacement of a hip joint and selected a special material with a price of NTD100,000. The amount of NHI copayment is NTD35, 000 and the insured person has an out-of-pocket payment of NTD65,000 for the difference. After he is released from the hospital, Mr. A is entitled to apply to the BLI for reimbursement of the money advanced (NTD65,000).

The BLI further explained that, when a worker applies for reimbursement of the difference for the partially covered special material, he/she should attach relevant application documents including: the Occupational Accident Insurance Up-front Medical Expense Reimbursement Application Form and Benefit Receipt, diagnosis statement, receipts and detailed list medical expenses, and agreement for the out-of-pocket payment.

For more details about the qualification, payment standards and application procedures of occupational accident medical care benefit and reimbursement of the out-of-pocket payments of difference for partially covered special material, please visit the global website of the BLI: “Occupational Accident Insurance/Medical Benefits”. 
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Last Update:2022-07-19
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