If workers sustain occupational injury/illness during their period of employment, they can request their insured unit to fill in an Occupational Injury/Illness Clinic Visit Form or Hospitalization Application Form (hereinafter referred to as the “Medical Form”), and also be entitled to waiver or exemption of medical expenses for medical copayments as stipulated by the NHI program if they seek medical attention at NHI designated hospitals/clinics using their NHI cards. Other benefits include subsidies for in-hospital meal charges under 30 days, thereby reducing the burden of medical care.
For example, as the Bureau of Labor Insurance (BLI) explains, if Mr. A, a restaurant chef, encounters a car accident on his way to work and sustains a laceration to his left knee, he is deemed to have suffered an occupational injury based on the relevant provisions of the “Regulations of the Examination of Injuries and Diseases Resulting from the Performance of Duties by the Insured Persons of the Labor Occupational Accident Insurance.” If he seeks care at the emergency room of a hospital, he is required to pay NT$1,000 out of pocket using his NHI card (NT$250 registration fee and $750 copayment). If he seeks medical attention holding an Occupational Injury/Illness Clinic Form, he is required to pay just NT$250 in registration fees.
The BLI particularly emphasizes that those who are unable to obtain Medical Forms in time in the event of an emergency can proceed to a medical institution directly and obtain care using their NHI card. Within 10 days (weekends and holidays excluded) of seeking care or before they are discharged from the hospital following hospitalization, they should proceed to the hospital/clinic from which they originally sought care to request a refund by submitting their medical treatment form, original copy of medical payment receipt, and NHI card. Those unable to request a refund from the hospital/clinic within 10 days are still entitled to apply for reimbursement of out-of-pocket medical expenses within 6 months (5 years for those undergoing longer treatment periods) with the BLI without damaging their occupational accident medical rights. For those who, due to occupational injury/illness, choose special material items specified in Paragrah 1, Article 45 of the National Health Insurance Act, which require partial out-of-pocket payments and are deemed medically necessary by a physician, and pay the cost difference up-front, an application can also be submitted for reimbursement of the cost difference.
For detailed explanations about the eligibility, benefit levels and claim procedures for occupational accident medical benefits, please see
Medical Care Benefits of Labor Occupational Accident Insurance