Medical Care Benefits

The Bureau of Labor Insurance provides occupational accident medical benefits to worker who has occupational injury or disease during the period of insurance coverage in need of outpatient and hospitalization. Worker having the status of occupational accident of  labor occupational accident insurance enjoy more privileges!

【Qualification】

1. The insured suffers an occupational injury or disease accident after the insurance becomes effective and before the termination of the insurance and meets the requirements 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" and requires outpatient or hospitalization.
2. An insured person who is involved in occupational accident and disease during the period of insurance coverage who needs outpatient or hospitalization within 1 year of termination of his/her labor insurance.
3. After the insured suffers an occupational injury or disease during the effective period of the insurance, during the period of being covered by the labor insurance in accordance with the "Regulations Governing Renewal of Labor Insurance by Workers with Occupational Accidents Who Withdraw from Insurance Program in the Medical Period  " and the same occupational injury and disease and the other diseases caused thereby require outpatient or hospitalization.

【Claim Standard】

1. If the insured suffers occupational injury or disease, he/she shall visit the NHI hospital or clinic for diagnosis and treatment and is not required to pay the out-of-pocket medical expenses stipulated by NHI and may have the subsidy for hospital meals for a period of 30 days  at most. The payment standards for medical expenses are limited to those stipulated in the "Labor Occupational Accident Insurance Medical Care Benefits Item and Payment Standards" in addition to the relevant provisions of the National Health Insurance.
2. If the insured visits a domestic non-NHI hospital or clinic due to an emergency occupational injury or disease or if the insured suffers an occupational injury or disease in a foreign country, the insured shall seek medical treatment locally. The insured may apply to BLI for reimbursement of medical expenses through his/her insured unit, and the supporting documents, reimbursement period, reimbursement criteria, procedures and emergency injury and disease coverage to apply for reimbursement of medical expenses shall be handled mutatis mutandis the National Health Insurance Act and its relevant regulations.
3. If due to illness caused by occupational injuries and diseases the insured is identified as having medical needs by the physicians in the NHI hospital or clinic and such insured selects special materials and items specified in Paragraph 1 of Article 45 of the National Health Insurance Act, after paying the difference in advance, he may apply to the Bureau of Labor Insurance, Ministry of Labor for the reimbursement of the amount of difference.

【Documents Required】

1. When applying for outpatient or inpatient treatment, the insured shall submit the following documents to the NHI hospital or clinic:
   (1)The "Occupational Injury and Disease Outpatient Form" or the "Occupational Injury and Disease Hospitalization Application Form" filled in by the insured unit. (If the insured unit fails to fill in the documents according to the regulations, the insured may apply to BLI and local offices for reimbursement, which will be conducted after verification.)
   (2)National Health Insurance Card and national identity card or other documents sufficient to prove his/her identity. (If the NHI card contains the ID photo, the submission of other identity documents may be exempted)
2. If the insured visits a NHI hospital or clinic for any occupational injury or disease, and for reasons not attributable to  him/herself, he/she fails to submit the occupational injury and disease outpatient form or application for hospitalization within 10 days from the date of medical treatment or before discharge from the hospital, and seeks medical treatment using the coverage of NHI may, within 6 months from the date of outpatient treatment or the date of discharge (5 years for any insured with special reasons), fill in the following application form and apply to BLI  for reimbursement of medical expenses.
   (1) Labor Insurance Occupational Accident Insurance Up-front Medical Expense Reimbursement Application Form and benefit receipt.
   (2) Original medical expense receipt and detailed list of expenses. In case the original medical expense receipt and detailed list of expenses were lost or use in other purpose, photocopies of the said bills should be submitted and duly affixed with the official seal of the issuing medical institution stating that these are true and correct copies of the original. 〈Should also state the reason for not able to submit the originals.〉
   (3) Medical certificate or certification documents, Chinese translation should be submitted if these certificates are in foreign language.
   (4) For any accident on the way to and getting off work or on a business trip, please fill in the " Labor Occupational Accident Insurance Insured Person Report of Injury Resulting from an Accident on the Way to or from Work or during Business Trip", and submit a copy of the front and back of the driver's driver's license. If handled by the police and other relevant agencies, please submit a copy of the relevant records.
   (5) If the insured has any disease due to the occupational injury or disease resulting from the injury, if the physician determines that there is a medical need and chooses the special materials and items stipulated in Paragraph 1 of Article 45 of the National Health Insurance Act, after the out-of-pocket payment is paid in advance, a consent form for out-of-pocket payment that complies with the provisions of the National Health Insurance Medical Service Institution's Special Contract and Management Regulations shall be submitted.
   (6) If the insured suffers an occupational injury or disease abroad, he/she shall first be treated in a local hospital or clinic, and a copy of the entry-exit permit and a certificate of assignment or business trip issued by the insured unit shall be submitted.
   (7) For those who want to apply for reimbursement of medical expenses for their more than 5 day hospitalization in mainland China area, their medical proof documents (original copy of the medical expense receipt, details of expenses, medical diagnosis report or other proof documents) must be notarized by a Public Notary Office in mainland China area, and then they should apply for verification to Strait Exchange Foundation with the original copy of the Notary certificate. After the documents are verified, then they could be used to apply for the reimbursement.

【Note】

1. There are upper and lower parts on the outpatient treatment form. The insured person may use the outpatient treatment form at a maximum of 6 times for the same occupational injury or disease at the same national health insurance service institution. If the insured person must go to another national health insurance service institution for treatment of the same occupational injury or disease, the insured unit should issue another outpatient treatment form.  There are upper and lower parts on the hospitalization application form. One hospitalization application form shall be used only once.
2. If the insured suffers an occupational injury or disease during the effective period of the insurance and needs outpatient and hospitalization within 1 year after the insurance expires, he/she may still use the occupational injury and disease outpatient service form and application form for hospitalization.
3. If occupational unions, fishermen’s associations, National Chinese Seamen’s Union, Master Mariners’ Association or their insureds due to arrears in the payment of insurance premiums and late payment fees are temporarily refused by the insurer in accordance with Article 23 of the Labor Occupational Accident Insurance and Protection Act, before the payment is completed, the insured unit shall not fill in and issue the insured's occupational injury and disease medication form. However, if the insured has already paid the insurance premium to the insured unit, the distribution shall still be conducted.
4. If the insured unit fails to pay the insurance premium and late payment fee, and the insured him/herself is obliged to pay, or acts as the representative or person in-charge of other  insured unit having arrears and the insurer temporarily refuses to distribute the benefits in accordance with the provisions of Article 23 of the Labor Occupational Accident Insurance and Protection Act, from the day of temporary refusal of distribution, the insured shall not be issued the occupational injury and disease medication form.
5. If the insured unit fills out the medication form, which does not comply with the insurance benefits regulations, is false, or is handed to a user other than the insured, all medical expenses shall be paid by the insured unit, except for those who are borne by the National Health Insurance insurer in accordance with the relevant laws and regulations of NHI.

【Form Downloading】

Public／Service／Table Download／Labor Occupational Accident Insurance／Insurance Benefits／Labor Insurance Occupational Accident Insurance Up-front Medical Expense Reimbursement Application Form and benefit receipt

Public／Service／Table Download／Labor Occupational Accident Insurance／Insurance Benefits／Labor Occupational Accident Insurance Insured Person Report of Injury Resulting from an Accident on the Way to or from Work or during Business Trip