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Title: Regulations for Examination of Farmer Health Insurance Disputes CH
Category: Council of Agriculture, Executive Yuan(行政院農業委員會)
Chapter 1 General Provisions
Article 1
The present Regulations are stipulated according to paragraph 3, Article 4 of Farmer Health Insurance Act.
Article 2
The insuring establishments, insured persons, beneficiaries, persons paying mortuary and burying expenses, and the medical institutions established by the insurer itself or under contracts (hereinafter referred to as the Applicants) may apply pursuant to the present Regulations for examining the disputes arising from the insurer's decisions related to –
1. Qualifications of the insured persons and beneficiaries, and the insuring ;
2. Insurance premiums or fines for delay payments therefore;
3. Insurance benefits;
4. Degrees of disabilities;
5. Medical fees of the medical institutions established by the insurer itself or under contract; and
6. Other matters relating to the rights of insurance.
Article 3
An applicant who applies for examination in pursuance to the previous article shall fill out an application form for the examination of farmer health insurance disputes (hereinafter referred to as the Examination Application Form) in duplicate for submitting with enclosure of relevant certificates to Supervisory Commission of Farmer Health Insurance (hereinafter referred to as the Supervisory Commission) within sixty (60) days after receipt of the document from the insurer advising of its decision. Any application made beyond the said time limit shall not be accepted. However, if the overdue application is caused due to any reason not attributable to the applicant, an application for examination can be made with a written statement elaborating the reason for delay within thirty (30) days after the extermination of such reason.
The day on which the Supervisory Commission accepts the application for examination shall be deemed as the base day for such application.
In case the original decision referred to an application for examination, which was not accepted due to exceeding the time limit as mentioned in paragraph 1, is proven to be unlawful or improper, the insurer or the competent authority may annul or change such decision pursuant to the authority it possesses.
Article 4
An applicant may entrust a representative with his/her application for examination, to which Articles 24 to 26 of Administrative Procedure Act shall apply.
Any application from an incompetent, a person with limited disposing capacity or who is subject to the order of commencement of assistance shall be made by his/her legal representative or assistant in his/her behalf.
The insured establishment may make an application for its insured person or beneficiary thereof at his/her request but, however, may not violate the intention of the insured person or his/her beneficiary.
Article 5
After applying for examination, the applicant may withdraw his/her application before the decision report of examination is delivered. However, in case of withdrawing, no application referring to the same case of dispute may be made again.
Article 6
For the application that is inconsistent with law but can be supplemented and/or corrected, the Supervisory Commission shall notify the applicant to make supplements and/or corrections within fifteen (15) days. However, the Supervisory Commission shall not accept the applications that cannot be supplemented and/or corrected and that supplements and/or corrections are made exceeding the said time limit.
An extension of time to make the correction as mentioned in the preceding paragraph may be requested before expiration if the cause for such extension is justifiable.
If the original decision referred to the application for examination that is rejected as mentioned in paragraph 1 is proven to be unlawful or improper, the insurer or the competent authority may annul or change such decision pursuant to the authority it possesses.
Article 7
After receiving an examination application form, the Supervisory Commission shall send one copy of which to the insurer, except that it is rejected pursuant to Article 3 and 6. The insurer shall submit its comments together with necessary files to the Commission within twenty (20) days after the day following that on which the form is received. However, if the insurer thinks that the application is justifiable, it may renew its decision for the case and directly notify the applicant, with a copy sent to the Supervisory Commission.