Chapter 3 Insurance finance and calculation and payment of insurance premiums
Article 45
The annual insurance budget shouldered by the government prescribed in Paragraph 1 of Article 3 of the Act refers to the following premiums:
1. The premiums the government is required to shoulder as a group insurance applicant according to Items 1 and 2 of Subparagraph 1 of Article 27 and Article 34 of the Act.
2. The premiums charged to the insured and their dependents of all categories, which should be subsidized by the government pursuant to Article 27 of the Act and other related acts or regulations.
3. The premiums subsidized by the government instead of originally being subsidized by the employer during the period of unpaid parental leave of the employees.
Article 46
The following insured amount of the insured shall be reported to the Insurer and be taken into account the amount levels of the Insured Amount Grading Table in accordance with the following rules:
1.For the unsalaried civil servants:
(1)City councilors, county councils, councilors, and representatives of township councils shall subscribe to the insurance based on the same level of the insured payroll-related amount of their civil servant counterparts under article 3 of the Statue of Fees Paid to Local Representatives and Subsidiary Fees for Administrators of Sub-towns or Villages.
(2)Heads of villages (subtowns) and of a local community shall subscribe to the Insurance coverage according to the insured payroll-related amount under the 12th level of the Grading Table of insured payroll-related amount.
2.For employees:
(1)The total salary and remuneration shall be used to calculate the insured payroll-related amount in the case of individuals who are qualified as the insured under the Civil Servant and Teacher Insurance or the Military Personnel Insurance.
(2)The wages in compliance with the Labor Standard Act shall be used to calculate the insured payroll-related amount in the case of employees other than those specified in the preceding item. Those who have no fixed or steady salaries may report their insured payroll-related amount based on their average monthly salaries in the past three months, but in no case shall their reported insured amount be lower than the minimum insured amount set forth for the respective bracket which they belong to.
3.Responsible persons in charge of a business who hire over five insured, or those accountants, attorneys, architects, doctors, dentists, and Chinese medical doctors who are independent practitioners, except for those who subscribe according to their insured payroll-related amount claim with proof, shall subscribe to the highest level of the Insured Amount Grading Table. For those who subscribe according to their insured payroll-related amount claim with proof, [that amount] must be no less than either the highest level of the Insured Salary Grading Table of Labor Insurance or the highest insured payroll-related amount applied to their employees.
4.Where the responsible persons in charge of a business who hire fewer than five insured, independently practicing professionals and specialized technicians other than those mentioned in the preceding sub-paragraph, or the insured in Category 1 who are self-employed business owners, except for those who subscribe according to their insured payroll-related amount file declarations by offering proof, they shall subscribe to coverage according to the highest level of the Grading Table of insured payroll-related amount. In the case that the insured payroll-related amount is declared with proof, the amount thereof may not be lower than either the average insured payroll-related amount of the insured set forth in Item 2 of Subparagraph 1 of Paragraph 1 of Article 10 of the Act, or the highest insured payroll-related amount of the employees. However, where professionals or technicians who practice independently without hiring salaried helpers file declarations by offering proof, the lowest insured payroll-related amount should be limited to the sixth level of the Grading Table of insured payroll-related amount.
5.When the accumulated growth of the average monthly insured payroll-related amount of those who do not have specific employers or are self-employed, join occupational unions, and do not report with the minimum insured amount set forth for item 1 of Category 2, reaches 4.5%, the Insurer should publicly announce their adjustment to the minimum insured payroll-related amount in accordance with the following rules:
(1) If the accumulated growth reaches 4.5% between January and June, the level corresponding to the minimum monthly insured payroll-related amount should be adjusted and advanced to one level higher, which shall take effect from January of the following year.
(2) If the accumulated growth reaches 4.5% between July and December, the level corresponding to the minimum monthly insured payroll-related amount should be adjusted and advanced to one level higher, which shall take effect from July of the following year.
6.For independent seamen who join the Master Mariners’ Association as its members and are insured through this association, except for those who subscribe according to their insured payroll-related amount claim with proof, the highest level of the Grading Table of insured payroll-related amount shall apply. For those who subscribe according to their insured payroll-related amount claim with proof, the insured payroll-related amount must be no less than the highest level of the Insured Salary Grading Table of Labor Insurance.
The heads of a local community indicated under Item 2 of Subparagraph 1 of the preceding paragraph refer to those heads of a local community who are not employed and subscribe to the Insurance pursuant to the provisions for civil servants under Paragraph 3 of Article 9.
Article 48
The interest payment prescribed in Article 28 of the Act shall be calculated daily according to the one-year fixed interest rate of post savings on January 1 each year.
Article 49
For monthly premium payable under Article 30 of the Act, the Insurer shall mail or electronically send premium calculation sheets and payment notes to the group insurance applicants or the insured by the end of the following month.
In the case that the group insurance applicants or the insured do not receive premium calculation sheets and payment notes described in the preceding paragraph by the end of the following month, they shall notify the Insurer of resending or delivering such sheets and notes, and shall make payment within the required period indicated in the re-sent or delivered sheets and notes. Where they fail to notify the insurer, the above sheets and notes are deemed as having been delivered at the end of the following month.
In the case that the group insurance applicants or the insured object to the premium calculation sheets and the payment notes, the group insurance applicants for the insured in Categories 1 and 6 and the insured in Category 6 shall pay the amounts as stated first, and the group insurance applicants for the insured in Categories 2 and 3 shall collect and pay the actually received premiums first, and then may file objection to the Insurer with rationales. Where the Insurer finds a mistake after investigation, it shall be balanced with the premium of the following month.
Article 50
The premiums which shall be shouldered or subsidized by the various levels of governments prescribed in Paragraph 2 of Article 3 and Subparagraph 4 of Paragraph 1 of Article 30 of the Act shall be approved and calculated by the Insurer. The Insurer shall submit the calculated premiums to the governments before January 15 and July 15 each year respectively and request such governments to advance the premium payments by the end of January and the end of July.
In the case that the premiums which are subsidized by the central social welfare authority set forth in Subparagraph 3 of Paragraph 1 of Article 30 of the Act, the Insurer shall calculate the subsidized premium and submit the payment request to the authority by the 15th day of the previous month for payment which shall be made by the 5th day of the month.
The Insurer shall calculate annually the premiums born or subsidized by all government agencies. If the advance payment is insufficient, the Insurer should, by the end of December, request the agencies to pay the premiums in full before the end of January of the following year.
Article 51
The group insurance applicants may open the “National Health Insurance” designated accounts with financial institutions, and notify the insured to pay the premium by transfer or direct payment to the account.
The group insurance applicants of the insured in Categories 2 and 3, subject to the consent of the insured or of the general (or representative) assembly of the members, may collect premiums of three or six months at a time in advance with issuing receipts, and then pay the Insurer monthly. The pre-collected premiums that have not been paid to the Insurer shall be kept and saved in the National Health Insurance designated account in the name of the group insurance applicants. The interest accrued therefrom shall be used only for the operation of the Insurance.
The group insurance applicants which pre-collect premiums may subscribe to Employee Honesty and Credit Guarantee Insurance for the personnel in charge.
Article 52
The unit of payment for premium or the overdue charge shall be in NT Dollar. Dime and smaller unit shall be rounded up or down to the nearest NT Dollar.
In the case that the premium borne by the insured and the premium subsidized by the government both comes to 50 cents as its smallest unit, the government’s subsidy amount shall be rounded up to the nearest NT Dollar.
Article 53
The group insurance applicants, when deduct or collect insurance premium for the insured and their dependents according to Subparagraphs 1 or 2 of Paragraph 1 of Article 30, shall make a note at the salary statement (envelope) or issue receipt.
Article 54
The group insurance applicants of the insured in Category 1, which do not deduct premiums from the insured’s income or collect premiums within the period stipulated in Article 30 of the Act for a cause, shall advance such payments for them.
In the case that the premium borne by the insured in Category 2 and Category 3 is not paid within the period stipulated in Article 30 of the Act, the group insurance applicants shall notify the insured of the overdue premium, and shall submit to the Insurer an overdue list when paying the premium.
The group insurance applicants provided in the preceding paragraph, which do not file grounds for objection under Paragraph 3 of Article 49, shall submit an overdue list indicating the difference between the premiums payable and the already-paid amounts within 15 days from the end of the grace period.
Article 55
The total amount of salary prescribed in Article 34 of the Act refers to the total amount of income from salaries and wages defined under Category 3 of Paragraph 1 of Article 14 of the Income Tax Act.
Article 56
Group insurance applicants shall calculate supplementary insurance premiums and complete and submit payment forms to the Insurer when making their monthly supplementary insurance premium payments to the Insurer according to Article 34 of the Act by the end of the following month. In the case of over-payment or shortfall, the Insurer may offset the overpayment or shortfall against premiums which are payable or already paid according to the law.
In the case that a group insurance applicant fails to pay the supplementary insurance premium in full as set forth in Article 34 of the Act, the Insurer may determine the supplementary insurance premium payable based on the income of salaries and wages which it discovers, and issue a payment note to the group insurance applicant to make the premium payment within the stipulated time.
Article 57
In the case that group insurance applicants, the beneficiary or premium withholders are required to pay the overdue charge under Paragraph 1 of Article 35 of the Act, the Insurer shall calculate the overdue charge and notify them to pay at the designated financial institutions.
Where the group insurance applicants or the premium withholders complete the payment form and pay the supplementary insurance premium, the financial institutions which are entrusted to receive the premium on behalf of the Insurer may calculate the amount of the overdue charge, and collect such charge together with the insurance premium.
Article 58
The premium payable by the beneficiary, who subscribed to Insurance more than once, shall be calculated and paid in accordance with Articles 17 and 18, and Article 11 of the Act. Where the premium is paid for twice, the group insurance applicants or the insured may apply for reimbursement within five years after the date on which the premium was paid for twice, or otherwise the application shall be rejected upon expiration.
After being verified by the Insurer to be true, the premium subject to reimbursement pursuant to the preceding paragraph shall be balanced when calculating the premium of the following month.