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Chapter Law Content

Title: National Health Insurance Act CH
Category: Ministry of Health and Welfare(衛生福利部)
Chapter 3 Insurance Finance
Article 17
The Central Government, the group insurance applicant, and the insured shall jointly shoulder the insurance budget after promulgated revenues have been deducted.
Article 18
The premium payable by the insured in Categories 1 to 3 and their dependents shall be calculated according to the insured payroll-related amount and the premium rate of the insured. The premium rate shall be set a maximum of 6 percent.
The premium payable by the dependents articulated in the previous paragraph shall be paid by the insured. When the number of dependents exceeds three, the premium shall be calculated on the basis of only three dependents.
Article 19
The insured payroll-related amount for the insured in Categories 1 to 3 shall be subject to a grading table drafted by the Competent Authority and be reported to the Executive Yuan for approval.
The minimum in the said Grading Table of insured payroll-related amount shall be equal to the base salary promulgated by the central competent authority in charge of labor affairs. Upon adjustment of the base salary, such minimum shall be adjusted accordingly.
The insured payroll-related amount of the top level of the Grading Table of insured pay-roll related amount has to be kept fivefold higher than the amount in the bottom level, and the said Grading Table has to be revised in one month after the basic salary is adjusted. In case that the number of the insured applicable to the highest level of insured payroll-related amount exceeds three percent of the total number of the insured for twelve consecutive months, the Competent authority shall readjust the Grading table of the insured payroll-related amount to advance a higher level starting from the following month.
Article 20
The insured payroll-related amount for the insured in Categories 1 and 2 is determined on the following basis:
1.Employees: the payroll;
2.Employers and self-employed: the business income;
3.Self-employed individuals and independently practicing professionals and technicians: the income from professional practice.
If the insured prescribed in Categories 1 and 2, has no stable income, the insured shall select the proper insured payroll-related amount from the Grading Table of insured payroll-related amount and such insured payroll-related amount shall be examined by the Insurer, who may make adjustment at its own discretion if the insured payroll-related amount is found inappropriate.
Article 21
In case that the income of the insured in Categories 1 and 2 as prescribed in the previous article is adjusted between February and July of the current year, the group insurance applicants shall notify the Insurer the adjusted insured payroll-related amount by the end of August of the same year, or notify the Insurer by the end of February of the following year if the adjustment is made between August of the current year and January of the following year, which shall become effective on the first day of the following month after notification.
Unless the insured payroll-related amount as prescribed in the preceding paragraph has reached the highest level of this Insurance, such amount shall not be lower than the monthly labor pension reserve deposit or the insured salary of other social insurance schemes to which the insured subscribes. In case that the insured payroll-related amount of this Insurance is lower, the group insurance applicant shall at the same time notify the Insurer to adjust accordingly, or the Insurer may also make adjustment at its own discretion.
Article 22
The insured payroll-related amount applicable to the insured in Category 3 shall be the average amount for those specified under items 2, 3 of subparagraph 1, and subparagraph 2 of paragraph 1, Article 10; provided, that the Insurer may adjust the level of insured payroll-related amount according to the financial viability of the insured and their dependents.
Article 23
The premium of the beneficiaries in Categories 4 to 6 shall be calculated according to the averaged actuarial premium based on the total number of the beneficiaries in accordance with Article 18.
The premium of the dependents stated in the previous paragraph shall be paid by the insured. When the number of the dependents exceeds 3, the payment shall be calculated on the basis of only three dependents.
Article 24
The Insurer should apply for a review one month after the premium rate of beneficiaries and each dependent in Article 18 is determined in a meeting of the NHIC coordinating the total amount of medical benefit payments. However, when premiums using the maximum rate are unable to balance with the medical benefit payments approved for that year, there should be new negotiations regarding the total amount of medical benefit payments.
Before the review from the previous paragraph, the NHIC should invite actuaries, insurance and finance experts, economists, and reputable public figures to provide opinions.
The review of Paragraph 1 should draft the total amount of medical benefit payments in accordance with the negotiations one month before the start of the year, completing the review of balance of payment rates. This shall be reported to the Competent Authority, which will in turn report to the Executive Yuan for approval before announcing it publicly. If review cannot be completed within the specified time, the Competent Authority shall report this matter to the Executive Yuan for approval before public announcement.
Article 25
The Insurer shall make the actuarial process at least once every five years for the premium finance, with each such actuarial process covering a period of 25 years.
Article 26
Upon the occurrence of any of the following events in this Insurance, the Insurer shall readjust the premium rate and present it to the NHIC which shall report it to the Competent Authority and then to the Executive Yuan for approval, after which the Competent Authority shall make the public announcement:
1.The reserve fund of this Insurance drops below total insurance benefit amount for a month.
2.Any addition to or reduction in benefit items, contents or payment schedules that affects the financial balance of this Insurance.