Chapter 4 Insurance Payment
Section 1 General Provisions
Article 18
The insured person or the beneficiary is not allowed to request payments unless the contingencies happen after the insurance takes effect and before the ending or termination of the insurance. However, requests for old age pension payments or guaranteed basic pension payments for mentally/physically disability are not included.
Article 18-1
The insurance benefits under this Act, except applications for old age pension payments will be issued monthly starting from the month of meeting the qualifications to the month when the insured person dies, other pension payments will be issued monthly starting from the month of the application approved to the month of pension termination or death of insured person.
The beneficiary of survivor's pension don't submit application on the month they qualify for the benefits, the insurer should compensate the benefits retroactively to those who are entitled to trace back to five years before they submitted the application. However, for the part which has been claimed by other beneficiary is not included.
Article 19
Payments of the Insurance will be calculated based on the monthly insured amount of the specific month when contingencies happen.
Calculation basis for pension payment will be adjusted when there are adjustments for the monthly insured amount.
Article 20
Same payments from the same contingencies cannot be requested repeatedly.
Article 21
The insured person is entitled to request for one payment only if he or she qualifies with the pension payment for the mentally/physically disability, basic guaranteed pension payment for mentally/physically disability, old age pension payment, old age basic guaranteed pension payment and surviving family pension payment at the same time.
Article 22
The insurer is entitled to request the insured person, beneficiary or medical institutions to provide documents related to the Insurance when examining requests for insurance payments or when the central competent authorities consider necessary when examining controversial cases. The insured person, beneficiary or the medical institutions are not entitled to refuse such requests.
Article 23
The insured person or the beneficiary should present related information and proving documents when requesting for insurance payments. The insurer is entitled to request for modification or supplements if no such presentation is made.
Article 24
The insurer is entitled to verify the pension payment requests made by the insured person or his or her surviving family and to suspend payment during the verification period. Once requests are verified and approved, payment during the suspension period should be compensated and regular payments should resume.
Recipients not qualified for receiving payments or when they die, himself or herself or the heir at law should present related documents and notify the insurer within 30 days of the happening of the legal facts. Payments will be terminated from the next month of the happening of the legal facts.
When pension payment receiver dies and the payable pension payment is not yet wired into the receiver’s account, the heir at law is entitled to present the registration of death and household certificate transcript for the applicant and the household certificate transcript for the heir at law to apply for the receiving of payment. When there are more than 2 people for the heir at law, they’ll have to present power of joint-attorney and a declaration entrusting one of them to apply for the receiving of the payment.
When over payment resulted from receiver’s failure or the failure of heir at law to notify the insurer according to the Paragraph 1 and 2, the insurer should send written notices to the receiver of the over payment requesting repayment within 30 days. The insurer is also entitled to deduct the over payment from the account used in receiving the pension payments.
Article 25
The insured person is entitled to apply for decrease of insurance payment. Such application is limited to once a year.
The period of decreased insurance payment from the previous paragraph should be at least one year and any subsequent request for compensation is not allowed once the application for decreased payment is filed. Regulations of decreased insurance payment will be drawn by the insurer. The insurer will then forward these regulations to the central competent authorities for approval and announcement.
Article 26
The insurer will not pay for the insurance payment except for the funeral expense if the insured person, the beneficiary or other stakeholders deliberately caused the contingencies to happen.
Insurance payment will not be paid, except for the beneficiary not involved in the misconduct, if the happening of contingencies was caused by deliberate crime behaviors of the insured person, his or her parent, sons and daughters, and spouse.
Insurance payment will not be paid if the contingencies were caused by war or social unrest.
Article 27
The insurer should cancel the qualification of the insured person if he or she is not qualified to participate in the Insurance and refund all premiums paid. The insurer should send written notices to the insured person requesting refund of the insurance payment within deadline if he or she has already received it.
For people not qualified to apply for insurance payment but over received or received by mistake of such payment, the insurer should send written notices requesting the return of such payment within deadline.
Article 28
The right to apply for insurance payment will extinguish after 5 years of non-exercise of such right starting from the first day when the right is ready to be asserted.
Section 2 old age Pension Payment and maternity payment
Article 29
The insured person or the one who participated in the Insurance before will be entitled to apply for old age pension payment when he or she aged 65 or above.
Article 30
Old age pension payment will be calculated based on the most advantageous method of the below:
1. Monthly insured amount times insurance period times 0.65% and then added NT3,000 dollars to the result.
2. The amount of monthly insured amount times insurance period times 1.3%.
Calculation in the subparagraph 1 of the previous paragraph is forbidden if one of the following conditions is met:
1. Period of unpaid premium is not included in the insurance period.
2. Recipient of related social welfare allowances
3. Recipient of old age benefit of related social insurances. But the insured person under Article 7, subparagraph 2 and subparagraph 3 receives the following payment is not included.
(1). The insured person receives only old age benefit of the labor insurance.
(2). The insured person receives discharge payments of military personnel insurance or old age insurance benefits of Civil Servant and Teacher Insurance, the amount of NT$3,000 monthly base will be accumulated from the month in which the insured person reaches the age of 65 years until the month in which the amount equals to his (her) total original old age insurance benefits.
In case an insured person has not paid insurance premiums or interests of the insurance within one year before the happening of contingency, the insurer is entitled to send written notices requesting him (her) to pay the bill within deadline. If the insured person fails to pay in full before the deadline, the issuer is entitled to calculate his (her) old age pension payments for the first three months according to 1st paragraph subparagraph 2.
The central competent authority will assume the differences between the old age pension payment calculated under the 1st paragraph, subparagraph 1 and the one calculated from subparagraph 2.
The old age pension payment will be paid monthly starting from the month of meeting the qualifications to the month when the insured person dies.
Applicants of the mentally/physically disability pension payment under Article 33 are entitled to switch to application of old age pension payment at the age of 65 years old. Their insurance period before the application of the mentally/physically disability pension payment are entitled to be calculated with the insurance period of this Article.
Article 31
Citizens will be deemed as the insured persons of the Insurance if they aged 65 or above at the time of the implementation of this act with household registered in ROC and live in ROC for more than 183 days per year for latest 3 years and are not qualified for any one of the following subparagraphs. The insured persons are entitled to apply for old age basic guarantee pension payment of NT3,000 dollars monthly until they die. But they are not applicable to the regulations regarding insurance payment as stipulated from Sec. 3 to Sec. 5 of this Chapter. Nor are they applicable to regulations of the insured persons and insurance effect in Chapter 2 and premium in Chapter 3.
1. Recipient of government’s full amount subsidy in accommodation.
2. Recipient of military personnel retirement pay (lifetime living subsidy), or government affair personnel, civil servant and teachers, and state-run enterprises employee receiving monthly retirement pay or lump sum retirement pay. But those who have one of the following conditions are not included.
(1) Recipient of military personnel retirement lump-sum pay, or government affair personnel, civil servant and teachers, and state-run enterprises employee receiving lump sum retirement pay without applying Preferential treatment deposits, nor receiving old age insurance benefits of Civil Servant and Teacher Insurance or discharge payments of Military Personnel Insurance; or if the person has received old age insurance benefits of Civil Servant and Teacher Insurance or discharge payments of Military Personnel Insurance, the amount of NT$3,000 monthly base will be accumulated from the month in which the insured person reachs the age of 65 years until the month in which the amount equals to the total original pension payment.
(2) aboriginals receiving lump sum retirement pay.
3. Recipient of social welfare allowances.
4. The total amount of every category income of personal consolidated income tax for the declaring year approved by the Revenue Service Office exceeds NT500,000 dollars.
5. The total value of personal land and houses exceeds NT$5,000,000 dollars.
6. Current serving sentences in the prison, or, being detained or kept in custody because of criminal cases.
The land value in the item 5 of previous paragraph will be calculated based on the announced land current value; as for the value of house, it will be calculated based on the appraised prices. However, deductions will be applied under the following conditions
1. The zoning code of part or all of the lands have been set legally as the land reservation for public facility. Additionally, these lands are not yet expropriated or compensated because of government financial problems or other causes which are not the landowner’s responsibility.
2. The house is the only one personally owned and actually lived. But the total deductible amount for the announced land current value together with the appraised house price is limited to NT4,000,000 dollars.
3. Lands Reserved for aboriginals without generating economic benefits
The applicants whose accumulated amount equals to the total original payment according to Paragraph 1, Subparagraph 2, Item 1 of this Act before the implementation of the amended Act on June 13rd 2011 cannot claim for a back payment of old age basic guarantee pension.
From January 1, 2012 onwards, those who have received old age basic guarantee pension still qualified for paragraph 1, subparagraph 1 to subparagraph 4 and subparagraph 6, after local governments adjust the announced land current value, and their land and houses have not increased, will nto be restricted by the stipulations of paragraph 1,subparagraph 5. The same rule shall be applied for the mentally/physically disability basic guaranteed pension payments and aboriginal benefits specified in Article 53.
Article 32
The insured persons, once qualified for the Insurance and the old age benefit of the labor insurance, are entitled to apply for insurance payments to any one of the insurers at the same time. The insurer accepting the application shall calculate the payments based on respective insurance periods. Payments calculated respectively will then be combined and paid to the applicant according to the rules. As for payments to be shared by other insurer, they will be repaid by the respective insurer.
Under the circumstances that insurance period from the previous paragraph do not meet the limits of applying for old age pension payments but qualify for such application if calculated in combination with other insurance period, the applicants are still entitled to apply for old age pension payments. The insured persons under Article 7, Subparagraph 1 and Subparagraph 3, are forbidden to choose payment methods stipulated in Article 30, Paragraph 1, Subparagraph 1 when applying for the old age pension payment of the Insurance if they have already received senior pension payments from other insurances.
Rules of the granting of combined old age pension payments, the repayments of respective shares among insurers and other related affairs as stipulated in Paragraph 1 will be drawn jointly by the central competent authority and the central competent authority of labor insurance.
Article 32-1
Maternity payments of the insured person are payable according to the following provisions:
1. In case of childbirth or prematurity of an insured person, she shall receive, a lump sum maternity payments equivalent to two monthly insurance amount.
2. In case of a plural birth resulting from childbirth or prematurity, maternity benefit shall be increased proportionately.
The insured person should choose one to apply when they’re qualified for other maternity benefits or subsidy conditions of related social insurance.
The insured person should choose one payment to apply when the maternity contingency is qualified for some maternity benefits or subsidy conditions of the Insurance and related social insurances. The insured person applies for maternity payment , and has been paying installments or delayed payments of premium and interests according to the proviso regulations of article16 of this Act, the amount of the premium and interests which have been paid should not be less than half of the total amount of matermity payment.
Section 3 Pension Payment for Mentally / Physically Disability
Article 33
Insured persons qualify for one of the followings are entitled to apply for mentally/physically disability pension payment according to the rules
1. The insured persons were harmed or had suffered from disease before but with current symptoms remain stable after the termination of treatment. No improvement is expected even continue the treatment. Additionally, the insured persons have to be diagnosed as severe mentally/physically disability without capability to work by qualified hospitals evaluated by central health care competent authority.
2. The insured persons still not yet recovered from the disease or harm suffered during the Insurance period after more than one years of treatment. The after effect of suffering from severe mentally/physically disability was diagnosed as never to be recovered and no capability to work by qualified hospitals.
The insured persons, after being diagnosed as severe mentally/physically disability with no capability to work, can only pick one to apply for payments if they also qualify for related social insurance regulations.
The regulations for relative stipulate such as valuation standards of the types, items, status, and treatment period for the insured persons diagnosed as severe mentally/physically disability with no capability to work as stipulated in Paragraph 1 and documents needed to apply for mentally/physically disability pension payments will be drawn jointly by the central competent authority and the central competent authority in charge of health care .
Article 34
mentally/physically disability pension payments will be calculated based on the insurance period of the insured persons. Monthly payment will be 1.3% of the monthly insured amount for every insurance year.
Monthly basic guaranteed amount will be issued until the insured person die if the amount calculated from the previous paragraph is lower than the basic guaranteed amount of NT4,000 dollars and none of the followings applied:
1. The period of unpaid premium is not included in the insurance period.
2. Recipient of related social welfare allowances.
In case an insured person has not paid insurance premiums or interests of the insurance within one year before the happening of contingency, the insurer is entitled to send written notices requesting him (her) to pay the bill within deadline. If the insured person fails to pay in full before the deadline, the insurer is entitled to calculate his (her) mentally/physically disability pension for the first three months according to paragraph 1, the preceding basic guaranteed pension payment NT$4,000 is not applicable.
Under the circumstances of applying for basic guaranteed amount according the previous paragraph, the difference between the amount calculated from Paragraph 1 and basic guaranteed amount will be assumed by the central competent authority.
The labor insurance period of the insured persons can be combined with the insurance years from Paragraph 1. The amount needed will be repaid by the insurer of labor insurance.
Article 35
Before participating the Insurance, the insured persons were diagnosed as severe mentally/physically disability with no capability to work as stipulated in Article 33 and has lived in ROC more than 183 days per year for three consecutive years before applying for mentally/physically disability basic guaranteed pension payments are entitled to, during the validation of the Insurance, apply for mentally/physically disability basic guaranteed pension payments of NT4,000 dollars per month per person if none of the followings applied:
1. Recipient of pension or lump sum payments of related social insurance for severe mentally/physically disability.
2. Qualified for one of the items stipulated in Article 31, Paragraph 1, Subparagraph 1, 3,4,5,6.
The insured persons are not entitled to apply for mentally/physically disability pension payments if they have already applied for mentally/physically disability basic guaranteed pension payments according to the rule of previous paragraph. However, they’re entitled to switch to apply for old age pension payments if they aged 65 or aobve.
Article 36
The fund needed for both the mentally/physically disability basic guaranteed pension payments from the previous Article, Paragraph 1 and the old age basic guaranteed pension payments from Article 31, Paragraph 1 will be budgeted and paid on a yearly basis by central competent authority.
Article 37
The insurers are entitled to examine the extent of mentally/physically disability on recipients of the mentally/physically disability pension payments or the mentally/physically challenged basic guaranteed pension payments every 5 years except for those exempted from such examination after being evaluated. The insurers are also entitled to ask for presentation of proof of mentally/physically disability diagnosis when necessary. The expense needed for such diagnosis will be paid by the insurance fund of the Insurance.
Pension payments should be suspended if the insured persons fail to present related documents to the insurers for examination as stipulated in the previous paragraph.
Under the circumstances the extent of mentally/physically disability eases to disqualify the insured persons for stipulation of Article 33 after the they received mentally/physically disability pension payments or the mentally/physically disability basic guaranteed pension payments, the pension payments will be terminated from the next month of the mentally/physically disability date written on the diagnosis documents presented by qualified hospitals.
Article 38
During the examination of mentally/physically disability pension payments or the mentally/physically disability basic guaranteed pension payments, the insured persons or the central competent authority are entitled to assign other hospitals or doctors to re-examine insurance related issues when necessary. The re-examination expense will be paid by the insurance fund of the Insurance.
Section 4 Funeral Payment
Article 39
Funeral payment will be the lump sum of 5 times the monthly insured amount when the insured persons die.
The funeral payment from the previous paragraph will be received by the one who actually paid for such expense. Recipient of this payment is limited to one person only. If there are other applications for such payment before the insurer’s approval of previous application, the insurer should advise each applicant to make an agreement of allowing only one of them to apply for such expense. The insurer should distribute the expense equally among the applicants if the applicants fail to make such an agreement.
Section 5 Surviving Family Pension Payment
Article 40
When the insured persons die, or the insured persons are entitled to apply for old age pension payment under Article 29 but die before claiming benefit, or the recipients of mentally/physically disability pension payments or old age pension payments die, their surviving family, such as spouses, sons & daughters, parents, grandparents, grandchildren, brothers or sisters are entitled to apply for surviving family pension payments.
Conditions for the surviving family pension payments of previous Article are:
1. Spouse should be aged 55 or above and their marriage relationship lasts more than one year. However, the following conditions are not included
(1). no capability to work.
(2). raising children as stipulated on Subparagraph 3.
2. Spouse should be aged 45 or above with marriage relationship lasts more than one year. Monthly income of the spouse does not exceed minimum wage when receiving the surviving family pension payments.
3. For children, they should qualify for one the following conditions. As for adopted children, the adoption relationship should last for more than 6 months:
(1) not an adult person;
(2) no capability to work;
(3) under the age of 25 and still goes to school with monthly work income not exceeding minimum wage when receiving surviving family pension payments.
4. Both the parents and the grandparents should aged 55 or above with monthly work income not exceeding minimum wage when receiving surviving family pension payments.
5. Grandchildren should be raised by the insured persons and qualify for one the followings:
(1) not an adult;
(2) no capability to work;
(3) under the age of 25 and still goes to school with monthly work income not exceeding minimum wage when receiving surviving family pension payments.
6. Brothers, sisters should be raised by the insured persons and qualify for one of the followings
(1) not an adult;
(2) no capability to work;
(3) aged 55 or above with monthly work income not exceeding minimum wage when receiving surviving family pension payments.
The applied boundary, examine standard and the regulation of other matters for “no capability to work” as stipulated in the previous paragraph will be decided by the central competent authority.
Article 41
Order of recipients of surviving family pension payment according the previous Article is
1. spouse and children;
2. parents;
3. grandparents;
4. grandchildren;
5. brothers and sisters.
Surviving families listed on the rear order as stipulated in the previous Paragraph are not entitled to apply for surviving family pension payment if surviving families listed on the front still exist. The same applies when the surviving family die after applying or become disqualified for applying.
Article 42
Standards for granting surviving family pension payments
1. In case the insured persons die, monthly payments are 1.3% of the monthly insured amount for every insurance year of the insured persons.
2. In case of death during the period of receiving the mentally/physically disability pension payments or old age pension, monthly payments are 50% payment of the mentally/physically disability pension payments or old age pension payments of the insured persons.
3. In case the insured persons entitled to apply for old age pension payment under Article 29 but die before claiming the benefit, a monthly payment is half of payments of 1.3% of the monthly insured for every insurance year of the insured person.
Monthly payment of NT3,000 dollars will be granted if the pension amount calculated from the previous Paragraph is less than NT3,000 dollars.
When there are more than two survivors listed on the same order, 25% more of the standard surviving family pension payment will be granted for every extra survivor. The maximum extra payment will be 50% of the standard payment.
Under the circumstances of receiving NT3,000 dollars surviving family pension payment based on Paragraph 2, the difference between the original amount calculated based on Paragraph 1 and the actual amount received will be assumed by the central competent authority.
Article 43
Surviving families should pick one to apply when they’re qualified for more than 2 types of pension payments.
Article 39, Paragraph 2 will be resorted if there are more than 2 surviving families listed on the same order in receiving surviving family pension payment.
Article 44
Surviving family pension payments should be suspended if surviving families qualify for one of the followings during the receiving period
1. Spouse getting married again.
2. Spouse less than 55 years old raising children not qualified for the application conditions stipulated in Article 40.
3. Spouse, children, parents, grandparents, grandchildren, brothers and sisters don’t qualify for the application conditions stipulated in Article 40.
4. Serving sentences in prison, detained or in custody because of criminal cases.
5. Disappearance.