Upon the occurrence of a contingency covered by the insurance after the beginning and before the end of the effective period of the insurance, an insured person or his beneficiary may claim insurance benefit payments pursuant to the provisions of this Act.
Insurance benefits payable in cash shall be computed on the basis of the insured's average monthly insurance salary and benefit standard. If the insured is employed by more than two insured units at the same time, the monthly insurance salary could be combined for computing his/her ordinary insurance benefit, however, the combined monthly insurance salary shall not exceed the highest level in the "Table of Grades of Insurance Salary for Labor Insurance". Furthermore, for those who continuously join the insurance in less than 30 days, the insurance salary shall not be combined.
The calculating method for the average insurance salary in the former paragraph is as following:
1.The average monthly insurance salary for Pension benefit and a lump sum old-age benefit: It is calculated by averaging the highest sixty monthly insurance salary during the period of joining insurance coverage; for those who joining the insurance for less than five years, it would be calculated using the average monthly insurance salary for the actual insurance period. But for those who choose to claim a lump sum old-age benefit according to paragraph 2 of article 58, it is calculated by averaging the actual monthly insurance salary of the previous three years prior to the month the insured terminates the insurance; for those who has joined the insurance for less than 3 years, it is calculated using the average monthly insurance salary for the actual insurance period.
2.The average monthly insurance salary for other benefit payable in cash: It is computed on the basis of average monthly insurance salary for the last six months prior to the month in which the insured contingency occurs; In case an insured person is paid on a daily-salary basis, his/her insurance benefits shall be determined by dividing his/her average monthly insurance salary by thirty.
For the calculation of insurance benefit standard I paragraph 2, if the insured who has joined the insurance for less than one year, it is calculated proportionally using the actual number of months for joining the insurance; for less than 30 days, it is calculated as one month.
In case an insured person is a full-time fisherman, aviation or navigation worker, or a mine-worker, and is declared missing as a result of an accident which occurred in the course of fishing, aviation, navigation, or mining as the case may be, in addition to the insurance benefit claims under this Act, a special missing allowance equivalent to seventy percent (70%) of his average monthly insurance salary shall be payable at the end of every three-month period from the day the insured person is declared missing in the census registry until the day prior to (1) his return alive, (2) the expiration of one year after he was declared missing, or (3) he is declared dead by law, whichever happens first.
In case an insured person has been missing for one year or has been declared dead by law, a claim for death benefit may be made in pursuance to the provisions of article 64.

For within one year after an insurance policy has been terminated, an insured person shall remain entitled to injury or sickness benefits, disability benefits, death benefit or occupational accident medical care benefits for an injury or sickness and the disease it causes occurred during the period of his insurance policy.
For within one year after an insurance policy has been terminated, an insured person who is pregnant during the period of her insurance policy, and conforms to the provisions of coverage days stipulated in the 1st or 2nd subparagraph of the 1 st paragraph of Article 31 of the Act, shall be entitled to maternity benefits for childbirth or premature due to the pregnancy.

Where it is confirmed after an insured person terminates the insurance that he/she got a kind of occupational disease during the valid period of the insurance, he/she may claim the occupational permanent disability benefits.
The regulations of the objects of the above-mentioned payment, kinds of occupational diseases, determination procedure, calculation of the amount payable and other related affairs shall be prescribed by the competent central authority.

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No insurance benefits may be claimed repeatedly for same contingency.

An insured person, his beneficiary, or any other interested person shall be entitled to no insurance benefits other than funeral grant for a covered contingency incurred intentionally for the purpose of receiving insurance benefits.

In case an insured unit intentionally files an application for person ineligible under the provisions of this Act to participate in the insurance program and to receive insurance benefits for or on behalf of such a person, the insurer shall take legal action to recover the insurance benefits paid to the ineligible insured person, but also to nullify his qualifications.

The insurer shall not be responsible for paying insurance benefits either to an insured person who refuses without adequate reason to submit to examination by a specially contracted hospital or clinic, or who refuses to submit, upon request, any required documents. The same applies to the beneficiary of an insured person who refuses to submit the required documents.

No insurance benefits shall be payable for a contingency incurred by war or civil commotion, or by an intentional criminal act committed by the insured person, his father, mother, son, daughter, or spouse.

An adopted son or daughter shall not be entitled to receive insurance benefits in case the adoption registration has been less than six months at the time when the contingency occurs.

Where deemed necessary for the insurer to audit insurance benefit or for the Labor Insurance Supervisory Commission to settle disputed cases, the insurer or the Commission may request the insured person, beneficiary, insured unit, hospital, clinic, or the physicians or midwifes who hold the certified license, to submit a report, or check the patient data, salary account books, examination and chemical test records or diagnosis radiographs (Ｘ-ray photos) as well as other related documents, and the insured person, beneficiary, insured unit, hospital, clinic, or the physicians or midwifes may not deny such request or check.

The title of an insured person, the beneficiary or person who pays for funeral expenses to all kinds of insurance benefits may not be assigned, offset, attached or mortgaged.
The persons, when applying for the insurance benefits per stipulations provided by the act, may present the proof of documentation the insured has issued to open a designated account at a financial institution exclusively for depositing the insurance benefits.
The deposit held in the above exclusive account may not be used as the instrument for offsetting, seizure, or as guarantee or court seizure.
In the event the insured person had received insurance benefits that were revoked or abolished by the insurer and did not repay the amount, the insurer may have the amount deducted from insurance benefits claimed by the insured person or his/her beneficiary.
An insured person who has not repaid interest on a loan referred to Subparagraph (4), Paragraph 1 of article 67 shall have the amount deducted from insurance benefits claimed by the insured person or his/her beneficiary.
The following regulations do not apply to unpaid interest on a loan in the preceding paragraph, and traces back to January 22nd, 2003:
1.Regulations on debt exemption stipulated in the Consumer Debt Clearance Act.
2.Regulations on debt exemption stipulated in the Bankruptcy Act.
3.Regulations on extinguishment of time limitation for claims in accordance with relevant laws.
The measures governing the type, method and amount of relevant deductibles on the insurance payout related to par IV and par V shall be defined by central competent authorities.
The insurer shall send written notices each year to an insured person or his/her beneficiary who has not repaid interest on a loan referred to Subparagraph (4), Paragraph 1 of article 67, and request that the person complete repayment in accordance with regulations.

Insurance benefits to be disbursed in cash as prescribed in the Act shall be paid within 15 days after the insurer makes the final confirmation; pension benefits shall be paid before the end of the following month. If overdue payment is attributable to the insurer, an interest shall be added to the benefits for the period delayed.

A claim for insurance benefits shall be extinguished if not filed within five years from the day on which the benefits become payable.