Medical care benefits consist of outpatient medical care benefits and inpatient hospitalization benefits.

With a view to protect the health of the insured persons, the insurer shall set up regulations to prevent the occurrence of occupational diseases.
The regulations referred to in the preceding paragraph shall be presented to the competent central authority for approval.

An insured person who has been injured or sick may apply for medical care by a hospital or clinic operated or specially contracted by the insurer.

The sphere of outpatient medical care benefits consists of the following:
1.Diagnostic services (including laboratory examination and medical consultation);
2.Pharmaceutical services and the supply of therapeutic materials; and
3.Treatment, operation or medical care.
Ten percent of the preceding expenses shall be paid by the insured person, provided that they do not exceed the maximum amount allowed by the competent central authority.

In case the diagnosis given by the hospital or clinic operated or specially contracted by the insurer decides that the insured person who conforms to one of the following conditions shall be hospitalized, his insured unit shall make such an application on his behalf, except when an insured person is already hospitalized on account of emergent injury or sickness:
1.Where an occupational injury has been sustained;
2.Where an occupational disease has been afflicted;
3.Where an ordinary injury has been inflicted; or
4.Where the insured person has accumulated insurance coverage for more than 45 days before he applies for hospitalization treatment on account of an ordinary sickness.

Where the insured person gets an occupational injury or disease, the insured unit shall fill in a clinic note of occupational disease or a letter of application for hospitalization (hereinafter referred to as "the Clinic Note or Application Letter for Occupational Disease") to apply for diagnosis and treatment;in case the insured unit doesn't produce the note or letter, the insured person may request the insurer to issue, and the insurer shall grant the note or letter after the case is confirmed.
Where the insured person has not the above-mentioned Clinic Note or Application Letter for Occupational Disease and is diagnosed to have got an occupational disease, the doctor may produce a clinic note of occupational disease. The acquisition and loss of the qualification to produce such note as well as the application and use of the clinic note shall be prescribed out by the insurer, and reported to the competent central authority for approval and issue.

Hospitalization care benefits shall include the following:
1.Diagnostic services (including laboratory examination and medical consultation);
2.Pharmaceutical services and the supply of therapeutic materials;
3.Treatment, operation or medical care;
4.Fifty percent of food expenses within 30 days; and
5.Hospital bed belonging to the same category as the Government Employees' Insurance Scheme.
The insured person shall be responsible to pay for five percent of the expenses referred to in subparagraphs (1) to (3) inclusive and subparagraph (5) of the preceding paragraph, provided that they do not exceed the maximum amount allowed by the competent central authority.
In case an insured person personally wishes to stay in a hospital bedroom of a higher category, he shall be responsible to pay for such additional expenses, besides the expenses referred to in the preceding paragraph.
The enforcement day and regulations of paragraph two of this article and paragraph two of article 41 shall be decided after they have been approved by the Legislative Yuan.

Medical care benefits shall not include legally declared epidemics, leprosy, narcotic addictions, birth deliveries, miscarriages, plastic surgery, artificial teeth, artificial eyes, eyeglasses or their accessories, patient transportation, special nurses, blood transfusions, registration fees, charges for documents, treatments for which facilities are not available at the hospital or clinic, or items which are not referred to in Articles 41 or 43, except in the case of blood transfusion in the emergency treatment of an insured person deemed by the hospital operated or specially contracted by the insurer to be strictly necessary.

In case an insured person has been receiving inpatient hospitalization care for an injury or sickness for more than one month, the hospital concerned shall file an application for further hospitalization of the insured person once every month.
In case an insured person receiving inpatient hospitalization care in a hospital operated or specially contracted by the insurer is recommended after due diagnosis to leave the hospital for convalescence elsewhere, he shall do so as soon as possible, or be responsible to pay for the cost of further hospitalization care himself.

An insured person shall have the option to receive medical care at any hospital or clinic operated or specially contracted by the insurer, unless otherwise specially provided.

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An insured person who has received medical care benefits during an effective coverage period shall remain entitled to insurance benefits of other categories.

All medical expenses incurred by an insured person shall be payable by the insurer directly to the hospital or clinic operated or specially contracted by the insurer, and shall not be payable to an insured person in cash.

All public hospitals or clinics located in an area in which this Act is applicable shall be recognized as hospitals or clinics specially contracted by the insurer for medical treatment under the labor insurance scheme, provided they are above the required standards. Hospitals or clinics operated by an insured unit or a private agency may apply to the insurer to become specially contracted for medical treatment of insured persons under the labor insurance scheme, provided they are above the required standards.
Regulations for the special contracting with and operation of hospitals or clinics specially contracted by the insurer for the labor insurance scheme referred to in the preceding paragraph shall be prescribed by the competent central authority in consultation with the competent central health authority.

A specially contracted hospital or clinic offering out-patient or inpatient hospitalization services shall charge an insured person for medical expenses due in accordance with the Schedule for the Payment of Medical Expenses in Labor Insurance, and the Schedule of sable Medicines and Their Prices.
The Schedule for the Payment of Medical Expenses in Labor Insurance, and the Schedule of Usable Medicines and Their Prices referred to in the preceding paragraph shall be prescribed by the competent central authority.
The medical expenses referred to in preceding paragraph 1 shall be subject to review by a screening committee consisting of various categories of doctors and pharmacists appointed by the insurer. The regulations concerning such a review shall be prescribed by the competent central authority.

In case an application for outpatient or inpatient hospitalization services filed by an insured unit is deemed not to have conformed with the provisions governing insurance benefits, medical care benefits, or hospitalization care benefits, or in case of misrepresentations in the application forms, or in case the application forms are given to noninsured persons for use, the insured unit shall be responsible for paying all the medical expenses incurred.
In case the medical care given by a specially contracted hospital or clinic does not fail within the sphere of medical care benefits, the medical expenses so incurred shall be borne by the hospital or clinic concerned or by the insured person himself.