Where an insurance accident occurs after the effectiveness of insurance has begun and has not expired yet, the insured person, the beneficiary, or the person paying the funeral expenses may claim the insurance payment according to the provisions of this Act.
.

Where an insured person must be hospitalized continuously for diagnosis and treatment after the effectiveness of insurance terminates due to an injury or disease occurred in the effective term, he may enjoy this kind of insurance payment within one year, and shall leave the hospital immediately after it is deemed by a medical institution established or designated by the insurer that it is time the insured person should leave the hospital for recuperation.

Any insured person may not repeatedly claim a same kind of insurance payment for a same accident.

Where an insured establishment effective this Insurance and receive the insurance payment for a person who doesn't meet the provisions of this Act, the insurer shall replevy the payment in accordance with law, and cancel the qualification of the insured person.

In any of the following occasion, an insured person may not enjoy the insurance payment:
1.The insurance accident is caused by war, turmoil, or intended crime committed by the insured person.
2.The insured person refuses to be examined by the medical institution established or designated by the insurer without due reasons, or doesn't submit the required certificates; or the beneficiary doesn't submit the required certificates.
3.Legal epidemic, leprosy, stupefacient addiction, beautification surgery, installation of artificial tooth, artificial eye, glasses, or other auxiliary appliances, transportation of patients, special nursing, blood transfusion for non-emergent injury or disease deemed by physician as necessary, registration fee, certification fee, and medical expenses for using equipment that the medical institution doesn't have.

For the necessity of auditing the insurance payment or reviewing disputes regarding the Insurance, an insured person or the Farmer Health Insurance Supervisory Commission may investigate the Insurance-related documents about the insured person in the insured establishment, the designated medical institution, or other related departments.

The rights of an insured person, a beneficiary, or a person paying the funeral expenses to receive various insurance payments may not be transferred, countervailed, detained, or used for guarantee.
In cases where the insurer revokes or terminates approval of the insurance payment, and where the already collected insurance payment shall be returned but has not been returned, the insurer may deduct the funds from the insurance payment that is claimed by the party collecting the insurance payment.

The right of claim for insurance payment shall be eliminated if it is not exercised within two years commencing from the day when the claim becomes effective.
The time limit for the period of effectiveness of the right of claim for insurance payment that has already begun prior to the coming into effect of the amendment to this Article of December 7, 2021, and which has not been completed as of the day of the coming into effect of the amendment, shall, starting from the day of its coming into effect, apply the amended provisions, with the period of effectiveness calculated by combining the periods of effectiveness before and after the coming into effect of the amendment.

In any of the following circumstances, an insured person or his/her spouse may claim the payment for procreation:
1.Childbirth after the insured person has been covered by the Insurance.
2.Premature delivery after the insured person has been covered by the Insurance.
Prior to the coming into effect of the amendment to this Article of December 7, 2021, in cases of childbirth or premature delivery, the provisions for claims for the payment for procreation from prior to the coming into effect of this amendment shall apply.

The standards for payment for procreation are as follows:
1.For childbirth or premature delivery, a sum three times the insured amount of the month when the incident occurs shall be paid in a single payment.
2.For twin birth or above, the sum shall be increased in proportion.
In cases in which the insured person qualifies at the same time to collect procreation payments from relevant social insurance, that person must choose to collect from only one form of insurance.
In cases in which childbirth or premature delivery occur prior to the taking effect of the amendments to these provisions made on January 10, 2023, the standards for their procreation payment that applied before the amendments shall continue to apply.

In case of injury or disease except emergent case, the insured persons shall apply to the medical institutions established or designated by the insurer for diagnosis and treatment. Where hospitalization is suggested by the designated medical institution after the process of diagnosis, the patient may apply for hospitalization.
To apply for hospitalization due to a common disease, the accumulated insured time shall be not less than 45 days.

The scope of payment for outpatient treatment is as follows:
1. Diagnosis (including examination and consultation)
2. Medicament or materials for treatment
3. Disposal, surgery, or treatment.
The insured persons shall burden 10% of the above-mentioned expenses. But the expenses burdened by an insured person may not exceed the maximum prescribed by the central competent authority.

The scope of payment for hospitalization is as follows:
1. Diagnosis (including examination and consultation)
2. Medicament or materials for treatment
3. Disposal, surgery, or treatment
4. A half of the accommodation fees within 30 days
5.The supply for farmer insurance sickrooms shall be provided according to the standard for public insurance sickrooms.
The insured persons shall burden 5% of the expenses referred to in Subparagraphs 1, 2, 3, and 5 of the above paragraph. But the expenses burdened by an insured person may not exceed the maximum prescribed by the central competent authority.
Where an insured person chooses a sickroom of a higher grade at his own will, he shall burden the expense prescribed in the above paragraph and the expense beyond that of a farmer insurance sickroom.
The date of and regulations on enforcement of the second paragraph and the second paragraph of Article 27 shall be approved by the Legislative Yuan prior to implementation.

Where an insured person is hospitalized due to injury or disease for more than one month, the medical institution shall handle the procedure for continuing hospitalization once every month.
Where it is diagnosed by a medical institution established or designated by the insurer that it is the time for the hospitalized insured person to leave for recuperation, the insured person shall immediately leave the hospital; otherwise, he shall burden the expenses required for continuing hospitalization.

An insured person has the right to freely choose a medical institution established or designated by the insurer for diagnosis and treatment. However, if it is prescribed otherwise in any special provisions, such provisions shall apply.

Where an insured person is disabled due to injury or disease and has received the payment for disability, he may not apply for hospitalization for the same injury or disease.

The insurer shall directly pay the expenses required for diagnosis and treatment to the medical institutions established or designated by the insurer, and the insured persons may not apply for insurance payment in cash.

Where an insured person accepts outpatient service or is hospitalized in a medical institution other than those established and designated by the insurer because he requires immediate treatment due to emergent injury or disease, he shall, within 2 months commencing from the next day after completion of the outpatient service or after leaving the hospital, submit the medical certificates and expense vouchers to the insured establishment for claiming insurance payment on the insurer. In case that the expense is more than the standard prescribed in the regulations on the insurer's paying expenses to the designated medical institutions, the excessive proportion shall be burdened by the insured person himself.

The regulations on designation and management of the designated medical institutions of this Insurance as well as the standard for payment of medical expenses shall be prescribed by the central competent authority together with the central competent authority in charge of health.

Where a bill for accepting diagnosis or a letter of application for hospitalization produced by an insured establishment doesn't meet the provisions prescribed by the insurer on medical payment, or is false, or is used by someone other than the insured, the insured establishment shall burden the whole expenses for diagnosis and treatment. However, if it is resulted in by causes not attributable to the insured establishment, the insurer may request the insured establishment to provide assistance in claiming compensation from the insured person.
Where the diagnosis and treatment provided by a designated medical institution to an insured person is not covered in the scope of payment for medical treatment, the expenses for diagnosis and treatment shall be burdened by the medical institution or the insured person.

The insured person can apply for a one-time disability payment based on his/her month insured amount for that month and the level of disabled condition and benefits standards, once he/she is diagnosed as permanently disabled and can’t further recover by further treatment by a medical institution established or designated by the insurer for diagnosis and treatment due to injury or disease, if his/her disability is fit for disability benefits standards.
A disability payment is not available if the insured person is dead on the date when the Diagnosis Report of Disability for Farmer Health Insurance is issued by the medical institution designated by the insurer.
The types of disability, conditions, levels, payment amount, levels of medical institution issuing the diagnosis report, examination criteria and other standards mentioned in Paragraph 1 shall be stipulated by the central competent authority and central health authority.

If the insured person originally has a partial disability and the severity worsens or he/she has suffered from additional disability, the insurer shall re-evaluate the level of the worsened or newly added disability. The payment should also be made based on the new disabled level. However, the highest payment amount should be limited to the first level.
In cases of an insured person who originally has a partial disability while his/her insurance is still in effect as mentioned in the preceding Paragraph but has not claimed the disability payment, the insurer shall, based on the level of disability following the increased severity of the disability, calculate and pay out the disability payment based on the standards for disability benefits. However, the highest payment amount should be limited to the first level.

To determine the application for disabled payment, the insurer is allowed to hire medical experts who have clinical or actual experiences to examine the diagnosis report and verify the case history or other treatment records. If necessary, the insurer is allowed to ask the insured for re-examination and designate a hospital or doctor for the examination.

Once the insured person receives the disabled payment according to Article 36, the insurer recognizes that the insured person cannot engage in farming activities any more, the effectiveness of the insurance qualification shall be terminated on the date when the Diagnosis Report of Disability for Farmer Health Insurance is issued by the designated medical institution by the insurer.

Upon the death of an insured person, a funeral and interment allowance 15 times the insured amount of the very month will be offered.
The funeral and interment allowance referred to in the above paragraph shall be received by the person who pays the funeral and interment expenses.