Chapter 4 Insurance Payment
Section 1 General Provisions
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.
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.
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.
Same payments from the same contingencies cannot be requested repeatedly.
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.
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.
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.
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.
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.
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.
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.
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.