Chapter 4 Insurance Payment
Section 3 Pension Payment for Mentally / Physically Disability
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 .
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.
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.
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.
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.
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.