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Chapter Law Content

Chapter II The Mediation Procedure
Section I Mediation Presentation and Mediation Approval
Article 3
The beneficiary, insured units, premium withholder and insurance contracted medical care institution shall be the applicants of the applications for mediation.
The insured unit shall put forward the applications referred to in the preceding paragraph at the request of the subordinate beneficiary.
Article 4
When the applicant applies for mediation, he or she shall fill out the National Health Insurance dispute mediation petition (hereinafter referred to as "petition"), and submit it to The National Health Insurance Dispute Mediation Committee (hereinafter referred to as "NHI Dispute Mediation Committee ") within sixty days from the next day of the arrival of the insurer's evaluation notification document.
Article 5
The application for mediation shall be based on the date of the NHI Dispute Mediation Committee receiving the petition; if the petition is sent to the NHI Dispute Mediation Committee by mail, the postmark date stamped by the original post office shall be referred.
Those who have missed the application for mediation due to natural disaster or any reasons not attributable to the applicant shall state the reasons in writing and apply for restoration within the ten days after the reasons fade away.
However, if it has been over one year since the deadline of the application for mediation, the applicant is not allowed to apply for restoration.
Those who apply for restoration shall carry out all the necessary mediation application procedures during the remedy period.
Article 6
After the applicant applies for mediation, he or she may withdraw his or her application prior to the mediation approval (hereinafter referred to as "approval"); the applicant who withdraws his or her application is not allowed to apply for mediation for the same dispute again.
Article 7
Those who apply for mediation without petitions or with petitions unconformable with the legal procedure and have abilities to correct this fault shall be informed to correct it within 20 days.
Those who have good reasons for postponement of the correction referred to in the preceding paragraph shall apply for postponement within 20 days.
Article 8
For the benefit or exclusive management case conformable with the legal procedure, the NHI Dispute Mediation Committee shall send the copy of petitions to the insurer to get his position paper; the same processes shall be applied to, the medical expenditure case conformable with the legal procedure as necessary.
The insurer shall present the position paper within one month from the next day of the arrival of the letter, and submit it together with necessary materials to the NHI Dispute Mediation Committee. If the insurer deems the application for mediation reasonable, he shall re-evaluate the matter concerned and notify the applicant directly and report it to the NHI Dispute Mediation Committee.
Article 9
The designated members shall make the preliminary assessment for the dispute mediation first and submit the comments on the preliminary assessment to the NHI Dispute Mediation Committee for resolution; and the doctors or experts of the related fields shall be invited to assist in making preliminary assessments for the cases involving special technology or mass occurrence.
Article 10
The dispute case shall adopt the written mediation. If necessary, the relevant institutions or academic institution shall be commissioned to make appraisals and sit in on the mediation to account for the dispute.
Article 11
The NHI Dispute Mediation Committee Chairperson or member who has a concern in the dispute mediation shall be recused and not participate in the mediation.
Article 12
The NHI Dispute Mediation Committee shall approve the dispute case within three months from the next day of receiving the petition; if it is necessary to postpone the approval of the dispute case, the NHI Dispute Mediation Committee shall notify the applicant, except that there is consent of applicant. The approval is allowed to be postponed for only one time and for less than three months.
The period referred to in the preceding Paragraph shall start from the next day of the correction for those who get notified of correction in accordance with the Article 7; from the next day of the end of the correction period for those who fail to make correction; and from the next day of the arrival of the represented reasons for those who represent reasons during the mediation.
If the case fails to be approved within the period referred to in Paragraph 1, the applicant shall start lawsuit over the dispute within the law.
Article 13
Approval shall take the conformation of other legal relations as the criterion. Before confirming the legal relations, the NHI Dispute Mediation Committee shall suspend the mediation procedures in conformity to the legal procedures and notify the applicant.