These regulations are enacted in accordance with Paragraph 2 of Article 80 of the National Health Insurance Act (hereinafter referred to as the “Act”).
The scope of the documents and relevant information prescribed under Paragraph 1 of Article 80 of the Act is set forth below:
1. Relevant information pertaining to the type of insured, premium ratable wage, income from salary and wage, payment of insurance premium and medical utilization of the insured;
2. Account records, receipts, name lists and forms in relation to the implementation of the National Health Insurance (hereinafter referred to as the “Insurance”) by group insurance applicants, premium withholders and contracted medical care institutions;
3. Information concerning the deduction of supplementary premium by premium withholders in accordance with the law;
4. Medical history, prescriptions and diagnosis records held by contracted medical care institutions;
5. Cost of medical expenses of contracted medical care institutions, items of self-payment and detailed fee statements of the insured, attendance records and shift information of all categories of medical personnel, information concerning the allocation of medical instruments and all types of wards as well as statistics on the status of insurance wards;
6. Related information pertaining to items, prices, quantities, certificates and contracts concerning contracted medical care institutions’ purchase of drugs dispensed by the Insurance; and
7. Other documents and information in relation to the Insurance.
Where the competent authority or the insurer requests the insured, group insurance applicants, premium withholders or contracted medical care institutions to provide documents or information, it shall clearly specify in an official document the statutory basis and cause for such request as well as name(s) and item(s) of document(s) or information. In the event of a straightforward or urgent case, the competent authority or the insurer may send a notification via facsimile to the other party which should appoint a designated person to answer inquiries conducted on the phone.
The respondent may provide written information in respect of the telephone inquiries in the preceding paragraph within three days if such respondent deems it is necessary.
The competent authority or the insurer shall comply with the following requirements when it visits group insurance applicants, contracted medical care institutions, premium withholders or the insured to undertake interviews:
1. It shall give a prior notice in the form of an official document. Notwithstanding, the above may not apply in the case of the prevention of destruction of evidence, collusion or any other urgent situations.
2. The visiting personnel shall directly present the inspection badge and supporting documents issued by the authority with which such person is employed, and explain the purpose of the interview. Notwithstanding, the visiting personnel is prohibited from disclosing the informant or anyone report the case.
3. All measures shall be taken in good faith and satisfy the principle of proportionality, which may not exceed the scope required for fulfilling the purpose of the interview. All respondents shall be given the opportunity to fully explain and respond.
4. The interview records shall be accurately produced which shall be affixed with signatures, stamps or fingerprints after being examined by respondents.
Relevant professional personnel may be invited to participate in interviews, make audio recordings, shoot photographs, make video recordings or access and duplicate documents or relevant information set forth in Article 2 as the case may be.
These Regulations shall take effect on January 1, 2013.