| CHAPTER 1 GENERAL PRINCIPLES | |
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| Article 2 | Labor insurance coverage consists of two types as the following: |
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| Article 3 | All labor insurance books and accounts, documents and operational receipts and payments shall be exempt from taxation. |
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| Article 4 | Council of Labor Affairs of the Executive Yuan and the municipal government shall be the competent labor insurance authorities. |
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| Article 6 | The following workers above 15 full years and below 60 years of age shall all be insured under this program as insured persons, with their employers, or the organizations or institutes to which they belong reckoned as the insured units: |
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| | Preceding provisions also apply to workers under 15 years of age, provided the character and conditions of whose employment have been recognized by the competent authority as not harmful to the physical and moral health of such persons. |
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| Article 7 | If after a labor insurance policy has been taken for workers referred to paragraph 1, subparagraphs (1) to (3) inclusive of the preceding Article, the number of workers employed by the insured unit has decreased to four or less, the insured unit shall continue to carry out the labor insurance project for these workers. |
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| Article 8 | The following persons may apply the provisions of this Act and participate in the labor insurance scheme: |
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| | Persons mentioned in the preceding paragraph who participate in the labor insurance scheme shall not be allowed to suspend the coverage unless they are permitted to do so under of this Act. |
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| Article 9 | An insured person who has any of the following conditions may continue in the insurance coverage: |
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| Article 9-1 | An insured person who has joined the scheme for a total period of more than 15 years and who has been laid off, may participate in the coverage voluntarily. Under such circumstances, the original insured unit shall take care of ordinary labor insurance procedures until the insured person reaches the age when he is entitled to claim old-age benefit. |
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| Article 10 | Each insured units shall handle the insuring procedure and other insurance-related affairs for its employees, and prepare a roll list of the employees or members. |
| | The insured units may consign the organization or labor association to which it is affiliated to handle mentioned in the preceding paragraph insuring procedure and other insurance-related affairs. |
| Article 11 | For workers mentioned in Article 6, all insured units shall compile a list and notify the insurer on the same day when the insured persons join the enterprise, or the association, start training courses, separate from the enterprise, withdraw from the association, or end the training courses. The beginning or the ending of such insurance coverage shall start from the day on which the lists were sent out by the insured unit. In case the insured unit fails to send out the list on the same day when the insured persons report for work, join the association, or begin training courses, the day following the day on which such a list is actually sent out to the insurer shall be counted as the day on which the coverage takes effect. In such a case. the insured units shall be fined according to the provisions of Article 72 of this Act. |
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| Article 12 | In case an insured person rejoins the labor insurance scheme after separation from the coverage, his accumulated years of insurance coverage shall be recognized. |
| | The insured person had received old-age benefits, should claim the shortage payment according to the proceeding paragraph in two years after last amended on December 19, 2001. |
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| Article 14 | The term "monthly insurance salary" referred to in the preceding Article shall mean the salary reported by an insured unit pursuant to the "Table of Grades of Insurance Salary" and on the basis of the insured person's total monthly salary. In case an insured person's wage is calculated on piecework basis, the monthly insurance salary shall be pro rata to that of a worker of the same grade in the Table reported by the insured unit. The monthly insurance salaries of workers referred to in paragraph 1 subparagraph (7) or (8) of Article 6 or paragraph 1 subparagraph (4) of Article 8 shall be assessed by the insurer pursuant to the Table subject to the approval of the competent central authority. |
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| Article 14-1 | Where the insured person’s insurance salary declared by the insured unit is not true, the insurer may directly make adjustment according to the insurance salary of an equivalent grade of the same occupation, and notify the insured unit about the adjustment. In case the insurance salary after being adjusted is not in conformity with the actual salary, the latter shall apply. |
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| Article 14-2 | In case of additional insurance under Subparagraph 3, Paragraph 1, Article 8, whose income is lower than the top grade of the "Table of Grades of Insurance Salary", the insured unit may quote and declare the insurance salary by itself. But the declared salary may not be lower than that of the grade applicable for the highest insurance salary as declared by the affiliated employees. |
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| Article 15 | Labor insurance premiums shall be calculated and paid in accordance with the following measures: |
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| Article 16 | The labor insurance premiums shall be paid monthly according to the following regulations: |
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| | All labor insurance premiums paid to the insurer shall not be refundable except for the consequence of cases which are neither attributable to the insured unit, nor to the insured person. |
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| Article 17 | In case an insured unit has not paid the premiums due before the date indicated in paragraph 1 of the preceding Article, they may be paid within a fifteen-day grace period. In case the premiums remain unpaid to the insurer within the grace period, an additional overdue penalty at the rate of 0.1 percent shall be paid for each day beginning from the expiration day of the grace period to one day before the premiums are paid in full, provided that the overdue penalty shall not be more than 20% the amount of the premiums. |
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| Article 18 | In case an insured person temporarily loses his salary because of an injury for which he receives injury or sickness benefits or hospital care benefits, he may be exempted from paying his portion of the premiums so long as his salary is suspended. |
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| Article 19 | Upon the occurrence of a contingency covered by the insurance after the beginning and before the end of the effective period of the insurance, an insured person or his beneficiary may claim insurance benefit payments pursuant to the provisions of this Act. |
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| Article 20 | For within one year after an insurance policy has been cancelled, an insured person shall remain entitled to injury or sickness benefits or hospital care benefits for an injury or sickness or a risk requiring medical care occurred during the period of his insurance policy. The provisions of Articles 35 and 36 shall limit the period in which an insured person may claim injury or sickness benefits. An insured person receiving medical care at a hospital operated or specially contracted by the insurer shall leave the hospital as soon as he is deemed fit for convalescence elsewhere. |
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| Article 20-1 | Where it is confirmed after an insured person retires and withdraws the insurance that he/she has got a kind of occupational disease during the valid period of the insurance, he/she may claim the occupational permanent disability benefits. |
| | The regulations of the above-mentioned payment, that objects, kinds of occupational diseases, determination procedure, calculation of the amount payable and other related affairs shall be prescribed by the competent central authority. |
| Article 21 | In case the permanent disability or old-age benefits claimed by an insured person before his death have been confirmed as payable by the insurer, these benefits may be received by the duly entitled survivors of the insured person. In case an insured person has no survivors referred to in Article 65, the person responsible for the funeral service shall be paid the funeral grant equivalent ten months' insurance salary of the insured person. |
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| Article 21-1 | In case an insured person cannot continue to work on account of disability but is entitled at the same time to claim either permanent disability or old-age benefits, he may choose either the one or the other. |
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| Article 22 | No insurance benefits may be claimed repeatedly for same contingency. |
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| Article 23 | An insured person, his beneficiary, or any other interested person shall be entitled to no insurance benefits other than funeral grant for a covered contingency incurred intentionally for the purpose of receiving insurance benefits. |
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| Article 24 | In case an insured unit intentionally files an application for person ineligible under the provisions of this Act to participate in the insurance program and to receive insurance benefits for or on behalf of such a person, the insurer shall take legal action to recover the insurance benefits paid to the ineligible insured person, but also to nullify his qualifications. |
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| Article 25 | The insurer shall not be responsible for paying insurance benefits either to an insured person who refuses without adequate reason to submit to examination by a specially contracted hospital or clinic, or who refuses to submit, upon request, any required documents. The same applies to the beneficiary of an insured person who refuses to submit the required documents. |
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| Article 26 | No insurance benefits shall be payable for a contingency incurred by war or civil commotion, or by an intentional criminal act committed by the insured person, his father, mother, son, daughter, or spouse. |
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| Article 27 | An adopted son or daughter shall not be entitled to receive insurance benefits in case the adoption registration has been less than six months at the time when the contingency occurs. |
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| Article 28 | Where deemed necessary for the insurer to audit insurance benefit or for the Labor Insurance Supervisory Commission to settle disputed cases, the insurer or the Commission may request the insured person, beneficiary, insured unit, hospital, clinic, or the physicians or midwifes who hold the certified license, to submit a report, or check the patient data, salary account books, examination and chemical test records or diagnosis radiographs (Ｘ-ray photos) as well as other related documents, and the insured person, beneficiary, insured unit, hospital, clinic, or the physicians or midwifes may not deny such request or check. |
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| Article 29 | The title of an insured person or his beneficiary to all kinds of insurance benefits may not be assigned, offset, attached or mortgaged. However, an insured person who has not repaid interest on a loan referred to Subparagraph (4), Paragraph 1 of Article 67 shall have the amount deducted from insurance benefits claimed by the insured person or other beneficiaries. |
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| Article 30 | A claim for insurance benefits shall be extinguished if not filed within two years from the day on which the benefits become payable. |
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| | In case of childbirth, premature labor, or miscarriage of the spouse of an insured person, claims may be made pursuant to the provisions of the preceding paragraph. |
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| Article 32 | Maternity benefits are payable according to the following provisions: |
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| | In case of difficult labor when the insured person has already claimed hospitalization benefits, delivery expenses shall no longer be payable. |
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| Article 34 | In case an insured person is not receiving salary payment on account of injury or occupational disease incurred on duty for which he is receiving medical treatment, he shall be paid occupational injury or disease compensation beginning from the fourth day on which he is incapacitated for work. The List of Occupational Diseases is attached hereto as Exhibit 1. |
| Article 35 | Ordinary injury or sickness benefits shall be payable at the rate of fifty percent of the average monthly insurance salary of an insured person, and payable once every half month for the maximum period of six months, provided that such benefits shall be payable for an additional six months in case the insured person has at least one full year of insurance coverage prior to the occurrence of the injury or sickness. |
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| Article 36 | Occupational injury or disease compensation shall be payable at the rate of seventy percent of the average monthly insurance salary of an insured person, and payable every half month for the maximum period of six months. In case the insured person has not recovered from the injury or disease after one full year, the compensation shall be reduced to fifty percent of the average monthly insurance salary for the maximum period of one year. |
| Article 37 | In case an insured person has received all payments of such insurance benefits provided in the preceding two Articles during the period of injury or sickness, and continues to participate in the insurance scheme after recovery, he shall be entitled to claim injury or sickness benefits according to the regulations in case the contingency arises. |
| Article 38 | In case an insured person has received all payments of such insurance benefits provided in Articles 35 and 36, and has not recovered in the end of the prescribed period, he may either apply for continued medical care or claim for permanent disability benefits in case the hospital operated or specially contracted by the insurer confirms that it will not be possible for him to recover from the injury or disease. |
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| Article 39 | Medical care benefits consist of outpatient medical care benefits and inpatient hospitalization benefits. |
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| Article 39-1 | With a view to protect the health of the insured persons, the insurer shall set up regulations to prevent the occurrence of occupational diseases. |
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| Article 40 | An insured person who has been injured or sick may apply for medical care by a hospital or clinic operated or specially contracted by the insurer. |
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| Article 41 | The sphere of outpatient medical care benefits consists of the following: |
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| | Ten percent of the preceding expenses shall be paid by the insured person, provided that they do not exceed the maximum amount allowed by the competent central authority. |
| Article 42 | In case the diagnosis given by the hospital or clinic operated or specially contracted by the insurer decides that the insured person who conforms to one of the following conditions shall be hospitalized, his insured unit shall make such an application on his behalf, except when an insured person is already hospitalized on account of emergent injury or sickness:
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| Article 42-1 | Where the insured person gets an occupational injury or disease, the insured unit shall fill in a clinic note of occupational disease or a letter of application for hospitalization (hereinafter referred to as "the Clinic Note or Application Letter for Occupational Disease") to apply for diagnosis and treatment;in case the insured unit doesn’t produce the note or letter, the insured person may request the insurer to issue, and the insurer shall grant the note or letter after the case is confirmed. |
| | Where the insured person has not the above-mentioned Clinic Note or Application Letter for Occupational Disease and is diagnosed to have got an occupational disease, the doctor may produce a clinic note of occupational disease. The acquisition and loss of the qualification to produce such note as well as the application and use of the clinic note shall be prescribed out by the insurer, and reported to the competent central authority for approval and issue. |
| Article 43 | Hospitalization care benefits shall include the following: |
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| | The insured person shall be responsible to pay for five percent of the expenses referred to in subparagraphs (1) to (3) inclusive and subparagraph (5) of the preceding paragraph, provided that they do not exceed the maximum amount allowed by the competent central authority. |
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| Article 44 | Medical care benefits shall not include legally declared epidemics, leprosy, narcotic addictions, child delivery, miscarriage, plastic surgery, artificial teeth, artificial eye, eyeglasses or accessories, patient transportation, special nurses, blood transfusion, registration fees, charges for documents, treatments for which facilities are not available at the hospital or clinic, or other subparagraphs which are not referred to in Articles 41 or 43, except in the case of blood transfusion in an emergency treatment of an insured person deemed by the hospital operated or specially contracted by the insurer to be strictly necessary. |
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| Article 45 | In case an insured person has been receiving inpatient hospitalization care for an injury or sickness for more than one month, the hospital concerned shall file an application for further hospitalization of the insured person once every month. |
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| Article 46 | An insured person shall have the option to receive medical care at any hospital or clinic operated or specially contracted by the insurer, unless otherwise specially provided. |
| Article 47 | An insured person who becomes disabled as a result of injury or sickness and has received permanent disability benefits shall not be entitled to claim for inpatient hospitalization care for the same injury or sickness. |
| Article 48 | An insured person who has received medical care benefits during an effective coverage period shall remain entitled to insurance benefits of other categories. |
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| Article 49 | All medical expenses incurred by an insured person shall be payable by the insurer directly to the hospital or clinic operated or specially contracted by the insurer, and shall not be payable to an insured person in cash. |
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| Article 50 | All public hospitals or clinics located in an area in which this Act is applicable shall be recognized as hospitals or clinics specially contracted by the insurer for medical treatment under the labor insurance scheme, provided they are above the required standards. Hospitals or clinics operated by an insured unit or a private agency may apply to the insurer to become specially contracted for medical treatment of insured persons under the labor insurance scheme, provided they are above the required standards. |
| Article 51 | A specially contracted hospital or clinic offering out-patient or inpatient hospitalization services shall charge an insured person for medical expenses due in accordance with the Schedule for the Payment of Medical Expenses in Labor Insurance, and the Schedule of sable Medicines and Their Prices. |
| Article 52 | In case an application for outpatient or inpatient hospitalization services filed by an insured unit is deemed not to have conformed with the provisions governing insurance benefits, medical care benefits, or hospitalization care benefits, or in case of misrepresentations in the application forms, or in case the application forms are given to noninsured persons for use, the insured unit shall be responsible for paying all the medical expenses incurred. |
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| Article 53 | In case an insured person suffers any residual physical handicap in the wake of a medical treatment of ordinary injury or sickness, and such disability conforms to the provisions of the Permanent Disability Benefits Payment Schedule, and the diagnosis by a hospital operated or specially contracted by the insurer confirms that the insured person will be disabled for the rest of his life, he may claim the payment of permanent disability benefits in one lump sum calculated on the basis of his average monthly insurance salary pursuant to the same category of disability in the Permanent Disability Benefits Payment Schedule, a sample of which is attached as Exhibit 2. |
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| Article 54 | An insured person shall be paid an additional fifty percent of permanent disability benefits calculated on the same category and payment schedule of permanent disability benefits in case he suffers, in the wake of I medical treatment for occupational injury or disease, any residual physical handicap which conforms to the provisions of the Permanent Disability Benefits Payment Schedule, and the diagnosis by a hospital operated or specially contracted by the insurer confirms that the insured person will be disabled for the rest of his life. Such permanent disability benefits shall be payable on a lump sum basis. |
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| Article 55 | A claim for permanent disability benefits shall be subject to screening and approval according to the following principles: |
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| Article 56 | If, in reviewing a claim for permanent disability benefits, the insurer deems it necessary to conduct a re-examination, another hospital or doctor may be appointed for the re-examination. |
| Article 57 | In case an insured person is unable to continue his original work after receiving permanent disability benefits, the effect of his insurance shall be terminated immediately. |
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| Article 58 | An insured person who has any of the following conditions may claim to receive old-age benefits: |
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| | An insured person who has received old-age benefits may no longer participate in the labor insurance. |
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| Article 59 | An insured person who claims old-age benefits payment in accordance with the provisions of paragraph 1 of the preceding Article shall receive one-month's old-age benefits for each one of his coverage years computed on the basis of his average monthly insurance salary. In case his coverage exceeds fifteen years, the insured person shall receive two-months' old-age benefits for each one of the excess years, provided that the maximum amount of old-age benefits payment shall not exceed forty-five months of insurance salaries, and the period exceeding half a year may be reckoned as one year. |
| Article 60 | (Deleted) |
| Article 61 | In case an insured person continues to work after attaining sixty years of age, his insurance coverage above that age shall not exceed five years. On resignation, he may claim old-age benefits payment according to the provisions of Article 59, provided that the maximum amount shall not exceed fifty months' insurance salaries including the old-age benefits receivable before he attained sixty years of age. |
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| Article 62 | In the event of death of the father, mother, spouse, or child of an insured person, he may claim funeral grant pursuant to the following provisions: |
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| Article 63 | In the event of the death of an insured person, five months of funeral grant is payable. In case he is survived by his spouse, child, father, mother, grandfather, or a dependent grandchild, brother(s) or sister(s), survivors' benefits may also be paid according to the following provisions:
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| Article 64 | In case an insured person dies from an occupational injury or disease, not only shall a five-month funeral grant be payable on the basis of his average monthly insurance salary, but forty-month survivors' benefits shall also be payable to his survivor, in case he is survived by his grandfather, father, mother, spouse, child, grandchild, brother or sister, irrespective of the length of his insurance coverage period. |
| Article 65 | Survivors' benefits referred to in the preceding two Articles shall be payable to the entitled survivor(s) according to the order prescribed below: |
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| Article 66 | The labor insurance fund shall be derived from the following sources: |
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| Article 67 | With due approval of the Labor Insurance Supervisory Commission, the labor insurance Fund may be used in the following manner: |
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| | The labor insurance Fund may be applied or disposed of for no other purposes than the payment of insurance benefits or for the purposes referred to in the preceding paragraph. The regulations on the administration of such Funds shall be prescribed by the competent central authority. A report on the Fund's receipts, a status report on how the Fund is being applied or used, and on the cumulative sum of the Fund shall be submitted by the insurer to the competent central authority for public notice on a yearly basis. |
| Article 68 | The insurer shall budget the administrative costs for handling the labor insurance program, to be computed at the rate of five and one half percent of the premiums collectible for the month of June of the current budget year and multiplied by twelve. Such costs shall be disbursed by the provincial or municipal government which has been entrusted to establish the Bureau of Labor Insurance, after the said budget has been duly reviewed and approved by the Labor Insurance Supervisory Commission. |
| Article 69 | Before the Central Bureau of Labor Insurance is established, in case of any loss in labor insurance, it shall be approved and made good by the provincial or municipal government which has been entrusted to establish the Bureau of Labor Insurance. |
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| Article 70 | In case a person receives insurance benefits through fraudulent or other improper act, or makes false certification, report, misrepresentation, or files a claim for medical expenses, he shall not only be fined an amount equivalent to twice the insurance benefits received, but also be liable to the insurer for compensation for damages. If criminally liable, he shall also be referred to the court for indictment. Any medical expenses so received by specially contracted hospital or clinic may be deductible from the expenses claimed or receivable by it. |
| Article 71 | A worker who, in violation of the provisions of this Act, has not participated in labor insurance and attended to the formalities thereof, shall be fined an amount no less than one hundred and no more than five hundred NT dollars. |
| Article 72 | Any insured unit that fails to carry out labor insurance formalities according to this Act for any of his employees in pursuance of the provisions hereof will be fined a sum two times the insurance premium amount payable for the period from employment to effecting insurance, and the loss caused by this to the employees shall be compensated by the insured unit pursuant to the payment standard prescribed in this Act. |
| | In case when the insurer performs inspection under Paragraph 3, Article 10, an insured unit rejects to provide the documents or infringes Paragraph 4 of the same article, the insured unit will be fined a sum of 2,000~6,000. |
| Article 73 | In case a penalty remains unpaid for no cause thirty days after the notice of the fine prescribed herein is served, the case shall be referred to the court for compulsory execution. |
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| Article 74 | The premium rates, the enforcement areas, the date and the measures for setting up unemployment insurance shall be prescribed by the Executive Yuan. |
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| Article 75 | (Deleted) |
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| Article 76 | In case an insured person is transferred to the Armed Forces Insurance, the Government Employees' Insurance, or the Insurance for Teaching and Administrative staff of Private Schools, who, at the time of such transference, is not yet entitled to draw old-age insurance benefits pursuant to the provisions of this program, his seniority qualifications shall be reckoned, and when he legally retires on reaching old age, he shall be entitled to claim old-age insurance benefits according to the provisions of Article 59 of this Act. |
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| Article 76-1 | The provisions including Article 2, Article 31, Article 32, Article 39-52 should not be applied to the delivery expense of maternity benefits and medical benefits of Ordinary Insurance when the National Health Insurance Program becomes effective. |
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| Article 77 | The Enforcement Regulations of this Act shall be prescribed by the competent central authority subject to the approval of the Executive Yuan. |
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| Article 78 | The enforcement areas of this Act shall be determined by the ordinances of the Executive Yuan. |
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| Article 79 | This Act shall become effective on the day of promulgation. |
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