Standard of review medical expenses refund

Outside Taiwan:

If the insured person travels or handles affairs abroad or in China, and if an unexpected emergency injury or emergency birth situation occurs temporarily, he must immediately seek medical treatment at the local medical institution, and he can submit the following documents to apply for the refund of medical expenses.

The standard of refund is to verify the payment according to the provisions of the National Health Insurance payment, but there is a limit, and the highest limit is paid to the domestic medical center standard, and it is announced quarterly. The following table is the amount in 2019 and 2020:

The documents should be attached

1. National Health Insurance self-advancement medical expense verification application.
2. The original medical expense receipt and details of expenses. If it is a document other than Chinese or English, a Chinese translation shall be attached.
3. If the medical certificate or supporting documents are not in Chinese or English, a Chinese translation shall be attached. (Inpatients: Attached medical record of discharge)
4. Photocopy of the current entry-exit certificate or the certificate issued by the service agency.

Precautions for medical treatment in China

Medical treatment in China, from April 1, 1999 (discharge date), apply for 5 days of hospital withdrawal (including 5 days, except for the discharge date, that is, hospitalization on January 1, 103, and discharge on January 5, 103, 4 days of hospitalization) For self-advancement medical expense verification and refund cases, the medical documents “Original Medical Expense Receipt” and “Diagnostic Certificate” must be notarized at a notary office in China, and then submitted to the Straits Exchange Foundation.

Then, you can apply for verification from the Strait Exchange Foundation (website: https://www.sef.org.tw) with the original notarial certificate. Only the cost details and the discharge of the hospital are not subject to notarization verification.

Refund application requirements

• Application deadline

For the medical expenses of the above-mentioned emergency injuries or emergency births, it must be within 6 months from the day of emergency, outpatient treatment, or discharge (the seafaring crew is within 6 months from the date of return to Taiwan).

• The maximum amount of refund for the partial burden of the whole year and each hospitalization

• Medical coverage of emergency injuries

3.1. Those with severe acute diarrhea, vomiting or dehydration.

3.2. Acute abdominal pain, chest pain, headache, back pain (low back, low back pain), arthralgia or toothache, need urgent treatment to identify the cause.

3.3. Hematemesis, hematochezia, epistaxis, hemoptysis, hemolysis, hematuria, vaginal bleeding or acute trauma bleeding.

3.4. Acute poisoning or acute allergic reaction.

3.5. Sudden body temperature instability.

3.6. Difficulty breathing, wheezing, cyanosis of lips or fingertips.

3.7. People with unconsciousness, coma, cramps or dysfunction of limb movement.

3.8 Those with foreign bodies remaining in the eyes, ears, respiratory tract, gastrointestinal tract, and urogenital tract or obstructions due to pathological changes in the body.

3.9. People with mental illness who endanger the safety of others or themselves, or who present symptoms of mental illness and need emergency treatment.

3.10. Acute injury caused by a major accident.

3.11 People with unstable life symptoms or other life-threatening symptoms.

3.12. Infectious diseases should be dealt with immediately, but excluding those budgeted by the government according to law.

3.13. Sudden illness or trauma that occurs during consecutive holidays of more than two days.

Note on health insurance audit refund

1. The validity period of applying for the refund of medical expenses for health insurance is within 6 months from the date of the day of medical treatment, it will not be accepted if it is overdue. Due to the consideration of the time required for administrative operations on both sides of the Taiwan Straits, please complete the required information within 2 months from the date of medical treatment and submit to the customer service department of the co-sponsored hospital;
2. The reimbursement for health insurance that has already been applied for shall not be applied repeatedly to avoid breaking the law, and the applicant shall bear the legal responsibility.
3. After the delivery, the Health Insurance Bureau will finalize the review within 3 to 6 months. After verification, the cheque will be sent or the refund will transfer to the application account according to the application situation. The “approval notice” or “check” will be mailed to the address of your designated payee by registered post, so please be sure to fill in the designated payee address and contact phone number in Taiwan and write in traditional Chinese.
4. The standard for fee review by the Health Insurance Bureau is based on the average medical expenses paid to the outpatient and inpatients of the special medical center in the previous quarter. If the application fee is lower than the average fee, the health insurance bureau will verify and pay the medical expenses to you, but the applied medical expenses are higher than the upper limit, and the excess will not be paid;
5. The passport and Taiwan compatriot card (original) are needed and deal with the procedure in the hospital.

Notarization requirements

From April 1, 2010, the Taiwan Health Insurance Bureau stipulates that for a medical insurance refund of more than 5 days to stay hospital (including 5 days), you must go to the Shanghai Notary Office for notarization procedures and the  Straits Exchange Foundation for verification procedures.

Documents required for notarization by the SEF

1. Original or photocopy of Mainland travel permit for Taiwan residents (need to include the first page of entry and exit and visa validity period page).
2. The original home page and original cost details of the current hospitalization.
3. The original hospital invoice and discharge record.
4. Power of Attorney: If the patient cannot handle it in person and can be entrusted to others, please fill in the power of attorney and the name of the client (patient),
5. ID card number, correspondence address (Shanghai), telephone (Shanghai), date of birth, authorizer, and client signature.

Documents to be prepared for the Shanghai Notary Office

1. Original Chinese notarial certificate.
2. Patient identification documents: front and back of ID card, seal, passport (original).
3. If the patient cannot handle it in person, he can entrust others to handle it; Please fill in the name of the client (patient) on the application form and the power of attorney, ID card number, telephone (Taiwan), correspondence address (Taiwan)

Precautions of Overseas medical treatment for health insurance application

1. It is not possible to go to the doctor directly with the health insurance card-it is better to explain to the doctor that you need to apply for the health insurance refund fee when back to Taiwan. Please pay attention when writing the diagnosis certificate.
2.  Health Insurance Bureau stipulates that refunds can only be made for acute and sudden diseases; chronic diseases cannot be refunded. Whether the refund can be made and the refund ratio is reviewed by the Health Insurance Bureau.
3. Photocopy of Mainland travel permit for Taiwan residents and Taiwan passports that use fast customs clearance to enter and exit Taiwan Customs do not have the customs date stamped on the certificates currently, just need to indicate the date and reason when filling out the application form.
4. If you do not know how to fill in the information, it is recommended that you can call the health insurance bureau offices around the world, and the staff will be patient to explain~

If the transportation is convenient, you can also directly request assistance to check the accuracy of the information in order to avoid the notification that the information is not correct after a few weeks of delivery, causing round-trip time and operation troubles