Click here to download the 2015/2016 Guide to the NHI System in English – at the page use the drop down to select the first link.
Taiwan’s National Health Insurance is one of the best universal coverage systems in the world. Taiwan’s NHI system has 20,453 hospitals and health care providers, or 93.40% of all health care facilities in the country. Another 5,615 pharmacies, 552 home-nursing care institutions, 191 psychiatric community rehabilitation centers, 14 midwife clinics, 219 medical laboratories, 13 physical therapy clinics, nine medical radiology institutions, two occupational therapy clinics and one respiratory care clinic. Do you know what your benefits are? Here is a brief explanation of how your coverage works, so you’ll understand what you are paying and why.
The NHI system offers a comprehensive and uniform benefits package to all those covered by the program. With a valid health insurance IC card, (健保卡）you have access to more than 20,000 contracted medical care facilities (hospitals, clinics, pharmacies and medical laboratories) around the country that offer inpatient and ambulatory care, dental services, traditional Chinese medicine therapies, child delivery services , physical rehabilitation, home care, and chronic mental illness care, among others. The system covers most forms of treatment, including general diagnoses and treatment, medical consultations and operations, and related expenses such as examinations, laboratory tests, anesthesia, prescription medications, supplies, nursing care, hospital rooms, and certain OTC drugs.
The basic co-payment fee for a visit to a western medicine facility is based on whether a patient was referred to the hospital or not. Patients who go directly to medical centers and regional and district hospitals without a referral from a clinic or hospital will pay a higher co-payment than if they have a referral. The co-payment for visits to dentists or traditional Chinese medicine clinics is uniformly NT$50. If drugs prescribed to a patient exceed a certain cost, a co-payment for the medication is also charged. Followup rehabilitation or traditional Chinese medicine treatments for the same course of therapy also carry co-payments of NT$50. (see below)
The co-payments for hospitalized patients are between 5% and 10% for more typical stays of 30 days or less but can go as high as 30% of their bills for longer stays. To minimize inpatients’ financial burden, co-payments on acute ward stays of fewer than 30 days and chronic ward stays of fewer than 180 days are capped by the Ministry of Health and Welfare, with the ceilings adjusted annually. For 2014, caps on hospital stay co-payments were set at NT$32,000 for a single hospital stay for a particular condition and at a cumulative NT$53,000 for the entire calendar year. (see below)
Basic Co-Payments for Outpatient Visits
Basic Co-Payments for Medication & Acute Care
The NHI’s refillable prescription option allows patients with chronic illnesses to get the medication they need by allowing doctors to write long-term prescriptions for them. When doctors certify that a patient has a chronic but stable illness, as recognized by the Ministry of Health and Welfare, they can write a prescription valid for three months covering 90 days of medication. The prescription must be filled in installments, with up to one month of medicine allowed to be dispensed at a time. Those with proof that they will be traveling abroad can collect the entire prescription at once if they present a waiver.
I hope this helps you understand better your benefits and how they work. Please post a comment or question if you need more information.