Regulations for the National Health Insurance Reimbursement of the Self-advanced Medical Expenses Article 6
The reimbursement of medical expenses, which the Insurer approves after its review, shall be made according to the following requirements and standards:1. The Insurer shall make reimbursement in cases that take place within the Taiwan area pursuant to the regulations governing the review, payment, benefit payment, and co-payment of the Insurance medical expenses;2. The Insurer shall make reimbursement in cases that take place outside the Taiwan area after it reviews and approves the application according to the regulations governing the payment and benefit payment of the Insurance medical expenses. However, in the event that the amount of self-advanced Insurance medical expenses under reimbursement application exceeds the average amount that the Insurer paid to all contracted hospitals or clinics for emergency treatment per patient, outpatient visit per patient, or inpatient care per patient day of the previous quarter of the date when the applicant receives emergency treatment or outpatient care or is discharged from the hospital, any amount in excess of the abovementioned average amount will not be reimbursed.The Insurer shall promulgate the standards for reimbursement set forth in Subparagraph 2 of the preceding paragraph every quarter.
中文原文 全民健康保險自墊醫療費用核退辦法第6條
保險人審查結果，認應核退醫療費用時，應依下列規定及基準辦理：
一、發生於臺灣地區內之案件：由保險人依本保險醫療費用審查、支付、給付及自行負擔費用等有關規定辦理核退。
二、發生於臺灣地區外之案件：由保險人依本保險醫療費用支付及給付規定審查後核實給付。
但申請費用高於其急診、門診治療日或出院之日前一季本保險支付特約醫院及診所急診每人次、門診每人次、住院每人日平均費用基準者，其超過部分，不予給付。
前項第二款有關核退費用之基準，由保險人每季公告之。
一、發生於臺灣地區內之案件：由保險人依本保險醫療費用審查、支付、給付及自行負擔費用等有關規定辦理核退。
二、發生於臺灣地區外之案件：由保險人依本保險醫療費用支付及給付規定審查後核實給付。
但申請費用高於其急診、門診治療日或出院之日前一季本保險支付特約醫院及診所急診每人次、門診每人次、住院每人日平均費用基準者，其超過部分，不予給付。
前項第二款有關核退費用之基準，由保險人每季公告之。