National Health Insurance Act Article 5

The National Health Insurance Committee (hereinafter referred to as the “NHIC”) shall be in charge of the following tasks:1. Review of insurance premiums;2. Review of the scope of benefits;3. Coordination of drafting and allocation of medical benefit payments;4. Study and interpretation of insurance laws and policies;5. Other supervisory functions pertaining to insurance matters.When the review and coordination done by the NHIC in the preceding paragraph find a reduction in insurance revenues or increase in insurance expenditures, it shall ask the Insurer to present a proposal for resource allocation and financial balance to be reviewed or coordinated jointly.When the NHIC reviews and coordinates matters relevant to this Insurance, it shall make its agenda public seven days before the meeting and the meeting minutes within ten days after the meeting. Before reviewing and coordinating major matters, it shall gather information on public opinion and organize related activities involving the public if necessary.The NHIC is made up of insureds, employers, insurance medical service providers, experts, reputable public figures, and representatives from relevant agencies. Representatives from premium payers shall not be less than one-half of the total number of NHIC members, while representatives from the insureds shall not be less than one-third.The Competent Authority shall determine the number of members, how they are selected, meeting regulations, self-disclosure of the representative’s interest, and disclosure to the public.Matters reviewed and coordinated by the NHIC shall be approved by the Competent Authority or presented to the Executive Yuan for approval. Matters approved by the Executive Yuan shall be sent to the Legislative Yuan for future reference.
中文原文 全民健康保險法第5條
本保險下列事項由全民健康保險會(以下稱健保會)辦理:
一、保險費率之審議。
二、保險給付範圍之審議。
三、保險醫療給付費用總額之對等協議訂定及分配。
四、保險政策、法規之研究及諮詢。
五、其他有關保險業務之監理事項。
健保會為前項之審議或協議訂定,有減少保險收入或增加保險支出之情事時,應請保險人同時提出資源配置及財務平衡方案,併案審議或協議訂定。
健保會於審議、協議本保險有關事項,應於會議七日前公開議程,並於會議後十日內公開會議實錄;於審議、協議重要事項前,應先蒐集民意,必要時,並得辦理相關之公民參與活動。
健保會由被保險人、雇主、保險醫事服務提供者、專家學者、公正人士及有關機關代表組成之;其中保險付費者代表之名額,不得少於二分之一;且被保險人代表不得少於全部名額之三分之一。
前項代表之名額、產生方式、議事規範、代表利益之自我揭露及資訊公開等有關事項之辦法,由主管機關定之。
健保會審議、協議訂定事項,應由主管機關核定或轉報行政院核定;其由行政院核定事項,並應送立法院備查。

English translation for reference only; the Chinese text prevails. Not legal advice.