Payment Standards of the Compulsory Automobiles Liability Insurance Article 2
The Insurer shall pay personal injury medical expense benefits only for necessary and reasonable relevant medical expenses actually incurred to the injured party in respect of his/her bodily injury suffered in an automobile traffic accident. The total of personal injury medical expense benefits is limited to NT$200,000 per person in any one accident.The relevant medical expenses referred to in the preceding paragraph shall cover the following expenses:1. "First-aid expense" means the expense for salvage search, ambulance and ambulance staff.2. "Expense for medical treatment" means:(1) The injured party receives the National Health Insurance coverage:A: The payment subject to the National Health Insurance Act and the related beneficiaries expenses paid by the injured party.B: The Non National Health Insurance Payment : Only for ward expense, registration fee, medical certificate fee, meal expense, deductible expense for material and installation of artificial limbs, teeth and eyes paid by the injured party, and any other expenses for medical material (supplementary equipments included) and other protective tools necessary certified by medical doctors.(2) The injured party doesn't receive the National Health Insurance coverage: The medical treatment expense may not exceed the standard amount paid for such treatment during the previous quarter from the date when the applicant receives the emergency treatment, or outpatient care, or is discharged from the hospital, as regulated in the Regulations for NHI Reimbursement of the Self-advanced Medical Expenses prescribed by the Ministry of Health and Welfare. If the injured party can provide the whole medical expense fits the National Health Insurance items and standards, all the medical expenses shall apply mutatis mutandis to the NHI Payment Standards.3. "Transportation expense" means the reasonable transportation expense for round-trip, transfer, or leave from a qualified hospital or clinic.4. "Nursing expense" means the expense for special nursing or nursing in hospitalization due to severe bodily injuries. But the necessity for home nursing must be certified by a qualified medical doctor.The payment of expense for medical treatment referred to in subparagraph 2 of the preceding paragraph is limited as follows:1. Deductible for ward expense: It means the injured party received hospitalization in a qualified hospital or clinic, and a ceiling of NT$1,500 per day.2. Meal expense: It means the injured party received hospitalization in the former subparagraph, and a ceiling of NT$180 per day.3. Deductible expense for the material and installation of artificial limbs: a ceiling of NT$ 50,000 per upper limb or lower limb.4. Expense for the material and installation of artificial teeth: a ceiling of NT$10,000 per tooth and a ceiling of NT$50,000 if more than 5 teeth.5. Expense for the material and installation of artificial eyes: a ceiling of NT$10,000 per eye.6. Other expense for necessary medical material (supplementary equipments included) and other protective tools: NT$20,000.Transportation expense referred to in subparagraph 3 of the paragraph 2 is limited to a ceiling of NT$20,000.Nursing expense referred to in subparagraph 4 of the paragraph 2 is limited to a ceiling of NT$1,200 per day and up to 30 days.After the injured party receives the benefits provided by the National Health Insurance, the insurer of the National Health Insurance may subrogate the right of the injured party to recover the expenses against the insurer of this insurance, subject to Article 95 of the National Health Insurance Act. But the amount of subrogation is limited to the balance of NT$200,000 deducted by the benefits of this insurance to the claimant.The payment for bodily injury medical expense by the Compensation Fund, subject to this Act, does not include the benefits provided by the National Health Insurance.
中文原文 強制汽車責任保險給付標準第2條
受害人因汽車交通事故致身體傷害,強制汽車責任保險(以下簡稱本保險)之保險人依本法規定為傷害醫療費用給付時,以其必須且合理之實際支出之相關醫療費用為限。
但每一受害人每一事故之傷害醫療費用給付總額,以新臺幣二十萬元為限。
前項所稱之相關醫療費用,指下列各款費用:
一、急救費用:指救助搜索費、救護車及隨車醫護人員費用。
二、診療費用:
(一)受害人以全民健康保險之被保險人診療者,包括下列:1.全民健康保險法所規定給付範圍之項目及受害人依法應自行負擔之費用。
2.非全民健康保險法所規定給付範圍之項目,以病房費差額、掛號費、診斷證明書費、膳食費、自行負擔之義肢器材及裝置費、義齒或義眼器材及裝置費用,及其他經醫師認為治療上必要之醫療材料(含輔助器材費用)及非具積極治療性之裝具所需費用為限。
(二)受害人非以全民健康保險之被保險人診療者,其診療費用不得高於衛生福利部所訂全民健康保險自墊醫療費用核退辦法規定急診、門診治療日或出院日前一季之平均費用標準。
但請求權人就其全部診療費用,提供該全民健康保險給付項目及費用之證明文件時,得按受害人以全民健康保險之被保險人診療者之規定核付。
三、接送費用:指受害人於合格醫療院所,因往返門診、轉診或出院之合理交通費用。
四、看護費用:指受害人於住院期間因傷情嚴重所需之特別護理費及看護費等。
但居家看護以經合格醫師證明確有必要者為限。
前項第二款所規定診療費用,其限額如下:
一、自行負擔之病房費差額:指受害人於合格醫療院所接受住院治療期間支付之病房費用,每日以新臺幣一千五百元為限。
二、膳食費:指前款在醫療院所住院期間之膳食費用,每日以新臺幣一百八十元為限。
三、自行負擔之義肢器材及裝置費:每一上肢或下肢以新臺幣五萬元為限。
四、義齒器材及裝置費:每缺損一齒以新臺幣一萬元為限。
但缺損五齒以上者,合計以新臺幣五萬元為限。
五、義眼器材及裝置費:每顆以新臺幣一萬元為限。
六、其他非全民健康保險法所規定給付範圍之醫療材料(含輔助器材費用)及非具積極治療性之裝具:以新臺幣二萬元為限。
第二項第三款所規定之接送費用,以新臺幣二萬元為限。
第二項第四款所規定之看護費用,每日以新臺幣一千二百元為限,但不得逾三十日。
受害人接受全民健康保險提供之給付,由全民健康保險之保險人依全民健康保險法第九十五條規定,向本保險之保險人代位請求。
但其代位金額以新臺幣二十萬元扣除本保險保險人給付請求權人金額後之餘額為限。
特別補償基金依本法規定為傷害醫療費用給付之補償時,不包括全民健康保險之給付金額。
但每一受害人每一事故之傷害醫療費用給付總額,以新臺幣二十萬元為限。
前項所稱之相關醫療費用,指下列各款費用:
一、急救費用:指救助搜索費、救護車及隨車醫護人員費用。
二、診療費用:
(一)受害人以全民健康保險之被保險人診療者,包括下列:1.全民健康保險法所規定給付範圍之項目及受害人依法應自行負擔之費用。
2.非全民健康保險法所規定給付範圍之項目,以病房費差額、掛號費、診斷證明書費、膳食費、自行負擔之義肢器材及裝置費、義齒或義眼器材及裝置費用,及其他經醫師認為治療上必要之醫療材料(含輔助器材費用)及非具積極治療性之裝具所需費用為限。
(二)受害人非以全民健康保險之被保險人診療者,其診療費用不得高於衛生福利部所訂全民健康保險自墊醫療費用核退辦法規定急診、門診治療日或出院日前一季之平均費用標準。
但請求權人就其全部診療費用,提供該全民健康保險給付項目及費用之證明文件時,得按受害人以全民健康保險之被保險人診療者之規定核付。
三、接送費用:指受害人於合格醫療院所,因往返門診、轉診或出院之合理交通費用。
四、看護費用:指受害人於住院期間因傷情嚴重所需之特別護理費及看護費等。
但居家看護以經合格醫師證明確有必要者為限。
前項第二款所規定診療費用,其限額如下:
一、自行負擔之病房費差額:指受害人於合格醫療院所接受住院治療期間支付之病房費用,每日以新臺幣一千五百元為限。
二、膳食費:指前款在醫療院所住院期間之膳食費用,每日以新臺幣一百八十元為限。
三、自行負擔之義肢器材及裝置費:每一上肢或下肢以新臺幣五萬元為限。
四、義齒器材及裝置費:每缺損一齒以新臺幣一萬元為限。
但缺損五齒以上者,合計以新臺幣五萬元為限。
五、義眼器材及裝置費:每顆以新臺幣一萬元為限。
六、其他非全民健康保險法所規定給付範圍之醫療材料(含輔助器材費用)及非具積極治療性之裝具:以新臺幣二萬元為限。
第二項第三款所規定之接送費用,以新臺幣二萬元為限。
第二項第四款所規定之看護費用,每日以新臺幣一千二百元為限,但不得逾三十日。
受害人接受全民健康保險提供之給付,由全民健康保險之保險人依全民健康保險法第九十五條規定,向本保險之保險人代位請求。
但其代位金額以新臺幣二十萬元扣除本保險保險人給付請求權人金額後之餘額為限。
特別補償基金依本法規定為傷害醫療費用給付之補償時,不包括全民健康保險之給付金額。