Regulations Governing the Access, Review, Inquiry, and Visit pertaining to National Health Insurance Information
2012-10-23
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Article 1
These regulations are made pursuant to Paragraph 2 of Article 80 of the National Health Insurance Act (hereinafter referred to as the “Act”).
Article 2
The scope of the documents and relevant information stipulated in Paragraph 1 of Article 80 of the Act is as follows:
1. relevant information pertaining to the classification/status, the insured payroll-related amount, income from salary and wage, payment of insurance premium, and medical utilization of a beneficiary;
2. account books, ledgers and receipts, rosters, and forms pertaining to the handling of the National Health Insurance (hereinafter referred to as the “Insurance”)-related affairs maintained by group insurance applicants, premium withholders and contracted medical care institutions;
3. information concerning the supplementary insurance premiums withheld by premium withholders in accordance with the law;
4. medical records, prescription slips, and treatment records of a beneficiary held by contracted medical care institutions;
5. costs related to medical expenses incurred by contracted medical care institutions, self-covered items and detailed billing statements of a beneficiary, records of attendance and duty shifts of all categories of medical personnel, information concerning the deployment of medical equipment and all types of hospital beds as well as statistics on the utilization of insured hospital beds;
6. transaction information (including items descriptions, prices, quantities, supporting documents, and contracts) pertaining to the purchase by contracted medical care institutions of drugs reimbursed under the Insurance; and
7. any other documents and information related to the Insurance.
1. relevant information pertaining to the classification/status, the insured payroll-related amount, income from salary and wage, payment of insurance premium, and medical utilization of a beneficiary;
2. account books, ledgers and receipts, rosters, and forms pertaining to the handling of the National Health Insurance (hereinafter referred to as the “Insurance”)-related affairs maintained by group insurance applicants, premium withholders and contracted medical care institutions;
3. information concerning the supplementary insurance premiums withheld by premium withholders in accordance with the law;
4. medical records, prescription slips, and treatment records of a beneficiary held by contracted medical care institutions;
5. costs related to medical expenses incurred by contracted medical care institutions, self-covered items and detailed billing statements of a beneficiary, records of attendance and duty shifts of all categories of medical personnel, information concerning the deployment of medical equipment and all types of hospital beds as well as statistics on the utilization of insured hospital beds;
6. transaction information (including items descriptions, prices, quantities, supporting documents, and contracts) pertaining to the purchase by contracted medical care institutions of drugs reimbursed under the Insurance; and
7. any other documents and information related to the Insurance.
Article 3
The competent authority administering the Insurance (the “Competent Authority”) or the insurer under the Insurance (the “Insurer”) shall clearly state in an official document the legal grounds and reasons for the request and the name(s) and item(s) of the requested document(s) or information, when requesting a group insurance applicant, a premium withholder, or a contracted medical care institution to provide the requested document(s) or information. In the event of a straightforward or urgent case, the Competent Authority or the Insurer may notify the respondent by sending the official document via facsimile, whereupon the respondent should appoint a designated person to respond to phone inquiries.
The respondent of the phone inquiries mentioned in the preceding paragraph may, if the respondent considers it necessary, further provide written information within three days following the phone inquiries.
The respondent of the phone inquiries mentioned in the preceding paragraph may, if the respondent considers it necessary, further provide written information within three days following the phone inquiries.
Article 4
The Competent Authority or the Insurer shall proceed in accordance with the following provisions when conducting a visit at the premises of a group insurance applicant, a contracted medical care institution, a premium withholder or a beneficiary:
1. the Competent Authority or the Insurer shall provide a prior notice in the form of an official document; provided, however, that this requirement shall not apply when not doing so is necessary to prevent the destruction of evidence or collusion between concerned parties, or when there is any urgent situations;
2. the visiting personnel shall, of their own accord, present their visit identification badge and their official credentials issued by their employing agency, and shall state the purpose of the visit. However, for any cases initiated based on a report,, the visiting personnel shall not disclose the source of the case;
3. all methods employed for a visit shall be taken in good faith and comply with the principle of proportionality, and shall not go beyond what is necessary for the visit. All respondents shall be afforded ample opportunity to present their statements; and
4. the visit records shall be produced in detail and accurately and shall be affixed with the signatures, seals, or fingerprints of the respondents after the respondents have reviewed that visit records.
1. the Competent Authority or the Insurer shall provide a prior notice in the form of an official document; provided, however, that this requirement shall not apply when not doing so is necessary to prevent the destruction of evidence or collusion between concerned parties, or when there is any urgent situations;
2. the visiting personnel shall, of their own accord, present their visit identification badge and their official credentials issued by their employing agency, and shall state the purpose of the visit. However, for any cases initiated based on a report,, the visiting personnel shall not disclose the source of the case;
3. all methods employed for a visit shall be taken in good faith and comply with the principle of proportionality, and shall not go beyond what is necessary for the visit. All respondents shall be afforded ample opportunity to present their statements; and
4. the visit records shall be produced in detail and accurately and shall be affixed with the signatures, seals, or fingerprints of the respondents after the respondents have reviewed that visit records.
Article 5
Where necessary for a visit, relevant professional personnel may be invited to accompany the visit, make audio recordings, take photographs, or make video recordings during the visit, or access and review, or duplicate documents or relevant information set forth in Article 2.
Article 6
These Regulations shall take effect from January 1, 2013.