農民健康保險條例

本條文說明本條例的立法目的，並規定本條例未規定的事項，適用其他有關法律。

被保險人退保後重新加保時，原有的保險年資要併計。

This provision sets the monthly insured amount at NT$20,400 and the insurance premium rate at 2.55%. Any adjustment must be drafted by the central competent authority, considering specified factors, and then submitted to the Executive Yuan for approval.

This provision splits the insurance premium between the insured person and government, and further allocates the government subsidy between central and local authorities depending on location.

被保險人要按期繳納自己負擔的保險費；投保單位在每年5月底前和11月底前收到後，應在30日內把保險費繳到保險人指定的金融機構。

投保單位逾期未繳保險費時，可先寬限30日；再逾期會按日加徵滯納金，但最高不超過應納費額一倍。

If the insured person does not pay premiums on time, there may be a 30-day grace period; after that, benefits can be temporarily refused until premiums and late fees are paid, and benefits already received during the unpaid period can be recovered.

各級政府繳納其應負擔的保險費，期限與被保險人相同；逾期可寬限30日，仍未繳納的，需按日計算利息，且保險人可請求扣減補助款並移送強制執行。

在保險效力開始後、停止前發生保險事故時，被保險人、其受益人或支付殯葬費的人可以依本條例請領保險給付。

被保險人在符合條件時，仍可在停效後一年內領取保險給付；住院中的被保險人如被認定可出院療養，應立即出院。

The same insurance benefit cannot be claimed more than once for the same accident.

如果投保單位替不符本條例規定的人辦理參加保險並已領取保險給付，保險人應依法追還，並取消該被保險人資格。

This provision classifies the farmers health insurance incidents into five types and states the related benefits that are provided.

如果被保險人出現列舉情形之一，保險給付不予給付。

保險人或農民健康保險監理委員會在必要時，可以向投保單位、特約醫療機構或其他有關機關調查被保險人的保險相關文件。

被保險人、受益人或負擔殯葬費的人，有領取各種保險給付的權利；這項權利不得讓與、抵銷、扣押或供擔保。

保險給付的請求權，自可以請領之日起算，若五年內不行使就消滅。

被保險人或其配偶在參加保險後分娩或早產時，得請領生育給付。

生育給付按規定發給；分娩或早產者，按事故發生當月投保金額一次給與三個月，雙生以上者按比例增加。

被保險人罹患傷病時，除緊急傷病外，應向保險人自設或特約的醫療機構申請診療；經特約醫療機構建議住院者，得申請住院治療。普通疾病申請住院診療前，參加保險年資須合計滿45日。

門診給付範圍包括診察、藥劑或治療材料，以及處置、手術或治療；相關費用由被保險人自行負擔百分之十，但不得超過中央主管機關規定的最高負擔金額。

住院診療給付包括診察、藥劑或治療材料、處置手術或治療等項目；部分費用由被保險人負擔5%，且有最高負擔上限。

住院超過一個月時，醫療機構每月要辦理一次繼續住院手續；若經診斷可出院療養，保險人應即出院，否則繼續住院費用由被保險人負擔。

This provision says which authority is the主管機關 for the insurance: the Council of Agriculture at the central level, the municipal government in a special municipality, and the county/city government in a county or city.

被保險人有權自由選擇在保險人自設或特約醫療機構接受診療；如有特別規定，依特別規定辦理。

領取身心障礙給付後，因同一傷病致身心障礙的被保險人，不得再以同一傷病申請住院診療。

保險人要直接支付被保險人診療所需費用給其自設或特約醫療機構；被保險人不得領取現金。

緊急傷病在非自設或特約醫療機構就醫時，被保險人要在門診結束或出院後兩個月內備妥醫療證明與費用憑證，透過投保單位向保險人申請給付；超過規定標準的部分由被保險人自行負擔。

中央主管機關會同中央衛生主管機關，訂定本保險特約醫療機構的特約與管理辦法及診療費用支付標準。

If claim forms are noncompliant, false, or used by someone other than the insured, the insured unit must pay all treatment costs. If the situation was not attributable to the insured unit, the insurer may ask the insured unit to help recover from the insured person. For non-covered treatment provided by a contracted medical institution, the treatment cost is borne by the institution or the insured person.

符合永久身心障礙條件的被保險人，可以按當月投保金額和給付標準一次請領身心障礙給付；若在診斷書記載的身心障礙當日死亡，則不給付。

保險人應依身心障礙加重或新增的程度計算並發給身心障礙給付，但合計不得超過第一等級給付上限。

保險人得為審核身心障礙給付，聘請醫學專家審查相關診斷、檢查與病歷；如認為需要複檢，也可另指定醫院或醫師。

If an insured person has received disability benefits under Article 36 and the insurer determines they cannot continue agricultural work, the insurance coverage ends at 24:00 on the date stated in the disability diagnosis certificate.

本條指定本保險的保險人，並規定由誰組成監理委員會，以及中央主管機關負責訂定相關組織與爭議審議辦法。

被保險人死亡時，會按其當月投保金額發給十五個月的喪葬津貼，並由支出殯葬費的人領取。

The insurance fund comes from four sources: the government’s one-time start-up payment, net balances from premiums and related income after benefit payments, late-payment charges on premiums, and returns from fund investments.

本保險基金只能按規定用途運用，不能挪作他用或轉讓處分；保險人還要每年向中央主管機關報請公告基金收支運用情形及積存數額。

保險人應按年度應收保險費總額的 5.5% 編列本保險所需經費預算，並經農民健康保險監理委員會審議通過。

如果本保險年度結算有虧損，相關機構可以申請中央主管機關補助；中央主管機關也要立即檢討虧損原因，並在認為需要時依規定程序調整保險費率。

中央主管機關得試辦農民職業災害保險；勞工保險局是保險人，基層農會是投保單位，保險費由被保險人及政府依比例負擔。

申請參加本保險的人，會同時被視為也申請參加本職災保險；中央主管機關並可訂定本職災保險試辦相關辦法。

If the occupational accident insurance funds or annual settlement have a deficit, Articles 43 and 44 apply mutatis mutandis.

If insurance benefits or treatment fees are obtained by fraud or other improper conduct, the amount may be fined at twice the amount received, civil damages may be claimed, and criminal matters are referred to the judicial authorities. A contracted medical institution may deduct related treatment fees from the amount it has reported as payable.

投保單位如果未依規定辦理投保手續，會被處以罰鍰，金額為被保險人應負擔保險費的一半，並且要依給付標準賠償農民因此受到的損失。

農民在投保單位審查資格通過後，如果不參加本保險，會被處以罰鍰。

If a fine under this regulation remains unpaid more than 30 days after a demand notice is served, the matter is sent to court for compulsory enforcement.

This provision says the insurer is the authority that makes penalty-related dispositions under the regulation.

Insurance account books, receipts, and business receipts and expenditures covered by this provision are exempt from taxation.

Certain insured persons may apply to withdraw or retroactively withdraw from insurance, and some former farm-association members are exempt from the prior participation restriction.

The central authority or insurer may ask related agencies for data needed to verify an insured person's eligibility, and agencies may not refuse without justifiable reason.

符合條件的農會會員或年滿15歲以上從事農業工作的農民，可以參加本保險；部分既有被保險人也可續保或重新申請。

符合條件的人可以申請參加本保險；部分人再參加時也不受原本的未領取老年給付限制，但仍有年齡、既領給付類型與未領取其他老年給付等條件。

中央主管機關有權訂定本條例的施行細則。

This provision sets when the act and certain amendments take effect, and gives the Executive Yuan power to set the commencement date for specified later amendments.

農民原則上應參加本保險；若同時符合國民年金保險加保資格，可以選擇參加國民年金保險。已參加本保險者，如再參加其他所列保險，原則上應退保，但部分勞保情形除外。

An insured person may continue participating in the insurance if one of the listed conditions is met.

各投保單位應為其轄區內符合第五條規定的農民辦理投保手續及相關保險事務，並備妥名冊供保險人查對。

投保單位必須在農民投保資格審查通過加保或退保的當天，向保險人列表通知；保險效力也從應通知當日起算。

加保、退保申報表若缺少姓名，保險人不受理；若少蓋印章或少填身分資料，保險人要書面通知投保單位補正，投保單位須在通知翌日起10日內補正。

This is Chapter 1, titled “General Provisions.”

This chapter is titled “Insurance Premiums.”

This chapter concerns insurance benefits.

This is a heading for the section of general rules.

Section heading: Maternity Benefit.

This section is titled “Medical Benefits.”

This section is titled “Chapter 46 — Disability benefits.”

This chapter is titled “Insurers, insured units, and insured persons.”

This provision is a section heading for funeral subsidy.

This chapter concerns insurance funds and expenses.

This chapter is about farmer occupational accident insurance.

This chapter is titled “Penalties.”

This is the heading for Chapter 7, titled Supplemental Provisions.