The National Health Insurance Administration (NHIA) yesterday announced that reimbursement of overseas medical care expenses covered by the National Health Insurance (NHI) system are to be reduced from Jan. 1.
People who have joined the NHI system can apply for reimbursement of overseas medical care expenses for treatments covered by the NHI, with the maximum amount from Jan. 1 to be the average expense of the treatment in Taiwan’s medical centers.
There have been many cases of people abusing the system, so the payouts are to be modified for the sake of fairness, the agency said.
NHIA official Lin Bao-feng (林寶鳳) said some people who sought medical attention abroad were claiming more than the average cost of the same treatment in Taiwan.
She cited cases where people had claimed NT$1,273 (US$42.44) for treatment for a cold — something that costs NT$420 in Taiwan.
The NHIA had discovered several cases of Taiwanese cooperating with clinics in China to defraud the NHI system through the overseas expenses mechanism.
The maximum payout for hospital and clinic visits varies, but the maximum amount this year was NT$2,001 for an outpatient visit, NT$3,636 for an emergency room visit and NT$7,535 per day for people who are hospitalized, Lin said.
The reduced payouts are expected to be NT$865 for each outpatient visit, NT$2,412 for each emergency room visit and NT$5,295 per day for people who are hospitalized, she said.
There were about 13,000 cases of overseas medical care expenses claims last year, which cost the system about NT$370 million, with about 10,000 cases reported in China, which cost about NT$260 million, the administration said.
Total reimbursement is expected to be reduced by NT$100 million next year after the new standards are enforced, the NHIA said, adding that foreign hospitals or clinics that submitted fake claims would be blacklisted.
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