February 2025
Amendment to the Enforcement Rules of the National Health Insurance Act: Abolishment of Suspension and Resumption Mechanism in National Health Insurance Coverage (Taiwan)
On December 23, 2024, the Ministry of Health and Welfare amended the Enforcement Rules of the National Health Insurance Act (hereinafter “Enforcement Rules”) to remove provisions related to the suspension and resumption of National Health Insurance (hereinafter “NHI”) coverage. This amendment aims to comply with the Constitutional Court’s Judgment 111-Hsien-Pan-19 and further enhance the legality and fairness of the NHI system. The revised Enforcement Rules also include transitional provisions to safeguard the rights of individuals who suspended their NHI coverage before or on December 22, 2024.
1. Summary of Judgment 111-Hsien-Pan-19 (2022)
Regarding Articles 37, Paragraph 1, Subparagraph 2, and Article 39, Paragraph 1, Subparagraph 2 of the original Enforcement Rules, which regulated the suspension and resumption of NHI coverage, the Constitutional Court ruled that:
(1) NHI is a mandatory social insurance system with functions of social assistance and risk-sharing, involving significant public interests. Therefore, it must be explicitly authorized by law or administrative regulations clearly delegated by law, in accordance with the principle of legal reservation.
(2) While the aforementioned provisions did not violate the proportionality principle (Article 23 of the Constitution of the Republic of China), nor infringe upon the right to manage personal health risks (Article 22 of the Constitution of the Republic of China), the protection of property rights (Article 15 of the Constitution of the Republic of China), or the right to equality (Article 7 of the Constitution of the Republic of China), the lack of explicit legal authorization rendered them unconstitutional.
(3) Consequently, these provisions lost their effect two years after the Constitutional Court ruling was published on December 23, 2022.
2. Amendments to the Enforcement Rules
(1) Removal of Suspension and Resumption Provisions
The original Articles 37 to 39 concerning NHI suspension and resumption have been deleted. From December 23, 2024, the National Health Insurance Administration (hereinafter “NHIA”) will no longer accept applications for insurance suspension.
All citizens with household registration in Taiwan must remain insured and continue paying premiums. If an insured individual experiences an unexpected medical emergency or childbirth abroad, they may seek treatment at a local medical institution and apply for reimbursement from the NHIA upon their return, providing proper documentation.
(2) Adjustment of Insurance Qualifications for Veterans and Their Dependents
Article 16 of the Enforcement Rules has been amended to align with the Veterans Affairs Council's policies under the Veterans Assistance Act. If a veteran loses their veteran benefits, the veteran and the household representative of survivors of veterans must switch to another eligible insurance category to continue NHI coverage.
(3) Establishment of Transitional Provisions
The amendment introduces Article 36-1 to the Enforcement Rules, specifying that:
a. Individuals who suspended their NHI coverage before or on December 22, 2024, may resume coverage before this date and pay the required premiums in accordance with the original Enforcement Rules;
b. If the suspension period extends beyond December 23, 2024, the suspension must be canceled, resumed, or subject to supplementary premium calculations on the day of their return to Taiwan, as per the original Enforcement Rules. Once the NHI coverage is resumed, further suspension will no longer be permitted1;
c. Government officials stationed abroad, along with their accompanying spouses and children, must resume their NHI coverage on the day of their return to Taiwan. After resumption, suspension will no longer be permitted.
1. Summary of Judgment 111-Hsien-Pan-19 (2022)
Regarding Articles 37, Paragraph 1, Subparagraph 2, and Article 39, Paragraph 1, Subparagraph 2 of the original Enforcement Rules, which regulated the suspension and resumption of NHI coverage, the Constitutional Court ruled that:
(1) NHI is a mandatory social insurance system with functions of social assistance and risk-sharing, involving significant public interests. Therefore, it must be explicitly authorized by law or administrative regulations clearly delegated by law, in accordance with the principle of legal reservation.
(2) While the aforementioned provisions did not violate the proportionality principle (Article 23 of the Constitution of the Republic of China), nor infringe upon the right to manage personal health risks (Article 22 of the Constitution of the Republic of China), the protection of property rights (Article 15 of the Constitution of the Republic of China), or the right to equality (Article 7 of the Constitution of the Republic of China), the lack of explicit legal authorization rendered them unconstitutional.
(3) Consequently, these provisions lost their effect two years after the Constitutional Court ruling was published on December 23, 2022.
2. Amendments to the Enforcement Rules
(1) Removal of Suspension and Resumption Provisions
The original Articles 37 to 39 concerning NHI suspension and resumption have been deleted. From December 23, 2024, the National Health Insurance Administration (hereinafter “NHIA”) will no longer accept applications for insurance suspension.
All citizens with household registration in Taiwan must remain insured and continue paying premiums. If an insured individual experiences an unexpected medical emergency or childbirth abroad, they may seek treatment at a local medical institution and apply for reimbursement from the NHIA upon their return, providing proper documentation.
(2) Adjustment of Insurance Qualifications for Veterans and Their Dependents
Article 16 of the Enforcement Rules has been amended to align with the Veterans Affairs Council's policies under the Veterans Assistance Act. If a veteran loses their veteran benefits, the veteran and the household representative of survivors of veterans must switch to another eligible insurance category to continue NHI coverage.
(3) Establishment of Transitional Provisions
The amendment introduces Article 36-1 to the Enforcement Rules, specifying that:
a. Individuals who suspended their NHI coverage before or on December 22, 2024, may resume coverage before this date and pay the required premiums in accordance with the original Enforcement Rules;
b. If the suspension period extends beyond December 23, 2024, the suspension must be canceled, resumed, or subject to supplementary premium calculations on the day of their return to Taiwan, as per the original Enforcement Rules. Once the NHI coverage is resumed, further suspension will no longer be permitted1;
c. Government officials stationed abroad, along with their accompanying spouses and children, must resume their NHI coverage on the day of their return to Taiwan. After resumption, suspension will no longer be permitted.
