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National Health Insurance (Employer-sponsored Insurance)

Medical Allowance (Cash)

Medical Allowance (Cash)

What is a medical allowance?

- When an employer-sponsored insurance subscriber or his/her dependent receives treatment of an illness or injury or delivers a child at an institution similar to a medical institution due to urgency or another compelling reason, or makes a delivery at a location which is not a medical institution, the value of the due medical benefits can be received as a medical allowance from the Service (Paragraph 1 of Article 49 of the National Health Insurance Act).

Institutions Similar to a Medical Institution

- Institutions similar to a medical institution are as follows (Paragraph 1 of Article 49 of the National Health Insurance Act and Paragraph 2 of Article 23 of the Enforcement Regulations of the National Health Insurance Act):

· Institutions excluded from the category of medical institutions in accordance with Article 42 of the National Health Insurance Act

· Vendors of drugs that are not a medical institution and sell the following items to chronic renal failure patients who receive medical benefits for peritoneal dialysis

√ Peritoneal dialysate

√ Consumable materials used for automated peritoneal dialysis (only vendors of drugs registered with the Service)

· Institutions which are not a medical institution providing oxygen therapy with the use of a medical oxygen generator, and which are registered with the Service (limited to eligible patients only)

· Vendors of medical devices which are not a medical institution, which sell consumable materials used for blood sugar tests and insulin injections to diabetics, and which are registered with the Service

· Vendors of medical devices which are not a medical institution, which sell consumable materials used for self-catheterization to neurogenic bladder patients, and which are registered with the Service

· Institutions which are not a medical institution, which loan respirators and cough assist equipment to patients that need them, and which are registered with the Service

· Any institution that is registered with the National Health Insurance Service as an institution other than a medical treatment institution that lends a patient a CPAP

Eligibility and Application for Medical Allowance

- Eligibility for a medical allowance and the methods of application are as follows (Paragraphs 1 and 3 of Article 23 of the Enforcement Regulations of the National Health Insurance Act):

Eligibility for medical allowance	How to apply
When treatment of illness, injury, or delivery (including stillbirth after the sixteenth week of pregnancy) is received because of an inability to access a medical institution or the unavailability of a medical institution	▪ Application for Medical Care Expense (attached Form 18 of 「Enforcement Rule of the National Health Insurance Act」) ▪ A copy of medical bill (prescription for medical expenses in the case of pharmacies) or tax invoice (including electronic version) ▪ Proof of the reason why treatment at a medical institution couldn't be accessed
When a chronic kidney disease patient purchases peritoneal dialysate or consumable materials used for automated peritoneal dialysis from a vendor of drugs that is not a medical institution after being issued a prescription by a doctor	▪ Application for Medical Care Expense (attached Form 18 of 「Enforcement Rule of the National Health Insurance Act」) ▪ Prescription ▪ One copy of each x-document verifying the payment receipt paid by the insured or dependent, such as a tax invoice or cash receipt
When a neurogenic bladder patient purchases consumable materials used for self-catheterization from a vendor of drugs that is not a medical institution after being issued a prescription by a doctor
When a patient requiring oxygen therapy receives oxygen therapy through the method announced by the Minister of Health and Welfare after being issued a prescription by a doctor	▪ Application for Medical Care Expense (attached Form 19 of 「Enforcement Rule of the National Health Insurance Act」) ▪ Prescription ▪ Proof of receipt of oxygen therapy ▪ One copy of each x-document verifying the payment receipt paid by the insured or dependent, such as a tax invoice or cash receipt
When a diabetes patient purchases consumable materials or diabetes control devices used for blood sugar testing or insulin injections from a vendor of drugs that is not a medical institution after being issued a prescription by a doctor ※ Medical allowance related to diabetes control devices shall apply to purchases based on prescriptions issued after January 1, 2020).	▪ Application for Medical Care Expense (attached Form 19-3 of 「Enforcement Rule of the National Health Insurance Act」) ▪ Prescription ▪ One copy of each x-document verifying the payment receipt paid by the insured or dependent, such as a tax invoice or cash receipt
When a patient with an illness announced by the Minister of Health and Welfare who requires a respirator or cough assist equipment borrows a respirator or cough assist equipment after being issued a prescription by a doctor	▪ Application for Medical Care Expense (attached Form 19-4 of 「Enforcement Rule of the National Health Insurance Act」) ▪ Prescription ▪ Proof of having borrowed a respirator or cough assist equipment ▪ One copy of each x-document verifying the payment receipt paid by the insured or dependent, such as a tax invoice or cash receipt
When a patient with sleep apnea borrows and uses, a CPAP machine based on a prescription	▪ Application for Medical Care Expense (attached Form 19-5 of 「Enforcement Rule of the National Health Insurance Act」) ▪ Prescription ▪ Proof of having borrowed a CPAP ▪ One copy of each x-document verifying the payment receipt paid by the insured or dependent, such as a tax invoice or cash receipt
When a delivery takes place at a location that is not a medical institution	▪ Application for Medical Care Expense (attached Form 18 of 「Enforcement Rule of the National Health Insurance Act」) ▪ Proof of delivery

※ See Attached Table 6 of the Standards and Methods of Medical Expense Coverage by National Health Insurance for the issuing criteria and values of different medical allowances.