Regulations Governing Handling of Group Insurance for Students by Schools at Senior Secondary Level and Below
Announced Date：2018-08-03
These Regulations have been formulated in accordance with the provisions of Paragraph 1 of Article 59 of the Senior High School Education Act and Paragraph 1 of Article 5-1 of the Primary and Junior High School Act.
Article 2
These Regulations are applicable to the educational units listed below (referred to in the following articles as a “school”):
1. Senior secondary schools.
2. Continuing education divisions of senior secondary schools.
3. Elementary schools and junior high schools affiliated with a national university or a national senior secondary school.
Article 3
The school shall arrange group insurance for its students (hereunder referred to as “the group insurance”) in accordance with the provisions of the Government Procurement Act. The insurance company that wins the tender to provide the insurance is the insurer, the school taking out the insurance is the policy holder, and the principal or a person delegated by the principal is the policy holder’s representative.
The procurement referred to in the preceding paragraph may be handled by the Ministry of Education in consultation with the special municipality, city, or county level competent authority.
Article 4
Students shall be enrolled in the group insurance as the Insured.
A student aged 65 or over shall provide information documents regarding their health to be provided to the insurer as for it to refer to decide whether or not to provide such a student with insurance.
The age of the student and of the Insured aged 65 or over referred to in the preceding paragraph, in Paragraph 2 of Article 5, in Paragraph 2 of Article 6, and in the proviso in Article 8 shall be deemed to be the age of the student or the Insured on August 1 of that school year.
Article 5
The Insured’s dying, being disabled or injured, or requiring medical treatment as a result of sickness or an accident are all within the scope of liability of the group insurance. The costs of clinic visits because of sickness, however, are not within the scope of the cover.
If the Insured is aged 65 or over, the scope of their insurance cover is limited to death, disability, injury, or requiring medical treatment as the result of an accident.
The Insured are each insured for an amount of up to NTD $1 million.
The insurance benefit payment items and the amount of cover the group insurance policy provides for each benefit item are set out in a table in the appendix.
Article 6
One-third of the cost of the insurance premium for the group insurance shall be subsidized by the competent authority of the school each school year, and the remainder of the cost shall be paid by the Insured or by their legal representative in two installments, half when registering for the first semester and half when registering for the second semester.
If the Insured is a person aged 65 or over, the Insured shall be responsible for the full cost of their insurance premiums.
Article 7
If the Insured is in any of the categories listed below, the policy holder shall thoroughly examine the associated documentary evidence of their being in such a category, draw up a register of all such students. The policy holder shall send the register to the insurer for compilation and accounting purposes and mail a report to the authority referred to in the preceding article and request the authority to fully subsidize the insurance premiums of the students listed on the register, without being subject to the provisions of the preceding article:
1. A student from a household which has been certified as a low-income household by the special municipality, city, or county government or the township (town, city, district) office where the household is registered.
2. A student with a severe or profound physical or mental disability who has been issued a physical or mental disability manual, or a student who is the child of a person with a severe or profound physical or mental disability.
3. A student who has an indigenous identity.
4. A student who attends a school which is situated in a grade 3 or grade 4 mountain area listed in the Chart of Regional Allowances for Public Teachers Serving in All Institutions and Schools, or in a school in a remote or mountain area.
5. Any student who is receiving their national compulsory education on an offshore island.
Article 8
If a student whose insurance premiums are fully subsidized in accordance with the provisions of the preceding article is hospitalized because of an illness or an accident and, within one year from the date of that event, undergoes a major surgical procedure which is listed in the clauses of the insurance policy, then in addition to the insurance benefit payment that they are entitled to from the group insurance, the student may submit the receipts for the medical treatment expenses they incurred and apply to the insurer for a subsidy of the surgery expenses on a case by case basis. The maximum subsidy paid for such surgical procedure costs is NT$200,000. However, if a student is aged 65 or over, this cover is limited to surgery that was required as a result of an accident.
Article 9
The group insurance is valid from August 1 each year to July 31 of the following year. If a student who takes out the group insurance cover, registers at the school and pays the insurance premium after August 1, their insurance cover will begin retrospectively from August 1.
Any student covered by the group insurance who is in their graduation year who subsequently graduates and is admitted to and registers at a tertiary college or university and has completed payment of the student group insurance premium for students at their tertiary college or university, the insurance cover which they had in secondary school will expire on the day that they complete payment of the premium for their tertiary studies stage student group insurance.
If the student who is in their graduation year referred to in the preceding paragraph does not subsequently continue with further studies, their cover under the group insurance will expire on August 31.
Article 10
If a student enrolls at a school after the semester classes have already begun, the insurance cover begins on the day that their enrollment is approved, and the insurance premium that was payable for the period before their enrollment will not be included in their insurance premium.
If a student loses their student status, their insurance cover ceases from the day that the loss of their student status occurs, and the insurer shall refund a part of the insurance premium that the student paid, based on the proportion of the full semester that the remaining number of months of the semester represent.
If a student transfers to another school that has the same insurer, their insurance premium will not be refunded. The insurance contract will continue to provide cover, and the policy holder shall notify the insurer of the transfer.
If a student suspends their studies, the insurance contract will continue to be valid. The policy holder shall notify the insurer of the student’s name and student number. If the student loses their student status at the end of the suspension period, the policy holder shall notify the insurer.
Article 11
If the Insured dies, is disabled or injured, or falls sick as a result of any of the following circumstances, the insurer is not liable for any insurance benefit payment:
1. Intentional suicidal behavior on the part of the Insured.
2. The Insured was engaged in some criminal activity.
3. The Insured illegally used any drugs specified in the drug-use prevention related ordinances.
4. The Insured undergoes surgery, reconstructive or cosmetic plastic surgery not performed for the purpose of treatment because of an accident covered by the insurance policy, or surgery to treat a congenital deformity. However, reconstructive surgery required as a result of being injured in an accident is not subject to this restriction.
5. War (whether declared or undeclared), civil disorder, or any other similar armed rebellion.
6. Intentional behavior on the part of the Insured or one or more of their beneficiaries.
Article 12
If any one of the following circumstances pertains to the Insured, the insurer is not liable for an insurance benefit payment:
- Abortion or childbirth. This provision does not apply, however, in the case of any one of the following four situations: a miscarriage, childbirth, a cesarean section, or surgery to treat an ectopic pregnancy, if a student became pregnant as the result of being raped.
- Dental restoration or installing artificial teeth, artificial limbs, prosthetic eyes, glasses, hearing aids, or other such accessories. This provision does not apply, however, if any such device is required as a result of an injury sustained because of an accident, and the following requirements are met:
(2) The Insured has a receipt issued by a hospital or clinic.
(3) Such fitting expenses will only be covered once.
3. Health examinations, recuperation, convalescence, drug addiction treatment, alcohol addiction treatment, nursing care, or old age care that is not directly for the purpose of diagnosis and treatment of the patient.
4. Expenses incurred for patient registration, a medical certificate of a diagnosis, transport of an injured person, a ward attendant, or a designated doctor.
5. Medical treatment provided by a person who does not have a medical practitioner’s license.
6. Dental surgery performed not for the purpose of the treatment required because of the accident that resulted in that hospitalization.
Article 13
A beneficiary who intentionally causes the death of the Insured or who unsuccessfully attempts to cause death of the Insured forfeits their right to be a beneficiary.
If a beneficiary has forfeited their right to be a beneficiary under the circumstances referred to in the preceding paragraph, and there is therefore no beneficiary to receive any insurance benefit payment, the insurance benefit payment that the person would have been entitled to receive will become part of the estate of the Insured. If there are any other beneficiaries of that estate, then the portion that the beneficiary who has forfeited their right to be a beneficiary was originally entitled to shall be proportionately allocated to the other beneficiaries in a way mutually agreed upon by those other beneficiaries.
Article 14
At the registration time each semester, the school shall collect the insurance premiums when students pay their student fees and list the premium cost as an additional item in each receipt. Within 20 days after collecting the premiums, the school shall fill out a proposal and two copies of a list of the names of all the Insured, and submit these documents, together with the collected insurance premiums, to the insurer or to an institution designated by the insurer. The insurer shall issue receipts for the insurance premiums and send a receipt to each school to keep.
If the school fails to handle matters in accordance with the provisions of the preceding paragraph, the competent authority shall oversee the matter and expedite the payments.
Article 15
If these Regulations do not have provisions applicable to some matter, the matter shall be handled in accordance with the provisions of the insurance clauses of the insurance policy.
Article 16
Special education schools may apply, mutatis mutandis, the provisions of these Regulations.
Article 17
The Ministry of Education may designate budget allocations for subsidies for the insurance premiums payable by special municipality, city, and county governments.
Article 18
These Regulations are effective from August 1, 2018.
Appendix Unit: New Taiwan Dollar NTD
| Claim Item | Benefit Payment | |||||
| Death Benefit | $1,000,000 | |||||
| Disability Insurance Benefits |
Level 1 | $1,000,000 | Additional Living Costs Subsidy |
After one year: | $150,000 | |
| After two years: | $200,000 | |||||
| After three years: | $250,000 | |||||
| After four years: | $300,000 | |||||
| Level 2 | $900,000 | Additional Living Costs Subsidy |
After one year: | $112,500 | ||
| After two years: | $150,000 | |||||
| After three years: | $187,500 | |||||
| After four years: | $225,000 | |||||
| Level 3 | $800,000 | |||||
| Level 4 | $700,000 | |||||
| Level 5 | $600,000 | |||||
| Level 6 | $500,000 | |||||
| Level 7 | $400,000 | |||||
| Level 8 | $300,000 | |||||
| Level 9 | $200,000 | |||||
| Level 10 | $100,000 | |||||
| Level 11 | $50,000 | |||||
| Medical Treatment Benefits | Hospitalization | Hospitalization Expenses | The maximum payment for a particular accident is $50,000. | |||
| Subsidies on a Case-by-case Basis | 1. Limited to students who are exempt from paying their own insurance premiums. 2. The maximum benefit payment related to a particular event is $200,000. |
|||||
| Outpatient Clinic for an Injury | The maximum benefit payment related to a particular event is $5,000. | |||||
| Burns and Scald Injuries and Required Reconstructive Surgery | The maximum benefit payment related to a particular event is $30,000. | |||||
| Compensation Payment | If the Insured collectively suffer poisoning and need to be hospitalized, each person will be given $3,000. | |||||
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