桃園市企劃從業人員職業工會

為增進遭遇職業傷病被保險人醫療給付權益，

✸ 因職業傷病醫療需要，選用健保所定自付差額特殊材料品項，可申請差額費用補助！
❏ 勞工職業災害保險及保護法上路後，被保險人因職業傷病及其引起之疾病，經全民健康保險特約醫院或診所醫師認定有醫療上需要使用自付差額特殊材料品項者，於先行墊付自付差額後，得向勞工保險局申請核退該差額費用！
➊持由投保單位填發的「職業傷病門診單」或「職業傷病住院申請書」，並繳驗全民健康保險卡及國民身分證或其他足以證明身分的文件。
➋前往全民健康保險特約醫院或診所診療。
➌經醫師認定有醫療上的需要，選用全民健康保險法第45條第1項所定自付差額特殊材料品項者，得向勞保局申請核退該差額費用。
✪ 前述自付差額特殊材料品項，以衛生福利部公告者為限，如被保險人選用「全自費」之醫療材料，非屬職災醫療給付範圍，仍需由被保險人自行負擔喔！
❖勞工職業災害保險自墊醫療費用核退申請書及給付收據 ➥https://pse.is/5nna7k
❖健保自付差額類別及品項 ➥https://pse.is/5nn9vf
❖法令依據 ➥https://pse.is/5mhz3l
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After the implementation of the Labor Occupational Accident Insurance and Protection Act. If due to illness caused by occupational injuries and diseases the insured is identified as having medical needs by the physicians in the NHI hospital or clinic and such insured selects special materials and items, after paying the difference in advance, he may apply to the insurer (the Bureau of Labor Insurance) for the reimbursement of the amount of difference.
➊Hold an occupational injury or disease Clinic Visit Form or Hospitalization Application Form that filled out by the insured unit. And submit the Certificate of National Health Insurance and National Identity Card or other documents sufficient to prove the identity.
➋The insured person who suffers occupational injury or disease shall seek treatment from a contracted hospital or clinic of national health insurance.
➌If the insured is identified as having medical needs by the physicians in the NHI hospital or clinic and such insured selects special materials and items specified in Paragraph 1 of Article 45 of the National Health Insurance Act, after paying the difference in advance, he may apply to the insurer for the reimbursement of the amount of difference.
✪Regarding the aforementioned special materials and items, it is limited to those announced by the Ministry of Health and Welfare. If the insured chooses to use medical materials under "full self-payment," which are not within the scope of occupational injury or disease medical care benefits, the insured is still responsible for bearing the cost.
❖Labor Insurance Occupational Accident Insurance Up-front Medical Expense Reimbursement Application Form and benefit receipt➥ https://pse.is/5nna7k
❖The special materials and items specified of the National Health Insurance Act➥ https://pse.is/5nn9vf
❖Labor Occupational Accident Insurance Medical Care Benefit Item and Payment Standards➥ https://pse.is/5mhz3l

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