COVID-19 Insurance Affected by New Policy 3/20起輕症免隔離 防疫險理賠問題引關注

Starting March 20, people diagnosed with COVID-19 in Taiwan will no longer have to undergo isolation. However, the policy has created new controversy over how patients with mild symptoms diagnosed after that date can apply for epidemic prevention insurance payments. The Financial Supervisory Commission said it will discuss with the Central Epidemic Command Center to clarify any ambiguity.

The policy of co-existing with COVID-19 has taken another step. Starting March 20, mild COVID-19 cases will be exempt from reporting, isolation and follow the "0+n policy of self-health management" instead. However, that means COVID patients might not be able to make a claim in the future.

Citizen: “That's what this insurance is for. It's not certain, but at least there is a guarantee. I think the symptoms will be relatively mild in the future. So it's okay.”

Citizen: “You may not get insurance compensation if you don't isolate. How do you feel about this? It's kind of unfair? Not fair? Yes, a little unfair.”

The Financial Supervisory Commission's Insurance Bureau stated bluntly that in the contract clauses of epidemic prevention insurance, the claim is for statutory infectious disease. So what needs to be clarified is whether mild symptoms that don't require isolation or notification are still considered statutory infectious diseases. COVID-19 still has not yet been downgraded. These details must be clarified with the Central Epidemic Command Center.

Lin Chih-hsien, Deputy Director, Insurance Bureau: “The terms of the contract state that compensation is only for statutory infectious diseases. The premise of the contract is the law. Compensation only takes place if the legal meaning is met. This is the policy's core.”

Martin Sha, Secretary General, ROC Non-Life Insurance Assoc.: “What should be the real terms of the policy? The CDC only said the new policy will be implemented starting March 20. But we don't know some of the details.”

According to FSC statistics, the total number of claims for epidemic prevention insurance and vaccine insurance in January and February this year exceeded 1.01 million. However, February's compensation amount was about NT$19.7 billion, the lowest single-month payout since July last year. As government policy has changed, there will be disputes over epidemic prevention insurance on whether to settle the claim. The FSC will ask the Non-Life Insurance Association to study claim settlement details. 

距離與病毒共存又更進一步，3月20日起，確診新冠肺炎輕症，免通報也免隔離，因法定傳染病必須通報，防疫險恐怕會有不理賠的空間。

民眾說道：「這個保險本來就是這樣，沒有一定就是有就是個保證，我覺得之後確診應該也比較輕症，也還好。」

記者問道：「不用隔離可能就得不到理賠，你會覺得這樣子？」

民眾回應：「有點不公平。」

對此防疫險主管機關金管會保險局直言，防疫險的契約條款中理賠的是法定傳染病，因此要釐清的就是，不隔離也不用通報的輕症是否還符合法定傳染病條件，目前新冠肺炎也還未降級，這些都必須再和指揮中心來釐清。

金管會保險局副局長林志憲表示：「契約條款是說法定傳染病的話，就是要符合理賠條件，前提就是法傳，如果是法傳與否的話後面，才是理賠的一個審酌條件，這個才是核心。」

保險公會秘書長沙克興指出：「到底應該怎麼樣做真正保單的條款，CDC他只講從3月20日實施，可是中間的一些細節我們也還搞不清楚。」

金管會統計，今（2023）年1、2月份防疫險、疫苗險合計理賠件數超過101萬件，不過2月給付金額約197億元，是去年7月以來的單月最低，隨政策調整，防疫險最後一哩路仍有理賠與否的爭議，會請產險公會理賠小組啟動研究。