Rise in Outpatient Surgeries Impacts Medical Insurance Claims; FSC Invites Insurers for Discussion
Taiwan's Financial Supervisory Commission (FSC) convened a meeting with insurers to discuss three major issues regarding medical insurance claims, including whether to relax inpatient claim requirements when inpatient surgeries are changed to outpatient procedures, the definition of 'one-day surgery' claims following the codification of nurse-to-patient ratios, and at-home acute care insurance. Most insurers believe claims should not be relaxed and should adhere to policy contract terms.
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- 📰 Published: June 10, 2026 at 21:57
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(Central News Agency, Taipei, June 10) The Financial Supervisory Commission (FSC) today invited insurance companies to a meeting to discuss three major issues regarding medical insurance claims. These include whether to relax inpatient claim requirements after inpatient surgeries are changed to outpatient procedures, the definition of 'one-day surgery' claims arising from the codification of three-shift nurse-to-patient ratios, and at-home acute care insurance. Regarding whether one-day surgeries can be covered under inpatient medical insurance, most insurers believe that coverage should not be relaxed and should be determined based on policy contract terms.
The FSC Insurance Bureau held the meeting this morning with insurers and related peripheral units, chaired by Deputy Director-General Tsai Huo-yen of the Insurance Bureau. The FSC emphasized after the meeting that today's session was primarily to hear opinions from the industry.
According to sources, the meeting discussed three major topics. The first topic addresses the shift of many inpatient surgeries to outpatient surgeries or treatments due to advancements in medical technology. Current medical insurance policies require an 'inpatient' status to apply for inpatient-related claims.
However, insurers explained that for surgical procedures currently under review that are highly substitutable between inpatient and outpatient settings, the industry has already adopted flexible practices. Common flexible procedures include cataract/lens, uterus, hemorrhoids, hernia, breast tumor, and stone/ESWL surgeries. This means that even without formal admission, claims may still be possible if surgery is performed, though actual determination is made on a case-by-case basis.
Attending insurers stated that the Insurance Bureau did not require comprehensive flexibility but hoped that insurers would establish clear evaluation principles to avoid subsequent claim disputes.
The meeting also discussed whether actual-expense inpatient medical insurance could provide partial coverage for cancer patients undergoing outpatient chemotherapy or radiation therapy.
The second topic is 'one-day surgery,' primarily arising from the codification of three-shift nurse-to-patient ratios. Medical institutions are planning to convert short-stay inpatient surgeries or minimally invasive surgeries into one-day surgeries. Some patients may not meet the policy's definition of 'inpatient' and thus cannot apply for inpatient-related claims.
According to sources, the Insurance Bureau asked insurers whether, if a policyholder is admitted in the morning and discharged in the afternoon or evening, even if staying only one day but having completed admission procedures, the inpatient medical insurance policy would still provide coverage.
Attending insurers reported that most in the industry believe whether to pay claims should be based on the policy contract. To pay a daily inpatient benefit, there must naturally be an inpatient fact. If it was originally an outpatient surgery, it should be determined according to the existing contract, and it is unlikely to relax the definition.
The industry pointed out that under the current medical system, it is practically unlikely for a patient not to be admitted due to personal geographic location, insufficient medical resources, or hospital bed scheduling difficulties. They also hope that the Ministry of Health and Welfare will clarify the scope and definition of 'one-day surgery' and its difference from current outpatient surgeries.
The third topic is the at-home acute care insurance expected to be launched by the end of this year. The FSC is actively communicating with the National Health Insurance Administration of the Ministry of Health and Welfare. The meeting also discussed the feasibility of relaxing inpatient medical insurance claims when conditions that should require inpatient treatment are changed to home-based medical care due to factors such as residence in outlying islands preventing travel to Taiwan proper for medical treatment, insufficient medical resources, or hospital bed scheduling difficulties, in situations not attributable to the policyholder.
Attending insurers stated that the Insurance Bureau made no ruling today. (Editor: Pan Yi-ching, Lin Ke-lun) 1150610
The FSC Insurance Bureau held the meeting this morning with insurers and related peripheral units, chaired by Deputy Director-General Tsai Huo-yen of the Insurance Bureau. The FSC emphasized after the meeting that today's session was primarily to hear opinions from the industry.
According to sources, the meeting discussed three major topics. The first topic addresses the shift of many inpatient surgeries to outpatient surgeries or treatments due to advancements in medical technology. Current medical insurance policies require an 'inpatient' status to apply for inpatient-related claims.
However, insurers explained that for surgical procedures currently under review that are highly substitutable between inpatient and outpatient settings, the industry has already adopted flexible practices. Common flexible procedures include cataract/lens, uterus, hemorrhoids, hernia, breast tumor, and stone/ESWL surgeries. This means that even without formal admission, claims may still be possible if surgery is performed, though actual determination is made on a case-by-case basis.
Attending insurers stated that the Insurance Bureau did not require comprehensive flexibility but hoped that insurers would establish clear evaluation principles to avoid subsequent claim disputes.
The meeting also discussed whether actual-expense inpatient medical insurance could provide partial coverage for cancer patients undergoing outpatient chemotherapy or radiation therapy.
The second topic is 'one-day surgery,' primarily arising from the codification of three-shift nurse-to-patient ratios. Medical institutions are planning to convert short-stay inpatient surgeries or minimally invasive surgeries into one-day surgeries. Some patients may not meet the policy's definition of 'inpatient' and thus cannot apply for inpatient-related claims.
According to sources, the Insurance Bureau asked insurers whether, if a policyholder is admitted in the morning and discharged in the afternoon or evening, even if staying only one day but having completed admission procedures, the inpatient medical insurance policy would still provide coverage.
Attending insurers reported that most in the industry believe whether to pay claims should be based on the policy contract. To pay a daily inpatient benefit, there must naturally be an inpatient fact. If it was originally an outpatient surgery, it should be determined according to the existing contract, and it is unlikely to relax the definition.
The industry pointed out that under the current medical system, it is practically unlikely for a patient not to be admitted due to personal geographic location, insufficient medical resources, or hospital bed scheduling difficulties. They also hope that the Ministry of Health and Welfare will clarify the scope and definition of 'one-day surgery' and its difference from current outpatient surgeries.
The third topic is the at-home acute care insurance expected to be launched by the end of this year. The FSC is actively communicating with the National Health Insurance Administration of the Ministry of Health and Welfare. The meeting also discussed the feasibility of relaxing inpatient medical insurance claims when conditions that should require inpatient treatment are changed to home-based medical care due to factors such as residence in outlying islands preventing travel to Taiwan proper for medical treatment, insufficient medical resources, or hospital bed scheduling difficulties, in situations not attributable to the policyholder.
Attending insurers stated that the Insurance Bureau made no ruling today. (Editor: Pan Yi-ching, Lin Ke-lun) 1150610
FAQ
What was decided at this meeting?
The FSC only listened to industry opinions; no specific decisions were made.
What is 'one-day surgery'?
A surgical model where medical institutions convert short-stay inpatient surgeries into same-day admission and discharge, driven by the codification of nurse-to-patient ratios.
What is at-home acute care insurance?
A new insurance product that allows patients who would normally require hospitalization to receive acute care at home.