Catastrophic Illness Categories under Taiwan NHI

Regulations on Co-payment Exemption for NHI Insured Persons, Article 2, Annex 1

Version ROC 113-09-16Effective 2025-01-01ICD ICD-10-CM/PCS 2023
128 of 128 items
1
Cancers requiring active or long-term treatment
5
  • C73
    Malignant neoplasm of thyroid gland
    3 years
  • C00.0-C06.9, C09.0-C10.9, C12-C14.8
    Stage I malignant neoplasm of oral cavity, oropharynx and hypopharynx
    3 years
  • C50.011-C50.929
    Stage I malignant neoplasm of breast
    3 years
  • C53.0-C53.9, C55
    Stage I malignant neoplasm of cervix uteri
    3 years
  • C00.0-C96.9 (excl. C73, C94.4, C94.6)
    Other malignant neoplasms
    5 years
2
Hereditary coagulation factor deficiency
4
  • D66
    Hereditary factor VIII deficiency
    Permanent
  • D67
    Hereditary factor IX deficiency
    Permanent
  • D68.1
    Hereditary factor XI deficiency
    Permanent
  • D68.2
    Hereditary deficiency of other clotting factors
    Permanent
3
Severe hemolytic and aplastic anemia
3
📋 Hemoglobin without treatment usually below 8 gm/dl in adults, or below 12 gm/dl in newborns
  • D55.0-D58.9
    Hereditary hemolytic anemias
    5 years
  • D59.0-D59.9
    Acquired hemolytic anemias
    5 years
  • D46.4, D60.0-D60.9, D61.01-D61.9
    Aplastic anemias
    5 years
4
Chronic kidney failure (uremia) requiring regular dialysis
3
⏳ Permanent if dialysis already confirmed at application; 3 months if not yet confirmed
  • N18.5, N18.6
    Chronic kidney disease
    Case-by-case
  • I12.0
    Hypertensive chronic kidney disease with stage 5 CKD or end-stage renal disease
    Case-by-case
  • I13.11, I13.2
    Hypertensive heart and chronic kidney disease with heart failure and stage 5 CKD or ESRD
    Case-by-case
5
Systemic autoimmune syndromes requiring lifelong treatment
18
  • M32.0-M32.9
    Systemic lupus erythematosus (SLE)
    Permanent
  • M34.0-M34.9
    Systemic sclerosis
    Permanent
  • M05.70-M06.09, M06.20-M06.39, M06.80-M06.8A, M06.9, M08.00-M08.9A
    Rheumatoid arthritis (including juvenile)
    ※ Meeting 1987 ACR revised diagnostic criteria
    Permanent
  • M33.20-M33.29
    Polymyositis
    Permanent
  • M33.00-M33.19, M33.90-M33.99, M36.0
    Dermatopolymyositis
    Permanent
  • M30.0, M30.2, M30.8
    Polyarteritis nodosa
    Permanent
  • M31.0
    Hypersensitivity angiitis
    Permanent
  • M31.30, M31.31
    Wegener's granulomatosis
    Permanent
  • M31.5, M31.6
    Giant cell arteritis
    Permanent
  • I73.1
    Thromboangiitis obliterans (Buerger's disease)
    Permanent
  • M31.4
    Aortic arch syndrome (Takayasu)
    Permanent
  • M35.2
    Behcet's disease
    Permanent
  • L10.0-L10.9
    Pemphigus
    Permanent
  • M35.00-M35.0C
    Sicca syndrome (Sjögren's)
    Permanent
  • K50.00-K50.919
    Crohn's disease
    Permanent
  • K51.00-K51.919
    Ulcerative colitis
    Permanent
  • M30.3
    Kawasaki disease (with coronary stenosis ≥50% or coronary aneurysm >8mm)
    5 years
  • M30.3
    Kawasaki disease (with coronary aneurysm 6-8mm)
    3 years
6
Chronic psychiatric disorders
10
📋 Chronic conditions; certificate must be issued by a board-certified psychiatrist with specialist license number
  • F01.A11-F01.C4, F03.A11-F03.C4
    Unspecified dementia (organic)
    By psychiatrist or neurologist only
    Permanent
  • F05
    Delirium due to known physiological condition
    ⏳ 6 months, reassessed every 6 months
    Case-by-case
  • F02.A11-F02.C4, F06.0, F06.1, F06.8
    Other mental disorders due to known physiological condition
    ⏳ 2 years initial; permanent on recurrence
    Case-by-case
  • F20.0-F20.9, F25.0-F25.9
    Schizophrenia
    Permanent
  • F30.10-F30.13, F30.2-F30.9, F31.0-F31.9, F32.2-F32.5, F33.2-F33.9
    Affective disorders
    ⏳ 2 years initial; permanent on recurrence
    Case-by-case
  • F22
    Delusional disorders
    ⏳ 2 years initial; permanent on recurrence
    Case-by-case
  • F84.0
    Autistic disorder
    ⏳ 5 years initial; permanent on recurrence
    Case-by-case
  • F84.3
    Other childhood disintegrative disorder
    ⏳ 5 years initial; permanent on recurrence
    Case-by-case
  • F84.5, F84.8
    Other pervasive developmental disorders (Asperger's)
    ⏳ 5 years initial; permanent on recurrence
    Case-by-case
  • F84.9
    Pervasive developmental disorder, unspecified
    ⏳ 3y initial; 5y on recurrence; 5y on re-recurrence; permanent from 4th onward
    Case-by-case
7
Congenital metabolic disorders (excluding G6PD deficiency)
17
  • E00.0-E00.9, E03.0, E03.1
    Congenital iodine deficiency syndrome (incl. congenital hypothyroidism)
    Permanent
  • E10.10-E10.9
    Type 1 diabetes mellitus
    Permanent
  • E23.2
    Diabetes insipidus
    Permanent
  • E25.0-E25.9
    Adrenogenital disorders
    Permanent
  • E70.0-E71.2, E72.00-E72.51, E72.59, E72.8, E72.9
    Disorders of amino-acid transport and metabolism
    Permanent
  • E74.00-E74.09
    Glycogen storage disease
    Permanent
  • E74.20-E74.29
    Galactosemia
    Permanent
  • E78.1
    Pure hyperglyceridemia
    Permanent
  • E88.1
    Lipodystrophy
    Permanent
  • E75.21-E75.22, E75.240-E75.249, E75.3, E77.0-E77.9
    Disorders of sphingolipid metabolism
    Permanent
  • E75.6, E78.70, E78.9
    Disorders of lipoid metabolism
    Permanent
  • E83.00-E83.09
    Disorders of copper metabolism (incl. Wilson's disease)
    Permanent
  • E20.1, E83.50-E83.59, E83.81
    Disorders of calcium metabolism
    Permanent
  • D81.30-D81.39, D81.5, E79.1-E79.9
    Disorders of purine and pyrimidine metabolism
    Permanent
  • E76.01-E76.9
    Disorders of glycosaminoglycan metabolism (MPS)
    Permanent
  • E71.310-E71.548, E80.3, E88.40-E88.89, H49.811-H49.819
    Other specified disorders of metabolism
    Permanent
  • E88.9
    Metabolic disorder, unspecified
    Permanent
8
Congenital anomalies of cardiac, pulmonary, gastrointestinal, renal, neurological, skeletal systems and chromosomal abnormalities
15
  • Q00.0-Q00.2
    Anencephaly and similar malformations
    Permanent
  • G90.1, Q01.0-Q04.9, Q06.0-Q06.9, Q07.8, Q07.9
    Other congenital anomalies of nervous system
    3 years
  • Q20.0-Q24.9
    Bulbus cordis anomalies and cardiac septal closure defects
    3 years
  • Q25.0-Q28.9
    Other congenital anomalies of circulatory system
    3 years
  • Q33.0
    Congenital cystic lung
    Permanent
  • Q33.3, Q33.6
    Agenesis, hypoplasia and dysplasia of lung
    Permanent
  • Q33.8, Q33.9
    Other congenital malformations of lung
    Permanent
  • Q41.0-Q45.9
    Other congenital anomalies of digestive system
    Permanent
  • Q60.0-Q60.6
    Renal agenesis and other reduction defects of kidney
    Permanent
  • Q61.00-Q61.9
    Cystic kidney disease
    Permanent
  • Q62.0-Q62.39
    Congenital obstructive defects of renal pelvis and ureter
    Permanent
  • Q63.0-Q63.9
    Other congenital malformations of kidney
    Permanent
  • Q77.0-Q77.2, Q77.4, Q77.5, Q77.7-Q77.9, Q78.4
    Osteochondrodysplasia with growth defects of tubular bones and spine
    Permanent
  • Q90.0-Q99.1, Q99.8, Q99.9
    Chromosomal abnormalities
    Permanent
  • Q35.1-Q35.7, Q36.0-Q37.9
    Congenital cleft palate and cleft lip (requiring multiple surgeries and speech rehabilitation)
    3 years
9
Burns covering ≥20% total body surface area; or facial burns with sensory organ dysfunction
3
  • T31.20-T31.99, T32.20-T32.99
    Burn of >20% of total body surface
    1 year
  • T26.00XA-T26.92XA
    Burn confined to eye and adnexa
    1 year
  • T20.30XA-T20.39XA, T20.70XA-T20.79XA
    Burn of face and head, deep necrosis (deep third degree) with loss of body part
    1 year
10
Organ transplantation
7
⏳ Surgery: physician's discretion, no certificate needed; Follow-up: permanent (bone marrow: 5 years)
  • Z94.0
    Kidney transplant follow-up
    Permanent
  • Z94.1
    Heart transplant follow-up
    Permanent
  • Z94.2
    Lung transplant follow-up
    Permanent
  • Z94.4
    Liver transplant follow-up
    Permanent
  • Z94.81, Z94.84
    Bone marrow transplant follow-up
    5 years
  • Z94.83
    Pancreas transplant follow-up
    Permanent
  • Z94.82
    Intestine transplant follow-up
    Permanent
11
Complications of poliomyelitis or cerebral palsy affecting neurological, muscular, skeletal, pulmonary systems (moderate or above disability level)
3
12
Major trauma rated ISS ≥ 16 (vegetative state cannot be calculated by ISS)
1
13
Long-term mechanical ventilation due to respiratory failure
4
14
Severe malnutrition with TPN >30 days, stable condition, oral diet insufficient
2
15
Severe decompression sickness or air embolism from improper diving/decompression (with cardio-respiratory or neurological complications requiring long-term treatment)
2
16
Myasthenia gravis
1
17
Congenital immunodeficiency disorders
5
18
Complications from spinal cord injury or disease (moderate disability or above)
3
19
Occupational disease
5
20
Acute cerebrovascular disease (within 1 month of acute onset)
4
21
Multiple sclerosis
1
22
Congenital muscular dystrophy
1
23
Congenital anomalies of integument
3
24
Leprosy (Hansen's disease)
1
25
Liver cirrhosis with one of the following complications
1
26
Complications in premature infants affecting neurological, muscular, skeletal, cardiac, pulmonary systems
2
27
Toxic effect of arsenic and its compounds (Black foot disease)
1
28
Motor neuron disease
1
29
Creutzfeldt-Jakob disease
1
30
Rare disease
1
Original source
全民健康保險重大傷病項目（衛生福利部中央健康保險署 (NHIA)）
Catastrophic Illness Categories under Taiwan NHI (NHIA English)

This tool builds on the official NHIA data, adding a cross-language, interactive interface. For the latest version, please refer to the official files.
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