精神疾病住院 醫療保險難申請乎？【本期企劃】 試閱
Too Difficult to Apply for Medical Insurance?
精神疾病之治療非短期內可獲治癒，且視患者病情輕重差異而容有不同之多元照護方式，倘在被保險人因精神疾病而須為日間住院之情形，其得否能向保險人申請住院保險金？本文認為日間留院係精神衛生法明文之治療方式，如保險契約中未於除外責任明示排除，則應採有利於被保險人之解釋；至於住院必要性之有無，則宜由實際為患者施行治療之醫師進行判斷。此外，日間住院卻給付全額住院保險金，恐與保險契約之對價關係容有未合，故可斟酌全日住院之比例予以給付。
It might be difficult for the psychosis to be cured in the short period and there might be various ways to take care of it, depending on the different conditions the patients have. Could an insured apply for insurance on the ground of the hospitalization to the insurer, when being hospitalized for the psychosis? In the opinion of this essay, since the hospitalization is a medical treatment written in the Mental Health Act, the explanation of the insurance contract should be in favor of the patient unless there was an explicit excluded liability the in the contract. As to the necessity of the hospitalization, the physicians who give the patient the medical treatment actually should make their judgment. Besides, it might inconsistent with the quid pro quo of the insurance contract to pay the hole insurance for the psychiatric day care. In proportion of the psychiatric day care might the payment consequently be.
034-042
