發文單位：司法院
解釋字號：釋字第472號
解釋日期：民國88年1月29日
解釋爭點：健保法就強制納保、繳費及滯納金之規定違憲？
資料來源：司法院公報 第 41 卷 2 期 6-24 頁
                    司法院大法官解釋（十一）（99年5月版）第 1-30 頁
                    總統府公報 第 6268 號 8-30 頁
                    守護憲法 60 年 第 255-256 頁
相關法條：中華民國憲法 第 155、157、23 條 ( 36.01.01 )
                    中華民國憲法增修條文 第 10 條 ( 86.07.21 )
                    全民健康保險法 第 11-1、30、69-1、85、87 條 ( 83.10.03 )

解釋文：
國家為謀社會福利，應實施社會保險制度；國家為增進民族健康，應普遍推行衛生保健事業及公醫制度，憲法第一百五十五條及第一百五十七條分別定有明文。又國家應推行全民健康保險，復為憲法增修條文第十條第五項所明定。中華民國八十三年八月九日公布、八十四年三月一日施行之全民健康保險法即為實現上開憲法規定而制定。該法第十一條之一、第六十九條之一及第八十七條有關強制納保、繳納保費，係基於社會互助、危險分攤及公共利益之考量，符合憲法推行全民健康保險之意旨；同法第三十條有關加徵滯納金之規定，則係促使投保單位或被保險人履行其繳納保費義務之必要手段。全民健康保險法上開條文與憲法第二十三條亦無牴觸。惟對於無力繳納保費者，國家應給予適當之救助，不得逕行拒絕給付，以符憲法推行全民健康保險，保障老弱殘廢、無力生活人民之旨趣。
已依法參加公、勞、農保之人員亦須強制其加入全民健康保險，係增進公共利益所必要，難謂有違信賴保護原則。惟有關機關仍應本於全民健康保險法施行時，該法第 八十五條限期提出改制方案之考量，依本解釋意旨，並就保險之營運（包括承保機構之多元化）、保險對象之類別、投保金額、保險費率、醫療給付、撙節開支及暫行拒絕保險給付之當否等，適時通盤檢討改進，併此指明。

理由書：
法律之制定與修正，為立法院之職權，行政院依憲法規定，僅得對立法院提出法律案。全民健康保險法第八十九條規定：「本法實施滿二年後，行政院應於半年內修正本法，逾期本法失效」，係指行政院應於本法實施二年後，重新檢討本法實施所面臨問題，並向立法院提出修正案而言。行政院已依同條規定於八十六年七月二十三 日向立法院提出全民健康保險法修正草案，尚不發生本法效力存否之問題，合先敘明。
「國家為謀社會福利，應實現社會保險制度」、「國家為增進民族健康，應普遍推行衛生保健事業及公醫制度」及「國家應推行全民健康保險」，既為憲法第一百五十五條、第一百五十七條及憲法增修條文第十條第五項明定之基本國策，立法機關自得制定符合上開憲法意旨之相關法律。至全民健康保險制度應如何設計，則屬立法裁 量之範圍。八十三年八月九日公布、八十四年三月一日施行之全民健康保險法即為實現上開憲法規定而制定。該法第十一條之一、第六十九條之一及第八十七條關於 強制全民參加全民健康保險之規定，係國家為達成全民納入健康保險，以履行對全體國民提供健康照護之責任所必要，符合憲法推行全民健康保險之意旨。同法第三 十條有關加徵滯納金之規定，係為促使投保單位或被保險人履行公法上金錢給付之義務，與前述強制納保均係實現全民健康保險之合理手段，應無逾越憲法第二十三條規定之必要程度。惟對於無力繳納保費者，國家應給予適當之救助，不得逕行拒絕給付，以符憲法推行全民健康保險，保障老弱殘廢、無力生活人民之旨趣。
公 務人員、勞工、農民已依公務人員保險法、勞工保險條例及農民健康保險條例規定分別參加公務人員保險、勞工保險、農民保險，復依全民健康保險法規定，須參加全民健康保險，係基於整合公勞農保之醫療給付，建立全國單一、公平之健康保險體系之目的，具有促使醫療資源合理分配，發揮社會保險之功能。此種強制性之社會保險，其保險之條件係由法律規定，一體實施，與依個人意願參加之保險契約有間，立法機關盱衡社會發展之需要，制定或修改法律，變更各項社會保險之規定，建立符合憲法意旨之社會安全制度，不生違背信賴保護利益之問題。惟有關機關仍應本於全民健康保險法施行時，該法第八十五條限期提出改制方案之考量，依本解釋意旨，並就保險之營運（包括承保機構之多元化）、保險對象之類別、投保金額、保險費率、醫療給付、撙節開支及暫行拒絕保險給付之當否等，適時通盤檢討改進。又農民健康保險條例於全民健康保險法施行後，關於其醫療保險部分，係以行政院函釋為權宜措施之依據，有欠允當，有關機關尤應注意及之，併此指明。

J. Y. Interpretation No.   472
Date：1999.1.29
Issue：Are compulsory national health insurance and the imposition of an overdue charge both unconstitutional?
Holding：
According to Article 155 of the Constitution: "The State, in order to promote social welfare, shall establish a social insurance system." Article 157 of the Constitution also specifies: "The State, in order to improve national health, shall establish extensive services for sanitation and health protection, and a system of public medical service." Furthermore, Article 10, Paragraph 5, of the Amendment of the Constitution provides: "The State shall promote national health insurance..." The National Health Insurance Act, promulgated on August 9, 1994, and implemented on March 1, 1995, is for the realization of the aforesaid provisions of the Constitution. Provisions in Article 11-1, Paragraph 1, Article 69-1, Paragraph 1, and Article 87 of the Act regarding compulsory subscription of insurance and premium payment are based on considerations of mutual social support, risk-sharing and the public interest, and therefore conform to the constitutional purpose of promoting national health insurance. The overdue charge prescribed in Article 30 of the Act is necessary to oblige a group insurance applicant or the insured to make premium payment. The aforesaid Article of the Act does not contradict Article 23 of the Constitution. However, to those who cannot afford to pay the premium, the State shall give appropriate assistance and relief and shall not refuse to pay benefits, in order to fulfill the constitutional purposes of promoting national health insurance, protecting senior citizens, the infirm and the financially disadvantaged.

Including those already covered, in accordance with law, by insurance for government employees, labor insurance, and insurance for farmers in the compulsory national health insurance system is necessary to promote the public interest, and therefore it is hard to argue that such decision contradicts the principle of trust and protection. Nonetheless, the authorities concerned shall, based on the provisions of Article 85 of the Act regarding presenting improvement proposals within a prescribed time period and this Judicial Yuan Interpretation No. 472, conduct at an appropriate time a full-range evaluation and implement improvement measures in aspects of the insurance operations (including diversification of the insurers), categories of the insured, the insured amount, premium rates, payment of medical insurance, austerity measures and the appropriateness of temporary suspension of insurance benefits.

Reasoning：
The Legislative Yuan is responsible for the promulgation and amendment of the laws. According to the Constitution, the Executive Yuan may only propose legislation bills to the Legislative Yuan. Article 89 of the National Health Insurance Act stipulates: "Two years after the implementation of the Act, the Executive Yuan shall amend the Act within half a year; otherwise, the Act shall cease to be effective upon such expiration," meaning that the Executive Yuan shall evaluate problems facing implementation of the Act and submit improvement proposals to the Legislative Yuan. Accordingly, the Executive Yuan submitted to the Legislative Yuan on July 23, 1997, a Draft Amendment Bill to the National Health Insurance Act. The legal effect of the Act is therefore beyond doubt.

　　"The State, in order to promote social welfare, shall establish a social insurance system"; "The State, in order to improve national health, shall establish extensive services for sanitation and health protection, and a system of public medical service"; and "The State shall promote national health insurance" are all basic national policies, according, respectively, to Articles 155 and 157 of the Constitution and Article 10, Paragraph 5, of the Amendment of the Constitution. The Legislative Yuan may therefore promulgate relevant laws and regulations conforming to the aforesaid constitutional purposes. The design of a national insurance system belongs to the discretionary power of the legislative branch. The National Health Insurance Act, promulgated on August 9, 1994, and implemented on March 1, 1995, is for the realization of the aforesaid provisions of the Constitution. Provisions in Article 11-1, Paragraph 1, Article 69-1, Paragraph 1, and Article 87 of the Act regarding compulsory subscription of insurance are necessary to enable the State to include the whole population in health insurance coverage, so as to perform the responsibility to provide health care for the general public, and therefore conform to the constitutional purpose of promoting national health insurance. Provisions in Article 30 of the Act regarding overdue charges are for the purpose of obliging a group insurance applicant or the insured to submit monetary payment in accordance with public laws. This and the compulsory subscription of insurance are reasonable measures to realize the system of national health insurance. Hence, there shall be no overstepping of Article 23 of the Constitution. However, to those who cannot afford to pay premiums, the State shall give appropriate assistance and relief and shall not refuse to pay benefits, in order to fulfill the constitutional purposes of promoting national health insurance, protecting senior citizens, the infirm and the financially disadvantaged.

　　Those already covered, respectively, in accordance with the Public Functionaries Insurance Act, the Labor Insurance Act and the Farmers Health Insurance Act, by the insurance for government employees, labor insurance and the insurance for farmers, must still join the National Health Insurance program. This is for the purposes of integrating medical insurance payment under the respective insurance plans for government employees, laborers and farmers, and establishing a single and fair health insurance system, so as to facilitate reasonable distribution of medical resources and provide social insurance. The terms and conditions of this compulsory social insurance are prescribed by the laws for national implementation and therefore it differs from an insurance policy selectively purchased by individuals. There is no resulting question of contradiction with trust and protection of interests where the legislative body, in consideration of the needs of social development, makes or amends the laws and changes various social insurance regulations so as to establish the social security system in conformance with the constitutional purposes. Nonetheless, the authorities concerned shall, based on the provisions of Article 85 of the Act regarding presenting an improvement proposal within a prescribed time period and this Yuan Interpretation No. 472, conduct at an appropriate time a full-range evaluation and implement improvement measures in aspects of the insurance operations (including diversification of the insurers), categories of the insured, the insured amount, premium rates, payment of medical insurance, austerity measures and the appropriateness of the temporary suspension of insurance benefits. With respect to the provisions regarding medical insurance as set forth in the Farmers Health Insurance Act, they have become inappropriate as a result of the implementation of the National Health Insurance Act, because the said provisions are temporary measures based on the letter issued by the Executive Yuan. Therefore, the authorities concerned shall pay special attention in this regard.

' Translated by Dr. C.Y. Huang of Tsar & Tsai Law Firm.