National health insurance service provides benefits in kind and benefits in cash for the prevention, diagnosis, and treatment of disease, injuries etc.
Types of Benefits
|Insurance Benefits||Benefits in kind||
|Benefits in cash||
Health Care Benefits
Those who are suspicious to be high blood pressure or get diabetes will have a second test for that
colorectal cancer, cervical cancer : no co-payment on patients
The co-payment is the portion of the health care service cost paid by patients to the medical service provider when they visit a hospital.
A co-payment rate is determined separately for paying the costs incurred in inpatient or outpatient service (according to the care institution level and type).
The co-payment rate is determined differently according to the types of service and the level of health care institutions.
This is to curb people’s strong preference of tertiary hospitals to general hospital and clinics nearby so that to help use of medical resources more efficiently.
|Inpatient||20% of total treatment cost
(Registered cancer patients 5%,
Registered rare/incurable diseases patients 10%)
|Outpatient||Higher level general hospital Tertiary Hospital||60% of total treatment cost and other expenses|
|General Hospital||50% (administrative district: Dong),
45% (administrative district: Eup, Myeon)
of total care benefit expenses
|Pharmacy||30% of total care benefit expenses|
|Hospital||40% of total care benefit expenses|
|Clinic||30% of total care benefit expenses|
Reimbursement of the overcharged co-payment
When the Health Insurance Review & Assessment Service (HIRA) confirms that co-payment in relation to the care institution service is overcharged, the excess amount is paid back to a medical beneficiary.
According to income level of the insured, an annual co-payment ceiling is determined. The co-payment amount above the ceiling during one fiscal year will be
reimbursed by NHIS (co-payments paid for non-covered services are NOT applicable)
|Year||The length of stay
in hospitals (day)
|NHI contribution deciles with 10 being the highest contribution|
|decile 1||decile 2~3||decile 4~5||decile 6~7||decile 8||decile 9||decile 10|
|2018||up to 120 days||800,000||1,000,000||1,500,000||2,600,000||3,130,000||4,180,000||5,230,000|
|over 120 days||1,240,000||1,550,000||2,080,000|
|2022||up to 120 days||830,000||1,030,000||1,550,000||2,890,000||3,600,000||4,430,000||5,980,000|
|over 120 days||1,280,000||1,600,000||2,170,000|
||up to 120 days
|over 120 days
Other kinds of benefits in cash are as follows ;