Insurance Benefits

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

Types of Benefits table
Insurance Benefits Benefits in kind
  • Healthcare Benefits
  • Health Checkup
Benefits in cash
  • Compensation for Excessive Co-payment
  • Reimbursement of expenses exceeding one’s co-payment ceiling
  • Reimbursement of assistive appliances expenses for the disabled
  • Pregnancy & Childbirth expenses

Health Care Benefits

  • Services provided by healthcare institutions in the case of diseases, injuries, and etc.
    Including diagnosis, tests, medical materials, treatments, surgeries, preventive care,  rehabilitation, hospitalization, nursing, and transportation

Health checkups

  • General Health checkup expenses : Free of Charge
    • 17 items including blood test and other items are added according to the age

      Those who are suspicious to be high blood pressure or get diabetes will have a second test for that

  • Cancer checkup
    • 6 Types of Cancer checkups: Stomach Cancer, Colorectal Cancer, Breast Cancer, Cervical Cancer, Liver Cancer and Lung Cancer
    • Cost is shared by NHIS (90%) and Beneficiary (10%)

      colorectal cancer, cervical cancer : no co-payment on patients

Co-Payment

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.

Co-Payment table
Type Co-Payment
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.

Co-payment ceiling

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)

Co-payment ceiling table
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
2014 1,200,000 1,500,000 2,000,000 2,500,000 3,000,000 4,000,000 5,000,000
2017 1,220,000 1,530,000 2,050,000 2,560,000 3,080,000 4,110,000 5,140,000
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
2023
 up to 120 days
 870,000
 1,080,000
 1,620,000
 3,030,000
 4,140,000
 4,970,000
 7,800,000
over 120 days
 1,340,000
 1,680,000
 2,270,000
 3,750,000
 5,380,000
 6,460,000
 10,140,000

Other kinds of benefits in cash are as follows ;

  • Purchasing cost of depletable resources for peritoneum perfusate and automated peritoneal dialysis of a patient suffering from chronic renal insufficiency
    • In case, patients with kidney failure purchase materials used for peritoneal dialysis which prescribed by doctors from the medicine & drug store
    • In case, a policy holder and his/her dependent gives birth to her baby at places other than hospitals
    • In case, a patient who need oxygen treatment get oxygen treatment with a doctor’s prescription and the rules made by a minister of health and welfare
    • In case, a patient with neurogenic bladder purchase materials used to self-catheterization from medical devices stores with the doctor’s prescription
    • In case, a patient with diabetes purchase materials used to a blood-glucose test or an insulin shot
    • In case, a patient with illnesses which are included in a category determined by a minister of health and welfare needs a medical ventilator or a mechanical insufflator-exsufflator rent it with a doctor’s prescription
  • Compensation for Excessive Co-payment
    • When a patient’s co-payment exceeds 870,000 KRW within 120days or 1,340,000 KRW over 120days, NHIS reimburses for the excess.
  • Appliance expenses for the disabled 90% of the purchase price by appliance type (walking sticks/canes, wheelchairs and hearing aids, etc)
    • When a policy holder or his/her dependent who are disabled and registered under the disabled’s welfare law purchase an assistive equipment (such as electric wheelchairs, and hearing aids, etc), however, there are the reimbursement ceiling on each item. (Benefit Limit: up to the standard price)

Additional Benefits

  • NHIS can subsidize medical service expenses for pregnancy, childbirth and infants treatment
    • Eligible persons : a policy holder or his/her dependent whose pregnancy is verified by a doctor
    • Subsidized expenses: 1,000,000 KRW per one pregnancy & childbirth