Approximately 2.26 million South Korean national health insurance subscribers whose medical expenses exceeded their individual annual caps last year will receive refunds totaling \u20a93.08 trillion (approximately $2.2 billion). The Ministry of Health and Welfare and the National Health Insurance Service (NHIS) announced on Aug. 30 that they will begin the excess payment disbursement process starting Aug. 31, following the finalization of individual out-of-pocket caps for 2025 medical treatments.<\/p>\n
The out-of-pocket cap system is a program under which the NHIS covers and refunds any amount exceeding an individual’s annual cap on out-of-pocket medical expenses. For last year, the caps ranged from \u20a9890,000 (approximately $650) to \u20a910.74 million (approximately $7,800) depending on income bracket. The calculation is based on actual patient payments for NHIS-covered medical services, excluding non-covered and selectively covered items.<\/p>\n
Under this finalization, 2,262,605 people are eligible for refunds totaling \u20a93.08 trillion (approximately $2.2 billion), averaging approximately \u20a91.36 million (approximately $990) per person. Compared to the previous year, the number of beneficiaries increased by 5.9% and the total payout rose by 10.2%. Compared to 2021, beneficiaries grew 29.3% from 1,749,831, while payouts increased 28.9% from \u20a92.39 trillion (approximately $1.7 billion), reflecting a steady expansion of the program’s coverage.<\/p>\n
Benefits Concentrated Among Bottom 50% Income Earners and Seniors 65+<\/p>\n
By income bracket, those in the bottom 50% accounted for 2,016,503 people, or 89.1% of all recipients. Refunds to this group totaled \u20a92.36 trillion (approximately $1.7 billion), representing 76.6% of the total payout. By age, seniors aged 65 and older formed the largest group at 1,310,761 people (57.9%), receiving \u20a92.06 trillion (approximately $1.5 billion), or 67% of the total.<\/p>\n
The program’s real-world impact is illustrated through individual cases. The NHIS highlighted the case of a septuagenarian identified as “A,” who was hospitalized for three months at a university hospital last year for a spinal fracture. Total medical expenses, excluding non-covered services, amounted to \u20a992.09 million (approximately $67,000). After the NHIS covered \u20a976.03 million (approximately $55,000), the patient’s out-of-pocket portion was \u20a916.06 million (approximately $12,000). However, since the out-of-pocket expenses incurred at the same hospital exceeded the maximum cap of \u20a98.26 million (approximately $6,000), the NHIS directly paid the excess \u20a97.8 million (approximately $5,700) to the healthcare provider.<\/p>\n
In the subsequent post-settlement, the patient’s out-of-pocket cap was finalized at \u20a9890,000 (approximately $650) based on the lowest income bracket. As a result, the patient received an additional refund of \u20a910.2 million (approximately $7,400), comprising \u20a97.37 million (approximately $5,400) from the \u20a98.26 million (approximately $6,000) already paid, plus \u20a92.83 million (approximately $2,100) in out-of-pocket expenses incurred at other healthcare facilities. Ultimately, of the \u20a918.89 million (approximately $14,000) in medical expenses incurred last year, the patient’s actual out-of-pocket burden was just \u20a9890,000 (approximately $650).<\/p>\n
Automatic Payments to Pre-Registered Accounts Starting Sept. 2<\/p>\n
A total of 27,742 people had already exceeded the maximum cap of \u20a98.26 million (approximately $6,000) in out-of-pocket payments at a single healthcare provider, and the NHIS had pre-paid \u20a9184.6 billion (approximately $134.6 million) to those providers. Excluding this amount, among the 2,261,271 people confirmed as eligible for excess refunds, 1,312,819 (58%) who registered direct deposit accounts will receive automatic payments sequentially starting Sept. 2 without any additional application.<\/p>\n
The remaining recipients must apply individually after receiving notification letters. By checking the “direct deposit account” option on the application form, they will automatically receive future excess refunds without needing to reapply. Even those who have not yet incurred excess payments can pre-register a direct deposit account. Accounts under the applicant’s own name can be registered through the NHIS customer center (1577-1000).<\/p>\n
The NHIS will begin sending notification letters, including application forms, sequentially starting Aug. 31. Starting this year, electronic documents will be sent first through Naver, KT (PASS app), and KakaoTalk, in that order. Postal mail will only be used for those who do not use or open electronic documents. Recipients can apply through convenient methods including the NHIS website, the “Health Insurance 25 Hours” mobile app, fax, phone, mail, or in-person visits.<\/p>\n
However, Article 44, Paragraph 3 of the National Health Insurance Act is scheduled to take effect on Oct. 8. After that date, when the NHIS disburses excess refunds, it may deduct any unpaid insurance premiums or legally mandated collections before payment.<\/p>\n
Yoo Joo-heon, Director General of the Health Insurance Policy Bureau at the Ministry of Health and Welfare, said, “The out-of-pocket cap system has firmly established itself as a critical medical safety net that alleviates the medical cost burden on economically vulnerable populations and the elderly. We will continue to pursue institutional improvements to reduce medical expense burdens so that citizens do not face economic hardship due to high medical costs.”<\/p>\n
Kim Nam-hoon, Executive Director of Benefits at the NHIS, stated, “The NHIS will continue to stand by the public and do its utmost in operating the system to ensure that no medically vulnerable populations emerge due to medical cost burdens.”<\/p>\n","protected":false},"excerpt":{"rendered":"Approximately 2.26 million South Korean national health insurance subscribers whose medical expenses exceeded their individual annual caps last…\n","protected":false},"author":2,"featured_media":136604,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[69378,69377,31,5367,38793,69375,33,69376],"class_list":["post-136603","post","type-post","status-publish","format-standard","has-post-thumbnail","category-south-korea","tag-direct-deposit-account","tag-kim-nam-hoon","tag-korea","tag-ministry-of-health-and-welfare","tag-national-health-insurance-service","tag-out-of-pocket-cap-system","tag-south-korea","tag-yoo-joo-heon"],"_links":{"self":[{"href":"https:\/\/www.europesays.com\/korea\/wp-json\/wp\/v2\/posts\/136603","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/korea\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/korea\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/korea\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/korea\/wp-json\/wp\/v2\/comments?post=136603"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/korea\/wp-json\/wp\/v2\/posts\/136603\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/korea\/wp-json\/wp\/v2\/media\/136604"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/korea\/wp-json\/wp\/v2\/media?parent=136603"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/korea\/wp-json\/wp\/v2\/categories?post=136603"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/korea\/wp-json\/wp\/v2\/tags?post=136603"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}