국민건강보험법

Article 1Purpose

The purpose of this Act is to improve citizens' health and promote social security by providing citizens with insurance benefits for the prevention, diagnosis, and medical treatment of and rehabilitation from diseases and injury, for childbirth and death, and for improvement of health.

Article 2Administration

The Minister of Health and Welfare shall administer the national health insurance program prescribed by this Act.

Article 3Definitions

The terms used in this Act are defined as follows:

1. The term "worker" means a person who, regardless of a type of his or her occupation, lives on remuneration received in return for his or her work (including a director or other executive officers of a corporation), except for a public official or a school employee;

2. The term "employer" means a person who falls under any of the following items:a. The owner of the workplace at which a worker is employed;b. The head of the organ by which a public official is employed, who is prescribed by Presidential Decree;c. The person who establishes and operates a private school (referring to a private school referred to in Article 3 of the Pension for Private School Teachers and Staff Act; hereafter in this Article the same shall apply) by which a school employee is employed;

3. The term "workplace" means a place of business or office;

4. The term "public official" means a person who is a regular employee of the State or a local government providing civil service;

5. The term "school employee" means a teacher at, or an employee of, a private school or an organization that manages the school.

Article 3-2Formulation of comprehensive national health insurance plans

(1) To operate the health insurance under this Act (hereinafter referred to as "health insurance") in a sound manner, the Minister of Health and Welfare shall formulate a comprehensive national health insurance plan (hereinafter referred to as "comprehensive plan") every five years, after deliberation by the Health Insurance Policy Deliberative Committee under Article 4 (hereafter in this Article referred to as the "Health Insurance Policy Deliberative Committee"). The same shall also apply to any modification to a comprehensive plan already formulated.

(2) Each comprehensive plan shall include the following:

1. Basic objectives of, and direction-setting for, health insurance policies;

2. Plans and methods for expanding health insurance coverage;

3. Medium- and long-term prospects for, and operation of, health insurance finance;

4. Matters concerning a system to impose insurance contributions;

5. Matters concerning the costs of health care benefits;

6. Matters concerning health promotion program;

7. Matters concerning support for the vulnerable;

8. Matters concerning the management of statistics and information on the health insurance;

9. Any other matters prescribed by Presidential Decree, which are necessary to improve the health insurance.

(3) The Minister of Health and Welfare shall formulate and implement an annual implementation plan (hereinafter referred to as ''implementation plan") in accordance with a comprehensive plan each year, after deliberation by the Health Insurance Policy Deliberative Committee.

(4) The Minister of Health and Welfare shall evaluate performance results according to the relevant implementation plan each year.

(5) Where any of the following causes arises, the Minister of Health and Welfare shall prepare a report on the relevant matter and report it to the competent Standing Committee of the National Assembly without delay:

1. Formulation or modification of a comprehensive plan referred to in paragraph (1);

2. Formulation of an implementation plan referred to in paragraph (3);

3. Evaluation of performance results according to an implementation plan referred to in paragraph (4).

(6) If deemed necessary for formulating a comprehensive plan, formulating and executing an implementation plan, or evaluating performance results according to an implementation plan, the Minister of Health and Welfare may request the head of a relevant agency to submit data. In such cases, the person so requested shall respond to such request, unless there is a compelling reason not to do so.

(7) Matters necessary to formulate and modify a comprehensive plan under paragraph (1), formulate and execute an implementation plan under paragraph (3), and evaluate performance results according to an implementation plan under paragraph (4), and other necessary matters shall be prescribed by Presidential Decree.[This Article Added on Feb. 3, 2016]

Article 4Health Insurance Policy Deliberative Committee

(1) The Health Insurance Policy Deliberative Committee (hereinafter referred to as the "Deliberative Committee") shall be established under the jurisdiction of the Minister of Health and Welfare to deliberate and resolve on the following matters regarding health insurance policies: <Amended on Feb. 3, 2016; Jan. 9, 2024; Feb. 6, 2024>1. Matters concerning a comprehensive plan provided in Article 3-2(1) and an implementation plan provided in Article 3-2(3) (excluding resolution thereof);

2. The standards for health care benefits provided for in Article 41(3);

3. Matters concerning the costs of health care benefits provided for in Articles 45(3) and 46;

4. The insurance contribution rates of the employee insured provided for in Article 73(1);

5. Insurance contribution rates for the self-employed insured and the monetary value per contribution point under Article 73(3);5-2. The following matters (excluding resolutions) concerning system improvement related to the imposition of insurance contributions (excluding resolutions thereof):(a) Investigations of and research on the status of income ascertainment of health insurance policyholders (hereinafter referred to as "the insured");b. Improvement measures to accurately ascertain the income of the insured and to ensure the imposition of insurance contributions more in line with such income;c. Other matters to be presented at meetings by the chairperson of the Deliberative Committee as matters regarding improvement to the system governing the imposition of insurance contributions.

6. Other important matters prescribed by Presidential Decree concerning health insurance.

(2) The Deliberative Committee shall be comprised of 25 members, including one Chairperson and one Vice Chairperson.

(3) The Chairperson of the Deliberative Committee shall be the Vice Minister of Health and Welfare and the Vice Chairperson shall be nominated by the Chairperson from among the members referred to in paragraph (4)4.

(4) The following persons shall be appointed or commissioned by the Minister of Health and Welfare as members of the Deliberative Committee:

1. Two persons each recommended by workers' organizations and employers' organizations;

2. One person each recommended by the civic group (referring to the non-profit, non-government organization provided for in Article 2 of the Assistance for Non-Profit, Non-Governmental Organizations Act; hereinafter the same shall apply), consumers' organization, organization of farmers and fishermen, and organization of self-employed persons;

3. Eight persons who are recommended by the organizations representing the medical profession and the organizations representing the medicine manufacturers;

4. Eight persons falling under each of the following items:a. Two public officials who belong to central administrative agencies prescribed by Presidential Decree;b. One person each recommended by the president of the National Health Insurance Service and the executive director of the Health Insurance Review and Assessment Service;c. Four persons with profound learning and experience in health insurance.

(5) The term of office of the members of the Deliberative Committee (excluding any member falling under paragraph (4)4a) shall be three years; provided, the term of office of any member newly appointed to fill a vacancy of a resigned member or due to other reasons shall be the remainder of the term of office for his or her predecessor.

(6) The Minister of Health and Welfare shall report matters deliberated on by the Deliberative Committee pursuant to paragraph (1)5-2 to the National Assembly. <Added on Jan. 9, 2024>(7) Matters necessary for the operation, etc. of the Deliberative Committee shall be prescribed by Presidential Decree. <Amended on Jan. 9, 2024>

Article 5Eligible persons

(1) Korean nationals who reside in the Republic of Korea shall be health insurance policyholders or their dependents; provided, this shall not apply to any of the following persons: <Amended on Feb. 3, 2016; Jan. 9, 2024>1. Persons who receive medical aid under the Medical Care Assistance Act (hereinafter referred to as "eligible recipient");Persons who receive medical care under the Act on the Honorable Treatment of Persons of Distinguished Service to Independence or the Act on the Honorable Treatment of and Support for Persons of Distinguished Service to the State (hereinafter referred to as "persons eligible for medical care for distinguished service"); provided, any of the following persons shall be the insured or a dependent:a. A person, from among persons eligible for medical care for distinguished service, who requests the insurer to provide him or her with health insurance cover;b. A person who does not request the insurer that he or she be excluded from health insurance cover, despite a change in his or her status from a person under the coverage of the health insurance to a person eligible for medical care for distinguished service.

(2) Dependents of the insured referred to in paragraph (1) refers to any of the following persons who are supported mainly by the employee insured and whose income or property falls below the standards prescribed by Decree of the Ministry of Health and Welfare: <Amended on Apr. 18, 2017>1. Spouses of the employee insured;

2. Lineal ascendants of the employee insured (including lineal ascendants of their spouses);

3. Lineal descendants (including lineal descendants of their spouses) and their spouses of the employee insured;

4. Siblings of the employee insured.

(3) The standards to determine the eligibility of the dependent referred to in paragraph (2), date of acquisition or loss of such eligibility, and other necessary matters shall be prescribed by Decree of the Ministry of Health and Welfare.

Article 6Categories of the insured

(1) The insured shall be divided into the employee insured and the self-employed insured.

(2) Workers and employers of all workplaces and public officials and school employees shall become the employee insured; provided, any of the following persons shall be excluded herefrom: <Amended on May 29, 2016>1. Daily-paid workers who are employed for a period of less than one month;

2. Soldiers in active service under the Military Service Act (including staff sergeants appointed without volunteering), secondment personnel, and candidates for military officers;

3. Public officials who assume office by winning an election, and who do not receive monthly remuneration or salary equivalent thereto;

4. Workers and employers of workplaces prescribed by Presidential Decree, in light of the characteristics of workplace, forms of employment, types of business and other matters, and public officials and school employees.

(3) Persons who are neither the employee insured nor their dependents shall be the self-employed insured.

(4) Deleted. <Dec. 11, 2018>

Article 7Reporting on workplace

Where an employer of a workplace falls under any of the following subparagraphs, he or she shall report such fact to an insurer, as prescribed by Decree of the Ministry of Health and Welfare within 14 days thereafter. This shall also apply where any matter reported to the insurer is changed because he or she falls under subparagraph 1:

1. Where his or her workplace becomes a workplace using employees, public officials, and school employees who become the employee insured pursuant to Article 6(2) (hereinafter referred to as "workplace of eligible persons");

2. Where a cause prescribed by Decree of the Ministry of Health and Welfare exists, such as suspension or closure of business.

Article 8Date of acquisition of eligibility

(1) The insured shall become eligible as the employee insured or the self-employed insured on the day he or she takes residence in the country; provided, a person who falls under any of the following subparagraphs shall become eligible for each on the applicable day:

1. For a former eligible recipient, on the day when he or she becomes excluded from such eligibility;

2. For a former dependent of the employee insured, on the day when he or she loses his or her eligibility;

3. For a person formerly eligible for medical care for distinguished service, on the day when he or she is excluded from such eligibility;

4. For a person eligible for medical care for distinguished service who requests the insurer for coverage under the health insurance under Article 5(1)2a, on the day when the request is made.

(2) If a person becomes eligible pursuant to paragraph (1), the employer of the relevant employee insured or the head of the household of the relevant self-employed insured shall report the particulars to the insurer, as prescribed by Decree of the Ministry of Health and Welfare, within 14 days after the date of acquisition of the eligibility.

Article 9Date of change in eligibility

(1) The eligibility of the insured shall change on the date when he or she falls under any of the following subparagraphs:

1. On the date the self-employed insured becomes an employer of a workplace of eligible persons or is employed as an employee, public official, or school employee (hereinafter referred to as "employee, etc.");

2. On the date the employee insured becomes an employer of another workplace of eligible persons or is employed as an employee, etc.;

3. On the date immediately following the date of expiration of employment relationship of employer, etc. who is the employee insured;

4. On the date immediately following the date on which any cause under subparagraph 2 of Article 7 occurs at the workplace of eligible persons;

5. On the date on which the self-employed insured moves into another household.

(2) Where the eligibility of the insured changes under paragraph (1), the employer of the employee insured or the head of a household of the self-employed insured shall report the particulars to the insurer according to the following classifications, as prescribed by Decree of the Ministry of Health and Welfare, within 14 days from the date on which the eligibility changes:

1. Where eligibility changes pursuant to paragraph (1)1 and 2: Employer of the employee insured;

2. Where there is a change in eligibility pursuant to paragraph (1)3 through 5: The head of a household of the self-employed insured.

(3) Where the employee insured or the self-employed insured falls under subparagraph 3 or 4 of Article 54, the Minister of Justice and the Minister of National Defense shall inform the insurer as provided by Decree of the Ministry of Health and Welfare within one month from the date of such change.

Article 9-2Notice of acquisition and change of eligibility

Upon confirmation of the acquisition or change of eligibility of the insured through the data received pursuant to Article 96(1), the NHIS shall give notice of the acquisition or change of the eligibility, as prescribed by Decree of the Ministry of Health and Welfare, when the billing of contribution is made to the person obligated to pay it under Article 79 for the first time after the acquisition or change of the eligibility.[This Article Added on Jan. 15, 2019]

Article 10Date of loss of eligibility

(1) The insured shall lose his or her eligibility on the day he or she falls under any of the following subparagraphs:

1. The day immediately following the date of his or her death;

2. The day immediately following the day he or she loses his or her nationality;

3. The day immediately following the day he or she ceases to reside within the country;

4. The day he or she becomes a dependent of the employee insured;

5. The day he or she becomes an eligible recipient;

6. The day a person formerly covered by health insurance makes a request for exclusion from coverage of the health insurance as he or she became a person eligible for medical care for distinguished service.

(2) If eligibility is lost pursuant to paragraph (1), the employer of the relevant employee insured or the head of a household of the self-employed insured concerned shall report the particulars to the insurer, as prescribed by Decree of the Ministry of Health and Welfare, within 14 days after the date of loss of the eligibility.

Article 11Confirmation of acquisition of eligibility

(1) Acquisition, change, or loss of the eligibility of the insured shall take effect retrospectively from the date of acquisition, change, or loss of the eligibility referred to in Articles 8 through 10. In such cases, the insurer may confirm the fact thereof.

(2) The insured or the former insured, or a dependent or a former dependent may request the confirmation referred to in paragraph (1).

Article 12Health insurance card

(1) The National Health Insurance Service shall issue a health insurance card upon application by the insured or his or her dependent. <Amended on Dec. 11, 2018>(2) When the insured or his or her dependent receives health care benefits, he or she shall present the insurance card referred to in paragraph (1) to a health care institution referred to in Article 42(1) (hereinafter referred to as "health care institution"); provided, this shall not apply if an unavoidable circumstance such as an act of God exists.

(3) Notwithstanding the main clause of paragraph (2), if it is possible for a health care institution to ascertain his or her eligibility using his or her resident registration certificate (including mobile resident registration certificate), driver's license, passport, or other identification cards prescribed by Decree of the Ministry of Health and Welfare (hereinafter referred to as "identification cards") to verify his or her identity, the insured or a dependent need not submit his or her health insurance card. <Amended on Dec. 26, 2023>(4) Where a health care institution provides health care benefits to the insured or his or her dependents, it shall verify the person‘s identity and eligibility using either a health insurance card or an identification card, as prescribed by Decree of the Ministry of Health and Welfare; provided, this shall not apply where it is impracticable for the health care institution to verify the identity of the insured and his or her dependents and the eligibility thereof, as prescribed by Decree of the Ministry of Health and Welfare. <Added on May 19, 2023>(5) Neither the insured nor his or her dependent shall obtain insurance benefits after losing eligibility under Article 10(1) by using documents that were previously employed to certify his or her eligibility. <Added on May 22, 2013; May 19, 2023>(6) No person shall allow another person to receive insurance benefits by transferring or lending his or her health insurance card or identification card. <Added on May 22, 2013; May 19, 2023>(7) No person shall receive insurance benefits by transferring, borrowing, or fraudulently using another person's health insurance card or identification card. <Amended on May 22, 2013; May 19, 2023>(8) Matters necessary for, among other things, the procedures and methods for applying for a health insurance card referred to in paragraph (1) and the forms, issuance, and use thereof shall be prescribed by Decree of the Ministry of Health and Welfare. <Amended on May 22, 2013; Dec. 11, 2018; May 19, 2023>

Article 13Insurer

The insurer of national health insurance shall be the National Health Insurance Service (hereinafter referred to as the "NHIS").

Article 14Services

(1) The NHIS shall administer the following affairs: <Amended on Feb. 8, 2017>1. Supervision of the eligibility of the insured and their dependents;

2. Imposition and collection of insurance contributions and other money collectible provided for in this Act;

3. Administration of insurance benefits;

4. Preventive programs prescribed by Presidential Decree, which are conducted by utilizing information on the current state of providing health care benefits and the results of medical examination for the purpose of early detection and prevention of diseases and health management of the insured and their dependents;

5. Payment of insurance benefit costs;

6. Programs for managing, operating, and increasing its assets;

7. Operation of medical facilities;

8. Education and training and public relation in connection with health insurance;

9. Investigative research and international cooperation in connection with health insurance;

10. Matters prescribed by this Act as the service of the NHIS;

11. Operations entrusted under the National Pension Act, the Act on the Collection of Insurance Premiums for Employment Insurance and Industrial Accident Compensation Insurance, the Wage Claim Guarantee Act, and the Asbestos Injury Relief Act (hereinafter referred to as "applicable Acts to the entrustment of collection");

12. Other services entrusted under this Act or other statutes and regulations;

13. Others determined by the Minister of Health and Welfare as being necessary in connection with health insurance.

(2) Programs for managing, operating, and increasing assets under paragraph (1)6 shall be conducted in accordance with each of the following methods, taking the stability and profitability into consideration:

1. Making deposits or setting up trust at postal service offices or banks established under the Banking Act;

2. Purchase of securities issued directly, or of which fulfillment of the obligation is guaranteed, by the State, local governments, or banks established under the Banking Act;

3. Purchase of securities issued by a corporation established under any Special Act;

4. Purchase of securities issued by trust business entities established under the Financial Investment Services and Capital Markets Act or collective investment business entities established under that Act;

5. Acquisition of real estates for use in operating the NHIS or partial lease thereof;

6. Other programs prescribed by Presidential Decree as necessary to increase the assets of the NHIS.

(3) If a service is provided, or the use of the facilities of the NHIS is allowed to, a specific person, the NHIS may collect a service charge or a use fee for the provision of the service or the use of the facilities, as prescribed by the NHIS' articles of incorporation.

(4) The NHIS shall disclose to the public the information that it maintains and manages in connection with health insurance as prescribed by the Official Information Disclosure Act.

Article 15Legal personality

(1) The NHIS shall be a corporation.

(2) The NHIS shall be established at the time it registers such establishment at the location of its main office.

Article 16Offices

(1) Location of the main office of the NHIS shall be prescribed by its articles of incorporation.

(2) If necessary, the NHIS may establish branch offices as prescribed by its articles of incorporation.

Article 17Articles of incorporation

(1) The articles of incorporation of the NHIS shall state the following matters:

1. Purpose;

2. Name;

3. The location of its office;

4. Matters concerning the executive officers and employees;

5. Operation of the board of directors;

6. Matters concerning the Financial Operation Committee;

7. Matters concerning insurance contributions and insurance benefits;

8. Matters concerning its budget and settlement of accounts;

9. Matters concerning its assets and accounting;

10. Services and execution thereof;

11. Matters concerning the amendment of the articles of incorporation;

12. Matters concerning public announcements.

(2) When the NHIS intends to modify its articles of incorporation, it shall obtain authorization from the Minister of Health and Welfare.

Article 18Registration

The registration of incorporation of the NHIS shall include the following matters:

1. Purpose;

2. Name;

3. Location of its principal office and branch offices;

4. Name, address, and resident registration number of the president.

Article 19Dissolution

Matters regarding the dissolution of the NHIS shall be prescribed by Acts.

Article 20Executive officers

(1) The NHIS shall have one president, 14 directors, and one auditor, as its executive officers. In such cases, the president, five directors, and the auditor shall be standing.

(2) The president shall be appointed by the President of the Republic of Korea upon recommendation of the Minister of Health and Welfare from among several persons recommended by the Committee for Recommendation of Executive Officers established under Article 29 of the Act on the Management of Public Institutions (hereinafter referred to as the "Committee for Recommendation of Executive Officers").

(3) Full-time directors shall be appointed by the president following the recommendation procedures prescribed by Decree of the Ministry of Health and Welfare.

(4) As part-time directors, following persons shall be appointed by the Minister of Health and Welfare:

1. Persons, each one of whom is recommended respectively by a labor union, employer organization, civil organization, consumer organization, agricultural and fisheries organization, and a senior citizens' organization;

2. Three relevant public officials recommended as prescribed by Presidential Decree.

(5) The auditor shall be appointed by the President upon recommendation of the Minister of Finance and Economy from among the plural number of persons recommended by the Committee for Recommendation of Executive Officers. <Amended on Oct. 1, 2025>(6) Part-time directors prescribed in paragraph (4) may receive reimbursement for actual expenses, as prescribed by the articles of incorporation.

(7) The term of the office of the president shall be three years, and that of directors (excluding directors who are public officials) and auditor shall be two years, respectively.

Article 21Collection director

(1) Among standing directors, a director who has extensive knowledge and experience in management, economy, and social insurance and who meets the qualification prescribed by Decree of the Ministry of Health and Welfare shall be appointed as a director in charge of the affairs provided for Article 14(1)2 and 11 (hereinafter referred to as "collection director").

(2) The NHIS shall have a committee, having directors as its members, for nominating collection directors (hereinafter referred to as the "Nomination Committee") in order to nominate candidates for a collection director. In such cases, a director nominated by the president shall be the Chairperson of the Nomination Committee.

(3) The Nomination Committee shall publicly announce recruitment advertisement for a collection director on major daily newspapers, and in addition, may examine a candidate who is regarded as qualified, or request a specialized organization to examine such candidate.

(4) The Nomination Committee shall screen persons recruited pursuant to paragraph (3) according to the candidate screening criteria for a collection director prescribed by Decree of the Ministry of Health and Welfare, and consult on the contractual terms with the collection director nominee.

(5) The president shall conclude a contract with the candidate for a collection director in accordance with the result of screening and consultation conducted under paragraph (4), and in such case, a standing director shall be deemed appointed under Article 20(3).

(6) Matters necessary for the consultation on contractual terms under paragraph (4), contract conclusion, etc. under paragraph (5), shall be prescribed by Decree of the Ministry of Health and Welfare.

Article 22Duties of executive officer

(1) The president shall represent the NHIS, exercise overall control over its services, and take responsibility for the management performance of the NHIS during the term of office.

(2) The standing directors shall perform the affairs of the NHIS under the order of the president.

(3) Where the president is unable to perform his or her duties due to any unavoidable cause, a standing director prescribed by the articles of incorporation shall act on behalf of the president, and where no standing director exists or a standing director is unable to perform such duties, an executive officer prescribed by articles of incorporation shall act on behalf of the president.

(4) The auditor shall audit the services, accounting, and property status of the NHIS.

Article 23Disqualification of executive officers

No person who falls under any of the following subparagraphs may become an executive officer of the NHIS:

1. A person who is not a national of the Republic of Korea;

2. A person falling under any subparagraph of Article 34(1) of the Act on the Management of Public Institutions.

Article 24Obligatory retirement and dismissal of executive officers

(1) If an executive officer falls under any of the subparagraphs of Article 23, or is confirmed to fall thereunder at the time of his or her appointment, he or she shall be obligated to retire.

(2) If an executive officer falls under any of the following subparagraphs, the person with the power to appoint may dismiss him or her:

1. Where he or she is deemed incapable of performing his or her duties due to a physical or mental disability;

2. Where he or she breaches an official duty;

3. Where he or she causes loss to the NHIS by intention or gross negligence;

4. Where he or she does an act that causes injury to his or her dignity, regardless of whether on or off duty.

5. Where he or she violates an order of the Minister of Health and Welfare issued under this Act.

Article 25Prohibition of concurrent offices of executive officers

(1) Standing executive officers and employees of the NHIS shall not engage in another business for the purpose of making profit, in addition to the duties assigned to them.

(2) Where a standing executive officer of the NHIS obtains permission from the person with the power to appoint or recommend, or where an employee of the NHIS obtains permission from the president thereof, such executive officer or employee may concurrently perform the affairs for non-profit purpose.

Article 26Board of directors

(1) The NHIS shall have a board of directors in order to deliberate on and resolve important matters (referring to matters prescribed in Article 17(1) of the Act on the Management of Public Institutions) of the NHIS.

(2) The board of directors shall be comprised of the chairperson and directors.

(3) The auditor may appear before the board of directors to speak.

(4) Matters necessary for the issues to be resolved by the board of directors and the operation of the board of directors shall be prescribed by Presidential Decree.

Article 27Appointment and dismissal of employees

The president shall appoint and dismiss employees as prescribed by the articles of incorporation.

Article 28Legal fiction as public officials in application of penalty provisions

The executive officers and employees of the NHIS shall be deemed to be public officials in applying Articles 129 through 132 of the Criminal Act.

Article 29Rules

Rules relevant to the organization, personnel management, remunerations, and accounting of the NHIS shall be determined with approval from the Minister of Health and Welfare after undergoing a resolution by the board of directors.

Article 30Appointment of agent

The president may select and appoint an agent, from among the directors or employees of the NHIS, in order to have the agent act on behalf of him or her in all judicial or extra-judicial acts relevant to the services of the NHIS.

Article 31Restriction on representative authority

(1) In connection with the matters with regard to which the interests of the NHIS and the interests of the president are in conflict, the president is not allowed to represent the NHIS. In such cases, the auditor shall represent the NHIS.

(2) Paragraph (1) shall apply mutatis mutandis to any litigation between the NHIS and the president.

Article 32Delegation of authority of president

From among the authority of the president referred to in this Act, those prescribed by Presidential Decree, including restrictions on benefits and notice to pay insurance contributions, may be delegated to the head of a branch offices pursuant to the articles of incorporation.

Article 33Financial Operation Committee

(1) The NHIS shall have the Financial Operation Committee to deliberate on and resolve the matters related to insurance finance, such as contracts on the costs of health care benefits provided for in Article 45(1) and the write-off of deficits provided for in Article 84.

(2) The Chairperson of the Financial Operation Committee shall be elected by the Committee from among the members referred to in Article 34(1)3.

Article 34Composition of Financial Operation Committee

(1) The Financial Operation Committee shall be comprised of the following members:

1. Ten members representing the employee insured;

2. Ten members representing the self-employed insured;

3. Ten members representing the public interest.

(2) As the members referred to in paragraph (1), the Minister of Health and Welfare shall appoint or commission the following persons:

1. For members referred to in paragraph (1)1, five recommended by the labor union and the other five by the employers' organization;

2. For members referred to in paragraph (1)2, persons recommended by the agricultural and fishery organization, the urban self-employed persons' organization, and the civic group, as prescribed by Presidential Decree;

3. For members referred to in paragraph (1)3, relevant public officials or persons with extensive knowledge on and experience in health insurance who are prescribed by Presidential Decree.

(3) The term of office of the Financial Operation Committee members (excluding the members who are public officials) shall be two years; provided, the term of office of any member newly appointed to fill the vacancy of a resigned member, etc. shall be the remaining term of his or her predecessor.

(4) Matters necessary for the operation etc. of the Financial Operation Committee, shall be prescribed by Presidential Decree.

Article 35Accounting

(1) The fiscal year of the NHIS shall be based on the fiscal year of the Government.

(2) The NHIS shall administer the finance of the employee insured and the self-employed insured in an integrated manner.

(3) The NHIS shall, separately from its other accounting, make accounting treatment for the health insurance program, as well as for the national pension program, employment insurance program, industrial accident compensation insurance program, and wage claim guarantee program entrusted pursuant to Acts authorizing the entrustment of collection, independently from one another. <Amended on Jan. 16, 2018>

Article 36Budget

The NHIS shall compile a budget bill for each fiscal year and obtain approval therefor from the Minister of Health and Welfare after a resolution by the board of directors. This shall also apply where it intends to modify the budget. <Amended on Mar. 22, 2016>

Article 37Loans

The NHIS may borrow funds where a shortage of cash exists in making reimbursement; provided, it shall obtain approval from the Minister of Health and Welfare for any long- term loan with a term of at least one year.

Article 38Reserve fund

(1) Out of the fund remaining after the settlement of accounts for each fiscal year, the NHIS shall accumulate, as its reserve fund, an amount equivalent to at least 5/100 of the expenses required for cost of insurance benefits for that fiscal year until the fund reaches 50/100 of the expenses required for that fiscal year.

(2) The reserve fund referred to in paragraph (1) may not be used except where it is used to meet shortages in the expenses incurred in paying insurance benefits or where a shortage of cash exists in making reimbursement; where the shortage of cash in making reimbursement is met out of the reserve funds, the amount shall be made up for within the fiscal year concerned.

(3) Matters necessary for the method of management, operation, etc. of the reserve funds referred to in paragraph (1) shall be prescribed by the Minister of Health and Welfare.

Article 39Settlement of accounts

(1) The NHIS shall prepare a report on the statement of accounts and a report on business performance for each fiscal year and report to the Minister of Health and Welfare thereon by the end of February in the following year.

(2) When the NHIS reports to the Minister of Health and Welfare on its report on statement of accounts and business report pursuant to paragraph (1), it shall publicly announce the contents thereof as prescribed by Decree of the Ministry of Health and Welfare.

Article 39-2Contribution to projects for supporting disastrous medical expenses

The NHIS may contribute fund within its budgetary limits every year to be appropriated for the expenses used for the project for supporting disastrous medical expenses under the Act on Support of Disastrous Medical Expenses. In such case, matters necessary for the upper limit amount of such contribution shall be prescribed by Presidential Decree.[This Article Added on Jan. 16, 2018]

Article 40Application mutatis mutandis of the Civil Act

Except as prescribed by this Act and the Act on the Management of Public Institutions, the provisions of the Civil Act that are relevant to an incorporated foundation shall apply mutatis mutandis to the NHIS.

Article 41Medical care benefits

(1) Health care benefits referred to in the following subparagraphs shall be provided for diseases, injuries, childbirths, etc. of the insured and their dependents:

1. Diagnosis and medical examination;

2. Supply of medicines and materials for medical treatment;

3. Treatment, surgery, or other types of medical care;

4. Prevention and rehabilitation;

5. Hospitalization;

6. Nursing;

7. Transfer.

(2) The scope (hereinafter referred to as "health care benefit item") of health care benefits under paragraph (1) (hereinafter referred to as "health care benefits") shall be as follows: <Added on Feb. 3, 2016>1. Health care benefits specified in each subparagraph of paragraph (1) (excluding medicines under paragraph (1)2): All except for the items determined to be non-benefit by the Minister of Health and Welfare under paragraph (4);

2. Medicines under paragraph (1)2: Medicines determined and publicly notified by the Minister of Health and Welfare as items eligible for health care benefits pursuant to Article 41-3.

(3) Criteria for the method, procedure, scope, and upper limit of health care benefits shall be prescribed by Decree of the Ministry of Health and Welfare. <Amended on Feb. 3, 2016>(4) In prescribing the criteria for health care benefits under paragraph (3), the Minister of Health and Welfare may determine medical treatment for ailments that do not cause difficulties at work or in daily life and other items prescribed by Decree of the Ministry of Health and Welfare, as items excluded from the items eligible for health care benefits (hereinafter referred to as "non-benefit item"). <Amended on Feb. 3, 2016>

Article 41-2Reduction of upper limit amount of costs of health care benefits for medicines

(1) The Minister of Health and Welfare may reduce the upper limit amount (referring to the amount set as the upper limit of each kind of medicine pursuant to Article 41(3); hereinafter the same shall apply) of costs of health care benefits for the medicines referred to in Article 41(1)2 as are involved in a violation of Article 47(2) of the Pharmaceutical Affairs Act within the extent not exceeding 20/100 of such amount. <Added on Mar. 27, 2018>(2) Where any medicine for which the upper limit amount of costs of health care benefits is reduced pursuant to paragraph (1) again becomes subject to the reduction of amount under paragraph (1) within the period prescribed by Presidential Decree within the extent of five years from the date when the upper limit amount of such medicine was reduced, the Minister of Health and Welfare may partially reduce the upper limit amount of costs of health care benefits for such medicine within the extent not exceeding 40/100 of such upper limit amount. <Added on Mar. 27, 2018>(3) Where any medicine for which the upper limit amount of costs of health care benefits is reduced pursuant to paragraph (2) is again involved in a violation of Article 47(2) of the Pharmaceutical Affairs Act within the period prescribed by Presidential Decree within the scope of five years from the date when the upper limit amount of costs of health care benefits for such medicine is reduced, the Minister of Health and Welfare may suspend the application of health care benefits for a fixed period not exceeding one year. <Amended on Mar. 27, 2018>(4) Standards and procedures for reducing the upper limit amount of costs of health care benefits and suspending the application of health care benefits pursuant to paragraphs (1) through (3), and other matters therefor shall be prescribed by Presidential Decree. <Amended on Mar. 27, 2018>[This Article Added on Jan. 1, 2014][Title Amended on Mar. 27, 2018]

Article 41-3Determination and adjustment of eligibility for health care benefits of acts, materials for medical treatment, or medicines

(1) A health care institution referred to in Article 42, a manufacturer or importer of materials for medical treatment, and other persons prescribed by Decree of the Ministry of Health and Welfare shall request the Minister of Health and Welfare to determine whether an act relating to health care benefits under Article 41(1)1, 3, or 4 or a material for medical treatment under Article 41(1)2 (hereinafter referred to as "act or material for medical treatment"), which has not been determined to be a health care benefit item or non-benefit item, is a benefit or non-benefit item.

(2) A manufacturer or importer of medicines under the Pharmaceutical Affairs Act and other persons prescribed by Decree of the Ministry of Health and Welfare may file an application with the Minister of Health and Welfare to determine whether a medicine under Article 41(1)2 (hereafter in this Article referred to as "medicine"), which is not included in items eligible for health care benefits, meets the criteria for health care benefit inclusion. <Amended on May 19, 2023>(3) Upon receipt of a request under paragraph (1) or (2), the Minister of Health and Welfare shall determine whether the relevant item is benefit or non-benefit item, and then notify the applicant of his or her determination, within a period prescribed by Decree of the Ministry of Health and Welfare, unless there is good cause.

(4) Even if no request is made under paragraph (1) or (2), the Minister of Health and Welfare may determine, ex officio, whether any act, material for medical treatment, or medicine is a benefit or non-benefit item, in cases prescribed by Decree of the Ministry of Health and Welfare where such determination is necessary to treat patients.

(5) The Minister of Health and Welfare may adjust ex officio, among other things, whether medicines determined and publicly notified as eligible for health care benefits pursuant to Article 41(2)2 continue to be eligible, the scope of such benefits, and the maximum amount of costs of health care benefits, as prescribed by Decree of the Ministry of Health and Welfare. <Added on May 19, 2023>(6) The timing, procedures, and methods for filing an application for determination of eligibility for health care benefits under paragraphs (1) and (2), matters necessary for the entrustment of affairs, etc., the procedures and methods for determining eligibility for health care benefits under paragraphs (3) and (4), the grounds for, procedures, methods, etc. of ex officio adjustment under paragraph (5), and other relevant matters shall be prescribed by Decree of the Ministry of Health and Welfare. <Amended on May 19, 2023>[This Article Added on Feb. 3, 2016][Title Amended on May 19, 2020]

Article 41-4Selective benefits

(1) Where economic feasibility, medical treatment effects, etc. are uncertain in determining health care benefits and thus additional grounds are required to verify them, where potential benefits exist for the recovery of health of the insured or their dependents despite low economic feasibility, or where Presidential Decree prescribes, the Minister of Health and Welfare may designate and provide selective benefits as preliminary health care benefits.

(2) The Minister of Health and Welfare shall regularly assess the appropriateness of health care benefits in relation to selective benefits under paragraph (1) (hereinafter referred to as "selective benefits") according to the procedures and methods prescribed by Presidential Decree, thereby re-determining whether to provide health care benefits therefor and adjusting the criteria for health care benefits under Article 41(3).[This Article Added on Mar. 22, 2016]

Article 41-5Home health care benefits

Where the insured or his or her dependent has difficulty moving on his or her own due to illness or injury or otherwise falls under any case prescribed by Decree of the Ministry of Health and Welfare, health care benefits pursuant to Article 41 may be provided by directly visiting the insured or dependent.[This Article Added on Dec. 11, 2018]

Article 42Health care institution

(1) Health care benefits (excluding nursing and transfers) shall be provided by the health care institutions referred to in the following subparagraphs; in such cases, the Minister of Health and Welfare may exclude medical facilities, etc. prescribed by Presidential Decree, which are unfit as health care institutions for the public interest or for national policy reasons, from among health care institutions: <Amended on Mar. 27, 2018>1. Medical institutions established under the Medical Service Act;

2. Pharmacies registered under the Pharmaceutical Affairs Act;

3. The Korea Orphan and Essential Drug Center established under Article 91 of the Pharmaceutical Affairs Act;

4. Public health clinics, public health and health care centers, and branches of public health clinics referred to in the Regional Public Health Act;

5. Public health clinics established under the Act on Special Measures for Health and Medical Services in Agricultural and Fishing Villages.

(2) If necessary for efficiently providing health care benefits, the Minister of Health and Welfare may recognize health care institutions meeting the standards prescribed by Decree of the Ministry of Health and Welfare, such as facilities, equipment, human resources, and medical departments, as specialized health care institutions, as prescribed by Decree of the Ministry of Health and Welfare. In such cases, he or she shall issue a written recognition for each of the relevant specialized health care institutions.

(3) If a health care institution recognized under paragraph (2) falls under any of the following cases, the Minister of Health and Welfare shall revoke such recognition:

1. Where it fails to meet the standards for recognition referred to in the former part of paragraph (2);

2. Where it returns the written recognition received under the latter part of paragraph (2).

(4) Health care institutions recognized to be specialized health care institutions under paragraph (2) or tertiary hospitals under Article 3-4 of the Medical Service Act may set the procedure for health care benefits referred to in Article 41(3) and the costs of health care benefits referred to in Article 45 differently from other health care institutions. <Amended on Feb. 3, 2016>(5) Health care institutions referred to in paragraphs (1), (2), and (4) may not refuse to provide health care benefits without good cause.

Article 42-2Management of provision of selective benefits by health care institutions

(1) Where any selective benefits require data accumulation or medical use and management, the Minister of Health and Welfare may predetermine the requirements for the provision of relevant selective benefits and only the health care institutions that satisfy such requirements may provide relevant selective benefits, notwithstanding Article 42(1).

(2) A health care institution which provides selective benefits pursuant to paragraph (1) shall submit data necessary to assess relevant selective benefits under Article 41-4(2).

(3) Where a health care institution fails to satisfy the requirements for the provision of selective benefits referred to in paragraph (1) or fails to submit data referred to in paragraph (2), the Minister of Health and Welfare may restrict the health care institution from providing relevant selective benefits.

(4) The requirements for the provision of selective benefits referred to in paragraph (1), the submission of data referred to in paragraph (2), restrictions on the provision of selective benefits referred to in paragraph (3), and other necessary matters shall be prescribed by Decree of the Ministry of Health and Welfare.[This Article Added on Mar. 22, 2016]

Article 43Reports on current status of health care institutions

(1) At the time a health care institution makes the first claim for reimbursement of costs of health care benefits under Article 47, the institution shall report on the current status of its facilities, equipment, human resources, etc. to the Health Insurance Review and Assessment Service (hereinafter referred to as the "Review and Assessment Service") established under Article 62.

(2) Where any matter reported under paragraph (1) (limited to any matter related to the increase or reduction of the costs of health care benefits under Article 45) is changed, the health care institution shall report thereon to the Review and Assessment Service within 15 days from the date on which such change is made, as prescribed by Decree of the Ministry of Health and Welfare.

(3) Matters necessary for the scope, subject, method, and procedure, etc. of the reporting prescribed in paragraphs (1) and (2) shall be prescribed by Decree of the Ministry of Health and Welfare.

Article 44Co-payment of expenses

(1) A person who receives health care benefits shall personally bear part of such expenses (hereinafter referred to as "co-payment"), as prescribed by Presidential Decree. In such cases, a higher share of co-payment may be applied to selective benefits than to other health care benefits. <Amended on Mar. 22, 2016>(2) Where the total amount to be borne by a beneficiary, as calculated from the following amounts, exceeds the amount prescribed by Presidential Decree (hereafter in this Article, referred to as "co-payment ceiling"), the NHIS shall bear the excess amount; in such cases, the NHIS shall notify the relevant parties of the excess amount and make the payment: <Added on Mar. 22, 2016; May 19, 2023; Feb. 20, 2024>1. Total co-payment amount;

2. Amount borne as health care or childbirth expenses under Article 49(1) (the publicly notified amount if the amount exceeds the amount determined and publicly notified by the Minister of Health and Welfare) minus the amount received as health care expenses under that paragraph.

(3) Where the total amount to be borne by a person, as calculated from the following amounts exceeds the amount prescribed by Presidential Decree (hereafter in this Article, referred to as "co-payment ceiling"), the NHIS shall bear the excess amount; in such cases, the NHIS shall notify the relevant parties of the excess amount and make the payment: <Added on Mar. 22, 2016; May 19, 2023; Feb. 20, 2024>(4) Matters necessary for the method for calculating the amounts under the subparagraphs of paragraph (2) and the total amount, the method for paying any amount exceeding the co-payment ceiling, and determining the co-payment ceiling based on the insured person's income level, etc. under paragraph (3) shall be prescribed by Presidential Decree. <Added on Mar. 22, 2016; Feb. 20, 2024>

Article 45Calculation of costs of health care benefits

(1) The costs of health care benefits shall be determined by contract between the president of the NHIS and persons prescribed by Presidential Decree who represent the medical and pharmaceutical communities. In such cases, the term of the contract shall be one year.

(2) If a contract is concluded under paragraph (1), it shall be deemed concluded between the NHIS and each individual health care institution.

(3) A contract under paragraph (1) shall be concluded by May 31 of the year in which the expiration date of the term of the immediately preceding contract falls; if no contract is concluded within that period, the costs of health care benefits shall be determined by the Minister of Health and Welfare by no later than June 30 of the year in which the expiration date of the term of the immediately preceding contract falls after reaching a resolution thereon by the Deliberative Committee. In such cases, the costs of health care benefits determined by the Minister of Health and Welfare shall be deemed the costs of health care benefits determined by contract under paragraphs (1) and (2). <Amended on May 22, 2013>(4) If the costs of health care benefits are determined under paragraph (1) or (3), the Minister of Health and Welfare shall give a public notice of the particulars of the costs of health care benefits without delay.

(5) The president of the NHIS shall conclude a contract under paragraph (1) after undergoing the deliberation and resolution by the Financial Operation Committee under Article 33.

(6) When the president of the NHIS requests for materials necessary to conclude a contract under paragraph (1), the Review and Assessment Service shall sincerely comply therewith.

(7) Details of a contract concluded under paragraph (1) and other necessary matters shall be prescribed by Presidential Decree.

Article 46Calculation of costs of health care benefits for medicines and materials for medical treatment

Notwithstanding Article 45, the costs of health care benefits for medicines and materials for medical treatment referred to in Article 41(1)2 (hereinafter referred to as "medicines and materials for medical treatment") may be calculated as prescribed by Presidential Decree, taking into consideration the purchase prices, etc. of the medicines and materials for medical treatment paid by the health care institutions.

Article 47Claims for and payment of costs of health care benefits

(1) A health care institution may claim the costs of health care benefits from the NHIS. In such cases, a request for review referred to in paragraph (2) shall be deemed a claim to the NHIS for the costs of health care benefits.

(2) A health care institution which intends to claim the costs of health care benefits under paragraph (1) shall request the Review and Assessment Service for a review of the costs of health care benefits, and the Review and Assessment Service upon receipt of the request, shall review the costs and notify the NHIS and the health care institution of the details of its review without delay.

(3) Upon receipt of the notification of the review details under paragraph (2), the NHIS shall, without delay, pay the costs of health care benefits to the health care institution in accordance with such details. In such cases, where the co-payment already paid is in excess of the amount notified under paragraph (2), the difference of the excess payment shall be subtracted from the amount to be paid to the health care institution and paid to the relevant insured.

(4) Where the NHIS pays the costs of health care benefits to a health care institution pursuant to the former part of paragraph (3), and where the health care institution fails to pay any insurance contributions payable to the NHIS pursuant to Article 77(1)1 or any other money collectible under this Act, the NHIS may pay the costs of health care benefits after deducting such insurance contributions or money collectible from the costs of health care benefits. <Added on Dec. 27, 2022>(5) The NHIS may offset the amount to be paid to the insured under the latter part of paragraph (3) against the insurance contributions and other money collectible under this Act which the relevant insured shall pay (hereinafter referred to as "insurance contributions, etc."). <Amended on Dec. 27, 2022>(6) Where the Review and Assessment Service evaluates the appropriateness of health care benefits referred to in Article 47-4 and notifies the NHIS of the results of such evaluation, the NHIS shall adjust the payment by increasing or reducing the costs of health care benefits in accordance with the evaluation results. In such cases, the criteria for increased or reduced payment of the costs of health care benefits shall be prescribed by Decree of the Ministry of Health and Welfare. <Amended on Jun. 10, 2022; Dec. 27, 2022>(7) A health care institution may authorize the following organizations to request a review referred to in paragraph (2) on its behalf: <Amended on Dec. 27, 2022>1. The physician's association, dentists' association, association of doctors of Korean medicine, midwives' association provided in Article 28(1) of the Medical Service Act or a branch or a sub-branch of each of those associations, each of which files a report pursuant to paragraph (6) of that Article;

2. The association of medical institutions provided in Article 52 of the Medical Service Act;

3. The Korean Pharmaceutical Association provided in Article 11 of the Pharmaceutical Affairs Act or a branch or a sub-branch of the association, which files a report pursuant to Article 14 of that Act.

(8) Matters necessary for the method and procedure for making the claim, review, payment, etc. of the costs of health care benefits referred to in paragraphs (1) through (7) shall be prescribed by Decree of the Ministry of Health and Welfare. <Amended on Dec. 27, 2022>

Article 47-2Withholding of payment of costs of health care benefits

(1) Notwithstanding Article 47(3), where the NHIS confirms that a health care institution which has filed a claim for the payment of the costs of health care benefits violates Article 4(2) or 33(2) or (8) of the Medical Service Act or Articles 20(1) and 21(1) of the Pharmaceutical Affairs Act or that such institution has been established and operated in violation of Article 33(10) of the Medical Service Act or Article 6(3) or (4) of the Pharmaceutical Affairs Act as a result of an investigation conducted by an investigative agency, the NHIS may withhold the payment of costs of health care benefits claimed by the relevant health care institution. In such cases, the effect of the disposition of withholding the payment of costs of health care benefits shall also extend to the costs of health care benefits claimed by the relevant health care institution after such disposition. <Amended on Dec. 29, 2020; Jul. 11, 2023>(2) Before withholding the payment of the costs of health care benefits under paragraph (1), the NHIS shall provide the relevant health care institution with an opportunity to submit its opinion.

(3) Where a court acquits a health care institution of charges related to violations of Article 4(2), 33(2) or (8) of the Medical Service Act or Article 20(1) or 21(1) of the Pharmaceutical Affairs Act or of the establishment and operation violations of Article 33(10) of the Medical Service Act or Article 6(3) or (4) of the Pharmaceutical Affairs Act, the NHIS may pay the health care benefits costs claimed by the relevant health care institution only for the those benefits provided after the ruling. <Added on Feb. 20, 2024>(4) Where the health care institution referred to in paragraph (1) is not proven to have violated Article 4(2) or 33(2) or (8) of the Medical Service Act or Article 20(1) or 21(1) of the Pharmaceutical Affairs Act or is not proven to have been established or operated in violation of Article 33(10) of the Medical Service Act or Article 6(3) or (4) of the Pharmaceutical Affairs Act due to reasons prescribed by Presidential Decree, such as where a court's judgment of acquittal becomes final and conclusive, the NHIS shall revoke the disposition to withhold payment and pay the relevant health care institution the health care benefits costs and the interest accrued during the period in which the payment of health care benefits costs has been withheld. In such cases, the interest shall be calculated based on the legal rate of interest under Article 379 of the Civil Act. <Amended on Dec. 29, 2020; Jul. 11, 2023; Feb. 20, 2024>(5) Matters necessary for the procedures, etc. for withholding the payment, submitting opinions under paragraphs (1) and (2), the payment procedures for the withheld health care benefits costs and interest under paragraph (3), and other relevant matters shall be prescribed by Presidential Decree. <Amended on Feb. 20, 2024>[This Article Added on May 20, 2014][Paragraph (1) of this Article was amended by Act No. 20593 on December 20, 2024, pursuant to the decision of unconstitutionality rendered by the Constitutional Court on March 23, 2023]

Article 47-3Different payment of costs of health care benefits

In order to redress imbalance between medical resources and the narrowing of the Medical Service gap by region, the costs of health care benefits may be separately set and paid by region.[This Article Added on Dec. 29, 2020]

Article 47-4Evaluation of appropriateness of health care benefits

(1) The Review and Assessment Service may conduct an evaluation of the appropriateness of health care benefits (hereafter in this Article referred to as "evaluation") in order to improve the quality of medical treatment covered by health care benefits.

(2) The Review and Assessment Service may include in the evaluation of health care benefits any matters related to health care benefits, such as human resources, facilities, equipment, and patient safety of a health care institution.

(3) The Review and Assessment Service shall notify the health care institution subject to evaluation of the evaluation results, and where the costs of health care benefits are added or subtracted based on the evaluation results, it shall notify the health care institution for whom the addition or subtraction is made and the NHIS of the evaluation results including decisions made.

(4) Matters necessary for the criteria for, scope of, procedures, and methods for evaluations, etc. under paragraphs (1) through (3) shall be prescribed by Decree of the Ministry of Health and Welfare.[This Article Added on Jun. 10, 2022]

Article 48Verification of eligibility for health care benefits

(1) The insured or the dependent may request the Review and Assessment Service to verify whether part of the medical expenses he or she has borne, other than co-payment, is excluded from health care benefit items in accordance with Article 41(4). <Amended on Feb. 3, 2016>(2) The Review and Assessment Service, upon receipt of a request for verification under paragraph (1), shall notify the person who requested the verification of its result. In such cases, if part of the medical expenses for which the verification is requested is verified to be entitled to health care benefits, the Review and Assessment Service shall notify the NHIS and the relevant health care institution of such facts.

(3) A health care institution upon receipt of notice under the latter part of paragraph (2), shall refund, without delay, the amount it has collected in excess of the amount it should have collected to the person who requested the verification (hereinafter referred to as "over-paid co-payment"); provided, where the relevant health care institution fails to refund the over-paid co-payment, the NHIS may refund such over-paid co-payment to the person who requests for verification after deducting them from the health care benefits it is liable to pay to such health care institution.

(4) The scope of requests for verification, the methods and procedures therefor, and the processing period under paragraphs (1) through (3), and other necessary matters shall be prescribed by Decree of the Ministry of Health and Welfare. <Added on Jan. 10, 2022>

Article 49Health care costs

(1) Where the insured or dependent, due to emergency or other unavoidable reasons prescribed by Decree of the Ministry of Health and Welfare, receives health care for a disease, injury, childbirth, etc. at an institution prescribed by Decree of the Ministry of Health and Welfare and performs functions similar to those of a health care institution (including a health care institution placed under a period of suspension of operation under Article 98(1); hereinafter referred to as "quasi-health care institution") or undergoes a childbirth at a place other than a health care institution, the NHIS shall disburse an amount equivalent to the health care benefits concerned to the insured or dependent as the health care costs, as prescribed by Decree of the Ministry of Health and Welfare. <Amended on Dec. 29, 2020>(2) A quasi-health care institution shall issue to the recipient of health care a detailed health care cost statement or a receipt stating the particulars of the health care, as prescribed by the Minister of Health and Welfare, and the person who has received the health care shall submit such statement or receipt to the NHIS. <Amended on Dec. 29, 2020>(3) Notwithstanding paragraphs (1) and (2), a quasi-health care institution may directly claim the payment of the health care expenses to the NHIS, if a policyholder or his or her dependent has been delegated thereto. In such cases, the NHIS may pay the health care expenses to the quasi-medical care institution after examining the appropriateness of the particulars that the benefits have been requested." <Added on Dec. 29, 2020>(4) Matters necessary for the request for the payment of health care expenses by quasi-health care institutions under paragraph (3), the review of the NHIS' appropriateness, etc. shall be prescribed by Decree of the Ministry of Health and Welfare. <Added on Dec. 29, 2020>

Article 50Additional benefits

In addition to the health care benefits prescribed in this Act, the NHIS may provide benefits for medical expenses for pregnancy and childbirth, funeral costs, sickness allowances, and other allowances, as prescribed by Presidential Decree. <Amended on May 22, 2013>

Article 51Special cases concerning persons with disabilities

(1) The NHIS may provide insurance benefits for assistive devices pursuant to subparagraph 2 of Article 3 of the Act on the Support for Assistive Devices for Persons with Disabilities and Senior Citizens and Promotion of Use Thereof (hereafter in this Article referred to as "assistive devices") for the insured and dependents with disabilities registered under the Act on Welfare of Persons with Disabilities. <Amended on Apr. 23, 2019>(2) A person who sells assistive devices to a policyholder or his or her dependent who is a person with disabilities, may claim insurance benefits directly to the NHIS where a policyholder or his or her dependent is delegated. In such cases, the NHIS may pay insurance benefits on assistive devices to a person who sells assistive devices after examining the appropriateness of the terms of a claim for payment. <Added on Dec. 29, 2020>(3) The scope and methods of, and procedures for, insurance benefits for assistive devices referred to in paragraph (1), a business entity selling assistive devices requests insurance benefits referred to in paragraph (2), the review of the NHIS's propriety, and other necessary matters shall be prescribed by Decree of the Ministry of Health and Welfare. <Amended on Apr. 23, 2019; Dec. 29, 2020>

Article 52Health checkups

(1) The NHIS shall provide health checkups for the insured and their dependents in order to facilitate early detection of diseases and provide subsequent health care benefits.

(2) The types of and candidates for health checkups under paragraph (1) are as follows: <Added on Dec. 11, 2018>1. General health checkups: The employee insured, the self-employed insured who is the head of a household, the self-employed insured of 20 years of age and over, and a dependent of 20 years of age and over;

2. Cancer checkups: A person who meets a checkup cycle, age standard, etc. by type of cancer under Article 11(2) of the Cancer Control Act;

3. Infant health checkups: The insured and a dependent under the age of six.

(3) The items of health checkups under paragraph (1) shall be designed based on personal characteristics, such as gender and age, and life cycle. <Added on Dec. 11, 2018>(4) Frequency of and procedures for the health checkup referred to in paragraph (1), and other necessary matters shall be prescribed by Presidential Decree. <Amended on Dec. 11, 2018>

Article 53Restrictions on benefits

(1) If a person eligible to receive insurance benefits falls under any of the following subparagraphs, the NHIS shall not provide any insurance benefit:

1. Where he or she has caused criminal conduct by intention or gross negligence or caused an accident by intent;

2. Where he or she has failed to follow health care-related instructions of the NHIS or the health care institution by intention or gross negligence;

3. Where he or she has refused to submit the documents referred to in Article 55 or other items or evaded questions or medical checkups by intention or gross negligence;

4. Where he or she receives or is eligible to receive insurance benefits or compensations under other statutes or regulations due to a disease, injury, or accident incurred relating to his or her business or in the line of duty.

(2) When a person eligible for health care benefits has received, from the State or a local government, benefits equivalent to the health care benefits or expenses equivalent to the costs of health care benefits under the provisions of other statutes or regulations, the NHIS shall not provide insurance benefits up to the limit of such amount.

(3) Where the insured fails to pay any of the following insurance contributions for at least the period prescribed by Presidential Decree, the NHIS may not provide insurance benefits to the insured or his or her dependents until the delinquent insurance contributions are paid in full; provided, this shall not apply where the total number of failures to pay monthly insurance contributions (delinquent insurance contributions which have already been paid shall be excluded in calculating the total number of failures, and the period of delinquency in paying insurance contributions shall not be taken into consideration) is below the number prescribed by Presidential Decree, or the income and property of the insured and his or her dependents are below the standard prescribed by Presidential Decree: <Amended on Dec. 11, 2018; Feb. 6, 2024>1. Insurance contributions based on extra monthly income other than remuneration under Article 69(4)2;

2. Insurance contributions per household referred to in Article 69(5).

(4) Where an employer liable to pay insurance contributions under Article 77(1)1 is delinquent in paying the insurance contributions based on monthly remuneration referred to in Article 69(4)1, paragraph (3) shall apply only if such delinquency is attributable to the employee insured himself or herself. In such cases, the dependents of the relevant employee insured shall also be subject to paragraph (3). <Amended on Apr. 23, 2019>(5) Notwithstanding the provisions of paragraphs (3) and (4), where approval for the installment payment from the NHIS pursuant to the provisions of Article 82 is obtained and the approved insurance contributions are paid at least once, the insurance benefits may be provided; provided, the same shall not apply where anyone who has obtained approval for the installment payment pursuant to the provisions of Article 82 fails to pay the approved insurance contributions at least five times (if the number of installments approved under paragraph (1) of that Article is less than five times, it means the number of installments; hereafter in this Article the same shall apply) without good cause. <Amended on Apr. 23, 2019>(6) The insurance benefits received in the period during which no insurance benefits are to be provided pursuant to paragraphs (3) and (4) (hereafter in this paragraph referred to as "benefit restriction period") shall be recognized as insurance benefits only in the following cases: <Amended on Apr. 23, 2019>1. Where the insurance contributions in arrears are fully paid by the due date for its payment in the month to which the date two months lapse from the date when the NHIS has served notice that insurance benefits were received during the benefit restriction period belongs;

2. Where the insurance contributions for which installment payment is approved pursuant to Article 82 are paid at least once by the due date for its payment in the month to which the date two months lapse from the date when the NHIS has served notice that insurance benefits were paid during the benefit restriction period belongs; provided, where anyone who has obtained approval for the installment payment pursuant to Article 82 fails to pay the approved insurance contributions on at least five times without good cause, his or her eligibility for insurance benefits shall be denied.

Article 54Suspension of benefits

When a person eligible to receive insurance benefits falls under any of the following subparagraphs, no insurance benefit shall be provided during that period; provided, in cases of subparagraphs 3 and 4, the health care benefits under the provisions of Article 60 shall be provided: <Amended on Apr. 7, 2020>1. Deleted; <Apr. 7, 2020>2. When he or she is staying abroad;

3. When he or she falls under Article 6(2)2;

4. When he or she is committed to a correctional institution or equivalent facilities.

Article 55Verification of benefits

If it is deemed necessary when providing insurance benefits, the NHIS may demand a person who receives insurance benefits to submit documents and other items or have such person be questioned or diagnosed by relevant personnel.

Article 56Reimbursement of health care costs

When there is a claim for reimbursement of health care costs or for additional benefits the NHIS is obligated to provide under this Act, the NHIS shall pay or provide them without delay.

Article 56-2Accounts for receipt of health care costs

(1) Where a recipient of health care costs who is paid in cash for insurance benefits under this Act (hereinafter referred to as "health care costs, etc.") requests, the NHIS shall pay the health care costs, etc. into an account opened in the name of the recipient of health care (hereinafter referred to as "account for receipt of health care costs, etc."); provided, where an account transfer is impossible due to an information and communications problem or any other unavoidable cause prescribed by Presidential Decree, it may pay the health care costs, etc., as prescribed by Presidential Decree, such as direct cash payment.

(2) A financial institution at which an account for receipt of health care costs, etc. is opened shall ensure that only the health care costs, etc. are deposited into such account, and shall manage it.

(3) Matters necessary for the methods of and procedures for application for, and the management of, an account for receipt of health care costs, etc. under paragraphs (1) and (2), shall be prescribed by Presidential Decree.[This Article Added on May 20, 2014]

Article 57Collection of unjust profit

(1) The NHIS shall collect an amount equivalent to either the insurance benefits or costs thereof from a person who has received insurance benefits, a quasi-health care institution, a business entity selling assistive devices, or a health care institution that has received insurance benefit costs by fraud or other improper means. <Amended on Dec. 29, 2020; May 19, 2023>(2) Where a health care institution that has received insurance benefit costs by fraud or other improper means under paragraph (1) falls under any of the following subparagraphs, the NHIS may require the person who has established such health care institution to pay the money collectible under paragraph (1), severally or jointly with such health care institution: <Added on May 22, 2013; Dec. 29, 2020; Jul. 11, 2023>1. A medical institution established and operated by a person prohibited from establishing a medical institution because he or she violated Article 33(2) of the Medical Service Act, by borrowing a health care provider's license or the name of a medical corporation;

2. A pharmacy established and operated by a person prohibited from establishing a pharmacy because he or she violated Article 20(1) of the Pharmaceutical Affairs Act, by borrowing a pharmacist's license;

3. A medical institution established and operated in violation of Article 4(2) or 33(8) or (10) of the Medical Service Act;

4. A pharmacy opened and operated in violation of Article 21(1) of the Pharmaceutical Affairs Act;

5. A pharmacy established and operated by borrowing a license in violation of Article 6(3) and (4) of the Pharmaceutical Affairs Act.

(3) Where insurance benefits have been provided based on a false report or false certification (including facilitating another person to receive insurance benefits by transferring or lending one's health insurance card or identification card, in violation of Article 12(6)) from the employer or the insured, or false diagnosis or false confirmation by a health care institution (including failure to verify the identity of the insured or his or her dependents and their eligibility), the NHIS may require payment of the money collectible under paragraph (1) from such person or institution, jointly with the person who received the insurance benefits. <Amended on May 22, 2013; Dec. 11, 2018; Dec. 29, 2020; May 19, 2023>(4) The NHIS may require payment of the money collectible under paragraph (1) from the insured who belongs to the same household as the person who has received insurance benefits by fraud or other improper means (referring to the employee insured if the person who has received the insurance benefits by fraud or other improper means is a dependent) severally or jointly with the person who has received the insurance benefits by fraud or other improper means. <Amended on May 22, 2013>(5) Where a health care institution has received the costs of health care benefits from the insured or his or her dependent by fraud or other improper means, the NHIS shall collect the amount thereof from the health care institution concerned and disburse it to the insured or his or her dependent without delay. In such cases, the NHIS may offset the amount payable to the insured or his or her dependent against the insurance contributions, etc. to be paid by such insured or his or her dependent. <Amended on May 22, 2013>

Article 57-2Disclosure of personal details on defaulters who are in arrears with unjust enrichment or unjust profit collectible

(1) Where a health care institution liable to pay the money collectible under Article 57(1) or (2), falling under any of the subparagraphs of paragraph (2) of that Article, or a person who has established such health care institution, fails to pay at least 100 million won in the money collectible for one year from the date immediately following its payment deadline specified in the billing under Article 79(1), the NHIS may disclose the violation that has given rise to the money collectible, personal details on the defaulter, the amount in arrears, and other information prescribed by Presidential Decree (hereafter in this Article referred to as "personal details, etc."); provided, this shall not apply if an objection under Article 87 or a request for trial under Article 88 is filed, or an administrative litigation is pending, with respect to the amount in arrears, or if there is a compelling reason prescribed by Presidential Decree not to do so, such as partial payment of the amount in arrears.

(2) A Deliberative Committee on Disclosure of Information on Unjust Enrichment and Unjust Profit in Arrears shall be established under the jurisdiction of the NHIS to deliberate on whether to disclose personal details, etc. under paragraph (1).

(3) The Deliberative Committee on Disclosure of Information on Unjust Enrichment and Unjust Profit in Arrears shall provide persons who are subject to disclosure of personal details, etc. an opportunity to defend themselves by notifying in writing that they shall be subject to the disclosure, and select the persons subject to the disclosure after six months lapse from the date of such notification taking into consideration the fulfillment, etc. of their obligation to pay the amount in arrears.

(4) Disclosure of personal details, etc. under paragraph (1) shall be made by publishing or posting it in the Official Gazette or on the website of the NHIS.

(5) Except as provided in paragraphs (1) through (4), matters necessary for the procedures for disclosure of personal details, etc., and for the organization and operation of the Deliberative Committee on Disclosure of Information on Unjust Enrichment and Unjust Profit in Arrears, shall be prescribed by Presidential Decree.[This Article Added on Dec. 3, 2019]