MEDICAL BENEFIT ACT
Act No. 6474, May 24, 2001
Amended by Act No. 6758, Dec. 5, 2002
Act No. 6875, May 15, 2003
Act No. 7182, Mar. 5, 2004
Act No. 7347, Jan. 27, 2005
Act No. 7736, Dec. 23, 2005
Act No. 8036, Oct. 4, 2006
Act No. 8114, Dec. 28, 2006
Act No. 8609, Aug. 3, 2007
Act No. 8694, Dec. 14, 2007
Act No. 8852, Feb. 29, 2008
Act No. 9932, Jan. 18, 2010
Act No. 10514, Mar. 30, 2011
Act No. 10784, jun. 7, 2011
Act No. 10788, jun. 7, 2011
Act No. 11042, Sep. 15, 2011
Act No. 11878, jun. 12, 2013
Act No. 12362, Jan. 28, 2014
Act No. 12933, Dec. 30, 2014
Act No. 13248, Mar. 27, 2015
Act No. 13657, Dec. 29, 2015
Act No. 14003, Feb. 3, 2016
Act No. 14697, Mar. 21, 2017
The purpose of this Act is to contribute to the improvement of national health and the enhancement of social welfare by providing medical benefits to indigent people.
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
The definitions of terms used in this Act shall be as follows:
| 1. | The term "eligible recipient" means a person eligible to receive medical benefits under this Act; |
| 2. | The term "institution providing medical benefits" means a medical institution, pharmacy, etc. that provides medical treatment, preparation and administration of medicines, etc. to eligible recipients; |
| 3. | The term "support obligor" means a person that is a lineal relative of an eligible recipient and his/her spouse, who is responsible for supporting the eligible recipient. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 3 (Eligible Recipients) |
| (1) | Eligible recipients under this Act shall be as follows: <Amended by Act No. 12933, Dec. 30, 2014; Act No. 13248, Mar. 27, 2015> |
| 2. | Disaster victims defined under the Disaster Relief Act, recognized by the Minister of Health and Welfare as those who need medical benefits; |
| 6. | Persons recognized by the Minister of Health and Welfare as those who need medical benefits from among persons recommended by the Administrator of the Cultural Heritage Administration as the ones in need of medical benefits, who are holders (including honorary holders) of national intangible cultural heritage designated pursuant to the Act on the Safeguarding and Promotion of Intangible Cultural Heritage and their family members; |
| 10. | Other persons prescribed by Presidential Decree as those who are unable to support their own living or who are indigent. |
| (2) | Matters concerning criteria, etc. for recognition of eligible recipients under paragraph (1) 2 and 5 through 9 shall be as prescribed by the Minister of Health and Welfare. |
| (3) | Details of and criteria for medical benefits for eligible recipients under paragraph (1) may be prescribed separately, as prescribed by Presidential Decree. |
| (4) | Matters necessary for the date of commencement of medical benefits for eligible recipients under paragraph (1) shall be prescribed by Presidential Decree. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 3-2 (Special Exception to Refugees) |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 3-3 (Procedures for Recognition of Eligible Recipients, etc.) |
| (1) | A person that intends to become an eligible recipient under Article 3 (1) 2 through 10 shall file an application for recognition as an eligible recipient to a Special Self-Governing City Mayor, a Special Self-Governing Province Governor, or the head of a Si (excluding the Administrative Mayor of a Special Self-Governing Province)/Gun/Gu (referring to the head of an autonomous Gu; hereinafter referred to as "head of a Si/Gun/Gu"), as prescribed by Ordinance of the Ministry of Health and Welfare. |
| (2) | Where necessary to ascertain whether it is appropriate to recognize an applicant under paragraph (1) as an eligible recipient, the head of a Si/Gun/Gu may require such applicant to submit a written consent to provide data or information under the subparagraphs of Article 21 (3) of the National Basic Living Security Act. |
| (4) | The Minister of Patriots and Veterans Affairs and the Administrator of Cultural Heritage Administration shall recommend a person that needs to be recognized as an eligible recipient under Article 3 (1) 5 and 6 and shall notify the head of a Si/Gun/Gu having jurisdiction over the eligible recipient's address of the results thereof. In such cases, a person that intends to become an eligible recipient under Article 3 (1) 5 and 6 shall be deemed to have filed an application for recognition as an eligible recipient under paragraph (1). |
| (5) | The head of a Si/Gun/Gu shall determine eligible recipients according to criteria for recognition of eligible recipients under Article 3 (2) among those who have applied for recognition (excluding those falling under Article 3 (1) 3 and 4) pursuant to paragraphs (1) and (4). |
| (6) | Other than those prescribed by paragraphs (1) through (5), matters necessary for procedures for recognition of eligible recipients shall be prescribed by Presidential Decree. |
[This Article Newly Inserted by Act No. 11878, Jun. 12, 2013]
| Article 4 (Exclusion from Application) |
| (1) | Where an eligible recipient receives any benefits, reward, or compensation under other statutes in connection with any illness or injury arising from the conduct of work or public duties, he/she shall not be provided with medical benefits under this Act. <Amended by Act No. 14697, Mar. 21, 2017> |
| (2) | Where an eligible recipient receives any benefits or expenses, which correspond to the medical benefits, from the State or local governments under other statutes, the medical benefits under this Act shall not be provided within the scope of such benefits. <Newly Inserted by Act No. 14697, Mar. 21, 2017> |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 5 (Guarantee Agencies) |
| (1) | The Special Metropolitan City Mayor, a Metropolitan City Mayor, a Do Governor, and the head of a Si/Gun/Gu who has jurisdiction over the place of residence of an eligible recipient shall conduct affairs concerning medical benefits under this Act. |
| (2) | Notwithstanding paragraph (1), the head of a Si/Gun/Gu who has jurisdiction over the district in which an eligible recipient that has no fixed residence actually resides shall conduct affairs concerning medical benefits on his/her behalf. |
| (3) | The Special Metropolitan City Mayor, a Metropolitan City Mayor, a Do Governor, and the head of a Si/Gun/Gu shall conduct programs necessary for maintaining and promoting the health of eligible recipients. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 5-2 (Case Management) |
| (1) | The Minister of Health and Welfare, the Special Metropolitan City Mayor, a Metropolitan City Mayor, a Do Governor, and the head of a Si/Gun/Gu may conduct case management in order to improve the health care ability of eligible recipients and induce them to reasonably use medical care. |
| (2) | For the case management under paragraph (1), the Special Metropolitan City, each Metropolitan City, Special Self-Governing City, Do, Special Self-Governing Province (hereinafter referred to as "City/Do") and Si (excluding an administrative Si in a Special Self-Governing Province; hereinafter the same shall apply)/Gun/Gu (referring to an autonomous Gu; hereinafter the same shall apply) shall have an administrator of medical benefits. |
| (3) | In order to provide professional support for case management programs under paragraph (1), the Minister of Health and Welfare may entrust the relevant affairs to a public or nongovernmental institution, organization, etc. |
| (4) | Matters concerning the management, such as qualification for an administrator of medical benefits, criteria for the assignment thereof, etc. under paragraph (2) and matters necessary for entrusting supporting affairs for case management programs under paragraph (3) shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 6 (Medical Benefits Deliberative Committee) |
| (1) | A medical benefits deliberative committee shall be established within the Ministry of Health and Welfare, each City/Do and Si/Gun/Gu to deliberate on matters concerning the administration of programs on medical benefits under this Act: Provided, That in cases of a medical benefits deliberative committee established in each City/Do and Si/Gun/Gu, where another committee which is appropriate to perform the functions thereof exists and the members of such committee meet qualification prescribed in paragraph (4), the committee may be authorized to perform the functions of the medical benefits deliberative committee, as prescribed by ordinance of each City/Do or Si/Gun/Gu. |
| (2) | A medical benefits deliberative committee established within the Ministry of Health and Welfare (hereinafter referred to as "central medical benefits deliberative committee") shall deliberate on the followings: |
| 1. | Matters concerning basic direction-setting of and the formulation of measures for medical benefits programs; |
| 2. | Matters concerning criteria for medical benefits and medical fees; |
| 3. | Other matters submitted for consideration by the Minister of Health and Welfare or the chairperson of the central medical benefits deliberative committee. |
| (3) | The central medical benefits deliberative committee shall be composed of up to 15 members including the chairperson thereof, and members shall be commissioned or appointed by the Minister of Health and Welfare from among the following persons, and the Vice Minister of Health and Welfare shall be the chairperson thereof: <Amended by Act No. 14697, Mar. 21, 2017> |
| 1. | Persons that represent the public interest (experts in medical security, who hold the office of assistant professor or higher in a university or hold the office of researcher in a research institute); |
| 2. | Persons that represent medical or pharmaceutical circles and persons that represent social welfare circles; |
| 3. | Public officials of Grade III or higher belonging to the relevant administrative agencies. |
| (4) | The Special Metropolitan City Mayor, a Metropolitan City Mayor, a Do Governor, or the head of a Si/Gun/Gu shall commission or appoint members of a City/Do or Si/Gun/Gu medical benefits deliberative committee under paragraph (1), and the relevant Special Metropolitan City Mayor, the relevant Metropolitan City Mayor, the relevant Do Governor, or the head of the relevant Si/Gun/Gu shall be the chairperson thereof: Provided, That where another committee replaces a medical benefits deliberative committee for the function of it pursuant to the proviso to paragraph (1), the chairperson thereof shall be designated by municipal ordinances: |
| 1. | Persons that have knowledge and experience relating to medical security; |
| 2. | Persons that represent the public interest; |
| 3. | Public officials belonging to related administrative agencies. |
| (5) | If necessary for deliberation, a medical benefits deliberative committee under paragraph (1) may request a guarantee agency under Article 5 to send public officials belonging thereto to attend the meeting thereof or submit data. In such cases, the relevant guarantee agency shall comply with such request unless there are justifiable grounds. |
| (6) | Necessary matters for the functions of each medical benefits deliberative committee established within the Ministry of Health and Welfare, each City/Do, and each Si/Gun/Gu and the composition and operation of each medical benefits deliberative committee shall be prescribed by Presidential Decree. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 7 (Details, etc. of Medical Benefits) |
| (1) | Details of medical benefits for illness, injury, childbirth, etc. of eligible recipients under this Act shall be as follows: |
| 1. | Medical consultation and examination; |
| 2. | Supply of medicine and materials for medical treatment; |
| 3. | Treatment, surgery, and other remedies; |
| 4. | Prevention and rehabilitation; |
| 7. | Transfer to other hospitals and other measures for accomplishing medical purposes. |
| (2) | Criteria for medical benefits, such as methods of, procedures for, the scope, limit, etc. of medical benefits under paragraph (1), shall be prescribed by Ordinance of the Ministry of Health and Welfare, and standard for medical fees and methods of calculation thereof shall be determined by the Minister of Health and Welfare. |
| (3) | When the Minister of Health and Welfare establishes criteria for medical benefits pursuant to paragraph (2), he/she may exclude matters prescribed by Ordinance of the Ministry of Health and Welfare, such as disease that does not disturb affairs or everyday lives of people, from subject matters eligible for medical benefits. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 8 (Medicare Card) |
| (1) | The head of a Si/Gun/Gu shall issue a medicare card to eligible recipients: Provided, That where unavoidable circumstances exist, he/she may issue a medicare certificate in lieu of a medicare card or may choose not to issue a medicare card, as prescribed by Ordinance of the Ministry of Health and Welfare. |
| (2) | Where an eligible recipient receives medical benefits, he/she shall submit a medicare card or medicare certificate under paragraph (1) to an institution providing medical benefits under Article 9 (1) (hereinafter referred to as "institution providing medical benefits"): Provided, That this shall not apply where a natural disaster occurs or other unavoidable circumstances exist. |
| (3) | Notwithstanding paragraph (2), where an institution providing medical benefits can confirm eligibility for an eligible recipient with his/her resident registration card, driver's license, passport or other identification card (hereinafter referred to as "identification card") prescribed by Ordinance of the Ministry of Health and Welfare that may confirm his/her identity, the eligible recipient may choose not to submit a medicare card or medicare certificate. |
| (4) | Necessary matters for the form and use of a medicare card and a medicare certificate under paragraph (1) shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 9 (Institution Providing Medical Benefits) |
| (1) | The following institutions providing medical benefits shall provide medical benefits. In such cases, where the Minister of Health and Welfare deems any of the following institutions inappropriate for an institution providing medical benefits for the public interest or national policies, he/she may exclude such institution from institution providing medical benefits, as prescribed by Presidential Decree: |
| 2. | A community health center, community medical center, or branch of a community health center established pursuant to the Regional Public Health Act; |
| (2) | Institutions providing medical benefits shall be classified as follows, and the scope of medical treatment by each institution providing medical benefits shall be prescribed by Ordinance of the Ministry of Health and Welfare: |
| 1. | Primary institutions providing medical benefits: |
| (b) | An institution providing medical benefits under paragraph (1) 2 through 4; |
| 2. | Secondary institutions providing medical benefits: Medical institutions that have obtained permission for the establishment thereof pursuant to the former part of Article 33 (4) of the Medical Service Act; |
| 3. | Tertiary institutions providing medical benefits: Medical institutions designated by the Minister of Health and Welfare among secondary institutions providing medical benefits. |
| (3) | No institution providing medical benefits under any subparagraph of paragraph (1) shall refuse to provide medical benefits under this Act without justifiable grounds. |
| (4) | Where an institution providing medical benefits under any subparagraph of paragraph (1) is opened or established, or where the reported, permitted, and registered matters of an institution providing medical benefits opened or established have been changed, the Special Metropolitan City Mayor, a Metropolitan City Mayor, a Do Governor, or the head of a Si/Gun/Gu shall notify the following specialized institutions of the details thereof, as prescribed by Ordinance of the Ministry of Health and Welfare: <Amended by Act No. 14697, Mar. 21, 2017> |
| 1. | A specialized institution that is entrusted with examination and adjustment of expenses incurred in providing medical benefits (hereinafter referred to as "expenses for benefits"), evaluation of the propriety of medical benefits, and confirmation of eligibility for benefits pursuant to Article 33 (2) (hereinafter referred to as "institution examining expenses for benefits"); |
| 2. | A specialized institution entrusted with affairs concerning reimbursement for expenses for benefits pursuant to Article 33 (2) (hereinafter referred to as "institution reimbursing expenses for benefits"). |
| (5) | Matters necessary for the criteria and procedures for designation of tertiary institutions providing medical benefits under paragraph (2) 3 shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 10 (Subsidizing Expenses for Benefits) |
The Medical Benefits Fund under Article 25 shall fully or partially subsidize expenses for benefits, as prescribed by Presidential Decree, and where the Medical Benefits Fund bears some of the expenses, an eligible recipient shall bear the rest of the expenses. [This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 11 (Claim for and Granting of Expenses for Benefits) |
| (1) | An institution providing medical benefits may claim for expenses for benefits borne by the Medical Benefits Fund pursuant to Article 10 from the head of a Si/Gun/Gu. In such cases, a request for examination under paragraph (2) shall be deemed a claim for expenses for benefits toward the head of a Si/Gun/Gu. |
| (2) | An institution providing medical benefits that intends to claim expenses for benefits pursuant to paragraph (1) shall request an institution examining expenses for benefits to examine such expenses, and such institution that is requested to examine such expenses shall examine the expenses and notify the head of a Si/Gun/Gu and the institution providing medical benefits of the details thereof without delay. |
| (3) | The head of a Si/Gun/Gu who is notified of the details of examination pursuant to paragraph (2) shall subsidize expenses for benefits to an institution providing medical benefits without delay in accordance with the details thereof. In such cases, where already paid expenses borne by an eligible recipient (referring to expenses for benefits which should be borne by the eligible recipient pursuant to Article 10; hereinafter the same shall apply) is excessive, the head of a Si/Gun/Gu shall deduct such overpaid amount from the amount payable to the institution providing medical benefits, and return such amount to the eligible recipient. |
| (4) | The head of a Si/Gun/Gu may evaluate the propriety of medical benefits and shall grant expenses for benefits by adjusting them based on the evaluation results. In such cases, the criteria for granting increased or reduced expenses for benefits upon evaluation shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 14697, Mar. 21, 2017> |
| (5) | The head of a Si/Gun/Gu may make public the results of an evaluation under paragraph (4). <Newly Inserted by Act No. 14697, Mar. 21, 2017> |
| (6) | An institution providing medical benefits may allow any of the following organizations to make a request for examination under paragraph (2) on its behalf: |
| (7) | Except as otherwise provided for in paragraphs (1) through (6), matters necessary for the methods and procedures for claiming expenses for benefits, conducting an examination, and making reimbursement shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 14697, Mar. 21, 2017> |
| (8) | Where the Korea Worker's Compensation and Welfare Service under Article 10 of the Industrial Accident Compensation Insurance Act paid benefits for medical treatment under Article 40 of the said Act to a person eligible for medical benefits pursuant to this Act but decision on the payment thereof has been revoked, and it claims expenses for benefits for medical treatment, the head of a Si/Gun/Gu may pay the amount equivalent to such medical benefits where such benefits for medical treatment are deemed equivalent to medical benefits that may be provided pursuant to this Act. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 11-2 (Preservation of Documents) |
| (1) | An institution providing medical benefits shall preserve documents relating to claims for expenses for benefits under Article 11 for five years from the date on which the provision of medical benefits terminates, as prescribed by Ordinance of the Ministry of Health and Welfare. |
| (2) | Notwithstanding paragraph (1), an institution providing medical benefits prescribed by Ordinance of the Ministry of Health and Welfare, such as a pharmacy, shall preserve each prescription record for three years from the date on which it claims expenses for benefits. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 11-3 (Confirmation, etc. of Eligibility for Medical Benefits) |
| (1) | An eligible recipient may request an institution examining expenses for benefits to confirm whether expenses he/she has borne in addition to the amount he/she should bear pertain to matters ineligible for medical benefits pursuant to Article 7 (3) (hereinafter referred to as "expenses ineligible for benefits"). |
| (2) | An institution examining expenses for benefits requested to confirm eligibility pursuant to paragraph (1) shall notify an eligible recipient of the confirmation results, and where it is confirmed that expenses requested for confirmation constitute expenses for benefits, it shall notify an institution granting expenses for benefits and a related institution providing medical benefits of the confirmation thereof. |
| (3) | An institution providing medical benefits which has been notified pursuant to paragraph (2) shall return the over-collected amount to an eligible recipient without delay. |
| (4) | Notwithstanding paragraph (3), where an institution providing medical benefits fails to return the over-collected amount to an eligible recipient, an institution granting expenses for benefits may deduct the over-collected amount from expenses for benefits payable to such institution and grant such deducted amount to such eligible recipient. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 11-4 (Prohibited Conduct of Institutions Providing Medical Benefits in Relation to Claims for Expenses) |
No institution providing medical benefits shall request an eligible recipient to pay the amount he/she should bear, or other expenses, such as guaranty deposit for hospitalization, apart from his/her sharing of the medical cost under this Act and expenses ineligible for benefits before it provides medical benefits.
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 11-5 (Deferment of Payment of Expenses Incurred in Providing Benefits) |
| (2) | Before the head of a Si/Gun/Gu defers payment of expenses incurred in providing benefits pursuant to paragraph (1), he/she shall give the relevant institution providing medical benefits an opportunity to express its opinion. |
| (3) | Where an allegation that an institution providing medical benefits violates Article 33 (2) of the Medical Service Act or Article 20 (1) of the Pharmaceutical Affairs Act is not substantiated due to a reason prescribed by Presidential Decree, such as that a court judgment of not guilty becomes final, etc., the head of a Si/Gun/Gu shall pay the relevant institution providing medical benefits an amount obtained by adding interest for the period during which payment has been deferred to the expenses incurred in providing benefits of which payment was deferred. |
| (4) | Matters necessary for procedures for deferment of payment, procedures for expressing opinion, etc. under paragraphs (1) and (2), and matters necessary for procedures for the payment of expenses incurred in providing benefits of which payment was deferred and interest thereon, for the calculation of interest, etc. under paragraph (3) shall be prescribed by Presidential Decree. |
[This Article Newly Inserted by Act No. 13657, Dec. 29, 2015]
| Article 12 (Medical Expenses) |
| (1) | Where an eligible recipient has received medical benefits in relation to disease, injury, childbirth, etc. in an institution prescribed by Ordinance of the Ministry of Health and Welfare, which is an institution performing the same functions as those of an institution providing medical benefits (including an institution providing medical benefits under the suspension of business pursuant to Article 28 (1)), due to an emergency or other inevitable circumstances prescribed by Ordinance of the Ministry of Health and Welfare, or given birth to a child in any place other than an institution providing medical benefits, the head of a Si/Gun/Gu shall pay an amount of money equivalent to such medical benefits to such eligible recipient as medical expenses, as prescribed by Ordinance of the Ministry of Health and Welfare. |
| (2) | An institution that has provided medical benefits pursuant to paragraph (1) shall issue a detailed statement of medical expenses prescribed by the Minister of Health and Welfare or a receipt stating the details of medical treatment to a person that has received medical treatment, and the person who received medical treatment shall submit such detailed statement or receipt to the head of a Si/Gun/Gu. |
| (3) | Necessary matters for methods, etc. of paying medical expenses under paragraph (1) shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 13 (Special Cases for Persons with Disabilities and Pregnant Women) |
| (2) | The head of a Si/Gun/Gu may provide a pregnant woman who is an eligible recipient with additional medical benefits for expenses incurred in receiving medical treatment in an institution providing medical benefits during the period of pregnancy (including expenses associated with childbirth). |
| (3) | Benefits for orthosis under paragraph (1) and necessary matters concerning methods of, procedures for, and the scope, limit, etc. of additional benefits under paragraph (2) shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 14 (Health Examinations) |
| (1) | The head of a Si/Gun/Gu may conduct health examinations on eligible recipients under this Act to detect a disease early and provide medical benefits following such detection. |
| (2) | Eligible recipients subject to health examinations under paragraph (1), the frequency and procedures for health examinations, and other necessary matters shall be prescribed by the Minister of Health and Welfare. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 15 (Restrictions on Medical Benefits) |
| (1) | Where an eligible recipient falls under any of the followings, the head of a Si/Gun/Gu shall not provide him/her with medical benefits under this Act: Provided, That this shall not apply where the Minister of Health and Welfare deems it necessary to provide medical benefits: |
| 1. | Where an eligible recipient becomes in need of medical benefits because of a criminal act he/she has committed on purpose or by gross negligence or because of an accident he/she has caused on purpose; |
| 2. | Where an eligible recipient fails to comply with any provision of this Act or instructions relating to medical treatment given by an institution providing medical benefits without justifiable grounds. |
| (2) | Where an eligible recipient falls under any subparagraph of paragraph (1), an institution providing medical benefits shall notify the head of a Si/Gun/Gu having jurisdiction over the place of his/her residence, as prescribed by Presidential Decree. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 16 (Change in Medical Benefits) |
| (1) | Where income, financial status, ability at work, etc. of an eligible recipient has been changed, the head of a Si/Gun/Gu may change the details, etc. of medical benefits ex officio or at the request of such eligible recipient, his/her relative or other interested persons. |
| (2) | When the head of a Si/Gun/Gu has changed the details, etc. of medical benefits pursuant to paragraph (1), he/she shall notify an eligible recipient of grounds therefor in writing. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 17 (Discontinuance, etc. of Medical Benefits) |
| (1) | Where an eligible recipient falls under any of the following, the head of a Si/Gun/Gu shall discontinue medical benefits: |
| 1. | Where the eligible recipient no longer requires medical benefits; |
| 2. | Where the eligible recipient refuses medical benefits. |
| (2) | Where an eligible recipient refuses medical benefits, the head of a Si/Gun/Gu shall discontinue medical benefits for all members of the household to which such eligible recipient belongs. <Amended by Act No. 14697, Mar. 21, 2017> |
| (3) | Where the head of a Si/Gun/Gu discontinues medical benefits pursuant to paragraph (1), he/she shall notify an eligible recipient in writing of grounds for the discontinuance of medical benefits. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 18 (Protection of Right to Receive Medical Benefits) |
No rights to receive medical benefits shall be transferred or seized.
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 19 (Right to Claim) |
| (1) | Where the head of a Si/Gun/Gu provides medical benefits for an eligible recipient due to a third party’s conduct, he/she shall acquire the right to claim damages against the third party within the limits of expenses incurred in providing such medical benefits. |
| (2) | Where a person that received medical benefits pursuant to paragraph (1) has already received damages from a third party, the head of a Si/Gun/Gu shall not provide medical benefits for such person within the scope of such damages. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 20 (Payment of Expenses for Benefits by Subrogation) |
| (1) | Where the Medical Benefits Fund partially subsidized expenses for benefits pursuant to Article 10, the Medical Benefits Fund under Article 25 may pay the rest of such expenses for benefits by subrogation (limited to the amount prescribed by the Minister of Health and Welfare) at the request of an eligible recipient or his/her support obligor. |
| (2) | Necessary matters for methods of requesting for subrogated payment and paying the amount under paragraph (1) shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 21 (Reimbursement of Payment by Subrogation) |
| (1) | A person that has received a subrogated payment from the Medical Benefits Fund pursuant to Article 20 (including his/her support obligor; hereinafter referred to as "reimbursement obligor”) shall redeem such payment to the head of a Si/Gun/Gu having jurisdiction over the place of his/her residence, as prescribed by Ordinance of the Ministry of Health and Welfare. In such cases, he/she shall redeem the payment without interest. |
| (2) | Where a reimbursement obligor relocates his/her place of residence to another Special Self-Governing City, Special Self-Governing Province, or Si/Gun/Gu, he/she shall redeem such payment to the head of a Si/Gun/Gu having jurisdiction over his/her new place of residence for the payment. |
| (3) | The head of a Si/Gun/Gu that is redeemed of subrogated payment pursuant to paragraphs (1) and (2) shall pay such payment amount to the Medical Benefits Fund under Article 25. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 22 (Pressing for Reimbursement of Payment by Subrogation, etc.) |
| (1) | If a reimbursement obligor fails to redeem subrogated payment by the deadline, the head of the Si/Gun/Gu shall issue a reminder without delay within a fixed period not exceeding six months from the expiration of the deadline for the reimbursement. |
| (2) | If a reimbursement obligor fails to redeem subrogated payment even after receiving a reminder under paragraph (1), the head of the Si/Gun/Gu may collect it in the same manner as the delinquent local taxes are collected. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 23 (Collection of Unlawful Gains) |
| (1) | The head of a Si/Gun/Gu shall collect all or part of an amount of money equivalent to medical benefits or expenses for benefits as unlawful gains from a person who has received medical benefits, or an institution providing medical benefits that has received expenses for benefits, by fraud or other improper means. |
| (2) | Where medical benefits under paragraph (1) have been provided by fraud or other improper means by an institution providing medical benefits in collusion with a person intending to receive medical benefits, the head of a Si/Gun/Gu may require such institution providing medical benefits to return unlawful gains under paragraph (1) jointly with the person who has received medical benefits. |
| (3) | Where an institution providing medical benefits that has received expenses for benefits by fraud or other improper means pursuant to paragraph (1) falls under any of the followings, the head of a Si/Gun/Gu may require a person who established the relevant institution providing medical benefits to return unlawful gains under paragraph (1) jointly with such institution providing medical benefits: |
| 1. | A medical institution established and operated by a person prohibited from establishing a medical institution because he/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; |
| (4) | Where an institution providing medical benefits has received expenses for benefits from an eligible recipient by fraud or other improper means, the head of a Si/Gun/Gu shall collect the relevant expenses for benefits from such institution providing medical benefits and grant such expenses to the eligible recipient without delay. |
| (5) | Where a person obligated to return unlawful gains under paragraphs (1) and (2) fails to return unlawful gains, the head of a Si/Gun/Gu may press him/her to return unlawful gains within a fixed period. |
| (6) | Where the head of a Si/Gun/Gu presses a person to return unlawful gains pursuant to paragraph (5), he/she shall issue a reminder by fixing the deadline for return for not less than 10 days nor more than 15 days. |
| (7) | Where a person urged to return unlawful gains pursuant to paragraph (5) fails to return unlawful gains by the deadline for return, the head of a Si/Gun/Gu may collect such unlawful gains in accordance with the precedents of dispositions on default of local taxes. |
| (8) | Where a person obligated to return unlawful gains under paragraphs (1) and (2) has moved his/her place of residence to another Special Self-Governing City, Special Self-Governing Province, or Si/Gun/Gu, he/she shall return such unlawful gains to the head of the Si/Gun/Gu having jurisdiction over the new place of residence. <Amended by Act No. 14697, Mar. 21, 2017> |
| (9) | Upon receipt of any unlawful gains under paragraph (8), the head of a Si/Gun/Gu shall transfer them to the Medical Benefits Fund referred to in Article 25. <Newly Inserted by Act No. 14697, Mar. 21, 2017> |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
Where grounds exist that constitutes any of the followings, the head of a Si/Gun/Gu may write off payments made on his/her behalf, unlawful gains, etc. following deliberation by a Special Self-Governing City, Special Self-Governing Province, or Si/Gun/Gu medical benefits deliberative committee:
| 1. | Upon the completion of disposition on payment in arrears, the allocated amount to be appropriated for the amount in arrears is less than the amount in arrears; |
| 2. | Where extinctive prescription for the relevant right is completed; |
| 3. | In cases prescribed by Presidential Decree, where it is deemed impossible to collect such payment by subrogation, unlawful gains, etc. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 25 (Establishment and Creation of Medical Benefits Fund) |
| (1) | A Medical Benefits Fund (hereinafter referred to as the "Fund") shall be established in each City/Do to raise funds for expenses for benefits under this Act. |
| (2) | The Fund shall be created with the following funds: |
| 1. | Subsidies from the National Treasury; |
| 2. | Contributions from a local government; |
| 3. | Payments by subrogation, which have been redeemed pursuant to Article 21; |
| 4. | Unlawful gains collected pursuant to Article 23; |
| 5. | Penalty surcharges collected pursuant to Article 29; |
| 6. | Surplus following the settlement of accounts of the Fund and other revenue. |
| (3) | The State and each local government shall secure a budget sufficiently for the operation of the Fund. |
| (4) | The ratio of subsidies from the National Treasury under paragraph (2) 1 shall be as prescribed by the Subsidy Management Act and related statutes. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 26 (Management and Operation of Fund) |
| (1) | The Fund shall be managed by a special account created separately from general accounts. |
| (2) | The Fund shall be used only for expenses for benefits, expenses incurred in making payment by subrogation, expenses incurred in entrusting affairs under Article 33 (2), or other expenses directly incurred in conducting affairs concerning medical benefits, as prescribed by Ordinance of the Ministry of Health and Welfare. |
| (3) | Where the Fund has a financial surplus, the Special Metropolitan City Mayor, a Metropolitan City Mayor, a Special Self-Governing City Mayor, a Do Governor, or a Special Self-Governing Province Governor (hereinafter referred to as the "Mayor/Do Governor") may manage such financial surplus of the Fund by the following means: |
| 1. | Depositing the financial surplus in a financial institution or post office; |
| 2. | Purchasing State or public bonds. |
| (4) | Except as otherwise provided for in this Act, matters necessary for the management and operation of the Fund shall be prescribed by ordinance of the relevant local government, as prescribed by Ordinance of the Ministry of Health and Welfare. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 27 (Deposit of Expenses for Benefits) |
| (1) | Where affairs concerning granting of expenses for benefits are entrusted pursuant to Article 33 (2), the Mayor/Do Governor shall deposit estimated expenses for benefits from the Fund in an institution granting expenses for benefits, as prescribed by Ordinance of the Ministry of Health and Welfare. |
| (2) | Where the budget of a local government for contributions under Article 25 (2) 2 has not been approved, notwithstanding Article 36 of the Local Finance Act, the Mayor/Do Governor shall immediately deposit subsidies from the National Treasury in an institution granting expenses for benefits. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 28 (Suspension of Business of Institutions Providing Medical Benefits) |
| (1) | Where an institution providing medical benefits falls under any of the followings, the Minister of Health and Welfare may order the suspension of business of such institution providing medical benefits within a fixed period not exceeding one year: |
| 1. | Where it makes an eligible recipient, his/her support obligor, or the head of a Si/Gun/Gu bear expenses for benefits by fraud or other improper means; |
| 2. | Where it preliminarily claims for the eligible recipient’s sharing of the medical cost, or other expenses, such as a guaranty deposit for hospitalization, in violation of Article 11-4; |
| 3. | Where it fails to make a report or submit a document under Article 32 (2), or makes a false report or submits a false document, or refuses, interferes with, or evades an inquiry or examination by a public official under his/her jurisdiction. |
| (2) | Where a tertiary institution providing medical benefits falls under any subparagraph of paragraph (1), the Minister of Health and Welfare may revoke the designation thereof. |
| (3) | The Minister of Health and Welfare shall not re-designate a tertiary institution providing medical benefits whose designation has been revoked pursuant to paragraph (2), as a tertiary institution providing medical benefits within one year from the date he/she revokes the designation thereof. |
| (4) | No person whose business has been suspended pursuant to paragraph (1) shall provide medical benefits during the period of the relevant suspension of business. |
| (5) | Where the Minister of Health and Welfare makes dispositions under paragraphs (1) and (2), he/she shall notify an institution examining expenses for benefits and an institution granting expenses for benefits of such fact, as prescribed by Ordinance of the Ministry of Health and Welfare. |
| (6) | A person who has taken over an institution providing medical benefits whose suspension of business was decided, or a corporation that survives the merger or corporation incorporated by the merger with such institution shall succeed to the effect of the suspension of business under paragraph (1), and when such institution providing medical benefits is still undergoing the procedure for suspension of business, a transferee, a corporation surviving the merger or corporation incorporated by the merger may undergo the procedure for suspension of business: Provided, That this shall not apply to cases where a transferee, a corporation that continues to exist after the merger or corporation incorporated by the merger proves that he/she does not know such disposition or violation. |
| (7) | A person that has been subjected to or is under the suspension of business under paragraph (1) shall immediately notify a transferee, a corporation that survives the merger or corporation incorporated in the course of the merger of the fact that he/she has been subjected to the suspension of business or the fact that he/she is under the suspension of business, as prescribed by Ordinance of the Ministry of Health and Welfare. |
| (8) | Criteria for administrative dispositions under paragraphs (1) and (2) shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 29 (Penalty Surcharges, etc.) |
| (1) | Where the Minister of Health and Welfare has to issue an order for the suspension of business because an institution providing medical benefits falls under Article 28 (1) 1, and he/she deems that the suspension of business would causes serious inconvenience to eligible recipients or that there are other special reasons, he/she may impose and collect the amount not exceeding five times the expenses for benefits that such institution providing medical benefits has caused an eligible recipient, his/her support obligor, or the head of a Si/Gun/Gu to bear by fraud or other improper means, as a penalty surcharge, in lieu of the suspension of business. In such cases, the Minister of Health and Welfare may allow the person concerned to pay in installment within the range of 12 months. |
| (2) | Where a person obligated to pay a penalty surcharge under paragraph (1) fails to pay it by the deadline, the Minister of Health and Welfare may, pursuant to Presidential Decree, revoke disposition of imposition of a penalty surcharge and issue disposition of suspension of business under Article 28 (1), or collect it in accordance with the precedents of disposition on default of national taxes, and where the authority to collect such penalty surcharge is delegated to a Mayor/Do Governor pursuant to Article 33 (1), the Mayor/Do Governor may collect it in the same manner as delinquent local taxes are collected. In such case, if issuing disposition of suspension of business under Article 28 (1) is not possible due to closure of the institution providing medical benefits, etc., it shall be collected in accordance with the precedents of disposition on default of national taxes or with the precedents of disposition on default of local taxes. <Amended by Act No. 14003, Feb. 3, 2016> |
| (3) | If necessary to collect a penalty surcharge, the Minister of Health and Welfare may request the head of the competent tax office or the head of the competent local government to provide tax information in writing, specifying the following matters: |
| 1. | Personal information on a tax payer; |
| 3. | Grounds and criteria for imposition of a penalty surcharge. |
| (4) | Amounts of penalty surcharges according to the types of offenses and the degree of violation subject to the imposition of penalty surcharges under paragraph (1) and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 29-2 (Prohibited Acts, etc. of Manufacturers, etc.) |
| (1) | Where a manufacturer, a dealer who entrusts manufacture, an importer or a dealer of medicines under the Pharmaceutical Affairs Act, and a manufacturer, an importer, a repair business operator, a dealer or a rental business operator of medical devices under the Medical Devices Act (hereinafter referred to as "manufacturer, etc.") calculates the scope of medical benefits and medical fees under Article 7 (2) in relation to medicines and materials for medical treatment, he/she shall not perform any act that causes the Fund to incur a loss by fraud or other improper means prescribed by Ordinance of the Ministry of Health and Welfare, such as raising the limits of prices or selling prices of medicines and materials for medical treatment by intervening in an offense committed by an institution providing medical benefits under Article 28 (1) 1 or submitting false data. |
| (2) | The Minister of Health and Welfare may instruct a manufacturer, etc. to submit related documents or a public official under his/her jurisdiction to conduct necessary examinations, such as inquiring of the persons concerned or examining related documents, in order to ascertain whether such manufacturer, etc. has violated paragraph (1). |
[This Article Newly Inserted by Act No. 11878, Jun. 12, 2013]
| Article 30 (Formal Objections, etc.) |
| (1) | A person who is dissatisfied with a disposition issued by the head of a Si/Gun/Gu in relation to eligibility for an eligible recipient, medical benefits and expenses for benefits may file a formal objection with the head of such Si/Gun/Gu. |
| (2) | Where a guarantee agency referred to in Article 5, an institution providing medical benefits, or an eligible recipient is dissatisfied with a disposition issued by an institution examining expenses for benefits concerning the examination or adjustment of expenses for benefits, evaluation of the propriety of medical benefits, and confirmation of eligibility, they may file a formal objection with such institution examining expenses for benefits. <Amended by Act No. 14697, Mar. 21, 2017> |
| (3) | A person that is dissatisfied with the disposition of the head of a Si/Gun/Gu or an institution providing medical benefits that is dissatisfied with the disposition of an institution examining expenses for benefits shall file a formal objection under paragraphs (1) and (2) in writing (including an electronic document) within 90 days from the date he/she or it learns that such disposition has been made, and he/she or it shall not file a formal objection after 180 days have passed from the date such disposition was made: Provided, That this shall not apply to cases where he/she or it explains that he/she or it was unable to file a formal objection within such period due to justifiable grounds. |
| (4) | Notwithstanding paragraph (3), where an institution providing medical benefits intends to file a formal objection against the confirmation of an institution examining expenses for benefits under Article 11-3, it shall file such formal objection within 30 days from the date it is notified pursuant to paragraph (2) of the same Article. |
| (5) | Except as otherwise provided for in paragraphs (1) through (4), necessary matters concerning methods of, decision on, a formal objection and notification of such decisions shall be prescribed by Presidential Decree. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 30-2 (Requests for Adjudication) |
| (1) | Any person who is dissatisfied with a decision by an institution examining expenses for benefits, rendered on a formal objection under Article 30 (2), may file a request for adjudication with the Health Insurance Dispute Mediation Committee under Article 89 of the National Health Insurance Act. In such cases, Article 30 (3) shall apply mutatis mutandis to the relevant period for and the methods of requesting adjudication. |
| (2) | Any person who intends to request adjudication under paragraph (1) shall submit a written request for adjudication prescribed by Presidential Decree to an institution examining expenses for benefits that rendered the relevant disposition under Article 30 (2) or the Health Insurance Dispute Mediation Committee under paragraph (1). |
| (3) | Except as otherwise expressly provided for in paragraphs (1) and (2), necessary matters concerning procedures and methods for requesting adjudication, decisions on requests filed, notification of such decisions, etc. shall be prescribed by Presidential Decree. |
[This Article Newly Inserted by Act No. 12362, Jan. 28, 2014]
| Article 31 (Extinctive Prescription) |
| (1) | Where the following rights are not exercised for three years, extinctive prescription shall be completed: |
| 1. | Right to receive medical benefits; |
| 2. | Right to receive expenses for benefits; |
| 3. | Right to be reimbursed with payment by subrogation. |
| (2) | Prescription under paragraph (1) shall be interrupted for reasons that constitute any of the following: |
| 1. | Claim for expenses for benefits; |
| 2. | Notice of or demand for payment by subrogation. |
| (3) | Except as otherwise prescribed by this Act, the Civil Act shall apply to extinctive prescription and interruption of prescription. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 32 (Reporting and Inspections) |
| (1) | If necessary, the Minister of Health and Welfare may direct or supervise a City/Do and Si/Gun/Gu or require them to make necessary reports regarding matters related to the management and operation of the Fund and medical benefits. |
| (2) | The Minister of Health and Welfare may instruct an institution providing medical benefits (including an institution that has provided medical benefits pursuant to Article 12) and an organization that makes requests for examination of expenses for benefits by proxy under Article 11 (6) (hereinafter referred to as "agency claimant organization") to report on medical benefits, such as medical treatment and administration of medicines, or submit related documents, or instruct a public official under his/her jurisdiction to make inquiries or examine the related documents. <Amended by Act No. 14697, Mar. 21, 2017> |
| (3) | The Minister of Health and Welfare or the head of a Si/Gun/Gu may require a person who receives medical benefits to report on details of such medical benefits or instruct a public official under his/her jurisdiction to make inquiries. |
| (4) | A public official who makes inquiries or conducts examinations pursuant to paragraphs (2) and (3) shall carry a certificate indicating his/her authority and documents stating matters prescribed by Ordinance of the Ministry of Health and Welfare, such as the period of examination, scope of examination, examiner, relevant statutes, etc., and produce them to interested persons. <Amended by Act No. 14003, Feb. 3, 2016> |
| (5) | Except for those prescribed by this Act, the Framework Act on Administrative Investigations shall be applicable to the details of inquiries or examinations, procedures therefor, methods thereof, etc. under paragraphs (2) and (3). <Newly Inserted by Act No. 14003, Feb. 3, 2016> |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 32-2 (Provision of Data) |
| (1) | The head of a Si/Gun/Gu, an institution examining expenses for benefits, and an institution granting expenses for benefits may request the State, local governments, institutions providing medical benefits, or other public organizations to submit data necessary for medical benefits programs. In such cases, a person in receipt of such request shall provide data in a conscientious manner. |
| (2) | An institution examining expenses for benefits may request an institution providing medical benefits to submit data necessary for examination and adjustment of expenses for benefits, evaluation of the propriety of medical benefits, and confirmation of eligibility. In such cases, the institution providing medical benefits requested to provide data shall comply with such request in the absence of special circumstances. <Amended by Act No. 14697, Mar. 21, 2017> |
| (3) | The head of a Si/Gun/Gu, an institution examining expenses for benefits, and an institution granting expenses for benefits shall be exempted from usage fees and service fees for data provided by the State, a local government, an institution providing medical benefits or other public organizations pursuant to paragraphs (1) and (2). |
[This Article Newly Inserted by Act No. 11878, Jun. 12, 2013]
| Article 32-3 (Payment of Prize Money and Grants) |
| (1) | The head of a Si/Gun/Gu may pay prize money to a person who reports an institution providing medical benefits that has received expenses for benefits by fraud or other improper means. |
| (2) | The head of a Si/Gun/Gu may pay a grant to an institution providing medical benefits that has contributed to the efficient financial management of medical benefits. |
| (3) | Necessary matters concerning criteria and procedures for, the scope and methods of payment of prize money and grants under paragraphs (1) and (2) shall be prescribed by Presidential Decree. |
[This Article Newly Inserted by Act No. 11878, Jun. 12, 2013]
| Article 33 (Delegation and Entrustment of Authority) |
| (1) | The Minister of Health and Welfare may delegate part of his/her authority under this Act to the Mayor/Do Governor, as prescribed by Presidential Decree. |
| (2) | The head of a Si/Gun/Gu may entrust a related specialized institution with part of affairs concerning medical benefits, such as the management of eligible recipients and affairs concerning the examination, adjustment, evaluation of the propriety of medical benefits, confirmation of eligibility, and payment of expenses for benefits, among his/her affairs under this Act, as prescribed by Presidential Decree. In such cases, expenses incurred in entrustment shall be borne by the Fund, as prescribed by the Minister of Health and Welfare. <Amended by Act No. 14697, Mar. 21, 2017> |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 34 (Treatment of Fractions and Small Amount of Money) |
| (2) | Where the amount of money that the Special Metropolitan City Mayor, a Metropolitan City Mayor, a Do Governor, and the head of a Si/Gun/Gu should collect, pay, or refund is less than two thousand won in a case, he/she shall not collect, pay, or refund such amount. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 35 (Penalty Provisions) |
| (1) | A person who uses, provides, or divulges financial information, credit information, or insurance information, in violation of Article 23-2 (6) of the National Basic Living Security Act which is applied mutatis mutandis pursuant to Article 3-3 (3), shall be punished by imprisonment with labor for not more than five years or by a fine not exceeding 50 million won. <Amended by Act No. 14697, Mar. 21, 2017> |
| (2) | Deleted. <by Act No. 14697, Mar. 21, 2017> |
| (3) | Any of the following persons shall be punished by imprisonment with labor for not more than three years or by a fine not exceeding 30 million won: <Amended by Act No. 14697, Mar. 21, 2017> |
| 2. | Deleted; <Act No. 14697, Mar. 21, 2017> |
| 3. | A member of an agency claimant organization who claims expenses for benefits by fraud or other improper means. |
| (4) | Any of the following persons shall be punished by imprisonment with labor for not more than one year or by a fine not exceeding ten million won: <Amended by Act No. 14697, Mar. 21, 2017> |
| 1. | A person who refuses medical benefits under this Act without justifiable grounds, in violation of Article 9 (3); |
| 2. | A person requiring a person who is not an agency claimant organization under Article 11 (6) to make a request for examination of expenses for benefits on his/her behalf; |
| 3. | A person who receives medical benefits or aids a third party to receive medical benefits by fraud or other improper means; |
| 4. | A person who has established an institution providing medical benefits that provides medical benefits during the suspension of business, in violation of Article 28 (4). |
| (5) | A person who fails to report or submit a document under Article 32 (2), or makes a false report or submits false data, or refuses, interferes with, or evades an examination without justifiable grounds shall be punished by a fine not exceeding ten million won. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 36 (Joint Penalty Provisions) |
If the representative of a corporation, or an agent or employee of, or other persons employed by, a corporation or individual commits an offense under Article 35 in relation to the business affairs of the corporation or individual, not only such offender shall be punished, but the corporation or the individual shall also be punished by a fine under the relevant Article: Provided, That this shall not apply to cases where such corporation or individual has not been negligent in giving due attention and supervision concerning the relevant business affairs to prevent such offense. [This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
| Article 37 (Administrative Fines) |
| (1) | A person who fails to notify a transferee, a corporation that survives the merger or a corporation incorporated in the course of the merger of the fact that he/she has been subjected to administrative disposition or of the fact that he/she is under administrative disposition, in violation of Article 28 (7), shall be punished by an administrative fine not exceeding five million won. |
| (2) | Any of the following persons shall be subject to an administrative fine not exceeding one million won: |
| 1. | A person who violates his/her duty to preserve documents under Article 11-2; |
| 2. | A person who fails to submit a document under Article 29-2 (2), submits a false document, refuses to answer a question, gives a false answer, or refuses, interferes with, or evades an examination without justifiable grounds. |
| (3) | The Minister of Health and Welfare shall impose and collect administrative fines under paragraphs (1) and (2), as prescribed by Presidential Decree. |
[This Article Wholly Amended by Act No. 11878, Jun. 12, 2013]
ADDENDA
Article 1 (Enforcement Date)
This Act shall enter into force on October 1, 2001.
Article 2 (Transitional Measures concerning Beneficiaries of Medical Care)
Beneficiaries of medical care under the former provisions as at the time this Act enters into force shall be deemed beneficiaries under amended provisions of Article 3. Article 3 (Transitional Measures concerning Medical Care Deliberation Committee)
A medical care deliberation committee established under the former provisions at the time this Act enters into force shall be a medical care deliberation committee established under amended provisions of Article 6. Article 4 (Transitional Measures concerning Medical Security Card)
Medical security cards issued under the former provisions as at the time this Act enters into force shall be deemed medical care cards issued under amended provisions of Article 8. Article 5 (Transitional Measures concerning Medical Institutions for Medical)
Medical care institutions under the former provisions at the time this Act enters into force shall be deemed institution providing medical benefitss under amended provisions of Article 9. Article 6 (Transitional Measures concerning Care Costs)
Care costs under the former provisions at the time this Act enters into force shall be deemed care costs under amended provisions of Article 10. Article 7 (Transitional Measures concerning Medical Care Fund)
The Medical Care Fund under the former provisions at the time this Act enters into force shall be deemed the Medical Care Fund under amended provisions of Article 25. Article 8 (Transitional Measures concerning Medical Care Institutions whose Designation was Cancelled)
A medical institution whose designation as an institution providing medical benefits was cancelled pursuant to the former provisions at the time the amended Medical Care Act (Act No. 5853) entered into force shall, if the period during which re-designation shall be restricted has not ended yet, be deemed to remain subject to the business suspension for medical care during the remaining period pursuant to Article 24 of the aforesaid Act. Article 9 (Transitional Measures concerning Cancellation of Designation)
Any disposition made against a person regarding whom proceedings were pending in order to cancel designation, suspend a license, impose a fine for negligence, or make a disposition regarding unjust enrichment at the time the amended Medical Care Act (Act No. 5853) entered into force shall be governed by the former provisions in force before the aforesaid Act entered into force. Article 10 (Transitional Measures concerning Fine for Negligence)
The collection of administrative fines and unjust enrichment claims imposed pursuant to the former provisions at the time this Act enters into force shall be governed by the former provisions.
Article 11 (Transitional Measures concerning Penalty Provisions)
For the purposes of applying penalty provisions, acts committed before this Act enters into force shall be governed by the former provisions.
Article 12 Omitted.
Article 13 (Relationships with Other Statutes)
A citation of the former Medical Care Act or any provision thereof by any other statute in force at the time this Act enters into force shall be deemed a citation of this Act or the corresponding provision hereof in lieu of the former provision, if a corresponding provision exists herein.
ADDENDUM <Act No. 6758, Dec. 5, 2002>
This Act shall enter into force on the date of its promulgation.
ADDENDUM <Act No. 6875, May 15, 2003>
This Act shall enter into force on the date of its promulgation.
ADDENDA <Act No. 7182, Mar. 5, 2004>
| (1) | (Enforcement Date) This Act shall enter into force on January 1, 2005. |
ADDENDA <Act No. 7347, Jan. 27, 2005>
Article 1 (Enforcement Date)
This Act shall enter into force on July 1, 2005.
Articles 2 through 4 Omitted.
ADDENDUM <Act No. 7736, Dec. 23, 2005>
This Act shall enter into force three months after the date of its promulgation.
ADDENDUM <Act No. 8036, Oct. 4, 2006>
This Act shall enter into force on the date of its promulgation.
ADDENDA <Act No. 8114, Dec. 28, 2006>
| (1) | (Enforcement Date) This Act shall enter into force three months after the date of its promulgation. |
| (2) | (Applicability to Relaxation of Restriction on Benefits) The amended provisions of Article 15 (1) 2 shall apply from the first medical care provided after this Act enters into force. |
ADDENDA <Act No. 8609, Aug. 3, 2007>
Article 1 (Enforcement Date)
This Act shall enter into force six months after the date of its promulgation. (Proviso Omitted.)
Articles 2 through 7 Omitted.
ADDENDA <Act No. 8694, Dec. 14, 2007>
Article 1 (Enforcement Date)
This Act shall enter into force on July 1, 2008. (Proviso Omitted.)
Articles 2 through 26 Omitted.
ADDENDA <Act No. 8852, Feb. 29, 2008>
Article 1 (Enforcement Date)
This Act shall enter into force on the date of its promulgation. (Proviso Omitted.)
Articles 2 through 7 Omitted.
ADDENDA <Act No. 9932, Jan. 18, 2010>
Article 1 (Enforcement Date)
This Act shall enter into force two months after the date of its promulgation. (Proviso Omitted.)
Articles 2 through 5 Omitted.
ADDENDUM <Act No. 10514, Mar. 30, 2011>
This Act shall enter into force three months after the date of its promulgation.
ADDENDA <Act No. 10784, Jun. 7, 2011>
Article 1 (Enforcement Date)
This Act shall enter into force one year after the date of its promulgation.
Articles 2 and 3 Omitted.
ADDENDA <Act No. 10788, Jun. 7, 2011>
Article 1 (Enforcement Date)
| (1) | This Act shall enter into force one year after the date of its promulgation. |
Articles 2 through 11 Omitted.
ADDENDA <Act No. 11007, Aug. 4, 2011>
Article 1 (Enforcement Date)
This Act shall enter into force one year after the date of its promulgation.
Articles 2 through 4 Omitted.
ADDENDA <Act No. 11042, Sep. 15, 2011>
Article 1 (Enforcement Date)
This Act shall enter into force on July 1, 2012.
Article 2 Omitted.
ADDENDA <Act No. 11298, Feb. 10, 2012>
Article 1 (Enforcement Date)
This Act shall enter into force on July 1, 2013.
Articles 2 and 3 Omitted.
ADDENDA <Act No. 11878, Jun. 12, 2013>
Article 1 (Enforcement Date)
This Act shall enter into force on the date of its promulgation: Provided, That the amended provisions of Article 3-2 shall enter into force on July 1, 2013, and the amended provisions of Articles 3-3, 8, 28 (6) and (7), 29, 29-2, 32-3, 35 (1) and (3), 37 (1) and (3) shall enter into force six months after the date of their promulgation. Article 2 (Applicability to Application for Recognition of Eligible Recipients)
The amended provisions of Article 3-3 (1) and (2) shall apply beginning with the first person that applies for recognition of an eligible recipient after the same amended provisions enter into force. Article 3 (Applicability to Collection of Unlawful Gains of Institutions Providing Medical Benefits)
The amended provision of Article 23 (3) shall apply beginning with the first case where the head of a Si/Gun/Gu collects unlawful gains from an institution providing medical benefits after this Act enters into force. Article 4 (Applicability to Succession to Effect of Administrative Dispositions)
The amended provisions of Article 28 (6) and (7) shall apply beginning with the first acquisition of an institution providing medical benefits by transfer, the first corporation that survives the merger or the first corporation incorporated in the course of the merger after the said amended provisions enter into force. Article 5 (Applicability to Period of Formal Objection)
| (1) | The amended provision of the main body of Article 30 (3) (excluding matters concerning electronic documents) shall apply beginning with the first disposition made by the head of a Si/Gun/Gu after this Act enters into force. |
| (2) | The amended provisions of Article 30 (4) shall apply beginning with the first notification that an institution providing medical benefits receives after this Act enters into force. |
Article 6 (Applicability to Payment of Prize Money)
The amended provision of Article 32-3 (1) shall apply beginning with the first person who reports that an institution providing medical benefits has received expenses for benefits by fraud or other improper means after the said amended provision enters into force. Article 7 (Applicability to Treatment of Small Amount of Money)
The amended provision of Article 34 (2) shall apply beginning with the first case where that amount of money that has to be collected, paid, or refunded is less than two thousand won per case after this Act enters into force. Article 8 (Transitional Measures concerning Medicare Card)
A medicare card under the former provisions of Article 8 at the time the amended provisions of Article 8 enter into force shall be effective during the period of validity of such medicare card.
ADDENDA <Act No. 12362, Jan. 28, 2014>
Article 1 (Enforcement Date)
This Act shall enter into force six months after the date of its promulgation.
Article 2 (Applicability to Requests for Adjudication)
The amended provisions of Article 30-2 shall apply beginning with cases where an institution examining expenses for benefits renders the first decision on a formal objection after this Act enters into force.
ADDENDA <Act No. 12933, Dec. 30, 2014>
Article 1 (Enforcement Date)
This Act shall enter into force six months after the date of its promulgation.
(Proviso Omitted.)
Articles 2 through 8 Omitted.
ADDENDA <Act No. 13248, Mar. 27, 2015>
Article 1 (Enforcement Date)
This Act shall enter into force one year after the date of its promulgation.
Articles 2 through 7 Omitted.
ADDENDUM <Act No. 13657, Dec. 29, 2015>
This Act shall enter into force six months after the date of its promulgation.
ADDENDUM <Act No. 14003, Feb. 3, 2016>
This Act shall enter into force six months after the date of its promulgation.
ADDENDA <Act No. 14697, Mar. 21, 2017>
Article 1 (Enforcement Date)
This Act shall enter into force six months after the date of its promulgation.
Article 2 (Applicability to Objection)
The amended provisions of Article 30 (2) shall apply beginning with the first disposition issued by an institution examining expenses for benefits after this Act enters into force.