NATIONAL HEALTH INSURANCE ACT
Wholly Amended by Act No. 11141, Dec. 31, 2011
Amended by Act No. 11787, May 22, 2013
Act No. 12176, Jan. 1, 2014
Act No. 12615, May 20, 2014
Act No. 12844, Nov. 19, 2014
Act No. 13985, Feb. 3, 2016
Act No. 14084, Mar. 22, 2016
Act No. 14183, May 29, 2016
Act No. 14557, Feb. 8, 2017
Act No. 14776, Apr. 18, 2017
Act No. 14839, Jul. 26, 2017
CHAPTER I GENERAL PROVISIONS
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.
The Minister of Health and Welfare shall administer the national health insurance program prescribed by this Act.
The definitions of the terms used in this Act shall be as follows:
| 1. | The term "worker" means a person who, regardless of a type of his/her occupation, lives on remuneration received in return for his/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 determined by Presidential Decree; |
| 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 3-2 (Formulation, etc. 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 referred to as the "Health Insurance Policy Deliberative Committee" in this Article). The same shall also apply to any modification to any comprehensive plan already formulated. |
| (2) | A 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 contribution; |
| 5. | Matters concerning the costs of health care benefit; |
| 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 any 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, except in extenuating circumstances. |
| (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 Newly Inserted by Act No. 13985, Feb. 3, 2016]
| Article 4 (Health Insurance Policy Deliberative Committee) |
| (1) | The Health Insurance Policy Deliberative Committee (hereinafter referred to as the "Deliberative Committee") shall be established to deliberate and vote on any of the following matters concerning health insurance under control of the Minister of Health and Welfare: <Amended by Act No. 13985, Feb. 3, 2016> |
| 1. | Matters concerning a comprehensive plan under Article 3-2 (1) and an implementation plan under Article 3-2 (3) (limited to deliberation thereon); |
| 2. | The standards for health care benefit provided for in Article 41 (3); |
| 3. | Matters concerning the costs of health care benefit provided for in Articles 45 (3) and 46; |
| 4. | The insurance contribution rates of the employee insured provided for in Article 73 (1); |
| 5. | The monetary value per contribution point of the self-employed insured provided for in Article 73 (3); |
| 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 respectively by workers' organizations and employers' organizations; |
| 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) | Two persons, each recommended respectively by the president of the National Health Insurance Service and the president of the Health Insurance and Assessment Service; |
| (c) | Four persons with profound learning and experience in health insurance. |
| (5) | The terms of office of the members of the Deliberative Committee shall be three years: Provided, That the term of office of any member newly appointed, filling a vacancy of a resigned member, etc. shall be the remainder of the term of office for his/her predecessor. |
| (6) | Matters necessary for operation, etc., the Deliberative Committee, shall be prescribed by Presidential Decree. |
| Article 5 (Eligible Persons, etc.) |
| (1) | Korean nationals who reside within Korea shall become the insured of the health insurance (hereinafter referred to as "the insured"), or their dependents: Provided, That this shall not apply to any of the following persons: <Amended by Act No. 13985, Feb. 3, 2016> |
| (a) | A person from among persons eligible for medical care for distinguished service, who requests the insurer to provide him/her with health insurance cover; |
| (b) | A person who does not request the insurer that he/she be excluded from health insurance cover, despite of change of his/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 do not have other remuneration or income: |
| 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 for determination of the dependent eligibility referred to in paragraph (2), date of acquisition or loss of such eligibility, and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 5 (Eligible Persons, etc.) |
| (1) | Korean nationals who reside within Korea shall become the insured of the health insurance (hereinafter referred to as "the insured"), or their dependents: Provided, That this shall not apply to any of the following persons: <Amended by Act No. 13985, Feb. 3, 2016> |
| (a) | A person from among persons eligible for medical care for distinguished service, who requests the insurer to provide him/her with health insurance cover; |
| (b) | A person who does not request the insurer that he/she be excluded from health insurance cover, despite of change of his/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 Ordinance of the Ministry of Health and Welfare: <Amended by Act No. 14776, 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 for determination of the dependent eligibility referred to in paragraph (2), date of acquisition or loss of such eligibility, and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
<<Enforcement Date: Jul. 1, 2018>>
| Article 6 (Categories 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, That any of the following persons shall be excluded herefrom: <Amended by Act No. 14183, 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, and types of business, and public officials and school employees. |
| (3) | Persons who are neither the employee insured nor their dependents shall be the self-employed insured. |
| (4) | Workers and employers under paragraph (2) 4 may either become the employee insured or withdraw from such status, according to the procedures prescribed by Presidential Decree. |
| Article 7 (Reporting on Workplace) |
Where an employer of a workplace falls under any of the following subparagraphs, he/she shall report such fact to an insurer, as prescribed by Ordinance of the Ministry of Health and Welfare within 14 days thereafter. This shall also apply where any matter reported to the insurer is changed as he/she falls under subparagraph 1:
| 1. | Where his/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 a "workplace of eligible persons"); |
| 2. | Where a cause prescribed by Ordinance of the Ministry of Health and Welfare exists, such as suspension or closure of business. |
| Article 8 (Date, etc. of Acquisition of Eligibility) |
| (1) | The insured shall become eligible as the employee insured or the self-employed insured on the day he/she takes residence in the country: Provided, That 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/she becomes excluded from such eligibility; |
| 2. | For a former dependent of the employee insured, on the day when he/she loses his/her eligibility; |
| 3. | For a person formerly eligible for medical care for distinguished service, on the day when he/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) 2 (a), on the day when the request is made. |
| (2) | If a person becomes eligible under 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 Ordinance of the Ministry of Health and Welfare within 14 days after the date of acquisition of the eligibility. |
| Article 9 (Date, etc. of Change in Eligibility) |
| (1) | The eligibility of the insured shall change on the date when he/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 an "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 distinction as prescribed by Ordinance of the Ministry of Health and Welfare within fourteen 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 National Defense and the Minister of Justice shall inform the insurer as provided by Ordinance of the Ministry of Health and Welfare within one month from the date of such change. |
| Article 10 (Date, etc. of Loss of Eligibility) |
| (1) | The insured shall lose his/her eligibility on the day he/she falls under any of the following subparagraphs: |
| 1. | The day after when he/she dies; |
| 2. | The day after when he/she loses his/her nationality; |
| 3. | The day after when he/she ceases to reside within the country; |
| 4. | The day he/she becomes a dependent of an employee insured; |
| 5. | The day he/she becomes an eligible recipient; |
| 6. | The day a request for exclusion from coverage of the health insurance is made by a person formerly covered by health insurance but became a person eligible for medical care for distinguished service. |
| (2) | If eligibility is lost under 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 Ordinance of the Ministry of Health and Welfare within 14 days after the date of loss of the eligibility. |
| Article 11 (Confirmation of Acquisition, etc. 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 under 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 12 (Health Insurance Card) |
| (1) | The National Health Insurance Service shall issue health insurance cards to the insured. |
| (2) | When the insured or his/her dependent receives health care benefit, he/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, That this shall not apply if an unavoidable circumstance such as a natural disaster exists. |
| (3) | Notwithstanding the main sentence of paragraph (2), if it is possible for a health care institution to ascertain his/her eligibility using his/her resident registration certificate, driver's license, passport, or other identification cards prescribed by Ordinance of the Ministry of Health and Welfare to verify his/her identity, the insured or a dependent may not submit his/her health insurance card. |
| (4) | Neither the insured nor his/her dependent may receive insurance benefits after losing his/her eligibility under Article 10 (1) by a document that had been used to certify his/her eligibility before. <Newly Inserted by Act No. 11787, May 22, 2013> |
| (5) | No person is allowed to arrange another person to receive insurance benefits by transferring or lending his/her health insurance card or identification card. <Newly Inserted by Act No. 11787, May 22, 2013> |
| (6) | No person is allowed to receive insurance benefits by transferring, borrowing, or fraudulently using, another person's health insurance card or identification card. <Amended by Act No. 11787, May 22, 2013> |
| (7) | Matters necessary for the form of the health insurance card referred to in paragraph (1) and issuing and using it, shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 11787, May 22, 2013> |
CHAPTER III NATIONAL HEALTH INSURANCE SERVICE
The insurer of national health insurance shall be the National Health Insurance Service (hereinafter referred to as the "NHIS").
| Article 14 (Services, etc.) |
| (1) | The NHIS shall administer the following: <Amended by Act No. 14557, Feb. 8, 2017> |
| 1. | Supervision of the eligibility of the insured and their dependents; |
| 2. | Imposition and collection of insurance contribution and other fees 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 benefit 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; |
| 12. | Other services entrusted under this Act or other statutes; |
| 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; |
| 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 15 (Legal Personality, etc. of NHIS) |
| (1) | The NHIS shall be a juristic person. |
| (2) | The NHIS shall be established upon registering its establishment at the seat of its main office. |
| (1) | Location of the main office of the NHIS shall be determined by its articles of incorporation. |
| (2) | If necessary, the NHIS may establish branch offices as prescribed by its articles of incorporation. |
| Article 17 (Articles of Incorporation) |
| (1) | The articles of incorporation of the NHIS shall state the following matters: |
| 4. | Matters concerning its executive officers and employees; |
| 5. | Management of board of directors; |
| 6. | Matters concerning its financial operation committee; |
| 7. | Matters concerning insurance contribution 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 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 18 (Registration) |
The registration of incorporation of the NHIS shall include the following matters:
| 3. | Seat of the main office and branch offices; |
| 4. | Name, address, and resident registration number of the president. |
Matters regarding the dissolution of the NHIS shall be prescribed by Acts.
| Article 20 (Executive Officers) |
| (1) | The NHIS shall have one president, fourteen 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 executive officer recommendation committee established under Article 29 of the Act on the Management of Public Institutions (hereinafter referred to as "executive officer recommendation committee"). |
| (3) | Full-time directors shall be appointed by the president following the recommendation procedures prescribed by Ordinance 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 of the Republic of Korea upon recommendation by the Minister of Strategy and Finance from among several persons recommended by the executive officer recommendation committee. |
| (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 21 (Collection Director) |
| (1) | Among standing directors, a director who has extensive knowledge and experience in management, economy, and social insurance and who meets the qualification determined by Ordinance of the Ministry of Health and Welfare shall be appointed as a director in charge of the service under Article 14 (1) 2 and 11. |
| (2) | The NHIS shall have a committee for nominating collection directors (hereinafter referred to as "Nomination Committee") in order to nominate candidates for a collection director, having directors as its members. In such cases, a director nominated by the president shall be the chairperson of the Nomination Committee. |
| (3) | The Nomination Committee shall publish 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 determined by Ordinance 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 a 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 paragraphs (5), shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 22 (Duties 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. |
| (2) | The standing directors shall conduct the services of the NHIS under the order of the president. |
| (3) | Where the president is unable to perform his/her duties due to any unavoidable cause, a standing director determined 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 determined by articles of incorporation shall act on behalf of the president. |
| (4) | The auditor shall audit the services, accounting, and assets status of the NHIS. |
| Article 23 (Disqualification 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; |
| Article 24 (Obligatory 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/her appointment, he/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/her: |
| 1. | Where he/she is deemed unable to perform his/her duties due to mental disorders; |
| 2. | Where he/she breaches an official duty; |
| 3. | Where he/she causes loss to the NHIS by intention or gross negligence; |
| 4. | Where he/she commits an act that damages his/her dignity, regardless of whether on duty or not; |
| 5. | Where he/she violates an order of the Minister of Health and Welfare issued under this Act. |
| Article 25 (Prohibition, etc. 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 services for non-profit purpose. |
| Article 26 (Board of Directors) |
| (2) | The board of directors shall be comprised of the president 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 27 (Appointment and Dismissal of Employees) |
The president shall appoint and dismiss employees as prescribed by the articles of incorporation.
| Article 28 (Legal Fiction as Public Officials in Application of Penalty Provisions) |
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 30 (Selection and Appointment 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/her in all judicial or extra-judicial acts relevant to the services of the NHIS.
| Article 31 (Limitation on Representation) |
| (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 32 (Delegation of Authority of President) |
From among the authority of the president referred to in this Act, those prescribed by Presidential Decree, including restriction of benefits and notice to pay insurance contribution, may be delegated to the head of a branch offices pursuant to the articles of incorporation.
| Article 33 (Financial Operation Committee) |
| (1) | The NHIS shall have a financial operation committee to deliberate on and resolve the matters related to insurance finance, such as contracts on the costs of health care benefit provided for in Article 45 (1), the deficit disposal provided for in Article 84. |
| (2) | The chairperson of the financial operation committee shall be elected by the committee from among the committee members referred to in Article 34 (1) 3. |
| Article 34 (Composition, etc. 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, That the term of office of any member newly appointed to fill a vacancy of a resigned member, etc. shall be the remaining term of his/her predecessor. |
| (4) | Matters necessary for operation etc., of the financial operation committee, shall be prescribed by Presidential Decree. |
| (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 keep the accounting for the health insurance program, and the national pension program, employment insurance program, industrial accident compensation insurance program, and wage claim guarantee program entrusted under the applicable Acts to the entrustment of collection separate from its other accounting. |
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 by Act No. 14084, Mar. 22, 2016>
The NHIS may borrow funds where a shortage of cash exists in making reimbursement: Provided, That 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 38 (Reserve 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. the reserve funds referred to in paragraph (1), shall be prescribed by the Minister of Health and Welfare. |
| Article 39 (Settlement 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 under paragraph (1), it shall publicly announce the contents thereof as prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 40 (Application Mutatis Mutandis of Civil Act) |
CHAPTER IV INSURANCE BENEFITS
| Article 41 (Health Care Benefit) |
| (1) | Health care benefit referred to in the following subparagraphs shall be provided for diseases, injuries, childbirths, etc. of the insured and their dependents: |
| 1. | Diagnosis, and medical examinations; |
| 2. | Supply of medicines and materials for medical treatment; |
| 3. | Treatment, surgery, or other types of medical care; |
| 4. | Prevention, and rehabilitation; |
| (2) | The scope (hereinafter referred to as "health care benefit item") of health care benefit under paragraph (1) (hereinafter referred to as "health care benefit") shall be as follows: <Newly Inserted by Act No. 13985, Feb. 3, 2016> |
| 1. | Health care benefit 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 benefit pursuant to Article 41-3. |
| (3) | Criteria for the method, procedure, scope, and upper limit of health care benefit shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 13985, Feb. 3, 2016> |
| (4) | In prescribing the criteria for health care benefit 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 determined by Ordinance of the Ministry of Health and Welfare, as items excluded from the items eligible for health care benefit (hereinafter referred to as "non-benefit item"). <Amended by Act No. 13985, Feb. 3, 2016> |
| Article 41-2 (Exclusion, etc. of Medicines from Health Care Benefit) |
| (2) | Where a medicine suspended from the application of health care benefit under paragraph (1) becomes the subject of suspension under paragraph (1) again, the Minister of Health and Welfare may exclude it from the application of health care benefit, taking the total suspension period, severity of violation, etc. into consideration. |
| (3) | Criteria and procedures for the suspension of, and exclusion from, the application of health care benefit under paragraphs (1) and (2) and other necessary matters shall be prescribed by Presidential Decree. |
[This Article Newly Inserted by Act No. 12176, Jan. 1, 2014]
| Article 41-3 (Determination of Whether Acts, Materials for Medical Treatment, or Medicines Are Health Care Benefit Items) |
| (1) | A health care institution referred to in Article 42, a manufacturer or importer of materials for medical treatment, and other persons prescribed by Ordinance of the Ministry of Health and Welfare shall request the Minister of Health and Welfare to determine whether an act relating to health care benefit 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 Ordinance of the Ministry of Health and Welfare may request the Minister of Health and Welfare to determine whether a medicine under Article 41 (1) 2 (hereafter referred to as "medicine" in this Article), which is not included into health care benefit item, is a health care benefit item. |
| (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/her determination, within a period prescribed by Ordinance of the Ministry of Health and Welfare, except in extenuating circumstances. |
| (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 Ordinance of the Ministry of Health and Welfare where such determination is necessary to treat patients. |
| (5) | Matters necessary for the timing, procedures and method for requesting a determination of a benefit or non-benefit item under paragraphs (1) and (2), entrustment with relevant business, etc. and matters concerning the procedures, method, etc. for determining a benefit or non-benefit item under paragraphs (3) and (4), shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
[This Article Newly Inserted by Act No. 13985, Feb. 3, 2016]
| Article 41-4 (Selective Benefit) |
| (1) | Where economic feasibility, medical treatment effects, etc. are uncertain in determining health care benefit 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 benefit as preliminary health care benefit. |
| (2) | The Minister of Health and Welfare shall regularly assess the appropriateness of health care benefit in relation to selective benefit under paragraph (1) (hereinafter referred to as "selective benefit") according to the procedures and methods prescribed by Presidential Decree, thereby redetermining whether to provide health care benefit therefor and adjusting the criteria for health care benefit under Article 41 (3). |
[This Article Newly Inserted by Act No. 14084, Mar. 22, 2016]
| Article 42 (Health Care Institution) |
| (1) | Health care benefit (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. determined by Presidential Decree, which are unfit as health care institutions for the public interest or for national policy reasons, from among health care institutions: |
| 4. | Public health clinics, public health and health care centers, and branches of public health clinics referred to in the Regional Public Health Act; |
| (2) | If necessary for efficiently providing health care benefit, the Minister of Health and Welfare may recognize health care institutions meeting the standards prescribed by Ordinance of the Ministry of Health and Welfare, such as facilities, equipment, human resources, and medical departments, as specialized health care institutions, as prescribed by Ordinance of the Ministry of Health and Welfare. In such cases, he/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 forepart 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 benefit referred to in Article 41 (3) and the costs of health care benefit referred to in Article 45 differently from other health care institutions. <Amended by Act No. 13985, Feb. 3, 2016> |
| (5) | Health care institutions referred to in paragraphs (1), (2) and (4) may not refuse to provide health care benefit without any justifiable ground. |
| Article 42-2 (Management of Provision of Selective Benefit by Health Care Institutions) |
| (1) | Where any selective benefit requires data accumulation or medical use and management, the Minister of Health and Welfare may predetermine the requirements for the provision of relevant selective benefit and only the health care institutions that satisfy such requirements may provide relevant selective benefit, notwithstanding Article 42 (1). |
| (2) | A health care institution which provides selective benefit pursuant to paragraph (1) shall submit data necessary to assess relevant selective benefit under Article 41-4 (2). |
| (3) | Where a health care institution fails to satisfy the requirements for the provision of selective benefit 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 benefit. |
| (4) | The requirements for the provision of selective benefit referred to in paragraph (1), the submission of data referred to in paragraph (2), restrictions on the provision of selective benefit referred to in paragraph (3), and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
[This Article Newly Inserted by Act No. 14084, Mar. 22, 2016]
| Article 43 (Reports 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 benefit under Article 47, the institution shall report on the current status of its facilities, equipment, human resource, etc. to the Health Insurance 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 benefit under articleArticle 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 Ordinance 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 Ordinance of the Ministry of Health and Welfare. |
| Article 44 (Co-Payment of Expenses) |
| (1) | A person who receives health care benefit 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 benefit than to other health care benefit. <Amended by Act No. 14084, Mar. 22, 2016> |
| (2) | Where the total amount of annual co-payment borne by the insured pursuant to paragraph (1) exceeds the amount prescribed by Presidential Decree (hereafter referred to as "co-payment ceiling" in this Article), the NHIS shall bear such excess amount. <Newly Inserted by Act No. 14084, Mar. 22, 2016> |
| (3) | The co-payment ceiling referred to in paragraph (2) shall be determined in consideration of the income levels, etc. of the insured. <Newly Inserted by Act No. 14084, Mar. 22, 2016> |
| (4) | The method of calculating the co-payment ceiling, paying an amount in excess of the co-payment ceiling under paragraph (2), or determining the co-payment ceiling based on income levels of the insured and others under paragraph (3), and other necessary matters shall be prescribed by Presidential Decree. <Newly Inserted by Act No. 14084, Mar. 22, 2016> |
| Article 45 (Calculation, etc. of Costs of Health Care Benefit) |
| (1) | The costs of health care benefit shall be determined by contract between the president of the NHIS and persons determined 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 benefit 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 benefit determined by the Minister of Health and Welfare shall be deemed the costs of health care benefit determined by contract under paragraphs (1) and (2). <Amended by Act No. 11787, May 22, 2013> |
| (4) | If the costs of health care benefit are determined under paragraph (1) or (3), the Minister of Health and Welfare shall give a public notice the particulars of the costs of health care benefit without delay. |
| (5) | The president of the NHIS shall conclude a contract under paragraph (1), subject to 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 46 (Calculation, etc. of Costs of Health Care Benefit for Medicines and Materials for Medical Treatment) |
Notwithstanding Article 45, the costs of health care benefit 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 47 (Claims for and Payment, etc. of Costs of Health Care Benefit) |
| (1) | A health care institution may claim the costs of health care benefit 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 benefit. |
| (2) | A health care institution which intends to claim the costs of health care benefit under paragraph (1) shall request the Review and Assessment Service for a review of the costs of health care benefit, and the Review and Assessment Service in receipt of the request, shall review the matter and immediately notify the NHIS and the health care institution of the details of its review. |
| (3) | Upon receipt of the notification of the review details under paragraph (2), the NHIS shall immediately pay the costs of health care benefit 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) | For accounting purposes, the NHIS may offset the amount to be paid to the insured under paragraph (3) against the insurance contributions and other collections under this Act which the relevant insured should pay (hereinafter referred to as "insurance contributions, etc."). |
| (5) | Where the Review and Assessment Service evaluates the appropriateness of health care benefit referred to in Article 63 and notifies it to the NHIS, the NHIS shall adjust the payment by increasing or reducing the costs of health care benefit in accordance with the results of the evaluation. In such cases, the standards for increased or reduced payment of the costs of health care benefit shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| (6) | A health care institution may authorize any of the following organizations to claim for a review referred to in paragraph (2) on its behalf: |
| 1. | The association of medical doctors, the association of dentists, the association of oriental medical doctors, and the association of midwives provided for in Article 28 (1) of the Medical Service Act or a branch office or a branch of each of those associations, each of which files a report pursuant to paragraph (6) of the same Article; |
| (7) | Matters necessary for the method and procedure for making the claim, review, payment, etc. of the costs of health care benefit referred to in paragraphs (1) through (6), shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 47-2 (Withholding of Payment of Costs of Health Care Benefit) |
| (2) | Before withholding the payment of the cost of health care benefit under paragraph (1), the NHIS shall provide the relevant health care institution with an opportunity to submit its opinion. |
| (3) | Where the suspicion that a health care institution under paragraph (1) has violated Article 33 (2) of the Medical Service Act or Article 20 (1) of the Pharmaceutical Affairs Act is not substantiated, due to grounds prescribed by Presidential Decree such as final verdict of acquittal, the NHIS shall pay the relevant health care institution the interest for the period the payment of the costs of health care benefit is withheld in addition to the amount of health care benefit cost of which the payment is withheld. |
| (4) | Matters necessary for the procedure for withholding the payment, the procedure for submission of opinions, etc. under paragraphs (1) and (2), and matters necessary for the payment procedure of the health care benefit cost of which the payment is withheld and its interest, the calculation of interest, etc. under paragraph (3), shall be prescribed by Presidential Decree. |
[This Article Newly Inserted by Act No. 12615, May 20, 2014]
| Article 48 (Verification of Eligibility for Health Care Benefit, etc.) |
| (1) | The insured or the dependent may request the Review and Assessment Service to verify whether part of the medical expenses he/she has borne, other than co-payment, is excluded from health care benefit items in accordance with Article 41 (4). <Amended by Act No. 13985, Feb. 3, 2016> |
| (2) | The Health Insurance and Assessment Service in 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 benefit, the Review and Assessment Service shall notify the NHIS and the relevant health care institution of such facts. |
| (3) | A health care institution in 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, That 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 benefit it is liable to pay to such health care institution. |
| Article 49 (Health Care Costs) |
| (1) | Where the insured or dependent, due to emergency or other unavoidable reasons determined by Ordinance of the Ministry of Health and Welfare, receives health care for a disease, injury, childbirth, etc. at an institution determined by Ordinance 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)) or undergoes a childbirth at a place other than a health care institution, the NHIS shall disburse an amount equivalent to the health care benefit concerned to the insured or dependent as the health care costs, as prescribed by Ordinance of the Ministry of Health and Welfare. |
| (2) | An institution that has provided health care under paragraph (1) 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. |
| Article 50 (Additional Benefits) |
In addition to the health care benefit prescribed in this Act, the NHIS may provide benefits for medical expenses for pregnancy and childbirth, funeral costs, sickness allowances including others, as prescribed by Presidential Decree. <Amended by Act No. 11787, May 22, 2013>
| Article 51 (Special Rules for Persons with Disabilities) |
| (2) | The scope, and method of, and procedure for the insurance benefits for supportive equipment referred to in paragraph (1), and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 52 (Health Checkups) |
| (1) | The NHIS shall provide health checkups for the insured and their dependents in order to facilitate early detection of diseases and subsequent health care benefit. |
| (2) | Candidates for, frequency of, and procedures for the health checkup referred to in paragraph (1), and other necessary matters shall be prescribed by Presidential Decree. |
| Article 53 (Restriction of 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/she has caused criminal conduct by intention or gross negligence or caused an accident by intention; |
| 2. | Where he/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/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/she receives or is eligible to receive insurance benefits or compensations under other statutes due to a disease, an injury, or a disaster incurred relating to his/her business or in the line of duty. |
| (2) | When a person eligible for health care benefit has received benefits from the State or a local government benefit equivalent to the health care benefit or expenses equivalent to the costs of health care benefit under the provisions of other statutes, the NHIS shall not provide insurance benefits up to the limit of such amount. |
| (3) | Where the insured fails to pay the insurance contributions falling under any of the following subparagraphs for a period prescribed by Presidential Decree, the NHIS may not provide insurance benefits to the insured or his/her dependants until the delinquent insurance contributions are paid in full: Provided, That this shall not apply where the total number of failure to pay monthly insurance contributions is below the number prescribed by Presidential Decree (delinquent insurance contributions which have already been paid shall be excluded in calculating the number of failure), regardless of the period of delinquency in paying insurance contributions: |
| 1. | Insurance contributions based on monthly income referred to in 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/herself. In such cases, the dependants of the relevant employee insured shall also be subject to paragraph (3). |
| (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 once or more, the insurance benefits may be provided: Provided, That 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 twice without any justifiable grounds therefor. |
| (6) | The insurance benefits received in the period during which no insurance benefits are to be provided pursuant to paragraphs (3) and (4) (hereafter referred to as "benefit suspension period" in this paragraph) shall be recognized as insurance benefits only in the following cases: |
| 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 suspension period belongs; |
| 2. | Where the insurance contributions for which installment payment is approved pursuant to Article 82 is 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 suspension period belongs: Provided, That where anyone who has obtained approval for the installment payment pursuant to Article 82 fails to pay the approved insurance contributions on at least twice without justifiable grounds therefor, his/her eligibility for insurance benefits shall be denied. |
| Article 54 (Suspension 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, That in cases of subparagraphs 3 and 4, the health care benefit under the provisions of Article 60 shall be provided: | 1. | When he/she is travelling abroad; |
| 2. | When he/she is engaged in business affairs abroad; |
| 4. | When he/she is committed to a correctional institution or equivalent facilities. |
| Article 55 (Verification 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 be subject to questioning or diagnosis by relevant personnel.
| Article 56 (Reimbursement of Health Care Costs, etc.) |
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 56-2 (Accounts for Receipt of Health Care Costs, etc.) |
| (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, That where an account transfer is impossible due to an information and communications problem or any other inevitable 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 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 Newly Inserted by Act No. 12615, May 20, 2014]
| Article 57 (Collection of Unjust Enrichment or Unjust Profit) |
| (1) | The NHIS shall collect all or part of an amount equivalent to the insurance benefits or the insurance benefit costs from a person who has received insurance benefits or a health care institution that has received insurance benefit costs by fraud or other improper means. |
| (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 collectable under paragraph (1), severally or jointly with such health care institution: <Newly Inserted by Act No. 11787, May 22, 2013> |
| 1. | A medical institution established and operated by a person ineligible to establish the institution due to the violation of Article 33 (2) of the Medical Service Act, by borrowing the license of a medical specialist or the name of a medical corporation, etc.; |
| (3) | Where insurance benefits have been provided based on a false report or false testimony of the employer or the insured, or false diagnosis by a health care institution, the NHIS may require payment of the money collectable under paragraph (1) from such person or institution jointly with the person who received the insurance benefits. <Amended by Act No. 11787, May 22, 2013> |
| (4) | The NHIS may require payment of the money collectable 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 by Act No. 11787, May 22, 2013> |
| (5) | Where a health care institution has received health care benefit from the insured or his/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/her dependent without delay. In such cases, the NHIS may offset the amount payable to the insured or his/her dependent against the insurance contributions, etc. to be paid by such insured or his/her dependent. <Amended by Act No. 11787, May 22, 2013> |
| Article 58 (Rights to Demand Reimbursement) |
| (1) | When the NHIS has provided an insurance benefit to the insured or dependent because the grounds for the insurance benefit have arisen due to the act of a third party, the NHIS shall have the right to claim compensation from the third party up to the amount of the expenses incurred for the benefit concerned. |
| (2) | Where the person who receives the insurance benefit has already received compensation for the loss from the third party under paragraph (1), the NHIS shall withhold the insurance benefit, up to the amount of such compensation. |
| Article 59 (Protection of Entitlement to Benefits) |
| (1) | Entitlement to receive insurance benefits shall be unalienable and unseizable. <Amended by Act No. 12615, May 20, 2014> |
| (2) | Health care costs, etc. paid into an account for receipt of health care costs under Article 56-2 (1) shall not be seized. <Newly Inserted by Act No. 12615, May 20, 2014> |
| Article 60 (Payment of Costs of Health Care Benefit to Soldiers, etc. in Active Service) |
| (1) | Where any person who falls under subparagraphs 3 and 4 of Article 54 has received medical care, etc. prescribed by Presidential Decree (hereafter referred to as "health care benefit" in this Article) at an health care institution, the NHIS may pay the costs necessary therefor (hereafter referred to as the "costs of health care benefit" in this Article) to be borne by it, after receiving a deposition from the Minister of Justice, Minister of National Defense, Minister of Public Safety and Security, Commissioner General of the National Police Agency, Administrator of the National Fire Agency, or Commissioner of the Korea Coast Guard. In such cases, as prescribed by Presidential Decree, the Minister of Justice, Minister of National Defense, Minister of Public Safety and Security, Commissioner General of the National Police Agency, Administrator of the National Fire Agency, or Commissioner of the Korea Coast Guard shall pre-deposit the annual costs of health care benefit anticipated, except for the inevitable cases in their budgets. <Amended by Act No. 12844, Nov. 19, 2014; Act No. 14839, Jul. 26, 2017> |
| (2) | Articles 41, 41-4, 42, 42-2, 44 through 48, 55, and 56 shall apply mutatis mutandis to the matters concerning the health care benefit and costs of health care benefit. <Amended by Act No. 14084, Mar. 22, 2016> |
| Article 61 (Settlement of Costs of Health Care Benefit) |
Where the Korea Workers' Compensation and Welfare Service under Article 10 of the Industrial Accident Compensation Insurance Act claims costs of health care benefit for the health care benefit already paid pursuant to Article 40 of the Industrial Accident Compensation Insurance Act to a person eligible to receive the health care benefit pursuant to this Act because of the cancellation of the decision to pay the relevant health care benefit, the NHIS may pay an amount equivalent to the health care benefit on the condition that the health care benefit are accepted to be an amount equivalent to health care benefit providable pursuant to this Act.
CHAPTER V HEALTH INSURANCE REVIEW AND ASSESSMENT SERVICE
| Article 62 (Establishment) |
In order to review the costs of health care benefit and evaluate the appropriateness of health care benefit, the Health Insurance Review and Assessment Service shall be established.
| Article 63 (Services, etc.) |
| (1) | The Review and Assessment Service shall be in charge of the services referred to in the following subparagraphs: |
| 1. | Review of the costs of health care benefit; |
| 2. | Evaluation of the appropriateness of health care benefit; |
| 3. | Development of criteria for review and evaluation; |
| 4. | Investigative research and international cooperation related to the services referred to in subparagraphs 1 through 3; |
| 5. | Services delegated to it in connection with review of the costs of benefits or evaluation of the appropriateness of medical care that are provided for under the provisions of other Acts; |
| 6. | Services determined by the Minister of Health and Welfare to be necessary in connection with the health insurance program; |
| 7. | Other services prescribed by Presidential Decree in connection with review of the costs of insurance benefits and evaluation of the appropriateness of insurance benefits. |
| (2) | The criteria, procedures, methods, etc. relevant to the evaluation of the appropriateness of health care benefit referred to in paragraph (1) 2 and 7, and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 64 (Legal Personality, etc.) |
| (1) | The Review and Assessment Service shall be a juristic person. |
| (2) | The Review and Assessment Service shall come into existence with the registration of its establishment at the seat of its main office. |
| Article 65 (Executive Officers) |
| (1) | The Review and Assessment Service shall have the president, 15 directors, and one auditor as its executive officers. In this case, the president, four directors, and the auditor shall be standing. <Amended by Act No. 13985, Feb. 3, 2016> |
| (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 the plural number of persons recommended by the executive officer recommendation committee. |
| (3) | Standing directors shall be appointed by the president following the recommendation procedures prescribed by Ordinance of the Ministry of Health and Welfare. |
| (4) | As non-standing directors, ten persons from among the persons falling under the following subparagraphs and one relevant public official recommended as prescribed by Presidential Decree shall be appointed by the Minister of Health and Welfare: |
| 1. | One person recommended by the NHIS; |
| 2. | Five persons recommended by a medicine related organization; |
| 3. | Persons, each one of whom is recommended respectively by a labor unions' group, an employers' organization, a consumer organization, and an agricultural and fishing organization. |
| (5) | The auditor shall be appointed by the President upon recommendation of the Minister of Strategy and Finance from among the plural number of persons recommended by executive officer recommendation committee. |
| (6) | Non-standing directors prescribed in paragraph (4) may receive reimbursement for actual expenses, as prescribed by the articles of incorporation. |
| (7) | The term of office of the president shall be three years, and that of directors (excluding a director who is a public official) and the auditor shall be two years, respectively. |
| Article 66 (Medical Treatment Review Committee) |
| (1) | In order to efficiently conduct the services of the Review and Assessment Service, a medical treatment review committee (hereinafter referred to as "review committee") shall be established under the Review and Assessment Service. |
| (2) | The review committee shall be comprised of no more than 90 full-time review members, including the chairperson of the committee, and no more than 1,000 part-time review members, and it may establish a subcommittee for each area of medical specialization. <Amended by Act No. 13985, Feb. 3, 2016> |
| (3) | Full-time review members referred to in paragraph (2) shall be appointed by the president of the Review and Assessment Service from among the persons prescribed by Ordinance of the Ministry of Health and Welfare. |
| (4) | Part-time review members referred to in paragraph (2) shall be commissioned by the president of the Review and Assessment Service from among the persons prescribed by Ordinance of the Ministry of Health and Welfare. |
| (5) | If a review member falls under any of the following subparagraphs, the president of the Review and Assessment Service may dismiss or remove him/her: |
| 1. | Where he/she is deemed incapable of performing his/her duties due to a mental disorder; |
| 2. | Where he/she breaches or neglects an official duty; |
| 3. | Where he/she causes loss to the Review and Assessment Service by intention or gross negligence; |
| 4. | Where he/she does an act that causes injury to his/her dignity, regardless of whether on duty or off duty. |
| (6) | Necessary matters concerning the qualifications and the term of office of the members of the review committee, the organization and operation of the committee, etc., other than those prescribed in paragraph (1) through (5), shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 67 (Fundraising and Others) |
| (1) | The Review and Assessment Service may collect charge from the NHIS to provide the service referred to in Article 63 (1) (excluding the service referred to in Article 63 (1) 5). |
| (2) | Where services related to review of the costs of benefits or evaluation of the appropriateness of medical care are entrusted to the Review and Assessment Service under Article 63 (1) 5, the Review and Assessment Service may collect a fee from the delegator. |
| (3) | The amount and collecting method of the charge and fee referred to in paragraphs (1) and (2) and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 68 (Provisions Applicable Mutatis Mutandis) |
Articles 14 (3) and (4), 16, 17 (excluding Article 17 (1) 6 and 7), 18, 19, 22 through 32, 35 (1), 36, 37, 39 and 40 shall apply mutatis mutandis in regard to the Review and Assessment Service. In this regard, the "NHIS" shall be deemed the "Review and Assessment Service" and the "president of the NHIS" shall be deemed the "president of the Review and Assessment Service," respectively. <Amended by Act No. 11787, May 22, 2013>
CHAPTER VI INSURANCE CONTRIBUTION
| Article 69 (Insurance Contribution) |
| (1) | To meet the expenses incurred for the health insurance program, the NHIS shall collect insurance contribution from the persons obligated to pay insurance contribution referred to in Article 77. |
| (2) | The insurance contribution referred to in paragraph (1) shall be collected from the month following that in which the date the insured becomes eligible falls until the month in which the date before the date the insured loses his/her eligibility falls: Provided, That where the eligibility of the insured is obtained on the first day of any month, it shall be collected from the relevant month. |
| (3) | In collecting insurance contribution under paragraphs (1) and (2), where the eligibility of the insured has been altered, the insurance contribution of the month whereto belongs the altered day shall be collected on the basis of eligibility prior to such alteration: Provided, That where the eligibility of the insured is altered on the first day of any month, it shall be collected on the basis of the altered eligibility. |
| (4) | The amount of the monthly insurance contribution for the employee insured shall be the amount calculated as follows: |
| 1. | The amount of insurance contribution based on monthly remuneration: The amount obtained by multiplying the amount of monthly remuneration calculated under Article 70 by the insurance contribution rate under Article 73 (1) or (2); |
| 2. | The amount of insurance contribution based on the monthly income: The amount obtained by multiplying the amount of monthly income calculated under Article 71 by 50/100 of the insurance contribution rate under Article 73 (1) or (2). |
| (5) | The amount of the monthly insurance contribution for the self-employed insured shall be calculated per unit of household, but the insurance contribution per month for the household to which the self-employed insured belongs shall be the amount obtained by multiplying the monetary value per contribution point under Article 73 (3) by the contribution points calculated under Article 72. |
| Article 69 (Insurance Contribution) |
| (1) | To meet the expenses incurred for the health insurance program, the NHIS shall collect insurance contribution from the persons obligated to pay insurance contribution referred to in Article 77. |
| (2) | The insurance contribution referred to in paragraph (1) shall be collected from the month following that in which the date the insured becomes eligible falls until the month in which the date before the date the insured loses his/her eligibility falls: Provided, That where the eligibility of the insured is obtained on the first day of any month, it shall be collected from the relevant month. |
| (3) | In collecting insurance contribution under paragraphs (1) and (2), where the eligibility of the insured has been altered, the insurance contribution of the month whereto belongs the altered day shall be collected on the basis of eligibility prior to such alteration: Provided, That where the eligibility of the insured is altered on the first day of any month, it shall be collected on the basis of the altered eligibility. |
| (4) | The amount of the monthly insurance contribution for the employee insured shall be the amount calculated as follows: <Amended by Act No. 14776, Apr. 18, 2017> |
| 1. | The amount of insurance contribution based on monthly remuneration: The amount obtained by multiplying the amount of monthly remuneration calculated under Article 70 by the insurance contribution rate under Article 73 (1) or (2); |
| 2. | The amount of insurance contribution based on the monthly income: The amount obtained by multiplying the amount of monthly income calculated under Article 71 by the insurance contribution rate under Article 73 (1) or (2). |
| (5) | The amount of the monthly insurance contribution for the self-employed insured shall be calculated per unit of household, but the insurance contribution per month for the household to which the self-employed insured belongs shall be the amount obtained by multiplying the monetary value per contribution point under Article 73 (3) by the contribution points calculated under Article 72. |
| (6) | The upper limit and lower limit of the amount of the monthly insurance contribution referred to in paragraphs (4) and (5), shall be set in accordance with the standards prescribed by Presidential Decree, in consideration of the amount equivalent to a specified ratio of the average insurance contribution of the insured. <Newly Inserted by Act No. 14776, Apr. 18, 2017> |
<<Enforcement Date: Jul. 1, 2018>>
| Article 70 (Amount of Monthly Remuneration) |
| (1) | The amount of monthly remuneration of the employee insured provided for in Article 69 (4) 1 shall be calculated on the basis of the amount of remuneration received by each of the employee insured and the upper limit and the lowest limit thereof may be set according to the standards prescribed by Presidential Decree. |
| (2) | Insurance contribution based on monthly remuneration for the insured to whom a part or all of his/her remuneration is not paid due to a leave of absent from office or other circumstances (hereinafter referred to as a "person temporarily retiring from office, etc.") shall be calculated on the basis of the monthly remuneration amount for the month before the occurrence of the circumstance in question. |
| (3) | Remunerations referred to in paragraph (1) shall mean money and other valuables (excluding anything in the nature of reimbursement for expenses) that workers, etc. receive from employers, the State or local governments for providing their labor, which are determined by Presidential Decree. In such cases, if it falls under the cases prescribed by Presidential Decree, such as there are no data relating to the remunerations or they are indistinct, the amount determined and publicly notified by the Minister of Health and Welfare shall be regarded as the remunerations. |
| (4) | Matters necessary for calculation, etc., of the amount of monthly remuneration referred to in paragraph (1) and calculation, etc., of the amount of monthly remuneration for unremunerated employers, shall be prescribed by Presidential Decree. |
| Article 70 (Amount of Monthly Remuneration) |
| (1) | The amount of monthly remuneration of the employee insured provided for in Article 69 (4) 1, shall be calculated on the basis of the amount of remuneration received by each of the employee insured. <Amended by Act No. 14776, Apr. 18, 2017> |
| (2) | Insurance contribution based on monthly remuneration for the insured to whom a part or all of his/her remuneration is not paid due to a leave of absent from office or other circumstances (hereinafter referred to as a "person temporarily retiring from office, etc.") shall be calculated on the basis of the monthly remuneration amount for the month before the occurrence of the circumstance in question. |
| (3) | Remunerations referred to in paragraph (1) shall mean money and other valuables (excluding anything in the nature of reimbursement for expenses) that workers, etc. receive from employers, the State or local governments for providing their labor, which are determined by Presidential Decree. In such cases, if it falls under the cases prescribed by Presidential Decree, such as there are no data relating to the remunerations or they are indistinct, the amount determined and publicly notified by the Minister of Health and Welfare shall be regarded as the remunerations. |
| (4) | Matters necessary for calculation, etc., of the amount of monthly remuneration referred to in paragraph (1) and calculation, etc., of the amount of monthly remuneration for unremunerated employers, shall be prescribed by Presidential Decree. |
<<Enforcement Date: Jul. 1, 2018>>
| Article 71 (Amount of Monthly Income) |
| (1) | Where the amount of income of the employee insured excluding the amount of remuneration included in the calculation of the amount of monthly remuneration under Article 70 (hereinafter referred to as "extra income other than remuneration") exceeds the amount prescribed by Presidential Decree, the amount of monthly income shall be calculated on the basis of the amount of the extra income other than remuneration, and the upper limit thereof may be set according to the standards prescribed by Presidential Decree. |
| (2) | Matters necessary for calculating the amount of monthly income, including the standards for and method of the calculation, shall be prescribed by Presidential Decree. |
| Article 71 (Amount of Monthly Income) |
| (1) | Where the amount of income of the employee insured excluding the amount of remuneration included in the calculation of the amount of monthly remuneration under Article 70 (hereinafter referred to as "extra income other than remuneration") exceeds the amount prescribed by Presidential Decree, the amount of monthly income shall be calculated according to the following formula: <Amended by Act No. 14776, Apr. 18, 2017> |
(Annual extra income other than remuneration - Amount prescribed by Presidential Decree) x 1/12
| (2) | Matters necessary for calculating the amount of monthly income, including the standards for and method of the calculation, shall be prescribed by Presidential Decree. |
<<Enforcement Date: Jul. 1, 2018>>
| Article 72 (Contribution Point) |
| (1) | The contribution point provided for in the provisions of Article 69 (5) shall be set taking into account the income, property, standard of living, and the participation rate in economic activities, etc. of each of the self-employed insured and the upper limit and the lowest limit thereof may be set according to the criteria prescribed by Presidential Decree. |
| (2) | In determining the method and criteria for calculating the contribution point under the provisions of paragraph (1), assets in relation to which excercise of property rights is restricted under statutes may be treated differently from other assets. |
| (3) | Methods and criteria for calculating contribution points and other necessary matters shall be prescribed by Presidential Decree. |
| Article 72 (Contribution Point) |
| (1) | The contribution point provided for in Article 69 (5), shall be calculated based on the income and property of each of the self-employed insured. <Amended by Act No. 14776, Apr. 18, 2017> |
| (2) | In determining the method and criteria for calculating the contribution point under the provisions of paragraph (1), assets in relation to which excercise of property rights is restricted under statutes may be treated differently from other assets. |
| (3) | Methods and criteria for calculating contribution points and other necessary matters shall be prescribed by Presidential Decree. |
<<Enforcement Date: Jul. 1, 2018>>
| Article 72-2 (Committee on Improvement of Insurance Contribution Imposition System) |
| (1) | To improve a system related to the imposition of insurance contributions, a Committee on Improvement of the Insurance Contribution Imposition System (hereinafter referred to as the "System Improvement Committee") consisting of public officials of relevant central administrative agencies and private experts, shall be established under the jurisdiction of the Minister of Health and Welfare. |
| (2) | The System Improvement Committee shall deliberate on the following matters: |
| 1. | Surveys and research on the actual conditions of income of the insured ascertained; |
| 2. | Improvement plans to ascertain income of the insured and to strengthen the imposition of insurance contributions on such income; |
| 3. | Any other matters brought to the System Improvement Committee by the chairperson, in connection with the improvement of a system related to the imposition of insurance contributions. |
| (3) | The Minister of Health and Welfare shall report results of the operation of the System Improvement Committee established under paragraph (1), to the National Assembly. |
| (4) | Matters necessary for organization, operation, etc., the System Improvement Committee, shall be prescribed by Presidential Decree. |
[This Article Newly Inserted by Act No. 14776, Apr. 18, 2017]
<<Enforcement Date: Jul. 1, 2018>>
| Article 72-3 (Evaluating Appropriateness of Insurance Contribution Imposition System) |
| (1) | The Minister of Health and Welfare shall evaluate the appropriateness of the standards for determination of the dependent eligibility referred to in Article 5 (hereafter referred to as "determination standards" in this Article) and that of the criteria, method, etc. for calculating the insurance contribution, amount of monthly remuneration of the employee insured, amount of income of the employee insured, and contribution point under Articles 69 through 72 (hereafter referred to as "calculation criteria" in this Article); and adjust them four years after this Act enters into force. |
| (2) | Where the Minister of Health and Welfare evaluates the appropriateness under paragraph (1), he/she shall comprehensively take account of the following matters: |
| 1. | Status of income of the insured ascertained and improvement plans therefor, which have undergone deliberation by the System Improvement Committee pursuant to Article 72-2 (2) 2; |
| 2. | Status of income-related data owned by the NHIS; |
| 3. | Taxation status of global income referred to in Article 4 of the Income Tax Act (including global income subject to global taxation and global income subject to separate taxation); |
| 4. | Balance between insurance contributions imposed on the employee insured and those imposed on the self-employed insured; |
| 5. | Changes in insurance contributions caused by adjustment of the determination standards and calculation criteria referred to in paragraph (1); |
| 6. | Any other matters prescribed by the Minister of Health and Welfare, which may be subject to the evaluation of the appropriateness. |
| (3) | The procedures and method for evaluating the appropriateness under paragraph (1) and other necessary matters, shall be prescribed by Presidential Decree. |
[This Article Newly Inserted by Act No. 14776, Apr. 18, 2017]
<<Enforcement Date: Jul. 1, 2018>>
| Article 73 (Insurance Contribution Rate, etc.) |
| (1) | Insurance contribution rates for the employee insured shall be determined by Presidential Decree, within the limit of 80/1,000 after undergoing a resolution by the Deliberative Committee. |
| (2) | Insurance contribution rates for the employee insured who is engaged outside of Korea for business operations shall be 50/100 of the insurance contribution rate determined under the provisions of paragraph (1). |
| (3) | The monetary value per contribution point for each of the self-employed insured shall be determined by Presidential Decree after undergoing deliberation by the Deliberative Committee. |
| Article 74 (Exemption from Insurance Contribution) |
| (1) | Where the employee insured falls under any of subparagraphs 2 through 4 of Article 54, the NHIS shall exempt him/her from payment of insurance contribution: Provided, That the employee insured falling under subparagraph 2 of Article 54 shall be exempted from paying insurance contribution only if he/she does not have any dependent who resides within Korea. |
| (2) | Where the self-employed insured falls under any of subparagraphs 2 through 4 of Article 54, contribution points referred to in Article 72 shall be excluded from calculation of the insurance contribution for the household to which such insured belongs. |
| (3) | For the exemption of insurance contribution under paragraph (1) or the contribution point to be exempted from the computation of insurance contribution under paragraph (2), it shall apply from the month following the month whereto belongs the day on which the reasons for allowance suspension falling under any of subparagraphs 2 through 4 of Article 54 occurs to the month whereto belongs the day on which the reasons cease to exist: Provided, That where the reasons for allowance suspension cease to exist on the first day of each month, the insurance contribution of relevant month shall not be exempted, or the contribution point shall not be exempted from the computation of insurance contribution. |
| Article 75 (Reduction, etc. of Insurance Contribution) |
| (1) | Regarding the insured prescribed by Ordinance of the Ministry of Health and Welfare from among the following insured, part of the insurance contribution of the insured or the households to which the insureds belong may be reduced: |
| 1. | Persons who reside on islands, in remote areas or agricultural and fishery communities, etc. prescribed by Presidential Decree; |
| 2. | Persons who are at least 65 years old; |
| 5. | Persons who take a leave of absent from office; |
| 6. | Other persons designated and publicly notified by the Minister of Health and Welfare as the persons whose insurance contribution need to be reduced on the grounds of the economic hardship and natural disaster, etc. |
| (2) | Where a person obligated to pay insurance contribution under Article 77 falls under any of the following, he/she may be granted such financial benefits as reduction of insurance contribution, etc. as prescribed by Presidential Decree: <Newly Inserted by Act No. 11787, May 22, 2013> |
| 1. | Where he/she receives a billing of insurance contribution by means of an electronic document under Article 79 (2); |
| 2. | Where he/she pays insurance contribution by means of automatic account transfer. |
| (3) | Methods and procedures for reducing insurance contribution under paragraph (1) and other necessary matters shall be determined and publicly notified by the Minister of Health and Welfare. <Amended by Act No. 11787, May 22, 2013> |
| Article 76 (Burden of Insurance Contribution) |
| (1) | The insurance contribution for the employee insured shall be borne, 50/100 each, by the employee insured and the person referred to in the following classifications: Provided, That where the employee insured is a school employee working for a private school, 50/100, 30/100, and 20/100 of the amount of the insurance contribution shall be borne by the said employee insured, the person prescribed in subparagraph 2 (c) of Article 3, and the State, respectively: <Amended by Act No. 12176, Jan. 1, 2014> |
| 1. | Where the employee insured is a worker: The employer prescribed in subparagraph 2 (a) of Article 3; |
| 2. | Where the employee insured is a public official: The State or the local government to which that public official belongs; |
| 3. | Where the employee insured is a school employee (excluding school employees working for private schools): The employer prescribed in subparagraph 2 (c) of Article 3. |
| (2) | Insurance contribution based on monthly income of the employee insured shall be borne by the employee insured. |
| (3) | The insurance contribution for the self-employed insured shall be borne jointly by all the self-employed insured who reside in the same household as the said insured does. |
| (4) | Where the employee insured is a school employee, and if an employee prescribed in subparagraph 2 (c) of Article 3 is unable to bear the whole amount to be borne, the deficiency may be made to be borne from the account of the school. <Newly Inserted by Act No. 12176, Jan. 1, 2014> |
| Article 77 (Obligation for Payment of Contribution) |
| (1) | Insurance contribution of the employee insured shall be paid by the person prescribed as follows pursuant to the following classifications: |
| 1. | Insurance contribution based on monthly remuneration: In such cases, where the workplace has more than two employers, the employers of the workplace shall jointly pay the insurance contribution of the relevant employee insured; |
| 2. | Insurance contribution based on monthly income: The employee insured. |
| (2) | Insurance contribution of the self-employed insured shall be paid jointly by all the self-employed insured of a household to which the insured belong: Provided, That minors who have no income or property and minors who meet the criteria prescribed by Presidential Decree in consideration of income, property, etc., shall not be liable to pay insurance contribution. <Amended by Act No. 14776, Apr. 18, 2017> |
| (3) | An employer shall pay the portion of the insurance contribution for the month to be borne by the employee insured out of the insurance contribution based on monthly remuneration by deducting it from his/her remunerations. In such cases, the employer shall inform the employee insured of the amount of deduction. |
| Article 77-2 (Secondary Payment Obligation) |
| (1) | Where any deficit exists even after a corporation's property has been used to cover insurance contribution, arrears, and expenses for disposition on default to be paid by the corporation, a partner with unlimited liability or oligopolistic stockholder as of the date obligation for payment of the insurance contribution was imposed on the corporation (referring to a person falling under any subparagraph of Article 39 of the Framework Act on National Taxes) shall have secondary payment obligation for such deficit: Provided, That in cases of an oligopolistic stockholder, the amount of payment shall not exceed an amount obtained by dividing the deficit either by the total number of stocks (excluding nonvoting stocks) issued or by the total amount of investment made by the corporation, and then by multiplying the resulting amount either by the number of stocks (excluding nonvoting stocks) or the investment amount over which the oligopolistic stockholder exercises the substantial rights. |
| (2) | Where business has been transferred or acquired by transfer, and any deficit exists even after the transferor's property has been used to cover insurance contribution, arrears, and expenses for disposition on default the payment obligation for which was imposed on the transferor before the transfer date, the business transferee shall have secondary payment obligation for such deficit, within the value of property acquired by transfer. In such cases, the scope of the transferee and the value of property acquired by transfer shall be prescribed by Presidential Decree. |
[This Article Newly Inserted by Act No. 13985, Feb. 3, 2016]
| Article 78 (Due Date for Payment of Insurance Contribution) |
| (1) | A person who is liable to pay insurance contribution under Article 77 (1) and (2) shall pay the insured's insurance contribution for the applicable month by the tenth day of the following month: Provided, That insurance contribution based on monthly income of the employee insured and insurance contribution of the self-employed insured may be paid quarterly, as prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 11787, May 22, 2013> |
| (2) | Where any cause or event prescribed by Ordinance of the Ministry of Health and Welfare, such as delay in the delivery of billing of payment, occurs, the NHIS may extend the payment due date up to one month from the payment due date provided under paragraph (1) at the request of the person obligated to make such payment, notwithstanding paragraph (1). In such cases, matters relating to the method and procedures for applying for the extension of payment due date and other relevant matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Newly Inserted by Act No. 11787, May 22, 2013> |
| Article 78-2 (Additional Charge) |
| (1) | Where an employer of a workplace falsely reports to the insurer a person, who constitutes the grounds prescribed by Presidential Decree and is therefore ineligible for the employee insured, as the employee insured, in violation of Article 8 (2) or 9 (2), the NHIS shall impose, on the employer, and collect additional charge equivalent to 10/100 of the amount obtained by subtracting the amount referred to in subparagraph 2 from the amount referred to in subparagraph 1: |
| 1. | The total amount of insurance contribution to be paid by the insured who was reported by the employer as the employee insured in the period during which the insured was managed as the employee insured, pursuant to Article 69 (5); |
| 2. | The total amount of insurance contribution calculated pursuant to Article 69 (4) and imposed by the NHIS on the relevant insured during the period referred to in subparagraph 1. |
| (2) | Notwithstanding paragraph (1), the NHIS may not collect additional charge, in cases prescribed by Presidential Decree, such as where additional charge are small sums or where it is deemed inappropriate to collect additional charge. |
[This Article Newly Inserted by Act No. 14084, Mar. 22, 2016]
| Article 79 (Billing of Contribution, etc.) |
| (1) | When the NHIS intends to collect insurance contribution, etc., it shall determine the amount thereof and make a billing to each person who is obligated to pay it by means of written notice wherein the following matters are stated: |
| 1. | Types of insurance contribution, etc. to be collected; |
| 2. | Amount subject to be paid; |
| 3. | Due date for and place of payment. |
| (2) | If requested by a person obligated to pay the insurance contribution, when a billing is to be made under paragraph (1), the NHIS may notify it by means of an electronic document, such as exchange of electronic messages. In such cases, matters necessary for the method, procedures, etc. to apply for notice by means of an electronic document, shall be prescribed by Ordinance of the Minister of Health and Welfare. <Amended by Act No. 13985, Feb. 3, 2016> |
| (3) | Where the NHIS makes a billing by means of an electronic document under paragraph (2), it shall be deemed received by the person obligated to make payment at the time it is saved on the information and communications network prescribed by Ordinance of the Ministry of Health and Welfare or entered into the address of an electronic mail designated by the person obligated to make payment. |
| (4) | Where the employers of the employee insured are two or more persons or where a household of the self-employed insured consists of two or more persons, notice made to any one of them shall be deemed to take its effect to all other employers of the relevant workplace or all the other the self-employed insured who are the relevant household members. |
| (5) | The billing made to a person taking leave of absence etc. may be postponed until the time the reason for leave of absence, etc. disappears, as prescribed by Ordinance of the Ministry of Health and Welfare. |
| (6) | Where the NHIS makes a billing to a person who has secondary payment responsibility under Article 77-2, it shall notify such fact to the employer that is the relevant corporation or to the business transferor. <Amended by Act No. 13985, Feb. 3, 2016> |
| Article 79-2 (Payment of Contribution, etc. by Credit Cards, etc.) |
| (1) | The person who pays insurance contribution, etc., the billing of which is made by the NHIS may pay them by credit card, debit card, etc. (hereafter referred to as "credit card, etc." in this Article) through an institution, etc. prescribed by Presidential Decree for vicarious payment of insurance contribution, etc. (hereafter referred to as "institution for vicarious payment of insurance contribution, etc." in this Article). <Amended by Act No. 14557, Feb. 8, 2017> |
| (2) | Where payment is made by credit card, etc. under paragraph (1), the date the institution for vicarious payment of insurance contribution, etc. approves it shall be deemed the date of payment. |
| (3) | An institution for vicarious payment of insurance contribution, etc. may collect fees from payers of insurance contribution, etc. in return for its vicarious payment of insurance contribution, etc. |
| (4) | Matters necessary for designating and operating institutions for vicarious payment of insurance contribution, etc., fees, etc., shall be prescribed by Presidential Decree. |
[This Article Newly Inserted by Act No. 12615, May 20, 2014]
| (1) | If a person obligated to pay insurance contribution, etc. fails to pay insurance contribution, etc. by the payment due date, the NHIS shall collect arrears calculated by adding an amount equivalent to 1/1,000 of the insurance contribution, etc. in arrears thereto each day from the date payment thereof becomes overdue. In such cases, the arrears shall not exceed 30/1,000 of the insurance contribution, etc. in arrears. <Amended by Act No. 13985, Feb. 3, 2016> |
| (2) | If a person obligated to pay insurance contribution, etc. fails to pay insurance contribution, etc. in arrears, the NHIS shall collect another additional charge equivalent to 1/3,000 of the insurance contribution, etc. in arrears in addition to the arrears under paragraph (1) each day from the date 30 days elapses after the payment due date. In such cases, the arrears shall not exceed 90/1,000 of the insurance contribution, etc. in arrears. <Amended by Act No. 13985, Feb. 3, 2016> |
| (3) | If any natural disaster occurs or any other extenuating circumstance prescribed by Ordinance of Ministry of Health and Welfare exists, collection of arrears referred to paragraphs (1) and (2) may be forgone, notwithstanding paragraphs (1) and (2). |
| Article 81 (Overdue Notice of Insurance Contribution, etc. and Disposition on Default) |
| (1) | Where a person who is liable to pay insurance contribution, etc. pursuant to Articles 57, 77, 77-2, 78-2, and 101 fails to pay the insurance contribution, etc., the NHIS may make overdue notice by the specified period. In such cases, where the number of employers of the employee insured is at least two, or the household of the self-employed insured consists of two or more members, overdue notice made to any of the employers or any of the household members shall be deemed effective regarding the other employers of the relevant workplace or the other self-employed insured who are the members of the household. <Amended by Act No. 13985, Feb. 3, 2016; Act No. 14084, Mar. 22, 2016> |
| (2) | Where overdue notice is being made under paragraph (1), a payment period of at least 10 days, but no more than 15 days shall be determined and a letter of overdue notice shall be issued. |
| (3) | Where a person who receives overdue notice referred to in paragraph (1) fails to pay the insurance contribution, etc. by the payment due date, the NHIS may collect it in the same manner as national taxes in arrears are collected, after obtaining approval from the Minister of Health and Welfare. |
| (5) | Where the Korea Asset Management Corporation conducts an auction on behalf of the NHIS under paragraph (4), the NHIS may pay a fee, as prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 81-2 (Provision of Data concerning Disposition on Default or Deficits) |
| (1) | Where any centralized credit information collection agency provided for in Article 25 (2) 1 of the Credit Information Use and Protection Act requests data concerning the personal information, amount in arrears, or amount written off, of any of the following defaulters or persons whose amount in arrears is written off (hereafter referred to as "data concerning default, etc." in this Article), the NHIS may provide such data, if necessary for the collection of insurance contribution or for public interest: Provided, That this shall not apply where any administrative appeal or administrative litigation is pending in connection with the insurance contribution in arrears or any other amount collectable under this Act, or where any other cause or event prescribed by Presidential Decree occurs: |
| 1. | A person in whose case the total amount of insurance contribution remaining unpaid for a period exceeding one year from the following day of the due date for payment under this Act, other amount to be paid, and the disposition fee for arrears under this Act is not less than five million won; |
| 2. | A person in whose case the total amount written off under Article 84 is not less than five million won. |
| (2) | Matters relating to the procedures for the provision of data concerning arrear, etc. shall be prescribed by Presidential Decree. |
| (3) | No person who is provided with data concerning arrear, etc. under paragraph (1) shall divulge or use them for any purpose other than for performing his/her official duties. |
[This Article Newly Inserted by Act No. 11787, May 22, 2013]
| Article 81-3 (Certification of Payment of Insurance Contribution) |
| (1) | Where a person obligated to pay insurance contribution under Article 77 (hereafter referred to as "person obligated to make payment" in this Article) receives the price for a construction project, manufacture, purchase, service or any other contract prescribed by Presidential Decree from the State, a local government, or a public institution referred to in Article 4 of the Act on the Management of Public Institutions (hereafter referred to as "public institution" in this Article), the person shall certify the fact that he/she has paid insurance contribution, subsequent arrears and expenses for disposition on default: Provided, That the same shall not apply to cases prescribed by Presidential Decree, including where a person obligated to make payment intends to pay all or some of the price for a contract with insurance contribution in arrear. |
| (2) | Where a person obligated to make payment needs to certify that he/she has made payment under paragraph (1), the competent government agency or public institution in charge of a contract under paragraph (1) may inquire with the NHIS to confirm whether the person has paid the insurance contribution, subsequent arrears and expenses for disposition on default after obtaining consent from the person, instead of certifying payment under paragraph (1). |
[This Article Newly Inserted by Act No. 13985, Feb. 3, 2016]
| Article 82 (Installment Payments of Insurance Contribution in Arrears) |
| (1) | Regarding a person who has been in arrear with insurance contribution three times or more, the NHIS may grant approval for his/her payment of insurance contribution in installments, as prescribed by Ordinance of the Ministry of Health and Welfare. |
| (2) | Where a person who is approved to pay insurance contribution in installments pursuant to paragraph (1) fails to pay the approved insurance contribution at least twice without any justifiable grounds therefor, the NHIS shall revoke its approval for payment of his/her insurance contribution in installments. |
| (3) | Necessary matters concerning procedures, methods and standards, etc. for approval, and the revocation of approval to pay insurance contribution in installments shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 83 (Disclosure of Personal Information of Payers in Arrear with Large Amount or in Habitual Arrears) |
| (1) | Where a person who has defaulted in the payment of insurance contribution, arrears and expenses for disposition on default (including insurance contribution, arrears and expenses for disposition on default which has been written off under Article 84 but the extinctive prescription for which has not run out) which have been in arrears for more than two years from the day following the payment due date under this Act in the amount of not less ten million won in total despite the fact that he/she has the ability to pay them, the NHIS may disclose his/her personal information, amount in arrears, etc. (hereafter referred to as "personal information, etc." in this Article): Provided, That, this shall not apply where any administrative appeal or administrative litigation is pending or where any cause prescribed by Presidential Decree, such as partial payment of the amount in arrears, exists. |
| (2) | The Deliberative Committee on Disclosure of insurance contribution Information shall be established in the NHIS in order to deliberate on whether to disclose personal information, etc. under paragraph (1) of persons in arrear. |
| (3) | The Deliberative Committee on Disclosure of Insurance Contribution Information shall provide persons who are subject matter of disclosure of personal information, etc. an opportunity to defence 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) | Personal information, etc. of persons in arrear under paragraph (1) shall be disclosed by means of publication in the official gazette or posting on the website of the NHIS. |
| (5) | Matters necessary for the criteria for the ability to make payment, procedures for disclosure, organization, and operation of the committee, etc. concerning the disclosure of personal information, etc. of persons in arrear under paragraphs (1) through (4) shall be prescribed by Presidential Decree. |
| Article 84 (Dispositions on Deficit) |
| (1) | Where any of the following grounds occurs, the NHIS may write off insurance contribution, etc. as deficit after obtaining a resolution by the financial operation committee: |
| 1. | Where the disposition on default is concluded and the portion to be appropriated for the amount in arrears is insufficient for meeting the amount in arrears; |
| 2. | Where the extinctive prescription for the claim concerned has run out; |
| 3. | Cases determined by Presidential Decree where the possibility of collection is recognized nonexistent. |
| (2) | Where the NHIS discovers the existence of other seizable assets after the disposition on loss under paragraph (1) 3, it shall immediately cancel the disposition and effect a disposition on default. |
| Article 85 (Precedence of Collection of Insurance Contribution, etc.) |
Insurance contribution, etc. shall be collected before other claims except for national taxes and local taxes: Provided, That this shall not apply to the claims guaranteed by a right to lease on a deposit basis, a pledge right, a mortgage, or a security right pursuant to the Act on Security over Movable Property, Claims, Etc. where an asset of which the registration of establishment of a right to lease on a deposit basis, a pledge right, a mortgage, or a security right pursuant to the Act on Security over Movable Property, Claims, Etc. has been verified is sold prior to the due date for the payment of the insurance contribution, and the insurance contribution is collected from the proceeds from sale of such asset.
| Article 86 (Appropriation for and Return of Insurance Contribution, etc.) |
| (1) | Where any payment of the insurance contribution, etc., arrears, or expenses for disposition on default is overpaid or erroneously paid by a person liable to make such payment, the NHIS shall immediately determine the overpayment or erroneous payment as a refund. |
| (2) | The refund referred to in paragraph (1) shall be appropriated for any insurance contribution, etc., arrears, or expenses for disposition on default yet to be paid as prescribed by Presidential Decree, and any balance remaining after the appropriation shall be disbursed to the payer within 30 days after the date of the determination referred to in paragraph (1). In such cases, when the NHIS appropriates or disburses a refund, it shall add interest prescribed by Presidential Decree to the refund. |
CHAPTER VII FILING OF OBJECTIONS AND REQUESTS FOR TRIAL, ETC.
| Article 87 (Raising an Objection) |
| (1) | A person not satisfied with the decisions of the NHIS on the qualification, insurance contribution, etc., insurance benefits, and insurance benefit costs for the insured or his/her dependents, may formally raise such objection to the NHIS. |
| (2) | The NHIS, a health care institution, or other entity not satisfied with the decisions of the Review and Assessment Service on evaluation, etc. of the appropriateness of the costs of health care benefit and health care benefit may formally raise the objection to the Review and Assessment Service. |
| (3) | Any objection referred to in paragraphs (1) and (2) (hereinafter referred to as "filing of objection") shall be filed in writing within 90 days after the date the person became aware of such decision and shall not be filed after 180 days from the date the decision is made: Provided, That this shall not apply where an explanation is made that the objection within the relevant period could not be raised due to a legitimate reason. |
| (4) | Notwithstanding the main sentence of paragraph (3), where a health care institution intends to file an objection to the verification of the Health Insurance Review and Assessment Service referred to in Article 48, it shall do so within 30 days from the date it receives notice referred to in paragraph (2) of the same Article. |
| (5) | Matters necessary for the method of raising an objection and decision thereon, and notice of the decision, etc., other than those prescribed in paragraph (1) through (4), shall be prescribed by Presidential Decree. |
| Article 88 (Requests for Trial) |
| (1) | A person who appeals against a decision on an objection filed may request the Health Insurance Dispute Mediation Committee for a trial pursuant to Article 89. In such cases, Article 87 (3) shall apply mutatis mutandis to a request for trial. |
| (2) | A person who intends to request a trial pursuant to paragraph (1) shall submit a request for trial prescribed by Presidential Decree to the NHIS or the Review and Assessment Service, whichever of the two made a decision pursuant to Article 76 (1) or (2) or with the Health Insurance Dispute Mediation Committee under Article 89. |
| (3) | Matters necessary for the procedure and method for filing a request for trial, decision, notification of such decision, etc., other than those prescribed in paragraphs (1) and (2), shall be prescribed by Presidential Decree. |
| Article 89 (Health Insurance Dispute Mediation Committee) |
| (1) | The Health Insurance Dispute Mediation Committee (hereinafter referred to as the "Dispute Mediation Committee") shall be established under the Ministry of Health and Welfare to deliberate on and resolve requests for trial pursuant to Article 88. |
| (2) | The Dispute Mediation Committee shall be comprised of up to 60 committee members, including a chairperson, and one committee member, excluding the chairperson, shall be an ex officio member. <Amended by Act No. 12176, Jan. 1, 2014> |
| (3) | The meetings of the Dispute Mediation Committee shall have a total of nine members, being the chairperson, one ex officio member, and seven committee members as designated by the chairperson each time a meeting is held. |
| (4) | Resolutions of the Dispute Mediation Committee shall be passed by the attendance of the majority of committee members under paragraph (3) and affirmative voting of the majority of those present. |
| (5) | A secretariat shall be established under the Dispute Mediation Committee to provide assistance at working level. <Newly Inserted by Act No. 12176, Jan. 1, 2014> |
| (6) | Matters necessary for organizing, operating, etc., the Dispute Mediation Committee and the secretariat, other than those prescribed in paragraphs (1) through (5), shall be prescribed by Presidential Decree. <Amended by Act No. 12176, Jan. 1, 2014> |
| (7) | For the purposes of applying Articles 129 through 132 of the Criminal Act, a member of the Dispute Mediation Committee who is not a public official shall be deemed a public official. <Newly Inserted by Act No. 13985, Feb. 3, 2016> |
| Article 90 (Administrative Litigation) |
A person who has an objection to a decision of the NHIS or the Review and Assessment Service or a person who protests against a decision on the objection raised under Article 87 or a request for trial filed under Article 88 may institute an administrative action pursuant to the Administrative Litigation Act.
CHAPTER VIII SUPPLEMENTARY PROVISIONS
| Article 91 (Prescription) |
| (1) | The extinctive prescription of the following rights shall become complete if not exercised for three years: <Amended by Act No. 14084, Mar. 22, 2016> |
| 1. | Entitlement to collect insurance contribution, arrears, and additional charges; |
| 2. | Entitlement to be refunded any excessive or mistaken amount paid as insurance contribution, arrears, or additional charges; |
| 3. | Entitlement to receive an insurance benefit; |
| 4. | Entitlement to receive reimbursement of insurance benefit costs; |
| 5. | Entitlement to receive a refund of excess individual co-payment under the latter part of Article 47 (3); |
| 6. | A right of the Korea Workers' Compensation and Welfare Service under Article 61. |
| (2) | The prescription referred to in paragraph (1) shall be interrupted by an occurrence of any of the following events: |
| 1. | A notice or overdue notice of insurance contribution; |
| 2. | A claim for insurance benefit or insurance benefit costs. |
| (3) | The extinctive prescription of the right to collect insurance contribution from a person who takes a leave of absence, etc. shall not, if notification is suspended pursuant to Article 79 (5), proceed until the reason for leave of absence, etc. ceases to exist. |
| (4) | Except for matters prescribed in this Act, the term of extinctive prescription pursuant to paragraph (1), interruption of prescription pursuant to paragraph (2) and suspension of prescription pursuant to paragraph (3) shall be in accordance with the Civil Act. |
| Article 92 (Calculation of Periods) |
Except as otherwise expressly provided for in this Act, the provisions of the Civil Act that are relevant to periods shall apply mutatis mutandis to the calculation of the periods prescribed by this Act or by orders under this Act.
| Article 93 (Protection of Rights and Interests of Workers) |
An employer who employs workers at all places of business who do not fall under any subparagraph of Article 6 (2) shall not prevent the workers he/she has employed from becoming the employee insured under this Act or take a measure that is injurious to the workers, such as denial of a worker's promotion or wage increase or the dismissal of a worker, for the purpose of evading an increase of the employer's share to be borne by the employer in question and without any justifiable ground therefor.
| Article 94 (Reporting, etc.) |
| (1) | The NHIS may require an employer, the employee insured, or the head of a household to report the following matters or to submit relevant documents (including those recorded by an electronic method): <Amended by Act No. 11787, May 22, 2013> |
| 1. | The change of residence of the insured; |
| 2. | The remuneration and income of the insured; |
| 3. | Other matters necessary for the health insurance program. |
| (2) | Where the NHIS recognizes a necessity for factual verification of the materials reported or submitted under paragraph (1), the NHIS may require employees under its charge to investigate the matters in question. |
| (3) | The NHIS's employees who conduct an investigation under paragraph (2) shall carry documents indicating their authority and produce them to related persons. |
| Article 95 (Forwarding, etc. of Data on Reduction or Omission of Income) |
| (1) | Where the NHIS recognizes that remuneration, income, etc. reported under Article 94 (1) is reduced or omitted, it may forward in writing the matters on income reduction or omission to the Commissioner of the National Tax Service through the Minister of Health and Welfare. |
| (2) | Where the Commissioner of the National Tax Service conducts any tax investigation under related Acts, such as the Framework Act on National Taxes, on the matters forwarded under paragraph (1), he/she shall forward the matters on the remuneration or income, from among the results of relevant investigation to the NHIS. |
| (3) | Matters necessary for forwarding procedures under paragraphs (1) and (2) and other necessary matters, shall be prescribed by Presidential Decree. |
| Article 96 (Furnishing of Materials) |
| (1) | The NHIS may request the State, local governments, health care institutions, insurance companies, and actuarial organizations under the Insurance Business Act, public institutions under the Act on the Management of Public Institutions, other public organizations, etc. to furnish the data prescribed by Presidential Decree on resident registration, family relation registration, national taxes, local taxes, land, buildings, immigration control, etc. to perform the following: <Amended by Act No. 12615, May 20, 2014> |
| 1. | Implementation of health insurance programs, such as supervision of eligibility of the insured and their dependents, imposition and collection of insurance contribution, and administration of insurance benefits; |
| (2) | The Review and Assessment Service may request the State, local governments, health care institutions, insurance companies, and actuarial organizations under the Insurance Business Act, public institutions under the Act on the Management of Public Institutions, other public organizations, etc. to furnish the data prescribed by Presidential Decree on resident registration, immigration control, medical records, supply of medicine and medical supplies, etc. to examine the costs of health care benefit and to assess the appropriateness of health care benefit. <Amended by Act No. 12615, May 20, 2014> |
| (3) | Those who have received request to furnish materials under paragraphs (1) and (2) shall sincerely comply therewith. |
| (4) | Where the NHIS or the Review and Assessment Service requests health care institutions, insurance companies or actuarial organizations under the Insurance Business Act to furnish the data referred to in paragraph (1) or (2), it shall forward a written request for the furnishing of data which states the grounds and reasons for the request for the data, persons and period subject to the furnishing of the data, time limit for furnishing the data, data to be furnished, etc. <Newly Inserted by Act No. 14084, Mar. 22, 2016> |
| (5) | Fees, commissions, etc. shall be exempted for the materials furnished to the NHIS or the Review and Assessment Service by the State, local governments, health care institutions, insurance contribution rate computing organizations under the Insurance Business Act and other public institutions and public organizations under paragraphs (1) and (2). <Amended by Act No. 14084, Mar. 22, 2016> |
| Article 96-2 (Preservation of Documents) |
| (1) | Each health care institution shall store the documents related to any claim for costs of health care benefit under Article 47 for five years from the date of end of provision of such health care benefit, as prescribed by Ordinance of the Ministry of Health and Welfare: Provided, That pharmacies and other health care institutions prescribed by Ordinance of the Ministry of Health and Welfare shall store prescriptions for three years from the date the relevant costs of health care benefit are claimed. |
| (2) | Each employer shall store documents related to health insurance including management of the eligibility requirements and calculation of insurance contribution for three years, as prescribed by Ordinance of the Ministry of Health and Welfare. |
[This Article Newly Inserted by Act No. 11787, May 22, 2013]
| Article 97 (Reports and Inspections) |
| (1) | The Minister of Health and Welfare may order an employer, the employee insured, or the head of a household to report or submit materials on the relocation, remuneration, income, and other necessary matters of the insured or require public officials under his/her charge to question relevant persons or inspect relevant documents. |
| (2) | The Minister of Health and Welfare may require a health care institution (including any institution that has provided health care under Article 49) to report on the matters relevant to insurance benefits, such as the provision of health care and medicine, or submit relevant documents or require public officials under his/her charge to question relevant persons or inspect relevant documents. |
| (3) | The Minister of Health and Welfare may require a person who has received an insurance benefit to report on the details of the relevant insurance benefit or require public officials under his/her charge to question the person. |
| (4) | The Minister of Health and Welfare may order an organization that is assigned to vicariously file claims for examining costs of health care benefit pursuant to Article 47 (6) (hereinafter referred to as "vicarious claim organization") to submit necessary materials or require public officials under his/her charge to investigate and verify the materials, etc. pertaining to the vicarious claims. |
| (5) | Public officials who conduct an investigation under any of paragraph (1) through (4) shall carry documents indicating their authority and produce them to related persons. |
| Article 98 (Suspension of Operation) |
| (1) | Where a health care institution falls under any of the following subparagraphs, the Minister of Health and Welfare may order the health care institution to suspend its operation by specifying a period of within one year: <Amended by Act No. 13985, Feb. 3, 2016> |
| 1. | Where it places the burden of costs of health care benefit on the insurer, the insured, or dependent by fraud or other improper means; |
| 2. | Where it violates the order referred to in Article 97 (2), files a false report, or rejects, interferes with, or evades an inspection or questioning by a public official belonging to competent authorities; |
| 3. | Where it performs or uses an act or material for medical treatment for the insured or their dependents by fraud or other improper means and then places the burden of costs on the insured or their dependents, without applying for the determination under Article 41-3 (1) without any justifiable grounds. |
| (2) | A person who has been ordered to suspend operation under the provisions of paragraph (1) shall not provide health care benefit during the period of suspension of the operations in question. |
| (3) | The effect of the disposition of suspension of operation under paragraph (1) shall be succeeded by a person who takes over the health care institution for which such disposition has been made, a corporation which survives after a merger, or a corporation established by a merger, and where any procedure of the disposition of suspension of operation is pending, it may proceed regarding the transferee, the corporation which continues to exist after a merger or the corporation established by a merger: Provided, That the same shall not apply to a transferee or corporation surviving a merger where he/she or it proves that he/she or it was unaware of such disposition or the fact of violation. |
| (4) | A person who is subject to the disposition of the suspension of operation under paragraph (1) or a person for whom the procedure of the disposition of suspension of operation is under way shall notify, without delay, a transferee, a corporation surviving a merger or a corporation incorporated in the course of a merger of the fact that it is subject to an administrative disposition or the fact that the procedure of an administrative disposition is under way under the conditions as prescribed by Presidential Decree as prescribed by Ordinance of the Ministry of Health and Welfare. |
| (5) | The standards of administrative disposition by the type, degree, etc. of violating acts which are subject to the suspension of operation under paragraph (1), and other necessary matters shall be prescribed by Presidential Decree. |
| Article 99 (Penalty Surcharges) |
| (1) | Where a health care institution is subject to the disposition of suspension of operation by falling under Article 98 (1) 1 or 3, if such disposition causes a serious inconvenience to persons who use a health care institution or if any special causes prescribed by the Minister of Health and Welfare are deemed to exist, the Minister of Health and Welfare may impose and collect a penalty surcharge in the amount not exceeding five times the amount to be imposed on conducts by fraud or other improper methods in lieu of the disposition of suspension of operation. In such cases, the Minister of Health and Welfare may have it paid in installments within 12 months. <Amended by Act No. 13985, Feb. 3, 2016> |
| (2) | Where the Minister of Health and Welfare deems there exists a special ground on worries on that the suspension or exclusion of any medicine from health care benefit under Article 41-2 (1) or (2) may cause serious hazard to national health, he/she may impose and collect a penalty surcharge up to 40% of the total amount of health care benefit for the relevant medicine, in lieu of the suspension or exclusion thereof from the health care benefit, as prescribed by Presidential Decree. In such cases, the Minister of Health and Welfare may have it paid in installments within 12 months. <Newly Inserted by Act No. 12176, Jan. 1, 2014> |
| (3) | The total amount of costs of health care benefit for the relevant medicine to be prescribed by Presidential Decree under paragraph (2) shall not exceed the total amount of health care benefit paid for one year taking into consideration the record, etc. of health care benefit for the relevant medicine paid in the past. <Newly Inserted by Act No. 12176, Jan. 1, 2014> |
| (4) | Where a person liable to pay a penalty surcharge under paragraph (1) fails to make such payment by a due date thereof, the Minister of Health and Welfare shall cancel the disposition of imposing the penalty surcharge in accordance with the procedures prescribed by Presidential Decree, and then shall take a disposition of suspending operation under Article 98 (1) or collect it in the same manner as delinquent national taxes are collected: Provided, That if it is impracticable to take a disposition of suspending operation under Article 92 (1) due to discontinuance, etc. of business of the relevant health care institution, a penalty surcharge shall be collected in the same manner as delinquent national taxes are collected. <Amended by Act No. 14084, Mar. 22, 2016> |
| (5) | Where a person liable to pay a penalty surcharge under paragraph (2) fails to make such payment by a due date thereof, the Minister of Health and Welfare shall collect it in the same manner as delinquent national taxes are collected. <Newly Inserted by Act No. 14084, Mar. 22, 2016> |
| (6) | If necessary for collecting a penalty surcharge, the Minister of Health and Welfare may file a written request to furnish tax information with the head of the tax office or the head of the relevant local government wherein following matters are stated: <Amended by Act No. 12176, Jan. 1, 2014; Act No. 14084, Mar. 22, 2016> |
| 1. | Personal information of a taxpayer; |
| 3. | Grounds and standards for imposition of the penalty surcharge. |
| (7) | No penalty surcharges collected under paragraphs (1) and (2) shall be used for any purpose, other than the following: <Amended by Act No. 12176, Jan. 1, 2014; Act No. 14084, Mar. 22, 2016> |
| 1. | Funds that the NHIS provides as costs of health care benefit pursuant to Article 47 (3); |
| (8) | The amount of penalty surcharges under paragraphs (1) and (2), necessary matters for the payment thereof, the amount of support from penalty surcharges by use referred to in paragraph (7), procedure for use, and other necessary matters shall be prescribed by Presidential Decree. <Amended by Act No. 12176, Jan. 1, 2014; Act No. 14084, Mar. 22, 2016> |
| Article 100 (Publication of Fact of Violation) |
| (1) | If a health care institution which has received an administrative disposition under Article 98 or 99 because of claims for costs of health care benefit in falsehood by falsifying or forging relevant documents falls under any of the following subparagraphs, the Minister of Health and Welfare may publish the act of violation, details of disposition, the name and address of the relevant health care institution, the name of the representative of the relevant health care institution, and other matters prescribed by Presidential Decree which are necessary to distinguish it from other health care institutions. In such cases, the motive, degree, frequency, results, etc. of the violation shall be taken into consideration in deciding whether to make such publication: |
| 1. | Where the amount claimed in falsehood exceeds fifteen million won; |
| 2. | The rate of amount claimed in falsehood exceeds 20/100 of the total amount of costs of health care benefit. |
| (2) | The Minister of Health and Welfare shall establish and operate the Health Insurance Publication Deliberation Committee (hereafter referred to as the "Publication Deliberation Committee" in this Article) to deliberate on whether to make a publication, etc. under paragraph (1). |
| (3) | The Minister of Health and Welfare shall notify a health care institution which becomes subject to publication, undergoing the deliberation by the Publication Deliberation Committee of the fact that it is subject to publication, in order to provide it with an opportunity to submit explanatory materials or appear to make a statement of opinion. |
| (4) | The Minister of Health and Welfare shall select health care institutions to become subject to publication after the Publication Deliberation Committee re-deliberates health care institutions to be subject to publication, taking into account explanatory materials or statements of opinion referred to in paragraph (3). |
| (5) | Matters necessary for the procedure for and method of publication, organization and operation, etc. of the Publication Deliberation Committee other than those prescribed in paragraphs (1) through (4), shall be prescribed by Presidential Decree. |
| Article 101 (Prohibited Acts of Manufacturers, etc.) |
| (1) | No manufacturer, operator of a manufacture by entrustment and sale business, importer nor distributor of drugs under the Pharmaceutical Affairs Act nor a manufacturer, importer, repairer, distributor and lessor of medical devices under the Medical Devices Act (hereinafter referred to as "manufacturer, etc.") shall cause any loss to the insurer, the insured or his/her dependent by committing any of the following acts, in determining items eligible for health care benefit pursuant to Article 41-3 or in calculating the costs of health care benefit pursuant to Article 46, in relation to medicines and materials for medical treatment: <Amended by Act No. 13985, Feb. 3, 2016> |
| 1. | Engaging in an act of a health care institution referred to in Article 98 (1) 1; |
| 2. | Submitting false data to the Ministry of Health and Welfare, the NHIS, or the Review and Assessment Service; |
| 3. | Exercising influence over the determination of items eligible for health care benefit and the calculation of the costs of health care benefit, by a deceit or by unjust means prescribed by Ordinance of the Ministry of Health and Welfare. |
| (2) | In order to ascertain whether a manufacturer, etc. has committed any violation of paragraph (1), the Minister of Health and Welfare may conduct a necessary investigation, such as issuing an order to the relevant manufacturer, etc. to submit the relevant documents, or assigning public officials under his/her control to ask questions to the related persons or inspect the relevant documents. In such cases, the competent public officials shall carry documents indicating their authority and produce them to related persons. |
| (3) | Where a manufacturer, etc. commits an act causing any loss to the insurer, the insured or his/her dependent in violation of paragraph (1), the NHIS shall collect an amount equivalent to the loss (hereafter referred to as "amount equivalent to the loss" in this Article) from such manufacturer, etc. <Newly Inserted by Act No. 13985, Feb. 3, 2016> |
| (4) | The NHIS shall pay the insured or his/her dependent an amount corresponding to the loss he/she has sustained, out of the amount equivalent to the loss collected pursuant to paragraph (3). In such cases, the NHIS may offset the amount to be paid to the insured or his/her dependent by the insurance contribution, etc. to be paid by him/her. <Newly Inserted by Act No. 13985, Feb. 3, 2016> |
| (5) | The procedures for calculating, imposing, and collecting the amount equivalent to the loss referred to in paragraph (3), the payment method therefor, and other necessary matters shall be prescribed by Presidential Decree. <Newly Inserted by Act No. 13985, Feb. 3, 2016> |
| Article 102 (Maintaining Information, etc.) |
No person who has been or is engaged in the services of the NHIS, the Review and Assessment Service, or a vicarious claim organization shall do any of the following acts: <Amended by Act No. 14084, Mar. 22, 2016>
| 1. | Using personal information (referring to personal information defined in subparagraph 1 of Article 2 of the Personal Information Protection Act; hereinafter referred to as "personal information") of the insured or their dependents for any purpose other than performing his/her duties, or providing such information to a third party without any justifiable grounds; |
| 2. | Using any information learned in the course of performing his/her duties (excluding personal information referred to in subparagraph 1) for any purpose other than performing his/her duties, or providing such information to a third party. |
| Article 103 (Supervision of NHIS, etc.) |
| (1) | In order for the NHIS and the Review and Assessment Service to achieve their management goals, the Minister of Health and Welfare may supervise them, such as ordering them to report on the following programs or services or inspecting the conditions of their programs, services or property: |
| 1. | Services of the NHIS set forth in Article 14 (1) 1 through 13, and services of the Review and Assessment Service set forth in Article 63 (1) 1 through 7; |
| 3. | Services entrusted to the NHIS and the Review and Assessment Service under this Act or other statutes; |
| 4. | Other projects related to the matters prescribed by related statutes. |
| (2) | Where necessary for supervision under paragraph (1), the Minister of Health and Welfare may order to amend the articles of incorporation or regulations, or order other necessary dispositions. |
| Article 104 (Payment of Monetary Rewards, etc.) |
| (1) | The NHIS may pay a reward to a person who reports a health care institution that has been paid costs of health care benefit by fraud or other improper means. |
| (2) | The NHIS may provide an incentive to a health care institution that has contributed to the efficient financial management of health insurance. <Newly Inserted by Act No. 11787, May 22, 2013> |
| (3) | Matters necessary for the criteria for and scope of payment of a reward and incentive, procedure and method of payment, and other necessary matters pertaining to paragraphs (1) and (2), shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 11787, May 22, 2013> |
| Article 105 (Prohibition from Use of Similar Names) |
| (1) | No person, other than the NHIS or the Review and Assessment Service, shall use such names as the National Health Insurance Service, Health Insurance Review and Assessment Service, or other names similar thereto. |
| (2) | A person, other than one who conducts a health insurance program prescribed by this Act, shall be prohibited from using the term, "national health insurance" in an insurance contract or in the name of an insurance contract. |
| Article 106 (Disposal of Small Sums) |
Where an amount to be collected or returned is less than 2,000 won in one case (excluding any individual co-payment refund and any amount to be paid to the insured or his/her dependent, which may be disposed of by offsetting under Article 47 (4), the latter part of Article 57 (5), and the latter part of Article 101 (4)), the NHIS shall not collect or return such amount. <Amended by Act No. 11787, May 22, 2013; Act No. 13985, Feb. 3, 2016>
| Article 107 (Disposal of Fractional Sum) |
| Article 108 (Government's Subsidies for Insurance Finance) |
| (1) | The State shall subsidize an amount equivalent to 14/100 of the amount of anticipated revenues from insurance contribution for the relevant year to the NHIS from the National Treasury each year within budgetary limits. |
| (3) | The NHIS shall appropriate financial resources provided pursuant to paragraph (1) for the following purposes: <Amended by Act No. 11787, May 22, 2013> |
| 1. | Insurance benefits for the insured and their dependents; |
| 2. | Operational expenses for the health insurance business; |
| 3. | Subsidies needed to reduce insurance contribution pursuant to Articles 75 and 110 (4). |
| (4) | The NHIS shall use the funds provided pursuant to paragraph (2) for the following businesses: |
| 1. | Projects undertaken to enhance health, such as health checkup; |
| 2. | Insurance benefits paid to treat diseases suffered by the insured and their dependents that are caused by smoking; |
| 3. | Insurance benefits paid to the aged who are at least 65 years old, from among the insured and their dependents. |
<<By Article 2 of the Addenda No. 1114 on December 31, 2011, this Article shall remain effective until December 31, 2022>>
| Article 109 (Special Rules for Foreigners, etc.) |
| (1) | The Government may arrange for separate health insurance for the workers at a workplace where a foreign government is the employer, in consultation with the foreign government. |
| (2) | An overseas Korean national or a foreigner residing in the Republic of Korea (hereinafter referred to as "foreigner, etc. residing in Korea) who is an employee, public official, or school employee of a workplace of eligible persons shall become the employee insured, notwithstanding Article 5, if he/she does not fall under any subparagraph of Article 6 (2) but falls under any of the following: <Amended by Act No. 14084, Mar. 22, 2016> |
| (3) | Where a foreigner, etc. residing in Korea who does not fall under the employee insured referred to in paragraph (2) satisfies all the following requirements, he/she may become the self-employed insured, notwithstanding Article 5, if he/she files an application with the NHIS: <Newly Inserted by Act No. 14084, Mar. 22, 2016> |
| 1. | The relevant person shall constitute the ground prescribed by Ordinance of the Ministry of Health and Welfare that he/she resided in Korea during the period prescribed by Ordinance of the Ministry of Health and Welfare or is expected to reside therein continuously during the relevant period; |
| 2. | The relevant person shall fall under any of the following: |
| (a) | A person specified in paragraph (2) 1 or 2; |
| (b) | A person who has filed for alien registration pursuant to Article 31 of the Immigration Act and holds the status of sojourn prescribed by Ordinance of the Ministry of Health and Welfare. |
| (4) | Where a foreigner, etc. residing in Korea who falls under any subparagraph of paragraph (2) satisfies all the following requirements, he/she may become a dependent, notwithstanding Article 5, if he/she files an application with the NHIS: <Newly Inserted by Act No. 14084, Mar. 22, 2016> |
| 1. | The relevant person's relationship with the employee insured shall fall under any subparagraph of Article 5 (2); |
| 2. | The relevant person shall meet the standards for determination of the dependent eligibility referred to in Article 5 (3). |
| (5) | Notwithstanding paragraphs (2) through (4), no foreigner, etc. residing in Korea shall become the insured or a dependent if he/she falls under any of the following cases: <Newly Inserted by Act No. 14084, Mar. 22, 2016> |
| 1. | Where the relevant person's stay in Korea violates any statute and any ground prescribed by Presidential Decree exists; |
| 2. | Where a person falling under paragraph (2) is eligible for medical guarantee equivalent to health care benefit referred to in Article 41 in accordance with foreign statutes, a foreign insurance or a contract concluded with his/her employer, etc. while he/she works in Korea and thus, his/her employer requests the exclusion of him/her from the insured, as prescribed by Ordinance of the Ministry of Health and Welfare. |
| (6) | Articles 5 through 11 shall apply mutatis mutandis to matters necessary for the timing, procedures, etc. for acquisition and loss of the eligibility of the insured or dependents by foreigners, etc. residing in Korea, except as otherwise expressly provided for in paragraphs (2) through (5): Provided, That matters to be expressly provided for in consideration of the nature of foreigners, etc. residing in Korea may be otherwise prescribed by Presidential Decree. <Newly Inserted by Act No. 14084, Mar. 22, 2016> |
| (7) | Where a foreigner, etc. residing in Korea who is the insured acquires the eligibility of the self-employed insured after the second day of any month and loses the eligibility in the month in which the date he/she acquired the eligibility falls, due to any ground publicly notified by the Minister of Health and Welfare, the insurance contribution for the month in which the date the eligibility was acquired falls shall be imposed and collected, notwithstanding the main sentence of Article 69 (2). <Newly Inserted by Act No. 14084, Mar. 22, 2016> |
| (8) | The insurance contribution for the self-employed insured who fall under foreigners, etc. residing in Korea (excluding foreigners who reside permanently in Korea) shall be paid by the 25th day of the immediately preceding month, notwithstanding the main sentence of Article 78 (1): Provided, That in any of the following cases, the insurance contribution shall be paid as determined by the NHIS: <Newly Inserted by Act No. 14084, Mar. 22, 2016> |
| 1. | Where the insurance contribution for the month in which the date the eligibility is acquired falls are collected; |
| 2. | Where the eligibility is acquired during the period from the 26th day to the end of any month. |
| (9) | Articles 69 through 86 shall apply mutatis mutandis to matters on the imposition and collection of insurance contribution for foreigners, etc. residing in Korea who are the insured, except as otherwise expressly provided for in paragraphs (7) and (8): Provided, That matters on the imposition and collection of insurance contribution for foreigners, etc. residing in Korea prescribed by Presidential Decree may be otherwise determined and publicly notified by the Minister of Health and Welfare, taking into account their nature. <Newly Inserted by Act No. 14084, Mar. 22, 2016> |
| Article 110 (Special Rules for the Unemployed) |
| (1) | From among the employee insured whose employment relationship has expired, any person prescribed by Ordinance of the Ministry of Health and Welfare may file an application with the NHIS for retaining his/her qualification as the employee insured by the date two months elapse after the due date for the payment of the insurance contribution stated in the first notice he/she receives as the self-employed insured under Article 79. <Amended by Act No. 11787, May 22, 2013> |
| (2) | Notwithstanding Article 9, the insured who files an application with the NHIS under paragraph (1) (hereinafter referred to as "voluntarily countinous insured person") shall retain his/her qualification during the period prescribed by Presidential Decree: Provided, That where he/she fails to pay the first insurance contribution of the employee insured to be paid after the filing of an application under paragraph (1) until two months elapse after the due date therefor, his/her qualification shall be suspended. <Newly Inserted by Act No. 11787, May 22, 2013> |
| (3) | A voluntarily countinous insured person's amount of monthly wage shall be the average amount of his/her wages paid for immediately preceding three months with the exception of the month in which the date the employment relationship expires falls, notwithstanding Article 70. <Amended by Act No. 11787, May 22, 2013> |
| (4) | Part of the insurance contribution of a voluntarily continuos insured person may be reduced, as published by the Minister of Health and Welfare. <Amended by Act No. 11787, May 22, 2013> |
| (5) | Total amount of the insurance contribution of voluntarily continuos insured persons shall be borne and paid by them notwithstanding Articles 76 (1) and 77 (1) 1. <Amended by Act No. 11787, May 22, 2013> |
| (6) | Where a voluntarily continuos insured person fails to pay the insurance contribution by a payment due date, Article 53 (3), (5) and (6) of shall apply mutatis mutandis. In such cases, the terms, "per household insurance contribution referred to in Article 69 (5)" shall be construed as "insurance contribution pursuant to Article 110 (5)". <Amended by Act No. 11787, May 22, 2013> |
| (7) | Matters relating to the methods and procedures for filing applications to become a voluntarily continuos insured person and other relevant matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 11787, May 22, 2013> |
| Article 111 (Assignment and Entrustment of Authority) |
| (1) | The authority of the Minister of Health and Welfare under this Act may be partially delegated to the Special Metropolitan City Mayor, Metropolitan City Mayors, Do Governors, or the Special Self-Governing Province Governor as prescribed by Presidential Decree. |
| (2) | The authority of the Minister of Health and Welfare under Article 97 (2) may be entrusted to the NHIS or the Review and Assessment Service, as prescribed by Presidential Decree. |
| Article 112 (Entrustment of Services) |
| (1) | The NHIS may entrust each of the following services to postal service agencies, financial institutions, or other persons prescribed by Presidential Decree: |
| 1. | Receipt of insurance contribution and verifying payment of insurance contribution; |
| 2. | Payment of insurance benefit costs; |
| 3. | Receipt of pension insurance contribution, employment insurance contribution, employment insurance and industrial accident compensation insurance contribution, contributions and other charges (hereinafter referred to as "insurance contribution, etc. entrusted for collection") collected according to the entrustment of the applicable Acts to the entrustment of collection, or verification of payment of insurance contribution. |
| (2) | The NHIS may entrust part of its services to state agencies, local governments, corporations that provide social insurance programs under other statutes, or other persons: Provided, That the same shall not apply to collection including insurance contribution and insurance contribution entrusted for collection. <Amended by Act No. 13985, Feb. 3, 2016> |
| (3) | The scope of the operations the NHIS may entrust under paragraph (2) and of the persons to whom they may be entrusted shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 113 (Allocation, Payment, etc. of Insurance Contribution, etc. Entrusted with Collection) |
| (1) | Where the amount of insurance contribution collected by the NHIS, subsequent fees or insurance contribution, etc. entrusted with collection is smaller than the amount the NHIS has to collect, it shall collect the payment in installments according to the criteria and means prescribed by Presidential Decree: Provided, That where a person liable to make such payment states otherwise, the NHIS shall comply therewith. |
| (2) | Where the NHIS has collected insurance contribution, etc. entrusted with collection, it shall immediately pay such to the relevant funds by insurance. |
| Article 114 (Purpose, etc. of Contributions) |
| (2) | Matters necessary for management, operation, etc., contributions received under paragraph (1), shall be prescribed by Presidential Decree. |
CHAPTER IX PENALTY PROVISIONS
| Article 115 (Penalty Provisions) |
| (1) | A person who uses personal information of the insured or their dependents for any purpose other than to perform his/her duties or provides such information to a third party without any justifiable grounds in violation of subparagraph 1 of Article 102 shall be punished by imprisonment with prison labor for not more than five years, or by a fine not exceeding 50 million won. <Newly Inserted by Act No. 14084, Mar. 22, 2016> |
| (2) | Any of the following persons shall be punished by imprisonment with prison labor for not more than three years, or by a fine not exceeding 30 million won. <Amended by Act No. 14084, Mar. 22, 2016> |
| 1. | A person who works for a claim processing agency and files a claim for costs of health care benefit by false or illegal means; |
| 2. | A person who uses any information learned in the course of performing his/her duties for any purpose other than to perform his/her duties or provides such information to a third party, in violation of subparagraph 2 of Article 102. |
| (3) | Any of the following persons shall be punished by imprisonment with labor for not more than one year, or by a fine not exceeding 10 million won: <Amended by Act No. 11787, May 22, 2013; Act No. 14084, Mar. 22, 2016> |
| 1. | The founder of a health care institution who provides selective benefit, in violation of Article 42-2 (1) or (3); |
| 2. | A person who permits any other person who is not a claim processing agency to vicariously examine such claims, in violation of Article 47 (6); |
| 4. | The founder of a health care institution, who violates Article 98 (2); |
| 5. | A person who receives or arranges another person to receive insurance benefits by fraud or other improper means. |
| Article 116 (Penalty Provisions) |
A person who fails to report or submit documents, a person who makes a false report or submits false documents, or a person who refuses, interferes with or evades inspection or questioning in violation of Article 97 (2) shall be punished by a fine not exceeding 10 million won.
| Article 117 (Penalty Provisions) |
A person who violates Article 42 (5) or a person who fails to issue a detailed statement of health care costs or a receipt stating the particulars of the health care in violation of Article 49 (2) shall be punished by a fine not exceeding five million won.
| Article 118 (Joint Penalty Provisions) |
Where the representative of a corporation, or an agent, employee or any other person working for the corporation or an individual commits any act which violates Articles 115 through 117 in connection with the business of the corporation or the individual, not only shall such violator be punished accordingly, but the corporation or the individual shall be punished by a fine prescribed in the relevant provisions: Provided, That the same shall not apply where the corporation or the individual has not been negligent in paying due attention and supervision to the relevant business in order to prevent such violation.
| Article 119 (Administrative Fines) |
| (1) | and (2) Deleted. <by Act No. 11787, May 22, 2013> |
| (3) | Any of the following persons shall be punished by an administrative fine not exceeding five million won: <Amended by Act No. 14084, Mar. 22, 2016> |
| 1. | An employer who fails to make a report or makes a false report, in violation of Article 7; |
| 2. | A person who fails to file a report or to submit documents without any justifiable grounds, or files a false report or submits false documents, in violation of Article 94 (1); |
| 3. | A person who fails to make a report or to submit documents without any justifiable grounds, or makes a false report or submits false documents, in violation of Article 97 (1), (3), or (4); |
| 4. | A person who fails to notify, without delay, the fact that he/she is subject to an administrative disposition or the fact that the procedure of an administrative disposition is under way, in violation of Article 98 (4); |
| 5. | A person who fails to submit documents or submits false documents without any justifiable grounds, in violation of Article 101 (2). |
| (4) | Any of the following persons shall be punished by an administrative fine not exceeding one million won: <Amended by Act No. 11787, May 22, 2013> |
| 1. | Deleted; <by Act No. 14084, Mar. 22, 2016> |
| 2. | A person who fails to make a report or makes a false report, in violation of Article 43 (1) or (2); |
| 3. | Deleted; <by Act No. 14084, Mar. 22, 2016> |
| 4. | A person who fails to preserve documents in violation of Article 96-2; |
| 5. | A person who violates an order issued under Article 103; |
| (5) | Administrative fines under paragraphs (3) and (4) shall be imposed and collected by the Minister of Health and Welfare, as prescribed by Presidential Decree. <Amended by Act No. 11787, May 22, 2013> |
ADDENDA
Article 1 (Enforcement Date)
This Act shall enter into force on September 1, 2012: Provided, That the amended provisions of Article 98 (2), 108, and 115 (2) 3 shall enter into force on the date of its promulgation. Article 2 (Term of Validity)
Article 108 shall remain in force until December 31, 2017. Article 3 (Succession of Rights by Universal Title, etc.)
The NHIS shall succeed, by universal title, to the rights and duties of the Medical Insurance Association and the Medical Insurance Federation referred to in the former Medical Insurance Act existing as of July 1, 2000 on which date the National Health Insurance Act (Act No. 5854) entered into force: Provided, That the Review and Assessment Service shall succeed, by universal title, to the rights and duties of the Medical Insurance Federation related with its review operations. Article 4 (Application Example concerning Collection and Exemption of Insurance Contribution)
The amended provisions of Articles 69 (2) and 74 (3) shall apply from the case where a person obtains qualifications or becomes disqualified for the insured or where a ground for suspension of benefits occurs or ceases to exist for the first time on or after November 1, 2006, on which date the partially amended National Health Insurance Act (Act No. 8034) entered into force. Article 5 (Application Example concerning Insurance Contribution)
The amended provisions of Article 69 (4) 1 and (5) shall apply from the first insurance contribution notified on or after January 1, 2007, on which date the partially amended National Health Insurance Act (Act No. 8153) entered into force. Article 6 (Applicable Example concerning Exemption of Minors from Obligation of Joint Payment of Insurance Contribution for the Self-Employed Insured and Collection of Additional Amount Added to Additional Dues)
| (1) | The amended provisions of the proviso to Article 77 (2) shall apply from the first insurance contribution, etc. notified on or after September 29, 2008, on which date they entered into force under the proviso to Article 1 of the Addenda of the partially amended National Health Insurance Act (Act No. 9022). |
| (2) | The amended provisions of Article 80 shall apply from the first insurance contribution, etc. notified on or after July 1, 2008, the date on which they entered into force under the proviso to Article 1 of the Addenda of the partially amended National Health Insurance Act (Act No. 9022). |
Article 7 (Applicable Example concerning Addition of Interests to Refunds)
The amended provisions of the latter part of Article 86 (2) shall apply from the first refund made on or after September 29, 2008, the date on which they entered into force under the proviso to Article 1 of the Addenda of the partially amended National Health Insurance Act (Act No. 9022). Article 8 (Applicable Example concerning Prescription)
The amended provisions of Article 91 (1) 6 shall also apply to the rights of the Korea Workers' Compensation and Welfare Service whose prescription is not completed as at the time this Act enters into force. Article 9 (Applicable Example concerning Fact of Violation)
The amended provisions of Article 100 shall apply from the first violation that occurs on or after September 29, 2008, the date on which they entered into force under the proviso to Article 1 of the Addenda of the partially amended National Health Insurance Act (Act No. 9022). Article 10 (Applicable Example concerning Government's Subsidies for Insurance Finance)
The amended provisions of Article 108 shall apply from the budget of fiscal year 2012. Article 11 (Special Case concerning Retirement Age of Employees Consequential to Integrating Collection Services of Social Insurance Contribution)
The retirement age of an employee who was transferred from the National Pension Service or the Korea Workers' Compensation and Welfare Service to the NHIS on January 1, 2011, the date on which the partially amended National Health Insurance Act (Act No. 9690) entered into force shall conform to the retirement age of the relevant National Pension Service or Korea Workers' Compensation and Welfare Service at the time he/she was transferred to the NHIS: Provided, That this shall not apply where the retirement age of an employee of the NHIS is higher than that of the relevant Service. Article 12 (Transitional Measures concerning Deliberative Committee and Financial Operation Committee)
| (1) | Members of the Deliberative Committee and the Financial Operation Committee appointed or commissioned under former provisions existing at the time this Act enters into force, shall be deemed appointed or commissioned under this Act, and the their term of office shall be the period remaining pursuant to former provisions. |
| (2) | Matters which have undergone the deliberation and resolution by the Deliberative Committee and the Financial Operation Committee at the time this Act enters into force shall be deemed to have undergone the deliberation and resolution under this Act. |
Article 13 (Transitional Measures concerning the NHIS)
Article 14 (Transitional Measures concerning Executive Officers)
Notwithstanding the amended provisions of Articles 20 and 65, the term of office of executive officers of the NHIS and the Review and Assessment Service appointed under former provisions at the time this Act enters into force shall continue until the date of completion of their term of office fixed at the time they were appointed. Article 15 (Transitional Measures concerning Permission for Executive Officers, etc. of the NHIS for Holding Concurrent Offices)
Where an executive officer or an employee of the NHIS or the Review and Assessment Service has obtained permission from the person with the power to appoint him/her to hold concurrent office under Article 37 (2) of the Act on the Management of Public Institutions at the time this Act enters into force, he/she shall be deemed to have obtained permission for holding concurrent offices under the amended provisions of Article 25 (2) (including the cases of application mutatis mutandis under Article 68). Article 16 (Transitional Measures concerning Report on Current Status of Health Care Institutions)
A health care institution which has filed a report on the current status of its manpower, facilities, equipment, etc. to the Review and Assessment Service at the time this Act enters into force shall be deemed to have filed such report under the amended provisions of Article 43. Article 17 (Transitional Measures concerning Collection of Insurance Contribution, etc.)
Article 18 (Transitional Measures concerning Extinctive Prescription of Previous Insurance Contribution, etc.)
The extinctive prescription of any of the rights to collect or receive insurance contribution, to receive a insurance benefit and to receive a refund of overpaid or erroneously paid individual co-payment which has occurred on or before July 1, 2000, on which date the National Health Insurance Act (Act No. 5854) entered into force shall be governed by the former Medical Insurance Act and the former National Medical Insurance Act. Article 19 (General Transitional Measures concerning Disposition, etc.)
Any act of the NHIS, Review and Assessment Service, Minister of Health and Welfare (hereafter referred to as the "NHIS, etc." in this Article) or any act against the NHIS, etc. done under former provisions at the time this Act enters into force shall be deemed an act corresponding thereto committed by or against the NHIS, etc. under this Act.
Article 20 (Transitional Measures concerning Disposition against Previous Offense)
| (2) | The application of penalty provisions and administrative fines against an act committed before this Act enters into force shall be governed by former provisions. |
Article 21 Omitted.
Article 22 (Relationship with Other Statutes)
Where any other statute cites the former provisions of the National Medical Insurance Act at the time this Act enters into force, it shall be deemed to have cited the relevant provisions of this Act in lieu of the former provisions, if any provisions corresponding thereto exist in this Act.
ADDENDA <Act No. 11787, May 22, 2013>
Article 1 (Enforcement Date)
This Act shall enter into force on the date of its promulgation: Provided, That the amended provisions of Articles 78, 81-2, and 104 shall enter into force six months after the date of its promulgation. Article 2 (Applicable Example concerning Collection of Unjust Enrichment or Unjust Profit Obtained by Health Care Institutions)
The amended provisions of Article 57 (2) shall apply where unjust enrichment or unjust profit is collected on or after the date this Act enters into force. Article 3 (Applicable Example concerning Extension, etc. of Period for Application for Special Cases for Unemployed Persons)
| (1) | The amended provisions of Article 110 (1) and (3) shall apply to persons notified of an insurance contribution as the self-employed insured on or after the date this Act enters into force (including persons notified of an insurance contribution as the self-employed insured before this Act enters into force and the payment due date has not elapsed as of the date this Act enters into force). |
| (2) | The amended provisions of Article 110 (2) shall also apply to voluntarily countinous insured persons in whose case two months have not elapsed since the due date for payment of the first insurance contributions of the employee insured. |
Article 4 (Transitional Measures concerning Penalty Provisions or Administrative Fines)
The application of penalty provisions or administrative fines against an act committed before this Act enters into force shall be governed by the former provisions.
ADDENDA <Act No. 12176, Jan. 1, 2014>
Article 1 (Enforcement Date)
This Act shall enter into force six months after the date of its promulgation: Provided, That the amended provisions of Article 76 shall enter into force on January 1, 2014. Article 2 (Applicability concerning Insurance Contribution for Employees of Private Schools)
The amended provisions of Article 76 shall apply to insurance contribution first notified after this Act enters into force.
ADDENDA <Act No. 12615, May 20, 2014>
Article 1 (Enforcement Date)
This Act shall enter into force six months after the date of its promulgation: Provided, That the amended provisions of Article 79-2 shall enter into force on September 25, 2014. Article 2 (Applicability concerning Payment Methods of Insurance Contribution, etc.)
The amended provisions of Article 79-2 shall begin to apply beginning with the first insurance contribution, etc. of which the billing is made after the same amended provisions enter into force.
ADDENDA <Act No. 12844, Nov. 20, 2014>
Article 1 (Enforcement Date)
This Act shall enter into force on the date of its promulgation: Provided, That among the Acts amended pursuant to Article 6, the amendments to Acts, which were promulgated before the enforcement date of this Act and of which the enforcement date has not arrived, shall enter into force on the date of the respective enforcement dates of the relevant Acts. Articles 2 through 7 Omitted.
ADDENDA <Act No. 13985, Feb. 3, 2016>
Article 1 (Enforcement Date)
This Act shall enter into force six months after the date of its promulgation: Provided, That the amended provisions of Article 80 (1) and (2) shall enter into force on June 23, 2016, and the amended provisions of Articles 65 (1) and 66 (2) shall enter into force on the date of its promulgation. Article 2 (Applicability to Reporting to National Assembly)
The amended provisions of Article 3-2 (5) shall begin to apply from the first comprehensive national health insurance plan and implementation plan formulated after this Act enters into force. Article 3 (Applicability to Secondary Payment Obligation)
| (1) | The secondary payment responsibility of a partner with unlimited liability or oligopolistic stockholder of a corporation under the amended provisions of Article 77-2 (1) shall apply from the insurance contribution or any other amount collectable under this Act first notified after this Act enters into force. |
| (2) | The secondary payment obligation of a business transferee under the amended provisions of Article 77-2 (2) shall begin to apply from the first person who acquires business by transfer after this Act enters into force. |
Article 4 (Applicability to Arrears)
The amended provisions of Article 80 (1) and (2) shall apply from the insurance contribution, etc. the due date for payment of which first arrives after the same amended provisions enter into force. Article 5 (Applicability to Certification of Payment of Insurance Contribution)
The duty of persons obligated to make payment under Article 77 to certify the payment of insurance contribution under the amended provisions of Article 81-3 (1) shall begin to apply from the first person who receives the price for a contract after this Act enters into force. Article 6 (Applicability to Collection of Amount Equivalent to Loss Caused by Prohibited Acts of Manufacturers, etc.)
The amended provisions of Articles 81 (1) and 101 shall apply, starting from where a manufacturer, etc. commits an act causing any loss to the insurer, the insured or his/her dependent in violation of Article 101 (1) after this Act enters into force.
ADDENDA <Act No. 14084, Mar. 22, 2016>
Article 1 (Enforcement Date)
This Act shall enter into force six months after the date of its promulgation: Provided, That the amended provisions of Articles 41-4, 42-2, 44, and 115 (3) 1 shall enter into force one year after the date of its promulgation; the amended provisions of Article 2 of the Addenda to the National Health Insurance Act (Act No. 11141) shall enter into force on the date of its promulgation; and Article 4 of the Addenda shall enter into force on August 4, 2016. Article 2 (Applicability to Collection of Additional Dues)
The amended provisions of Article 78-2 shall apply, starting from where a false report is made to the insurer in violation of Article 8 (2) or 9 (2) after this Act enters into force. Article 3 (Applicability to Collection of Insurance Contribution for Foreigners, etc. Residing in Korea Who Are the Self-Employed Insured)
The amended provisions of Article 109 (7) shall apply, starting from persons who acquire the eligibility of the self-employed insured after this Act enters into force. Article 4 Omitted.
ADDENDA <Act No. 14183, May 29, 2016>
Article 1 (Enforcement Date)
This Act shall enter into force six months after the date of its promulgation. (Proviso Omitted.)
Articles 2 through 5 Omitted.
ADDENDUM <Act No. 14557, Feb. 8, 2017>
This Act shall enter into force on the date of its promulgation: Provided, That the amended provisions of Articles 14 (1) 4 shall enter into force six months after the date of its promulgation.
ADDENDA <Act No. 14776, Apr. 18, 2017>
Article 1 (Enforcement Date)
This Act shall enter into force on July 1, 2018: Provided, That the amended provisions of Article 77 (2) and the amended provisions of Articles 2 and 6 (1) of the Addenda to the National Health Insurance Act (Act No. 11141), shall enter into force on the date of its promulgation. Article 2 (Applicability to Calculation Criteria for Insurance Contributions, Amount of Monthly Remuneration, Amount of Monthly Income, and Contribution Point)
The amended provisions of Articles 69 through 72 shall begin to apply from the insurance contribution for the month in which the enforcement date of this Act falls. Article 3 (Applicability to Obligation for Payment of Contribution)
The amended provisions of Article 77 (2) shall also apply to the insurance contribution, etc. imposed before the same amended provisions enter into force, which is still in arrears. Article 4 (Special Exceptions to Adjustment of Insurance Contribution)
Notwithstanding the amended provisions of Articles 5 and 72, all or some of the insurance contribution may be temporarily reduced for any of the following insured, as prescribed by Presidential Decree: | 1. | The self-employed insured prescribed by Presidential Decree, whose insurance contribution becomes higher than that determined under the former provisions, following the enforcement of this Act; |
| 2. | The self-employed insured who was a dependent before this Act enters into force but has lost his/her eligibility to become a dependent, following the enforcement of this Act. |
ADDENDA <Act No. 14839, Jul. 26, 2017>
Article 1 (Enforcement Date)
| (1) | This Act shall enter into force on the date of its promulgation: Provided, That among the Acts amended pursuant to Article of the Addenda, the amendments to Acts, which were promulgated before the enforcement date of this Act and of which the enforcement date has not arrived, shall enter into force on the date of the respective enforcement dates of the relevant Acts. |
Articles 2 through 6 Omitted.