Presidential Decree No. 29001, jun. 26, 2018
| Article 1 (Purpose) |
| Article 2 (Health Expenditure) |
| (1) | "Expenses falling within the scope prescribed by Presidential Decree" in subparagraph 1 of Article 2 of the Act on the Support for Catastrophic Health Expenditure (hereinafter referred to as the "Act") means the following: |
| 1. | The following expenses: |
| (a) | Expenses fully borne by a person, which are incurred in matters not included in the scope of health care benefits referred to in Article 41 (2) or (3) of the National Health Insurance Act; |
| (b) | Expenses fully borne by an eligible recipient, which are incurred in matters not included in the scope of medical benefits referred to in Article 7 of the Medical Care Assistance Act; |
| 2. | The following expenses, which are incurred in health care benefits specified in Article 41 (2) or (3) of the National Health Insurance Act and medical benefits prescribed in Article 7 of the Medical Care Assistance Act: |
| (a) | Expenses partially borne by a person who receives health care benefits under Article 44 of the National Health Insurance Act; |
| (b) | Expenses partially borne by an eligible recipient under Article 10 of the Medical Care Assistance Act. |
| (2) | Detailed scope of expenses borne by a person who receives health care benefits under paragraph (1) 2 (a), criteria for calculating such expenses, etc. shall be determined and publicly notified by the Minister of Health and Welfare. |
| Article 3 (Catastrophic Health Expenditure) |
| (1) | "Expenses calculated based upon the criteria prescribed by Presidential Decree" in subparagraph 3 of Article 2 of the Act means the relevant health expenditures where health expenditures classified in the subparagraphs of paragraph (2) exceed the following amounts: |
| 1. | A person falling under Article 7 (1) 1 or 2: An amount determined and publicly notified by the Minister of Health and Welfare, which does not exceed the standard median income of an one-person household specified in subparagraph 11 of Article 2 of the National Basic Living Security Act or Article 6-2 of that Act; |
| 2. | A person falling under Article 7 (1) 3: An amount determined and publicly notified by the Minister of Health and Welfare, in consideration of the size of the household to which such person belongs, annual income, etc.; |
| 3. | A person deemed eligible for support under Article 9 (2) of the Act: An amount determined and publicly notified by the Minister of Health and Welfare, in consideration of the characteristics of the illness suffered by such person, conditions of the household, necessity for support, etc. |
| (2) | The health expenditures referred to in paragraph (1) shall be any of the following expenses: |
| 1. | Expenses incurred in one inpatient treatment (referring to the inpatient treatment specified in Article 10 (1) 1 of the Act; hereinafter the same shall apply) and expenses for medication (hereinafter referred to as "expenses for medication") purchased under Article 10 (1) 3 of the Act in the course of such treatment; |
| 2. | Expenses incurred in outpatient treatment for the same illness and expenses for medication purchased in the course of such treatment, within one year before the last outpatient treatment (referring to the outpatient treatment specified in Article 10 (1) 2; hereinafter the same shall apply); |
| 3. | Expenses incurred in inpatient treatment or outpatient treatment and expenses for medication purchased in the course of each treatment, where the relevant inpatient treatment or outpatient treatment is deemed rendered for the same illness in the medical treatment process within one year before the last inpatient treatment or outpatient treatment. |
| (3) | Except as otherwise provided in paragraph (1) or (2), matters necessary for one inpatient treatment, the same illness, the scope of medical treatment process, calculation of catastrophic health expenditures, etc. shall be determined and publicly notified by the Minister of Health and Welfare. |
| Article 4 (Operation of Committee for Deliberation on Catastrophic Health Expenditure Support Policy) |
| (1) | The term of office of a member of the Committee for Deliberation on Catastrophic Health Expenditure Support Policy (hereinafter referred to as the "Deliberation Committee") established under Article 7 (1) of the Act shall be two years, and a member specified in Article 7 (3) 4 or 5 of the Act shall hold office while serving in the relevant position: |
| (2) | Where a member falls under any of the following cases, the Minister of Health and Welfare may remove or dismiss such member: |
| 1. | Where the member becomes unable to perform the duties due to mental or physical disability; |
| 2. | Where the member commits any misconduct in relation to the duties; |
| 3. | Where the member is deemed unsuitable as a member due to neglect of duty, injury to dignity, or other reasons; |
| 4. | Where the member voluntarily expresses an intention that there is difficulty in the performance of duties. |
| (3) | The chairperson of the Deliberation Committee shall convene and preside over the meetings. |
| (4) | The meeting of the Deliberation Committee shall be convened when two- thirds of the members request a meeting or the chairperson deems it necessary. In such cases, a majority of the members of the Deliberation Committee shall constitute a quorum, and any resolution thereof shall require the concurring vote of at least a majority of those present. |
| (5) | The Deliberation Committee shall have one executive secretary to manage the affairs. In such cases, the executive secretary shall be appointed by the Minister of Health and Welfare, from among public officials of Grade III or IV affiliated with the Ministry of Health and Welfare. |
| (6) | Except as otherwise provided in paragraphs (1) through (5), matters necessary to operate the Deliberation Committee shall be determined by the chairperson following a resolution. |
| Article 5 (Matters Entrusted to Working Committee) |
| Article 6 (Working Committee) |
| (1) | A working committee shall be established under the National Health Insurance Service (hereinafter referred to as the "NHIS") prescribed in Article 13 of the National Health Insurance Act to manage the following affairs. In such cases, a working committee shall be separately established in regions determined by the President of the NHIS in consideration of the current status of distribution of branch offices: |
| 1. | Matters entrusted under Article 5; |
| 2. | Matter regarding whether overpayment is deemed made under the proviso, with the exception of the subparagraphs, of Article 11 (2); |
| 3. | Other matters determined by the Minister of Health and Welfare to efficiently manage catastrophic health expenditure support programs. |
| (2) | A working committee by region shall be composed of up to 41 members, who are appointed or commissioned by the President of the NHIS from among the following persons: |
| 1. | The following persons: |
| (a) | Up to 20 persons who are working for a hospital-level medical institution five years after they were recognized as having qualifications for medical specialists under the Medical Service Act and who are recommended by medical-related associations, academies, or organizations; |
| (b) | One doctor affiliated with the NHIS; |
| 2. | Up to four persons recommended by social welfare-related institutions or organizations, from among those with at least three years of work experience in the field of social welfare and with the qualifications for social workers under the Social Welfare Services Act; |
| 3. | Up to six persons who have served at the rank of assistant professor or higher for at least three years in schools under subparagraphs 1 through 6 of Article 2 of the Higher Education Act; |
| 4. | The following persons: |
| (a) | One employee of the NHIS; |
| (b) | One person from among its employees recommended by the President of the Health Insurance Review and Assesment Service (hereinafter referred to as the "HIRA") established under Article 62 of the National Health Insurance Act; |
| (c) | Four persons recommended by related corporations and organizations which grant contributions or support money under Article 20 (1) 5 of the Act; |
| (d) | One public official recommended by the head of the Special Metropolitan City, a Metropolitan City, a Special Self-Governing City, a Special Self-Governing Province, or a |
| 5. | Three persons with abundant knowledge and experience in the field of social welfare who are working or have worked for, or are engaging or have engaged in the activities of, social welfare-related organizations for at least five years. |
| (3) | The meetings of a working committee shall be held after the head of a branch office of the NHIS located under the jurisdiction of the relevant working committee selects up to 10 members from among the members referred to in paragraph (2) and calls them. In such cases, a minimum of the relevant number of the following members must be selected: |
| 1. | A member prescribed in paragraph (2) 1: Two persons; |
| 2. | A member prescribed in paragraph (2) 2: One person; |
| 3. | A member prescribed in paragraph (2) 3, subparagraph 4 (d) or subparagraph 5 of that paragraph: One person; |
| 4. | A member prescribed in paragraph (2) 4 (a) or (b): One person, respectively; |
| 5. | A member prescribed in paragraph (2) 4 (c): One person (limited to where there is a related corporation or organization granting contributions or support money under Article 20 (1) 5 of the Act). |
| (4) | The chairperson of a working committee shall be elected from among and by members who attend the meeting, each time a meeting is convened. |
| (5) | Except as otherwise provided in paragraphs (1) through (4), matters necessary to operate working committees shall be determined by the NHIS with approval of the Minister of Health and Welfare. |
| Article 7 (Persons Eligible for Support) |
| (1) | "Citizens who meet the criteria prescribed by Presidential Decree" in Article 9 (1) of the Act means any of the following persons who bears catastrophic health expenditures: |
| 1. | A recipient defined in subparagraph 2 of Article 2 of the National Basic Living Security Act; |
| 2. | Any of the following persons: |
| (a) | A person with a rare and intractable disorder, etc. specified in subparagraph 3 (d) of attached Table 2 to the Enforcement Decree of the National Health Insurance Act, who is deemed eligible for co-payment reductions; |
| (b) | A recipient eligible for pensions for persons with disabilities who receives the additional benefits specified in subparagraph 2 of attached Table 1 to the Enforcement Decree of the Act on Pensions for Persons with Disabilities; |
| (c) | A person who receives disability allowances specified in Article 49 of the Act on Welfare of Persons with Disabilities or the allowances for children with disabilities referred to in Article 50 (1) of that Act; |
| (d) | A person falling under the second-lowest income bracket defined in subparagraph 10 of Article 2 of the National Basic Living Security Act; |
| 3. | Other persons meeting the criteria determined and publicly notified by the Minister of Health and Welfare, in consideration of incomes, property, etc. |
| (2) | "Person prescribed by Presidential Decree" in Article 9 (3) 1 of the Act means any of the following persons satisfying the requirements prescribed in paragraph (1) who files for alien registration under Article 31 of the Immigration Act or reports domicile under Article 6 of the Act on the Immigration and Legal Status of Overseas Koreans: |
| 1. | Any of the following persons who has been married to a Korean national: |
| (a) | A person who or whose wife is pregnant; |
| (b) | A person rearing a minor with Korean nationality (including relations between a child and his or her stepfather or stepmother or between a child and his or her adoptive parents; hereinafter the same shall apply); |
| (c) | A person who earns a living or dwells with lineal ascendant with Korean nationality of a spouse; |
| 2. | A person who has divorced or has been bereaved of a spouse with Korean Nationality and who either rears a minor with Korean nationality or is pregnant with a child of the spouse. |
| Article 8 (Persons Eligible for Support for Outpatient Treatment) |
| (1) | "Serious illness prescribed by the Presidential Decree" in Article 10 (1) 2 of the Act means the illnesses determined and publicly notified by the Minister of Health and Welfare, which are highly likely to incur significant health expenditures in the course of medical treatment, such as cancers, cerebrovascular diseases, heart diseases, and rare and intractable disorders. |
| (2) | "Cases prescribed by Presidential Decree" in Article 10 (1) 3 of the Act means where health expenditures are incurred in purchasing medication in accordance with a prescription given by the medical institutions, etc. specified in Article 10 (1) 1 of the Act at a pharmacy registered under the Pharmaceutical Affairs Act or at the Korea Orphan and Essential Drug Center established under Article 91 of that Act, in the course of inpatient treatment or outpatient treatment. |
| Article 9 (Scope of Financial Information) |
| (1) | "Data or information prescribed by Presidential Decree" in Article 10 (3) 1 of the Act means the following information on financial assets: |
| 1. | Demand deposits, such as passbook deposits, savings deposits, preferential savings deposits, or foreign currency deposits: The average balance for the last three months; |
| 2. | Savings deposits, such as time deposits, installment deposits, or time savings: The balance of deposits or the total payment amount; |
| 3. | Stocks, beneficiary certificates, investments, equity interests, or real estate (pension) trust: Final quotations. In such cases, Article 54 of the Enforcement Decree of the Inheritance Tax and Gift Tax Act shall apply |
| 4. | Bonds, bills, checks, debt instruments, certificates of preemptive right, or certificates of deposit: Nominal values; |
| 5. | Pension savings: An amount that is regularly paid or the final balance; |
| 6. | Interest, dividends, or discounts generated from the financial assets referred to in subparagraphs 1 through 5. |
| (2) | "Data or information prescribed by Presidential Decree" in Article 10 (3) 2 of the Act means the following information on the insurance referred to in the subparagraphs of Article 4 (1) of the Insurance Business Act: |
| 1. | Subscription information: A policyholder, a person who is to receive insurance proceeds, the insured person, the scope of coverage, and the date coverage begins and terminates; |
| 2. | Payment information: The date and amount of payment of insurance proceeds, and the grounds for payment; |
| 3. | Other information necessary to calculate the amount excluded from payment under Article 13 (2) of the Act. |
| Article 10 (Request for and Provision of Financial Information) |
| (1) | Where the NHIS requests the heads of the financial companies, etc. defined in subparagraph 1 of Article 2 of the Act on Real Name Financial Transactions and Confidentiality or the head of the credit information collection agency defined in subparagraph 6 of Article 2 of the Credit Information Use and Protection Act (hereinafter referred to as "financial institutions, etc.") to provide information under the subparagraphs of Article 9 (1) or (2) (hereinafter referred to as "financial information, etc.") of persons eligible for support and household members pursuant to Article 11 of the Act, a written request shall be made stating the following matters: |
| 1. | The names and resident registration numbers of persons eligible for support and the household members; |
| 2. | The scope of financial information, etc. requested, base date of inquiry, and inquiry period. |
| (2) | Upon receipt of a request for financial information, etc. on persons eligible for support and their household members under paragraph (1), the heads of financial institutions, etc. shall provide the relevant financial information, etc. in writing, stating the following matters: |
| 1. | The names and resident registration numbers of persons eligible for support and the household members; |
| 2. | The names of financial institutions, etc. that provide financial information, etc; |
| 3. | The names of financial products to be provided and account numbers; |
| 4. | The details of financial information, etc. |
| (3) | The NHIS may request the heads of financial institutions, etc. to provide the financial information, etc. referred to in paragraph (1) through the use of information and communications networks of associations, federations or national associations joined by the relevant financial institutions, etc. |
| Article 11 (Criteria for Support) |
| (1) | A person who is selected as a person eligible for support under Article 12 of the Act shall be paid an amount equivalent to 50/100 (any fraction of less than 10 won shall not be calculated) of the amount obtained by aggregating the following expenses (excluding the expenses publicly notified under the proviso of Article 2 (1)) pursuant to Article 13 of the Act: Provided, That, where the relevant amount is less than 100,000 won, payment shall not be provided: |
| 1. | Expenses falling under the items of Article 2 (1) 1; |
| 2. | The following expenses, among the expenses referred to in the items of Article 2 (1) 2: |
| (a) | The amounts of co-payment falling under the subparagraphs of Article 19 (3) of the Enforcement Decree of the National Health Insurance Act; |
| (b) | The share of expenses borne by an eligible recipient to be covered by benefits, which is excluded when the head of a |
| (2) | An amount paid under paragraph (1) shall not exceed any of the following: |
| 1. | An amount incurred in inpatient treatment or outpatient treatment by illness for up to 180 days in total per year; |
| 2. | The total annual amount of support determined and publicly notified by the Minister of Health and Welfare, which does not exceed 1.5 times the amount obtained by converting the standard median income of an one-person household prescribed in subparagraph 11 of Article 2 of the National Basic Living Security Act and Article 6-2 of that Act to the annual income. |
| Article 12 (Money and Valuables Excluded from Payment) |
| 1. | Where medical aid is provided under Article 9 (1) 1 (b) of the Emergency Aid and Support Act; |
| 2. | Where a person eligible for support has received or may receive insurance proceeds, money, valuables, etc. from insurance companies defined in the Insurance Business Act as health expenditures in accordance with a contract; |
| 3. | Where a person eligible for support has received or may receive benefits, money, valuables, etc. from the State or a local government as health expenditures under other statutes or regulations. |
| Article 13 (Method of Paying Support Money If Impossible to Transfer to Designated Account) |
| Article 14 (Arrears) |
| (1) | Where a person liable to provide payment for unjust enrichment prescribed in Article 17 (1) through (3) of the Act (hereinafter referred to as "unjust enrichment") fails to provide payment by the payment deadline, the NHIS shall collect arrears in an amount equivalent to 1/1,000 of the unjust enrichment in arrears for each day from the date the deadline expires. In such cases, the amount of arrears shall not exceed 30/1,000 of unjust enrichment in arrears. |
| (2) | Where a person liable to provide payment for unjust enrichment fails to provide payment of the unjust enrichment in arrears, the NHIS shall collect arrears in an amount equivalent to 1/3,000 of the unjust enrichment in arrears for each day from the date 30 days have elapsed after the payment deadline. |
| (3) | The sum of the arrears referred to in paragraphs (1) and (2) shall not exceed 90/1,000 of the unjust enrichment in arrears. In such cases, an amount of less than 10 won shall not be collected where there is any fraction of less than 10 won. |
| (4) | The NHIS need not collect arrears in the event of natural disasters or due to other unavoidable reasons prescribed by Ordinance of the Ministry of Health and Welfare, notwithstanding paragraph (1) or (2). |
| Article 15 (Disposition on Deficits) |
| 1. | Where extinctive prescription regarding a relevant right is completed under Article 24 (2) of the Act; |
| 2. | Where a defaulter has no property or there is verification that no remainder will be left after the estimated value of the total property subject to disposition on delinquency is appropriated for the expenses incurred in taking such disposition; |
| 3. | Where there is verification that no remainder will be left after the total property subject to disposition on delinquency is appropriated for repaying national taxes, local taxes, and debts secured by the right to lease on a deposit basis, a pledge, a mortgage, or security interests under the Act on Security over Movable Property, Claims, Etc., which take precedence over unjust enrichment; |
| 4. | Other cases where the Deliberation Committee decides that collection is impossible. |
| Article 16 (Funds) |
| Article 17 (Request for Providing Materials) |
| (1) | Materials that the NHIS may make a request to provide pursuant to Article 21 (1) of the Act shall be as specified in attached Table 1. |
| (2) | Where the materials referred to in paragraph (1) are stored in electronic formats or through computer programs, such as diskettes, magnetic tapes, micro films, or optical disks, the NHIS may request the materials to be provided in the relevant form. |
| Article 18 (Order to Submit Materials) |
| (1) | The Minister of Health and Welfare or the NHIS may order a person to submit the following materials (including electronic documents) pursuant to Article 22 (1) of the Act: |
| 1. | Materials that may be used to verify the detailed statement of health expenditures; |
| 2. | Materials necessary to calculate amounts excluded from payment pursuant to Article 13 (2) of the Act; |
| 3. | Materials necessary to verify whether a person is eligible for support under Article 7 (1) 3 and paragraph (2) of that Article. |
| (2) | Where the Minister of Health and Welfare or the NHIS orders a person to submit the materials specified in the subparagraphs of paragraph (1), the scope of such materials shall be the minimum necessary to determine whether a person is eligible for support or whether support money is granted. |
| (3) | The Minister of Health and Welfare or the NHIS shall firstly obtain the materials referred to in the subparagraphs of paragraph (1) from the related agencies, other relevant persons, etc. under Article 21 of the Act before ordering a person to submit the relevant materials under Article 22 (1) of the Act. |
| (4) | The Minister of Health and Welfare and the NHIS shall consult in advance for a schedule for investigation, etc. to ensure that the same person is not subject to repeated investigations, unless any unavoidable reason exists. |
| Article 19 (Method for Filing Objections) |
| (1) | A person who intends to file an objection under Article 23 (1) of the Act (hereinafter referred to as "objection") shall submit to the NHIS a written objection prescribed by Ordinance of the Ministry of Health and Welfare. |
| (2) | Upon receipt of an objection, the NHIS shall render a decision thereon following a resolution by the objection committee established in the NHIS under Article 53 of the Enforcement Decree of the National Health Insurance Act, within 60 days from the date of receipt of such objection: |
| (3) | Where the NHIS intends to extend the decision period under the proviso of paragraph (2), it shall inform a person who has filed an objection of such fact seven days before the expiration of the decision period referred to in the main clause of that paragraph. |
| (4) | Where the NHIS makes a decision on an objection, it shall, without delay, send an applicant an authentic copy of the written decision prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 20 (Entrustment of Business Affairs) |
| (1) | Pursuant to Article 27 (2) of the Act, the NHIS may entrust the following duties to the financial institutions defined in subparagraph 1 of Article 2 of the Act on the Structural Improvement of the Financial Industry, communications agencies referred to in the Postal Savings and Insurance Act, or corporations or organizations granting contributions or support money under Article 20 (1) 5 of the Act: |
| 1. | Business affairs regarding payment of support money under Article 14 (1) of the Act; |
| 2. | Business affairs regarding collection of unjust enrichment under Article 17 of the Act. |
| (2) | Where the NHIS entrusts business affairs pursuant to paragraph (1), public notification shall be provided in the Official Gazette of the entrusted persons and the details of business affairs entrusted. |
| Article 21 (Criteria for Imposing Administrative Fines) |