ENFORCEMENT DECREE OF THE MEDICAL BENEFIT ACT
Wholly Amended by Presidential Decree No. 17379, Sep. 29, 2001
Amended by Presidential Decree No. 17878, Jan. 2, 2003
Presidential Decree No. 18206, Dec. 30, 2003
Presidential Decree No. 18460, jun. 29, 2004
Presidential Decree No. 18622, Dec. 30, 2004
Presidential Decree No. 18935, Jul. 5, 2005
Presidential Decree No. 19129, Nov. 11, 2005
Presidential Decree No. 19313, Feb. 2, 2006
Presidential Decree No. 19445, Apr. 13, 2006
Presidential Decree No. 19918, Feb. 28, 2007
Presidential Decree No. 20612, Feb. 19, 2008
Presidential Decree No. 20679, Feb. 29, 2008
Presidential Decree No. 21313, Feb. 6, 2009
Presidential Decree No. 21395, Mar. 31, 2009
Presidential Decree No. 21957, Dec. 31, 2009
Presidential Decree No. 22075, Mar. 15, 2010
Presidential Decree No. 22384, Sep. 17, 2010
Presidential Decree No. 23488, Jan. 6, 2012
Presidential Decree No. 23844, jun. 7, 2012
Presidential Decree No. 24077, Aug. 31, 2012
Presidential Decree No. 24454, Mar. 23, 2013
Presidential Decree No. 24589, jun. 11, 2013
Presidential Decree No. 24700, Sep. 3, 2013
Presidential Decree No. 24995, Dec. 11, 2013
Presidential Decree No. 25477, Jul. 16, 2014
Presidential Decree No. 25840, Dec. 9, 2014
Presidential Decree No. 26365, jun. 30, 2015
Presidential Decree No. 26606, Oct. 29, 2015
Presidential Decree No. 26844, Dec. 31, 2015
Presidential Decree No. 27275, jun. 28, 2016
Presidential Decree No. 27730, Dec. 30, 2016
Presidential Decree No. 27934, Mar. 8, 2017
Presidential Decree No. 28349, Sep. 29, 2017
Presidential Decree No. 28550, Dec. 29, 2017
Presidential Decree No. 28603, Jan. 23, 2018
Presidential Decree No. 29003, jun. 26, 2018
Presidential Decree No. 29265, Oct. 30, 2018
Presidential Decree No. 29410, Dec. 24, 2018
Presidential Decree No. 29676, Apr. 2, 2019
Presidential Decree No. 29945, Jul. 2, 2019
Presidential Decree No. 29950, Jul. 2, 2019
Presidential Decree No. 30061, Aug. 27, 2019
Presidential Decree No. 30144, Oct. 22, 2019
Presidential Decree No. 30748, jun. 2, 2020
Presidential Decree No. 31097, Oct. 7, 2020
Presidential Decree No. 31337, Dec. 29, 2020
Presidential Decree No. 31614, Apr. 6, 2021
Presidential Decree No. 31633, Apr. 20, 2021
Presidential Decree No. 32528, Mar. 8, 2022
Presidential Decree No. 32551, Mar. 22, 2022
Presidential Decree No. 33716, Sep. 12, 2023
The purpose of this Decree is to prescribe matters delegated by the Medical Care Assistance Act and matters necessary for the enforcement of said Act. <Amended on Jul. 5, 2005>
| Article 2 (Eligible Recipients) |
| 1. | Persons without a permanent address, who are identified by police as someone without family or friends; |
| 2. | Other persons prescribed by Ordinance of the Ministry of Health and Welfare. |
[This Article Wholly Amended on Feb. 6, 2009]
| Article 3 (Classification of Eligible Recipients) |
| (1) | Eligible recipients shall be classified into either type 1 eligible recipients or type 2 eligible recipients. <Amended on Jun. 30, 2015> |
| (2) | Type 1 eligible recipients shall be any of the following persons: <Amended on Jan. 2, 2003; Dec. 30, 2003; Dec. 30, 2004; Jul. 5. 2005; Feb. 19, 2008; Feb. 29, 2008; Feb. 6, 2009; Dec. 31, 2009; Mar. 15, 2010; Jun. 7, 2012; Sep. 3, 2013; Jun. 28, 2016; Aug. 9, 2022> |
| (a) | Members of a household consisting solely of any of the following persons: |
| (i) | A person under 18 years of age; |
| (ii) | A person aged 65 or older; |
| (iv) | A person needing treatment or medical care due to disease, injury, or its aftereffect, who is judged to be unable to work by a Special Self-Governing City Mayor, a Special Self-Governing Province Governor, or the head of a Si (excluding the administrative head of a Special Self-Governing Province)/Gun/Gu (referring to an autonomous Gu; hereinafter referred to as "head of a Si/Gun/Gu") through a working ability evaluation; |
| (v) | A person determined by the Minister of Health and Welfare as unsuitable to work, such as a person who rears or nurses a household member; |
| (vi) | A woman who is pregnant or gave birth to a baby and for whom less than six months have elapsed since childbirth; |
| (c) | A person with tuberculosis, a rare and incurable disease, or a severe disease determined and publicly notified by the Minister of Health and Welfare; |
| 3. | A recipient specified in subparagraph 1 of Article 2; |
| 4. | A person specified in subparagraph 2 of Article 2 and deemed by the Minister of Health and Welfare in need of type 1 medical care benefit. |
| (3) | Matters necessary for the standards, methods, procedures, etc. for the working ability evaluation under paragraph (2) 1 (a) (iv) shall be determined and publicly notified by the Minister of Health and Welfare. <Newly Inserted on Aug. 9, 2022> |
| (4) | Type 2 eligible recipients shall be persons specified in any of the following: <Amended on Dec. 30, 2003; Dec. 30, 2004; Feb. 19, 2008; Feb. 29, 2008; Feb. 6, 2009; Mar. 15, 2010; Aug. 9, 2022> |
| 2. | Deleted; <Feb. 6, 2009> |
| 3. | A person specified in subparagraph 2 of Article 2 and deemed by the Minister of Health and Welfare as in need of type 2 medical care benefits. |
| Article 4 Deleted. <Dec. 11, 2003> |
| Article 5 Deleted. <Dec. 11, 2013> |
| Article 6 (Date of Commencement of Medical Benefits) |
Medical benefits shall begin to be provided to eligible recipients from the day they become recipients under the National Basic Living Security Act or the day they are recognized as an eligible recipient under Article 3-3 (5) of the Act: Provided, That medical benefits shall begin to be provided to those persons without family or friends under subparagraph 1 of Article 2 on the day an administrative agency grants them emergency medical care; and medical benefits shall begin to be provided to persons wounded for a just cause or the bereaved family members of those persons killed for a just cause under Article 3 (1) 3 of the Act on the day they are wounded or killed in order to save other persons' life, body or property. <Amended on Jun. 29, 2004; Dec. 11, 2013>
| Article 6-2 (Recommendation as Eligible Recipients) |
| (1) | A person who intends to be recommended by the Minister of Patriots and Veterans Affairs or the Administrator of the Cultural Heritage Administration pursuant to Article 3-3 (4) of the Act shall file a written application for recommendation prescribed by Ordinance of the Ministry of Health and Welfare with the Minister of Patriots and Veterans Affairs or the Administrator of the Cultural Heritage Administration, accompanied by documents (including electronic documents; hereinafter the same shall apply) prescribed by Ordinance of the Ministry of Health and Welfare. <Amended on Apr. 11, 2023> |
| (2) | The Minister of Patriots and Veterans Affairs or the Administrator of the Cultural Heritage Administration in receipt of an application for recommendation under paragraph (1) shall ascertain whether family members (referring to family members within the scope determined by the Minister of Patriots and Veterans Affairs and the Administrator of the Cultural Heritage Administration as necessary to receive medical benefits along with the relevant applicants; hereinafter referred to as "family members") of the relevant applicant satisfy the following requirements: <Amended on Apr. 11, 2023> |
| 2. | That all family members shall meet the criteria for recommendation under paragraph (6). |
| (3) | The Minister of Patriots and Veterans Affairs and the Administrator of the Cultural Heritage Administration shall recommend an applicant and his or her family members satisfying all the requirements specified in each subparagraph of paragraph (2) as persons who need to be recognized as eligible recipients defined in Article 3 (1) 5 or 6 of the Act (hereinafter referred to as "person eligible for medical care benefits") to the head of a Si/Gun/Gu having jurisdiction over the domicile of the relevant applicant and his or her family members. <Amended on Aug. 9, 2022; Apr. 11, 2023> |
| (4) | Where the Minister of Patriots or Veterans Affairs and the Administrator of the Cultural Heritage Administration recommend a person eligible for medical care benefits under paragraph (3), he or she shall simultaneously submit documents that are specified in paragraph (1) and received from the relevant applicant. <Amended on Apr. 11, 2023> |
| (5) | The head of a Si/Gun/Gu in receipt of recommendation for a person eligible for medical care benefits pursuant to paragraph (3) shall determine whether to recognize the person as an eligible recipient and the details of medical benefits if the person is acknowledged as an eligible recipient, and notify the details of determination in writing (including documents in electronic format) to the recommending agency. |
| (6) | The Minister of Patriots and Veterans Affairs and the Administrator of the Cultural Heritage Administration shall notify the Minister of Health and Welfare of the standards for recommendation of persons eligible for medical care benefits by September 30 of each year.<Amended on Apr. 11, 2023> |
| (7) | In addition to those prescribed in paragraphs (1) through (6), matters concerning recommendation of person eligible for medical care benefits shall be separately determined by the Minister of Health and Welfare. |
[This Article Newly Inserted on Dec. 11, 2013]
| Article 6-3 (Notification on Matters concerning Eligible Recipients) |
Where the following grounds arise, the head of a Si/Gun/Gu shall, without delay, notify such fact to the relevant eligible recipient and the National Health Insurance Service (hereinafter referred to as the "Insurance Service") under Article 13 of the National Health Insurance Act: | 3. | Where the details, etc. of medical benefits for an eligible recipient are changed pursuant to Article 16 of the Act; |
[This Article Newly Inserted on Dec. 11, 2013]
| Article 7 (Composition and Function of Committees) |
| (1) | A medical benefits deliberative committee established in the Special Metropolitan City, Metropolitan City, Special Self-Governing City, Do or Special Self-Governing Province under Article 6 of the Act (hereinafter referred to as "City/Do") shall consist of not more than seven members, including one Chairperson and one vice chairperson, based upon gender ratio, and a medical benefits deliberative committee established in a Si (excluding an administrative Si in a Special Self-Governing Province; hereinafter the same shall apply), Gun or Gu (referring to an autonomous Gu; hereinafter the same shall apply) shall consist of not more than five members, including one Chairperson and one vice chairperson, in consideration of gender ratio. <Amended on Dec. 11, 2013> |
| (2) | A medical benefits deliberative committee established in a City/Do shall deliberate on the following matters: <Amended on Dec. 11, 2013; Jul. 16, 2014> |
| 1. | Important matters concerning the management and operation of the Medical Benefits Fund (hereinafter referred to as the "Fund") under Article 25 of the Act; |
| 2. | Matters concerning coordination of Si/Gun/Gu medical benefits programs; |
| 3. | Other matters concerning medical benefits programs that the Special Metropolitan City Mayor, Metropolitan City Mayor, Special Self-Governing City Mayor, Do Governor or Special Self-Governing Province Governor (hereinafter referred to as "Mayor/Do Governor") submits for discussion as deemed necessary. |
| (3) | A medical benefits deliberative committee established in a Si/Gun/Gu shall deliberate on the following matters: <Amended on Jan. 2, 2003; Dec. 11, 2013> |
| 2. | Matters concerning approval to extend a period during which medical benefits are provided; |
| 3. | Other matters concerning medical benefits programs that the head of a Si/Gun/Gu submits for discussion as deemed necessary. |
| Article 8 (Term of Office and Duties of Members) |
| (1) | The term of office of the members of a medical benefits deliberative committee established in the Ministry of Health and Welfare, in Cities/Dos or in Sis/Guns/Gus shall be three years, and they may serve a consecutive term: Provided, That a member who is a public official under Article 6 (3) 3 of the Act or Article 6 (4) 3 of the Act shall hold the office of a member while he or she remains a public official. <Amended on Feb. 29, 2008; Mar. 15, 2010> |
| (2) | The Chairperson of each committee shall represent the relevant committee and be in charge of all the duties of the committee. |
| (3) | The vice chairperson of each committee shall assist the Chairperson, and perform the duties of the Chairperson in place of the Chairperson if the Chairperson is unable to perform duties in extenuating circumstances. |
| Article 8-2 (Termination of Entrustment Contract with Members of Committees) |
Where a member of a committee under the subparagraphs of Article 6 (3) of the Act or the subparagraphs of paragraph (4) of the same Article falls under any of the following, the Minister of Health and Welfare, a Mayor/Governor or the head of a Si/Gun/Gu may terminate an entrustment contract with the member or withdraw designation: | 1. | Where the member is unable to perform duties due to physical or mental disorder; |
| 2. | Where the member commits misconduct with regard to duties; |
| 3. | Where the member is deemed to be inappropriate as a member due to negligence, injury to dignity or other grounds; |
| 4. | Where the members, in person, express that performing further duties is difficult. |
[This Article Newly Inserted on Dec. 31, 2015]
| Article 9 (Committee Meetings) |
| (1) | The Chairperson of each committee shall convene a meeting of the committee and preside at the meeting. |
| (2) | The committee meeting shall be convened when the head of an agency in which the committee is established or at least 1/3 of the members on the register make a request or when deemed necessary by the Chairperson. |
| (3) | A meeting of a committee shall be called to order when a majority of members on the register is in attendance and a resolution shall be passed if a majority of the members present indicates agreement. |
The members present at the committee meeting may be paid allowances and traveling expenses within budgetary limit: Provided, That where a member who is a public official attends a meeting with direct relation to his or her duties as a public official, this shall not apply.
| Article 11 (Detailed Operational Rules) |
In addition to those prescribed by this Decree, necessary matters concerning the operation of each committee shall be determined by the Chairperson after decision-making by the committee.
| Article 12 (Medical Institutions Excluded from Institutions Providing Medical Benefits) |
| (1) | Medical institutions, etc. that the Minister of Health and Welfare may exclude from the institutions providing medical benefits pursuant to the latter part, with the exception of the subparagraphs, of Article 9 (1) of the Act shall be as listed hereunder: <Amended on Jul. 5. 2005; Feb. 28, 2007; Feb. 19, 2008; Feb. 29, 2008; Mar. 15, 2010> |
| 3. | A medical institution or a pharmacy to which disposition of suspension of business or disposition of imposition of a penalty surcharge has been issued at least two times during a five-year period pursuant to Article 28 or 29 of the Act; |
| 4. | A medical institution or a pharmacy established by an establisher of an institution that provides medical benefits for whom disposition of suspension of business is underway or who received disposition of suspension of business pursuant to Article 28 of the Act. |
| (2) | The period during which a medical institution is excluded from an institution that provides medical benefits shall be one year or less in case of paragraph (1) 2 and 3, and to the day disposition of suspension of business is completed in the case of paragraph (1) 4. |
[Title Amended on Feb. 28, 2007]
| Article 13 (Assumption of Responsibility for Expenses for Benefits) |
| (1) | The scope of expenses for benefits to be borne by the Fund pursuant to Article 10 of the Act shall be as listed in attached Table 1: <Amended on Dec. 30, 2003; Jul. 5. 2005; Dec. 11, 2013> |
1 Deleted; <Jul. 5, 2005>
2 Deleted. <Jul. 5, 2005>
| (2) | Deleted. <Jul. 5, 2005> |
| (3) | With regard to the cases prescribed by Ordinance of the Ministry of Health and Welfare, such as where medical benefits are restricted pursuant to Article 15 (1) of the Act, substantial burden is deemed to be placed on the Fund, etc., or to the items prescribed by Ordinance of the Ministry of Health and Welfare, an eligible recipient shall assume responsibility for the amount prescribed by Ordinance of the Ministry of Health and Welfare, notwithstanding paragraph (1). <Amended on Feb. 29, 2008; Mar. 15, 2010> |
| (4) | Upon request by an institution providing medical benefits, an eligible recipient shall pay the institution an amount apportionable to himself/herself (hereinafter referred to as "apportionment of share borne by an eligible recipient which is to be covered by benefits") besides the expenses for benefits to be borne by the Fund pursuant to paragraph (1), and the amount to be apportionable to himself/herself pursuant to paragraph (3). <Amended on Jun. 29, 2004> |
| (5) | Where the share of expenses (excluding an amount, borne by an eligible recipient which is to be covered by benefits, paid to an institution providing medical benefits by an eligible recipient pursuant to subparagraph 1 (d) and (e) of attached Table 1, subparagraph 2 (e) and (f) of the same Table and subparagraph 3 of the same Table; hereinafter the same shall apply in this Article), which is borne by an eligible recipient and is to be covered by benefits, paid to an institution providing medical benefits pursuant to paragraph (4) exceeds the following amount during each 30-day period, the head of a Si/Gun/Gu shall pay an amount equivalent to 50/100 of the excess to the eligible recipient as prescribed by Ordinance of the Ministry of Health and Welfare: Provided, That where the amount to be paid to the eligible recipient is less than 2,000 won, the head of a Si/Gun/Gu shall not pay it: <Amended on Jun. 29. 2004; Feb. 28, 2007; Feb. 29, 2008; Mar. 15, 2010; Jun. 7, 2012; Jul. 16, 2014> |
| 1. | Type 1 eligible recipient: 20,000 won; |
| 2. | Type 2 eligible recipient: 200,000 won. |
| (6) | Where the amount calculated by subtracting the amount received pursuant to paragraph (5) from the share of expenses borne by an eligible recipient which is to be covered by benefits exceeds the following amount, the Fund shall assume responsibility for the excess: Provided, That where the excess is less than 2,000 won, the eligible recipient shall assume the responsibility for it: <Amended on Jun. 29. 2004; Feb. 28, 2007; Mar. 31, 2009; Dec. 29, 2017> |
| 1. | Type 1 eligible recipient: 50,000 won during each 30-day period; |
| 2. | Type 2 eligible recipient: 800,000 won a year: Provided, That the amount shall be 1,200,000 won a year, where he or she is hospitalized for longer than 240 days a year at a care hospital referred to in Article 3 (2) 3 (d) of the Medical Service Act. |
| (7) | Where an eligible recipient pays the excess for which the Fund has to assume responsibility pursuant to the main clause of paragraph (6), the head of a Si/Gun/Gu shall pay the excess to the eligible recipient as prescribed by Ordinance of the Ministry of Health and Welfare. <Newly Inserted on Jun. 29, 2004; Feb. 29, 2008; Mar. 15, 2010> |
| Article 13-2 (Deferment of Payment of Expenses for Benefits) |
| (1) | Where the head of a Si/Gun/Gu intends to defer payment of expenses for benefits pursuant to Article 11-5 (1) of the Act, he or she shall give prior written notice of the details to the relevant institution providing medical benefits. In such cases, matters to be included in the writing shall be as listed hereunder: |
| 1. | Name, representative, address of the relevant institution providing medical benefits; |
| 2. | Facts being the reason for deferment of payment, expenses for benefits that are to be deferred and legal grounds for deferment; |
| 3. | That the relevant institution may submit an opinion on the matters under subparagraph 2 and what will happen if the institution does not submit an opinion. |
| (2) | If an institution providing medical benefits is in receipt of notification under paragraph (1) and has an objection to the deferment of payment, it shall submit an opinion on deferring payment of expenses for benefits together with the intent of filing an objection, reasons therefor and necessary data to the head of a Si/Gun/Gu within seven days of receipt of the notification. |
| (3) | After examining the opinion submitted by an institution providing medical benefits pursuant to paragraph (2), the head of a Si/Gun/Gu shall notify the findings to the institution in writing. |
| (4) | "Grounds prescribed by Presidential Decree, such as that a court's judgment of not guilty become final, etc." in Article 11-5 (3) of the Act means any of the following: Provided, That the same shall not apply in cases falling under subparagraph 2 or 3 where an institution providing medical benefits is found guilty through the ruling of a court after it was reinvestigated and an indictment was brought, though non-transfer decision or non-prosecution disposition had been rendered: <Amended on Dec. 29, 2020> |
| 1. | Judgment of not guilty becomes final; |
| 2. | Non-transfer decision (limited to the disposition to be cleared of suspicion or to be innocent; hereinafter the same shall apply); |
| 3. | Non-prosecution disposition (limited to the disposition to be cleared of suspicion or to be innocent; hereinafter the same shall apply). |
| (5) | Where an institution providing medical benefits is adjudicated not guilty or receives a non-transfer decision or non-prosecution disposition when deferment of payment of expenses for benefits to the institution is determined pursuant to Article 11-5 (1) of the Act, it shall, immediately, notify such fact to the head of a Si/Gun/Gu. <Amended on Dec. 29, 2020> |
| (6) | The head of a Si/Gun/Gu in receipt of notice under paragraph (5) shall, without delay, pay for expenses for benefits of which payment has been deferred and interest for the period during which payment has been deferred. In such cases, the interest shall be the amount obtained by multiplying the expenses for benefits of which payment has been deferred by the interest rate for the additional refund of national taxes under Article 43-3 (2) of the Enforcement Decree of the Framework Act on National Taxes for the period from the day payment was deferred to the day payment is made. |
| (7) | In addition to those matters prescribed in paragraphs (1) through (6), matters in detail necessary for the deferment of payment of expenses for benefits shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
[This Article Newly Inserted on Jun. 28, 2016]
| Article 13-3 (Methods of and Procedures for Application for Accounts for Receipt of Medical Expenses) |
| (1) | A person who intends to receive medical expenses, etc. through an account designated in the name of an eligible recipient (hereinafter referred to as "account for receipt of medical expenses, etc.") under the main clause of Article 12-2 (1) of the Act shall submit to the head of a Si/Gun/Gu a written request for medical expenses prescribed by Ordinance of the Ministry of Health and Welfare and others, with his or her account number to receive medical expenses, etc. stated therein, attached with a copy of his or her deposit passbook (referring to a page in which the account number is stated); The same shall also apply to any modification of an account for receipt of medical expenses, etc. |
| (2) | When a financial institution in which a recipient has opened an account for medical expenses is unable to operate its business as usual due to closure or suspension of its business or disruption of information and communications, etc. or when an account transfer is impracticable due to any unavoidable cause corresponding thereto, the head of a Si/Gun/Gu shall directly pay such amount in cash, pursuant to the proviso of Article 12-2 (1) of the Act. |
[This Article Newly Inserted on Sep. 12, 2023]
| Article 14 (Notification of Reasons for Restrictions on Benefits) |
| (1) | Where the head of an institution providing medical benefits deems that reasons for restrictions on benefits under Article 15 (1) of the Act applies to an eligible recipient, he or she shall, without delay, notify a doctor's opinion, statement of a patient, guardian or interested persons, personal data of the eligible recipient, etc. to the head of a Si/Gun/Gu having jurisdiction over the address of the eligible recipient. |
| (2) | Where the head of a Si/Gun/Gu receives notice under paragraph (1), he or she shall, without delay, inspect and ascertain whether medical benefits are necessary for the eligible recipient and notify the institution that provides medical benefits of the finding. |
"Cases prescribed by Presidential Decree" in subparagraph 3 of Article 24 of the Act shall mean the following cases: <Amended on Dec. 11, 2013> | 1. | Where a defaulter does not own any property or his or her whole property being the subject matter of disposition on default is estimated to be less than the cost of disposition on default; |
| 2. | Where a Si/Gun/Gu medical benefits deliberative committee determines that money is irrecoverable. |
| Article 16 (Fund Management Officials) |
From among public officials under jurisdiction, a Mayor/Do Governor shall appoint a treasurer of the Fund in charge of expenditure and determination on collection and a cashier of the Fund in charge of receipt and disbursement.
| Article 16-2 (Criteria for Administrative Disposition) |
The criteria for administrative disposition on institutions that provide medical benefits under Article 28 (8) of the Act shall be as listed in attached Table 2. [This Article Newly Inserted on Dec. 11, 2013]
| Article 16-3 (Disposition on Penalty Surcharge Defaulters) |
| (1) | Where a person who is to pay a penalty surcharge under Article 29 (1) of the Act fails to pay the penalty surcharge by the deadline, the Minister of Health and Welfare shall issue a written reminder within 15 days of the deadline under paragraph (2) of the same Article. In such cases, the new deadline shall be within 10 days of the date of issue of the written reminder. |
| (2) | Where a person who is to pay a penalty surcharge fails to pay it by the deadline after receiving a written reminder under paragraph (1), the Minister of Health and Welfare shall revoke the disposition of imposition of a penalty surcharge at the request of a Mayor/Do Governor who is delegated with the authority to collect penalty surcharges pursuant to Article 33 (1) of the Act and subparagraph 1 of Article 19 of this Decree, and issue disposition of suspension of business under Article 28 (1) of the Act or collect it in the same manner as national taxes or local taxes (limited to cases in which the authority of collecting penalty surcharges is delegated to a Mayor/Do Governor pursuant to Article 33 (1) of the Act and subparagraph 1 of Article 19 of this Decree) in arrears are collected. |
| (3) | Where the Minister of Health and Welfare intends to revoke the disposition of imposition of a penalty surcharge and issue a disposition to suspend business pursuant to paragraph (2), he or she shall notify the person on whom such disposition is to be issued of the details in writing. In such case, the document shall contain matters necessary for the disposition to suspend business, such as reasons for change of disposition, period of suspension of business. |
[This Article Newly Inserted on Jun. 28, 2016]
[Previous Article 16-3 moved to Article 16-4 <Jun. 28, 2016>]
| Article 16-4 (Criteria for Imposition of Penalty Surcharges) |
[This Article Newly Inserted on Dec. 11, 2013]
[Moved from Article 16-3 <Jun. 28, 2016>]
| Article 16-5 (Matters for Publication) |
"Matters prescribed by Presidential Decree" in the former part, with the exception of the subparagraphs, of Article 29-3 (1) of the Act means the matters specified in any of the following subparagraphs: | 1. | The kind of the relevant institution providing medical benefits and license number of the representative of such institution; |
| 2. | The name of the head of the relevant institution providing medical benefits where the founder of an institution providing medical benefits is a corporation; |
[This Article Newly Inserted on Sep. 12, 2023]
| Article 16-6 (Composition and Operation of Publication Deliberative Committee) |
| (1) | The Deliberative Committee on Publication of Medical Benefits (hereafter referred to as the "Publication Deliberative Committee") under Article 29-3 (2) of the Act shall be comprised of nine members, including one chairperson. |
| (2) | A person appointed or commissioned by the Minister of Health and Welfare who fall under under any of the following subparagraphs shall serve as a member of the Deliberative Committee on Publication, and the chairperson shall be elected from among the committee members under subparagraphs 1 through 4: |
| 1. | One person recommended by the consumers' organizations; |
| 3. | One legal expert, such as a lawyer; |
| 4. | Three persons recommended by organizations representing the medical and pharmaceutical industry, who have abundant knowledge and experience in medical benefits; |
| 5. | One public official in general service who belongs to the Senior Executive Service of the Ministry of Health and Welfare; |
| 6. | Two persons, each of whom is recommended by the president of the National Health Insurance Service and the president of the Health Insurance Review and Assessment Service (hereinafter referred to as the "HIRA") under Article 62 of the National Health Insurance Act; |
| (3) | The term of office of members of the Publication Deliberative Committee (excluding committee members referred to in paragraph (2) 5) shall be two years. |
| (4) | The chairperson of the Publication Deliberative Committee shall represent the Publication Deliberation Committee, and shall manage overall affairs of the Publication Deliberative Committee. |
| (5) | When the chairperson of the Publication Deliberative Committee is unable to perform his or her duties due to any unavoidable reason, the committee member designated by the chairperson shall perform the duties on his or her behalf. |
| (6) | The Publication Deliberative Committee shall open its meetings with the attendance of a majority of all the incumbent members and shall pass resolutions with concurrent votes of a majority of the members present. |
| (7) | Except as provided in paragraphs (1) through (6), matters necessary for composition, operation, etc. of the Publication Deliberative Committee shall be determined by its chairperson after its deliberation. |
[This Article Newly Inserted on Sep. 12, 2023]
| Article 16-7 (Dismissal or Decommission of Members of Publication Deliberative Committee) |
The Minister of Health and Welfare may dismiss or decommission a member of the Publication Deliberative Committee from office if he or she falls under any of the following cases:
| 1. | Where the committee member is unable to perform his or her duties due to a mental or physical weakness; |
| 2. | Where the committee member commits misconduct with regard to duties; |
| 3. | Where the committee member is deemed to be inappropriate as a committee member due to negligence, injury to dignity, or any other grounds; |
| 4. | Where the committee member voluntarily expresses that performing further duties is impractical. |
[This Article Newly Inserted on Sep. 12, 2023]
| Article 16-8 (Procedure for and Methods of Publication) |
| (1) | The Publication Deliberative Committee shall provide the institution providing medical benefits which has been notified that it is subject to deliberation for publication pursuant to Article 29-3 (3) of the Act with an opportunity to submit explanatory materials or to present itself and state opinions within 20 days from the date it received the notification. |
| (2) | The Minister of Health and Welfare shall publicly announce matters for publication (hereinafter referred to as "matters for publication") under Article 29-3 (1) of the Act for six months on the website of the Ministry of Health and Welfare for the institutions providing medical benefits selected to be published after deliberation by the Publication Deliberative Committee, and may publicly announce them on the bulletin board, etc. |
| v(3) | The Minister of Health and Welfare may request the National Health Insurance Service, HIRA, competent City/Do, Si/Gun/Gu, and public health clinics to publicly announce matters for publication on the website for six months. In such cases, each institution including the Insurance National Health Insurance Service and HIRA shall comply with such request, except in extenuating circumstances. |
| (4) | Where the Minister of Health and Welfare deems that additional publication is necessary because an institution providing medical benefits makes repetitive fraudulent claims falling under any subparagraph of Article 29-3 (1) or where its fraudulent claims constitute a serious violation, he or she may make additional publication in a newspaper under the Act on the Promotion of Newspapers or in a broadcast program under the Broadcasting Act, in addition to the public announcement under paragraph (2), after deliberation by the Publication Deliberative Committee. |
| (5) | When it is confirmed that any matters for publication is changed during the announcement period under paragraph (2) due to permission for modification, report on modification, etc. granted or filed under Article 33 (5) of the Medical Service Act, a City Mayor/Do governor, the head of Si/Gun/Gu, or the head of a public health clinic having jurisdiction over the relevant institution providing medical benefits shall notify the Minister of Health and Welfare of such fact without delay. In such cases, the Minister of Health and Welfare shall take necessary measures to ensure that the matters of modification are immediately reflected in the details of public announcement under paragraph (2). |
| (6) | Except as provided in paragraphs (1) through (5), matters necessary for the procedure for and methods of publication, change in the details of publication, etc. shall be prescribed by the Minister of Health and Welfare. |
[This Article Newly Inserted on Sep. 12, 2023]
| Article 17 (Decision on Objection and Notification) |
| (1) | Where the head of a Si/Gun/Gu or an institution examining expenses for benefits under Article 9 (4) 1 of the Act (hereinafter referred to as "institution examining expenses for benefits") is in receipt of an objection under Article 30 of the Act, he, she, or it shall make a decision within 60 days thereof: Provided, That where unavoidable reasons exist, he, she, or it may extend the period up to 30 days. |
| (2) | If the period to make a decision is extended pursuant to the proviso of paragraph (1), the objector shall be notified thereof by seven days before the period to make a decision expires. |
| (3) | When the head of a Si/Gun/Gu or an institution examining expenses for benefits makes a decision on an objection pursuant to paragraph (1), he or she/it shall, without delay, send the original copy of the decision to the objector and a copy to the interested parties. |
| Article 17-2 (Submission of Request for Adjudication) |
| (1) | A person who intends to request adjudication pursuant to Article 30-2 (1) of the Act shall submit a request for adjudication stating the following matters to an institution examining expenses for benefits or the Health Insurance Dispute Mediation Committee under Article 89 of the National Health Insurance Act (hereinafter referred to as the "Dispute Mediation Committee"): |
| 1. | Name and address of the applicant (in cases of a corporation, name of a corporation, name of its representative, and location of its main office); |
| 2. | Where the applicant was not issued disposition, the relationship with the person to whom a disposition is issued); |
| 3. | Entity that has issued disposition; |
| 4. | Details of disposition being the object of adjudication; |
| 5. | The day he or she learned that disposition was issued; |
| 6. | Intent of request for adjudication and reasons therefor; |
| 7. | Whether the request for adjudication was notified and details thereof; |
| 8. | Mark of accompanying documents. |
| (2) | Where an applicant submits a request for adjudication to an agency other than an institution examining expenses for benefits or the Dispute Mediation Committee, the agency shall, without delay, forward the request for adjudication to an institution examining expenses for benefits or the Dispute Mediation Committee. |
| (3) | The agency that forwards a request for adjudication to an institution examining expenses for benefits or the Dispute Mediation Committee pursuant to paragraph (2) shall, without delay, notify such fact to the applicant. |
| (4) | When the period of request for adjudication is calculated, a request for adjudication shall be deemed to be made at the time when a request for adjudication is submitted to an institution examining expenses for benefits or to the Dispute Mediation Committee under paragraph (1) or to an agency under paragraph (2). |
[This Article Newly Inserted on Jul. 16, 2014]
| Article 17-3 (Receipt and Handling of Request for Adjudication by Institutions Examining Expenses for Benefits) |
| (1) | An institution examining expenses for benefits in receipt of a request for adjudication pursuant to Article 17-2 (1) or (2), or a copy or duplicate of a request for adjudication pursuant to Article 17-4 (1) shall send, within 10 days, two copies of a reply to the request for adjudication accompanied by a copy of decision on objection under Article 17 (3) to the Dispute Mediation Committee. |
| (2) | The reply under paragraph (1) shall include the following: |
| 1. | Grounds for disposition and reasons therefor; |
| 2. | Intent of request for adjudication and a reply responding to reasons for request for adjudication. |
[This Article Newly Inserted on Jul. 16, 2014]
| Article 17-4 (Receipt and Handling by Dispute Mediation Committee) |
| (1) | Where the Dispute Mediation Committee receives a request for adjudication pursuant to Article 17-2 (1) or (2), it shall, without delay, send a copy or duplicate of the request for adjudication to an institution examining expenses for benefits. |
| (2) | Where the Dispute Mediation Committee receives a reply from an institution examining expenses for benefits pursuant to Article 17-3 (1), it shall send a duplicate of the reply to the requester. |
[This Article Newly Inserted on Jul. 16, 2014]
| Article 17-5 (Decision on Request for Adjudication and Notification) |
| (1) | The Dispute Mediation Committee shall make a determination within 60 days of the date a request for adjudication is received: Provided, That where unavoidable reasons exist, it may extend the period by 30 more days. |
| (2) | Where the Dispute Mediation Committee intends to extend the period to make a decision pursuant to the proviso of paragraph (1), it shall notify such fact to the applicant by seven days before the period to make a decision expires. |
| (3) | When the Chairperson of the Dispute Mediation Committee makes a decision on a request for adjudication, he or she shall, without delay, send an original copy of the written decision to the requester and a copy thereof to an institution examining expenses for benefits after putting signature or name and seal on the written decision stating following matters: |
| 1. | Name and address of the requester (in cases of a corporation, name of such corporation, name of its representative, and location of its main office); |
| 2. | Entity that has issued disposition; |
| 4. | Intent of request for adjudication; |
| 6. | Date on which decision is made. |
[This Article Newly Inserted on Jul. 16, 2014]
| Article 18 (Support for Inspection) |
Where it is necessary to inspect an institution providing medical benefits and an agency claimant organization referred to in Article 32 (2) of the Act, the Minister of Health and Welfare may have HIRA support the duties. <Amended on Jul. 5, 2005; Feb. 29, 2008; Mar. 15, 2010; Aug. 31, 2012; Dec. 11, 2013; Sep. 12, 2023>
| Article 18-2 (Payment of Monetary Awards) |
| (1) | A person who intends to file a report on a person specified in any subparagraph of Article 32-3 (1) of the Act shall report such fact to the head of a Si/Gun/Gu as prescribed by the Minister of Health and Welfare. In such cases, where two or more persons intend to file a report under joint accounts, they shall designate a representative. <Amended on Sep. 12, 2023> |
| (2) | Where the head of a Si/Gun/Gu receives a report under paragraph (1), he or she shall ascertain it, determine whether to pay a monetary award and notify the reporter the result (referring to the representative under the latter part of paragraph (1) where two or more persons have jointly filed a report; hereinafter the same shall apply in this Article). |
| (3) | Where a reporter is notified that the payment of a monetary award is determined pursuant to paragraph (2), he or she shall request the head of a Si/Gun/Gu to pay a monetary award as determined by the Minister of Health and Welfare. |
| (4) | Within one month of the day on which the head of a Si/Gun/Gu receives a request for payment of a monetary award pursuant to paragraph (3), he or she shall pay a monetary award to the reporter according to the criteria for the payment of monetary awards under attached Table 4. |
| (5) | A monetary award shall not be paid to a person who makes a report with the same contents as the one filed pursuant to paragraph (1). |
| (6) | In addition to those prescribed in paragraphs (1) through (5), matters concerning criteria for the payment of monetary awards, methods, procedures, etc. shall be determined and publicly notified by the Minister of Health and Welfare. |
[This Article Newly Inserted on Dec. 11, 2013]
| Article 18-3 (Award of Grants) |
| (1) | The head of a Si/Gun/Gu shall award a grant under Article 32-3 (2) of the Act (hereinafter referred to as "grant") to an institution providing medical benefits that contributes to the reduction of expenditures for medical benefits according to the methods determined and publicly notified by the Minister of Health and Welfare, such as that it prescribes or dispenses medications with lower expenses for benefits among medications with the same ingredient or effect that can be used as a replacement, etc. |
| (2) | A grant shall be the amount not exceeding 70/100 of the amount reduced when medical benefits incur expenditures from the Treasury due to the prescription or dispensing under paragraph (1). |
| (3) | Except as provided in paragraphs (1) and (2), matters concerning criteria for payment of grants, methods, procedures, etc. shall be determined and publicly notified by the Minister of Health and Welfare. |
[This Article Newly Inserted on Dec. 11, 2013]
| Article 19 (Delegation of Authority) |
Pursuant to Article 33 (1) of the Act, the following authority among the authorities of the Minister of Health and Welfare shall be delegated to the head of a Si/Gun/Gu: <Amended on Feb. 29, 2008; Mar. 15, 2010> | 1. | Authority to collect penalty surcharges imposed by the Minister of Health and Welfare on institutions providing medical benefits pursuant to Article 29 (1) of the Act; |
| 2. | Deleted. <Sep. 12, 2023> |
| Article 20 (Entrustment of Duties) |
| (1) | The head of a Si/Gun/Gu shall entrust the following duties to HIRA pursuant to Article 33 (2) of the Act: <Amended on Aug. 27, 2019> |
| 1. | Examination and adjustment of expenses for benefits (including health checkup expenses; hereinafter the same shall apply) under Article 11 (2) of the Act; |
| 3. | Establishment of criteria for examination and evaluation under subparagraphs 1 and 2. |
| (2) | The head of a Si/Gun/Gu shall entrust the following duties to the Insurance Service pursuant to Article 33 (2) of the Act: <Amended on Aug. 27, 2019; Mar. 22, 2022> |
| 1. | A program determined and publicly notified by the Minister of Health and Welfare among programs to maintain and improve health of eligible recipients under Article 5 (3) of the Act; |
| 4. | Fact-finding surveys and collection of data necessary for restriction on medical benefits under Article 15 of the Act; |
| 5. | Establishment or operation of the information system necessary for the following duties: |
| (b) | Management of eligible recipients subject to the expenses for benefits borne by the Fund pursuant to Article 10 of the Act, and subparagraph 1 (c) (5), and (d), (e) of attached Table 1 of this Decree, and subparagraph 2 (e) and (f) of attached Table 1 of this Decree; |
| (c) | Management of qualifications for eligible recipients and personal medical records. |
| Article 21 (Handling of Sensitive Information and Personally Identifiable Information) |
| 2. | Duties concerning businesses necessary for the health promotion of eligible recipients under Article 5 (3) or the Act; |
| 4. | Duties concerning operation of medical benefits deliberative committees under Article 6 of the Act; |
| 11. | Duties concerning administrative disposition on institutions providing medical benefits, report, inspection, request for data, payment of monetary awards and grants, etc. under Articles 28, 29, 29-2, 30, 32, 32-2 and 32-3 of the Act. |
[This Article Newly Inserted on Jan. 6, 2012]
| Article 21-2 (Re-Examination of Regulation) |
The Minister of Health and Welfare shall examine the appropriateness of the scope of expenses for benefits to be borne by the Fund specified in Article 13 (1) and attached Table 1 every three years from January 1, 2022 (referring to the period that ends on the day before January 1 of every third year) and take measures, such as making improvements. <Amended on Jun. 28, 2016; Mar. 8, 2022> [This Article Newly Inserted on Dec. 9, 2014]
| Article 22 (Criteria for Imposing Administrative Fine) |
[This Article Newly Inserted on Dec. 11, 2013]
ADDENDA <Presidential Decree No. 17379, Sep. 29, 2001>
Article 1 (Enforcement Date)
This Decree shall enter into force on October 1, 2001.
Article 2 Omitted.
Article 3 (Relationship with Other Statutes)
Where the previous Enforcement Decree of the Medical Care Assistance Act is cited by other statutes as at the time this Decree enters into force and any provision corresponding to the previous Enforcement Decree is included in this Decree, this Decree or the relevant provision of this Decree shall be deemed cited in lieu of the previous provision, respectively.
ADDENDA <Presidential Decree No. 17878, Jan. 2, 2003>
| (1) | (Enforcement Date) This Decree shall enter into force on the date of its enforcement: Provided, That the provisions concerning upper age limit under the amended provisions of Article 3 (2) 1 (a) (ii) shall enter into force in stages as listed hereunder: |
| 1. | From the day this Decree enters into force to December 31, 2003: 63 years of age; |
| 2. | On and after January 1, 2004: 65 years of age. |
| (2) | (Transitional Measures concerning Type 1 Eligible Recipients) A person selected as a type 1 eligible recipient according to the age standards under previous Article 3 (2) 1 (a) as at the time this Decree enters into force shall be deemed a type 1 eligible recipient under this Decree. |
| (3) | (Transitional Measures concerning Entrustment of Duties) The Insurance Corporation shall pay for the recuperation expenses and those for persons with disabilities that are to be provided pursuant to the previous provisions as at the time this Decree enters into force. |
ADDENDUM <Presidential Decree No. 18206, Dec. 30, 2003>
This Decree shall enter into force on January 1, 2004.
ADDENDA <Presidential Decree No. 18460, Jun. 29, 2004>
| (1) | (Enforcement Date) This Decree shall enter into force on July 1, 2004. |
| (2) | (Applicability to Upper Limit of Share of Expenses Borne by Eligible Recipients) The amended provisions of Article 13 (6) and (7) shall be applicable to medical benefits provided on and after July 1, 2004. |
ADDENDUM <Presidential Decree No. 18622, Dec. 30, 2004>
This Decree shall enter into force on January 1, 2005.
ADDENDUM <Presidential Decree No. 18935, Jul. 5, 2005>
This Decree shall enter into force on the date of its enforcement: Provided, That the amended provisions of subparagraph 3 of attached Table shall enter into force on January 1, 2005.
ADDENDA <Presidential Decree No. 19129, Nov. 11, 2005>
| (1) | (Enforcement Date) This Decree shall enter into force on the date of its promulgation. |
| (2) | (Applicability to Change in Share of Burden Borne by Fund) The amended provisions of subparagraph 4 of attached Table shall be applicable to medical benefits provided on and after September 1, 2005. |
ADDENDA <Presidential Decree No. 19313, Feb. 2, 2006>
| (1) | (Enforcement Date) This Decree shall enter into force on the date of its promulgation. |
| (2) | (Applicability to Exemption from Share of Expenses Borne by Eligible Recipients) The amended provisions of subparagraph 3 of attached Table shall be applicable to medical benefits provided on and after January 1, 2006. |
ADDENDUM <Presidential Decree No. 19445, Apr. 13, 2006>
This Decree shall enter into force on the date of its promulgation.
ADDENDA <Presidential Decree No. 19918, Feb. 28, 2007>
| (1) | (Enforcement Date) This Decree shall enter into force on July 1, 2007: Provided, That the amended part of Article 12 (1) shall enter into force on March 29, 2007. |
| (2) | (Applicability to Share of Expenses Borne by Type 1 Eligible Recipients, Partial Payment, etc.) The amended provisions of Article 13 (5) 1 and (6) 1, and subparagraph 1 of attached Table shall apply to the medical benefits provided for the first time on or after the day this Decree enters into force. |
ADDENDA <Presidential Decree No. 20612, Feb. 19, 2008>
Article 1 (Enforcement Date)
This Decree shall enter into force on April 1, 2008.
Article 2 (Applicability to Share of Expenses Borne by Eligible Recipients)
The amended provisions of subparagraph 1 (a) and subparagraph 2 (a) of attached Table shall be applicable to medical benefits provided for the first time after this Decree enters into force.
ADDENDA <Presidential Decree No. 20679, Feb. 29, 2008>
Article 1 (Enforcement Date)
This Decree shall enter into force on the date of its promulgation.
Articles 2 through 9 Omitted.
ADDENDUM <Presidential Decree No. 21313, Feb. 6, 2009>
This Decree shall enter into force on April 1, 2009.
ADDENDA <Presidential Decree No. 21395, Mar. 31, 2009>
Article 1 (Enforcement Date)
This Decree shall enter into force on the date of its promulgation: Provided, That the amended provisions of subparagraph 2 (a) of attached Table shall enter into force on June 1, 2009.
Article 2 (Applicability to Upper Limit of Share of Expenses Borne by Eligible Recipients which Is to Be Covered by Benefits)
| (1) | The amended provision of Article 13 (6) 2 shall begin to apply to the medical benefits provided for the first time on or after January 1, 2009. |
| (2) | Notwithstanding paragraph (1), with regard to a person to whom medical benefits began to be provided on or before December 31, 2008 and medical benefits continue to be provided even on and after January 1, 2009, the Fund shall assume responsibility for an amount whichever is greater between the amount in excess of 1,200,000 won during the six months after medical benefits began to be provided and an amount in excess of 600,000 won during the six months after January 1, 2009 pursuant to the amended provisions of Article 13 (6) 2. |
Article 3 (Applicability to Proportion to Be Borne by Type 2 Eligible Recipient)
To a person who is hospitalized before June 1, 2009 and stays in the hospital even on or after June 1, 2009, the amended provisions of subparagraph 2 (a) of attached Table shall be applicable from the hospitalization on or after June 1, 2009.
ADDENDA <Presidential Decree No. 21957, Dec. 31, 2009>
Article 1 (Enforcement Date)
This Decree shall enter into force on the date of its promulgation.
Article 2 (Applicability)
To a cancer patient, the amended provisions of subparagraph 4 of attached Table shall be applicable to the medical benefits provided on or after December 1, 2009; to a serious patient other than a cancer patient, the provision shall be applicable to the medical benefits provided on or after January 1, 2010.
ADDENDA <Presidential Decree No. 22075, Mar. 15, 2010>
Article 1 (Enforcement Date)
This Decree shall enter into force on March 19, 2010. (Proviso Omitted.)
Article 2 Omitted.
ADDENDUM <Presidential Decree No. 22384, Sep. 17, 2010>
This Decree shall enter into force on October 1, 2010.
ADDENDA <Presidential Decree No. 23488, Jan. 6, 2012>
Article 1 (Enforcement Date)
This Decree shall enter into force on the date of its promulgation. (Proviso Omitted.)
Article 2 Omitted.
ADDENDA <Presidential Decree No. 23844, Jun. 7, 2012>
Article 1 (Enforcement Date)
This Decree shall enter into force on June 8, 2012: Provided, That the amended provisions of Article 13 (5), and subparagraph 1 (d) and subparagraph 2 (e) of attached Table shall enter into force on July 1, 2012. Article 2 (Applicability)
The amended provisions of subparagraph 1 (c) of attached Table shall be applicable to the medical benefits provided for the first time on or after June 8, 2012; and the amended provisions of Article 13 (5), and subparagraph 1 (d) and subparagraph 2 (e) of attached Table shall be applicable to the medical benefits provided for the first time on or after July 1, 2012.
ADDENDA <Presidential Decree No. 24077, Aug. 31, 2012>
Article 1 (Enforcement Date)
This Decree shall enter into force on September 1, 2012. (Proviso Omitted.)
Articles 2 through 9 Omitted.
ADDENDA <Presidential Decree No. 24454, Mar. 23, 2013>
Article 1 (Enforcement Date)
This Decree shall enter into force on the date of its promulgation. (Proviso Omitted.)
Articles 2 through 4 Omitted.
ADDENDA <Presidential Decree No. 24589, Jun. 11, 2013>
Article 1 (Enforcement Date)
This Decree shall enter into force on July 1, 2013.
Article 2 (Applicability to Proportion of Denture Expenses to Be Borne by Fund)
The amended provisions of the former part of subparagraph 1 (d) and subparagraph 2 (e) of attached Table shall apply, beginning with the medical benefits provided after this Decree enters into force.
ADDENDA <Presidential Decree No. 24700, Sep. 3, 2013>
Article 1 (Enforcement Date)
This Decree shall enter into force on October 1, 2013.
Article 2 (Applicability to Exemption from Share of Expenses Borne by Persons with Serious Disease)
The amended provisions of subparagraph 1 (c) (v) and subparagraph 2 (d) of attached Table shall be applicable to the medical benefits provided after this Decree enters into force.
Article 3 (Transitional Measures concerning Family Members of Household with Person with Rare and Incurable Disease)
Notwithstanding the amended provisions of Article 3 (2) 1 (d), a family member of a household with a person with a rare and incurable disease under previous Article 3 (2) 1 (d) as at the time this Decree enters into force shall be deemed a type 1 eligible recipient under this Decree until such person with a rare and incurable disease becomes not a person with a rare and incurable disease under the previous provision or such person with a rare and incurable disease falls under subparagraph 2 or 4 of Article 5 after this Decree enters into force.
ADDENDA <Presidential Decree No. 24995, Dec. 11, 2013>
Article 1 (Enforcement Date)
This Decree shall enter into force on December 13, 2013.
Article 2 (Transitional Measures concerning Persons Selected as Eligible Recipients)
A person selected as an eligible recipient pursuant to the previous Article 4 (3) as at the time this Decree enters into force shall be deemed an eligible recipient (including a person acknowledged as an eligible recipient pursuant to Article 3-3 (5) of the Act) under the subparagraphs of Article 3 (1) of the Act. Article 3 (Transitional Measures concerning Criteria for Selection)
The criteria for selection notified by the Minister of Patriots and Veterans Affairs and the Administrator of the Cultural Heritage Administration pursuant to Article 4 (4) before this Decree enters into force shall be deemed the criteria for recommendation for the status of a person eligible for medical benefits notified by the Minister of Patriots and Veterans Affairs and the Administrator of the Cultural Heritage Administration pursuant to the amended provision of Article 6-2 (6).
ADDENDA <Presidential Decree No. 25477, Jul. 16, 2014>
Article 1 (Enforcement Date)
This Decree shall enter into force on July 29, 2014: Provided, That the amended provisions of Article 13 (5), subparagraph 1 (e) of attached Table 1, subparagraph 2 (f) of the same Table and subparagraph 3 of the same Table shall enter into force on the date of promulgation. Article 2 (Applicability to Share of Expenses Borne by Eligible Recipients which is to Be Covered by Benefits)
The amended provisions of Article 13 (5) shall apply, beginning with the share of expenses borne by eligible recipients to be covered by benefits, which are paid to an institution providing medical benefits on or after July 1, 2014. Article 3 (Applicability to Share of Expenses Borne by Fund from among Expenses Incurred in Providing Medical Benefits)
The amended provisions of subparagraph 1 (e) of attached Table 1, subparagraph 2 (f) of the same Table and subparagraph 3 of the same Table shall apply, beginning with the medical benefits provided on or after July 1, 2014.
ADDENDA <Presidential Decree No. 25840, Dec. 9, 2014>
Article 1 (Enforcement Date)
This Decree shall enter into force on January 1, 2015.
Articles 2 through 16 Omitted.
ADDENDA <Presidential Decree No. 26365, Jun. 30, 2015>
Article 1 (Enforcement Date)
This Decree shall enter into force on July 1, 2015.
Article 2 (Applicability to Share of Expenses Borne by Fund from among Expenses Incurred in Providing Medical Benefits)
The amended provision of attached Table 1 shall apply, beginning with the medical benefits provided on or after the day this Decree enters into force.
ADDENDA <Presidential Decree No. 26606, Oct. 29, 2015>
Article 1 (Enforcement Date)
This Decree shall enter into force on November 1, 2015.
Article 2 (Applicability to Share of Expenses Borne by Fund from among Expenses Incurred in Providing Medical Benefits)
The amended provisions of subparagraph 1 (f) and subparagraph 2 (h) of attached Table 1 shall apply, beginning with the medication dispensed according to a prescription issued on after November 1, 2015.
ADDENDUM <Presidential Decree No. 26844, Dec. 31, 2015>
This Decree shall enter into force on the date of its promulgation.
ADDENDA <Presidential Decree No. 27275, Jun. 28, 2016>
Article 1 (Enforcement Date)
This Decree shall enter into force on June 30, 2016: Provided, That the amended provisions of subparagraph 1 (d) and (e) of attached Table 1, and subparagraph 2 (c), (e) and (f) of the same Table shall enter into force on July 1, 2016; and the amended provision of Article 16-3 shall enter into force on August 4, 2016. Article 2 (Applicability to Disposition on Defaulters of Penalty Surcharges)
The amended provisions of Article 16-3 shall be applicable even to a person who does not pay a penalty surcharge by the deadline after this Decree enters into force even though he/she receives a reminder before August 4, 2016. Article 3 (Applicability to Medical Benefits of Dentures, Dental Implants, etc.)
The amended provisions of subparagraph 1 (d) and (e) of attached Table 1 and subparagraph 2 (c), (e) and (f) of the same Table shall apply, beginning with the medical benefits provided on or after July 1, 2016.
ADDENDA <Presidential Decree No. 27730, Dec. 30, 2016>
Article 1 (Enforcement Date)
This Decree shall enter into force on January 1, 2017.
Article 2 (Transitional Measures concerning Share of Expenses Borne by Fund for Out-Patient Treatment of Pregnant Women, etc.)
The amended provisions of subparagraph 2 (i) and (j) of attached Table 1 shall apply, beginning with the medical benefits provided on or after the day this Decree enters into force.
ADDENDA <Presidential Decree No. 27934, Mar. 8, 2017>
Article 1 (Enforcement Date)
This Decree shall enter into force on March 13, 2017.
Article 2 (Applicability to Share of Expenses Borne by Fund for Treatment of Mentally Ill Out-Patients)
The amended provisions of subparagraphs 1 (g) and 2 (k) through (m) of attached Table 1 shall apply, beginning with the medical benefits provided on or after the date this Decree enters into force.
ADDENDA <Presidential Decree No. 28349, Sep. 29, 2017>
Article 1 (Enforcement Date)
This Decree shall enter into force on October 1, 2017: Provided, That the amended provisions of subparagraphs 1 (d) and 2 (e) of attached Table 1 shall enter into force on November 1, 2017.
Article 2 (Applicability to Share of Medical Benefits Expenses Borne by Fund)
| (1) | The amended provisions of subparagraphs 1 (d) and 2 (e) of attached Table 1 shall apply, beginning with the medical benefits provided on or after November 1, 2017. |
| (2) | The amended provisions of subparagraph 2 (n) through (q) of attached Table 1 shall apply, beginning with the medical benefits provided on or after October 1, 2017. |
ADDENDA <Presidential Decree No. 28550, Dec. 29, 2017>
Article 1 (Enforcement Date)
This Decree shall enter into force on the date of its promulgation.
Article 2 (Applicability to Maximum Share of Expenses Borne by Eligible Recipients Which Is to Be Covered by Benefits)
The amended provisions of Article 13 (6) 2 shall apply, beginning with the medical benefits provided on or after the date this Decree enters into force.
ADDENDUM <Presidential Decree No. 28603, Jan. 23, 2018>
This Decree shall enter into force on the date of its promulgation.
ADDENDA <Presidential Decree No. 29003, Jun. 26, 2018>
Article 1 (Enforcement Date)
This Decree shall enter into force on July 1, 2018.
Article 2 (Applicability to Share of Medical Benefit Expenses Borne by Fund)
The amended provisions of attached Table 1 shall begin to apply to the medical benefits provided on or after July 1, 2018.
ADDENDA <Presidential Decree No. 29265, Oct. 30, 2018>
Article 1 (Enforcement Date)
This Decree shall enter into force on November 1, 2018.
Article 2 (Transitional Measures concerning Changing Criteria for Disposition of Business Suspension and Imposition of Penalty Surcharges)
| (1) | Notwithstanding the amended provisions of attached Table 2 or 3, the previous provisions shall apply to the disposition to suspend business or to impose a penalty surcharge for violations committed during an investigation period that ends before November 1, 2018. |
| (2) | The amended provisions of attached Table 2 or 3 shall apply to the disposition to suspend business or to impose a penalty surcharge for violations committed during an investigation period that commences before and ends after November 1, 2018: Provided, That the previous provisions shall apply where the application of such amended provisions is more disadvantageous to an institution providing medical benefits than the application of the previous provisions, during an investigation period until October 31, 2018. |
| (3) | Notwithstanding the proviso to Article 2 (1) and (2) of the Addenda, the amended provisions of subparagraph 1 (a) (i) of attached Table 2 and subparagraph 3 of attached Table 3 shall apply to reduction and exemption regarding violations committed during an investigation period until October 31, 2018. |
ADDENDA <Presidential Decree No. 29410, Dec. 24, 2018>
Article 1 (Enforcement Date)
This Decree shall enter into force on January 1, 2019.
Article 2 (Applicability to Share of Expenses Borne by Medical Benefits Fund for Out-Patient Treatment of Eligible Recipients under One Year of Age)
The amended provisions of subparagraph 2 (s) and (t) of attached Table 1 shall begin to apply to the medical benefits provided after this Decree enters into force.
Article 3 (Applicability to Share of Expenses Borne by Medical Benefits Fund for Eligible Recipients Provided with Medical Benefits in Excess of Limits)
The amended provisions of subparagraph 3 (c) of attached Table 1 shall begin to apply to the medical benefits provided after this Decree enters into force.
Article 4 (Applicability to Standards to Pay Monetary Awards)
The amended provisions of attached Table 4 shall begin to apply to the reporting of an institution providing medical benefits, which received expenses incurred in providing benefits by fraud or other improper means, after this Decree enters into force.
ADDENDA <Presidential Decree No. 29676, Apr. 2, 2019>
Article 1 (Enforcement Date)
This Decree shall enter into force on the date of its promulgation.
Article 2 (Applicability to Share of Expenses Borne by Medical Benefits Fund for Chuna Manual Therapy)
The amended provisions of subparagraph 3 (d) of attached Table 1 shall begin to apply to the medical benefits provided on or after April 8, 2019.
ADDENDA <Presidential Decree No. 29945, Jul. 2, 2019>
Article 1 (Enforcement Date)
This Decree shall enter into force on the date of its promulgation.
Article 2 (Applicability to Share of Expenses Borne by Medical Benefits Fund)
The amended provisions of subparagraph 3 (b) of attached Table 1 shall begin to apply to the medical benefits provided on or after July 1, 2019.
ADDENDUM <Presidential Decree No. 29950, Jul. 2, 2019>
This Decree shall enter into force on the date of its promulgation. (Proviso Omitted.)
ADDENDUM <Presidential Decree No. 30061, Aug. 27, 2019>
This Decree shall enter into force on the date of its promulgation.
ADDENDA <Presidential Decree No. 30144, Oct. 22, 2019>
Article 1 (Enforcement Date)
This Decree shall enter into force on November 1, 2019: Provided, That the amended provisions of subparagraph 2 (j) of attached Table 1 shall enter into force on January 1, 2020.
Article 2 (Applicability to Share of Expenses Borne by Medical Benefits Fund)
The amended provisions of subparagraphs 2 (j) and 3 (b) of attached Table 1 shall begin to apply to the medical benefits provided on or after the date this Decree enters into force.
ADDENDA <Presidential Decree No. 30748, Jun. 2, 2020>
Article 1 (Enforcement Date)
This Decree shall enter into force on July 1, 2020.
Article 2 (Applicability to Share of Expenses Borne by Medical Benefits Fund)
The amended provisions of subparagraph 1 (h) (ii) and subparagraph 2 (r) (ii) of attached Table 1 shall begin to apply to the medical benefits provided on or after July 1, 2020.
Article 4 (Applicability to Standards for Payment of Monetary Awards)
The amended provisions of subparagraph 1 of attached Table 4 shall begin to apply to reports filed on an institution providing medical benefits that receives the expenses for benefits by deceit or other improper means after this Decree enters into force.
ADDENDA <Presidential Decree No. 31097, Oct. 7, 2020>
Article 1 (Enforcement Date)
This Decree shall enter into force on the date of its promulgation.
Article 2 (Applicability to Share of Expenses Borne by Medical Benefits Fund)
The amended provisions of subparagraphs 1 (h) (iii) and 2 (r) (iii) of attached Table 1 shall begin to apply to the medical benefits provided on or after the date this Decree enters into force.
ADDENDA <Presidential Decree No. 31337, Dec. 29, 2020>
Article 1 (Enforcement Date)
This Decree shall enter into force on January 1, 2021.
Article 2 (General Applicability)
This Decree shall also apply to cases under criminal investigations by a judicial police officer as at the time this Decree enters into force.
ADDENDA <Presidential Decree No. 31614, Apr. 6, 2021>
Article 1 (Enforcement Date)
This Decree shall enter into force on April 6, 2021.
Articles 2 and 3 Omitted.
ADDENDA <Presidential Decree No. 31633, Apr. 20, 2021>
Article 1 (Enforcement Date)
This Decree shall enter into force on the date of its promulgation.
Article 2 (Applicability to Share of Expenses Borne by Medical Benefits Fund)
The amended provisions of subparagraphs 1 (g) and 2 (k) and (m) of attached Table 1 shall begin to apply to the medical benefits provided on or after the date this Decree enters into force.
ADDENDUM <Presidential Decree No. 32528, Mar. 8, 2022>
This Decree shall enter into force on the date of its promulgation.
ADDENDA <Presidential Decree No. 32551, Mar. 22, 2022>
Article 1 (Enforcement Date)
This Decree shall enter into force on the date of its promulgation: Provided, That the amended provisions of attached Tables 2 and 3 shall enter into force on April 1, 2022.
Article 2 (Applicability to Share of Expenses Borne by Medical Benefits Fund)
The amended provisions of subparagraphs 1 (i) and 2 (u) of attached Table 1 shall begin to apply to medical benefits provided after this Decree enters into force.
Article 3 (Applicability Following Change of Criteria for Disposition of Business Suspension and Imposition of Penalty Surcharges)
| (1) | The amended provisions of attached Tables 2 and 3 shall also apply to a disposition of business suspension or imposition of penalty surcharges against violations committed during an investigation period that begins before the enforcement date prescribed in the proviso of Article 1 of the Addenda and ends on or after the same enforcement date: Provided, That the previous provisions shall apply where the application of the amended provisions of attached Table 2 or 3 is more disadvantageous to an institution providing medical benefits than the application of the previous provisions. |
| (2) | Notwithstanding the amended provisions of attached Table 2 or 3, the previous provisions shall apply to a disposition of business suspension or imposition of penalty surcharges against violations committed during an investigation period that ends before the enforcement date prescribed in the proviso of Article 1 of the Addenda. |
ADDENDA <Presidential Decree No. 32865, Aug 9, 2022>
Article 1 (Enforcement Date)
This Decree shall enter into force on January 1, 2023.
Article 2 (Transitional Measures concerning Classification of Eligible Recipients of Medical Benefits)
| (1) | Notwithstanding the amended provisions of Article 3 (2) through (4), the former provisions shall apply where an application for recognition of eligibility was filed pursuant to Article 3-3 (1) of the Act before this Decree enters into force, or where the procedure is underway as at the time this Decree enters into force to recognize a person who is recommended and notified on by the Minister of Patriots and Veterans Affairs and the Administrator of the Cultural Heritage Administration as an eligible recipient, because the person is deemed necessary to be recognized as an eligible recipient. |
| (2) | Notwithstanding the amended provisions of Article 3 (2) through (4), a person recognized as a type 1 eligible recipient under the former provisions of Article 3 (2) 2 as at the time this Decree enters into force shall be deemed a type 1 eligible recipient until he or she loses his or her eligibility as an eligible recipient under Article 3 (1) of the Act after this Decree enters into force. |
AADDENDA <Presidential Decree No. 33382, Apr. 11, 2023>
Article 1 (Enforcement Date)
This Decree shall enter into force on June 5, 2023.
Articles 2 through 5 Omitted.
ADDENDUM <Presidential Decree No. 33716, Sep. 12, 2023>
This Decree shall enter into force on September 29, 2023.