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ENFORCEMENT DECREE OF THE ACT ON THE SUPPORT FOR CATASTROPHIC HEALTH EXPENDITURE

Presidential Decree No. 29001, jun. 26, 2018

Amended by Presidential Decree No. 32098, Nov. 1, 2021

Presidential Decree No. 34042, Dec. 26, 2023

 Article 1 (Purpose)
The purpose of this Decree is to prescribe matters mandated by the Act on the Support for Catastrophic Health Expenditure and those necessary for enforcing said Act.
 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: Provided, That excluded herefrom shall be the expenses incurred in items requiring less support, such as beauty treatment, plastic surgery, and medical treatment for preventing illnesses or not for improving vital functions of the body, which are determined and publicly notified by the Minister of Health and Welfare:
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 a 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) Health expenditure under paragraph (1) shall be any of the following expenses: <Amended on May 9, 2023; Dec. 26, 2023>
1. Expenses incurred in inpatient treatment within one year prior to the final inpatient treatment, and expenses incurred in the course of such treatment, which refer to those for purchasing drugs or medical devices falling under any item of article 10 (1) 3 of the Act (hereafter in this paragraph referred to as "expenses for purchasing drugs, etc.");
2. Expenses incurred in outpatient treatment within one year prior to the final outpatient treatment and expenses incurred in the course of such treatment, which refer to those for purchasing drugs, etc.;
3. Deleted. <Dec. 26, 2023>
(3) Except as provided in paragraphs (1) and (2), matters necessary for calculating catastrophic health expenditure shall be determined and publicly notified by the Minister of Health and Welfare. <Amended on Dec. 26, 2023>
 Article 4 Deleted. <May 9, 2023>
 Article 5 Deleted. <May 9, 2023>
 Article 6 Deleted. <May 9, 2023>
 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) Where the person rears any minor child who is a national of the Republic of Korea (including a person in a stepfather-stepchild relationship; stepmother-stepchild relationship; or adoptive relationship; hereafter in this Article, 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 Deleted. <May 9, 2023>
 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 mutatis mutandis to assessing the values of unlisted stocks;
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 National Health Insurance Service under Article 13 of the National Health Insurance Act (hereinafter referred to as the "NHIS") requests the head of a financial company, etc. under subparagraph 1 of Article 2 of the Act on Real Name Financial Transactions and Confidentiality or the head of a centralized credit information collection agency under Article 25 (2) 1 of the Credit Information Use and Protection Act (hereinafter referred to as "financial institution, etc.") to provide information referred to in the subparagraphs of Article 9 (1) or (2) (hereinafter referred to as "financial information, etc.") of persons eligible for support and their household members pursuant to Article 11 of the Act, it shall do so in writing stating the following: <Amended on Aug. 4, 2020; May 9, 2023>
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 eligible for support under Article 12 of the Act shall be paid an amount equivalent to 80/100 (any fraction 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, no payment shall be made: <Amended on Nov. 1, 2021>
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 Si/Gun/Gu calculates an amount paid to an eligible recipient under Article 13 (5) of the Enforcement Decree of the Medical Care Assistance Act.
(2) Notwithstanding the main clause of paragraph (1), an amount calculated at a rate determined and publicly notified by the Minister of Health and Welfare (any fraction less than 10 won shall not be calculated) of at least 50/100 but not more than 70/100 of the aggregate of expenses under the subparagraphs of paragraph (1) (excluding expenses publicly notified pursuant to the proviso of Article 2 (1)) shall be paid to the following persons eligible for support (excluding expenses publicly notified pursuant to the proviso of Article 2 (1)): <Newly Inserted on Nov. 1, 2021; May 9, 2023>
1. A person deemed necessary by the Minister of Health and Welfare to be provided with support pursuant to Article 9 (2) of the Act;
2. A foreigner who falls under any subparagraph of Article 9 (3) of the Act and who is determined and publicly notified by the Minister of Health and Welfare;
3. A person who falls under Article 7 (1) 3.
(3) The amount of support provided pursuant to paragraphs (1) and (2) shall not exceed any of the following amounts: <Amended on Nov. 1, 2021; May 9, 2023; Dec. 26, 2023>
1. An amount incurred in inpatient treatment or outpatient treatment 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 300/100 of the amount obtained by converting the standard median income of a one-person household prescribed in subparagraph 11 of Article 2 of the National Basic Living Security Act and Article 6-2 of that Act into the annual income.
 Article 12 (Money and Valuables Excluded from Payment)
"Cases prescribed by Presidential Decree" in Article 13 (2) of the Act means any of the following:
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)
When the NHIS cannot transfer support money to a designated account due to unavoidable reasons including an information and communications network malfunction, it may transfer the money to an account under the name of another person designated by a person eligible for support or may directly pay it in cash pursuant to the proviso of Article 14 (1) of the Act.
 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 (Write-Off of Deficits)
"Cases prescribed by Presidential Decree" in Article 19 (1) 2 of the Act means the following cases: <Amended on May 9, 2023>
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 it is verified that no remainder will be left after the total property subject to delinquency disposition is appropriated for the repayment of national taxes, local taxes, and debts secured by the right to lease on a deposit basis, a right of pledge, a mortgage, or obligation secured by security interests under the Act on Security over Movable Property and Claims, which take precedence over unjust enrichment;
4. Where the NHIS deems that the collection is unlikely to be made due to other unavoidable reasons.
 Article 16 (Funds)
"Revenues prescribed by Presidential Decree" in Article 20 (1) 6 of the Act means the revenues generated from managing the funds specified in Article 20 (1) 1 through 5 of the Act.
 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: Provided, That the period may be extended by up to 30 days where any unavoidable reason exists.
(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 10-2 (Processing of Sensitive Information and Personally Identifiable Information)
(1) The NHIS, healthcare institutions, institutions providing medical benefits, etc. may manage information on health under Article 23 of the Personal Information Protection Act and data containing resident registration numbers, passport numbers, or alien registration numbers under subparagraph 1, 2, or 4 of Article 19 of the Enforcement Decree of that Act, if unavoidable to perform the following affairs pursuant to Article 25 (1) 4 of the Act: Provided, That in cases of affairs referred to in subparagraphs 1 through 3, information on health under Article 23 of the Personal Information Protection Act shall be excluded:
1. Affairs regarding restrictions on payment under Article 15 of the Act;
2. Affairs regarding the right to demand reimbursement under Article 18 of the Act;
3. Affairs regarding write-off of deficits under Article 19 of the Act;
4. Affairs regarding requests for, and cooperation in, the provision of materials under Article 21 of the Act.
(2) The Minister of Health and Welfare or the NHIS may process information that constitute criminal history records under subparagraph 2 of Article 18 of the Enforcement Decree of the Personal Information Protection Act, if unavoidable to perform the following affairs:
1. Affairs regarding requests for the provision of materials under Article 21 of the Act (limited to where it is necessary to verify the appropriateness of the determination on the payment of support money or of the payment thereof);
2. Affairs regarding investigations, etc. under Article 22 of the Act.
[This Article Newly Inserted on Aug. 22, 2023]
 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)
The criteria for imposing administrative fines prescribed in Article 30 (1) of the Act shall be as specified in attached Table 2.
ADDENDUM <Presidential Decree No. 29001, Jun. 26, 2018>
This Decree shall enter into force on July 1, 2018.
ADDENDA <Presidential Decree No. 30760, Jun. 9, 2020>
Article 1 (Enforcement Date)
This Decree shall enter into force on June 11, 2020.
Articles 2 through 13 Omitted.
ADDENDA <Presidential Decree No. 30893, Aug. 4, 2020>
Article 1 (Enforcement Date)
(1) This Decree shall enter into force on August 5, 2020. (Proviso Omitted.)
(2) and (3) Omitted.
Articles 2 through 4 Omitted.
ADDENDA <Presidential Decree No. 31240, Dec. 8, 2020>
Article 1 (Enforcement Date)
This Decree shall enter into force on December 10, 2020.
Article 2 Omitted.
ADDENDA <Presidential Decree No. 32098, Nov. 1, 2021>
Article 1 (Enforcement Date)
This Decree shall enter into force on the date of its promulgation.
Article 2 (Applicability to Change of Rate of Support for Persons Eligible for Support)
The amended provisions of Article 11 shall also apply to those in whose case the procedures for the payment of catastrophic health expenditure are in progress as at the time this Decree enters into force.
ADDENDUM <Presidential Decree No. 33455, May 9, 2023>
This Decree shall enter into force on the date of its promulgation.
ADDENDUM <Presidential Decree No. 33675, Aug. 22, 2023>
This Decree shall enter into force on September 29, 2023.
ADDENDA <Presidential Decree No. 34042, Dec. 26, 2023>
Article 1 (Enforcement Date)
This Decree shall enter into force on January 1, 2024.
Article 2 (Applicability to Standards for Calculation of Catastrophic Health Expenditure and Standards for Support)
The amended provisions of Articles 3 (2) and 11 (3) 1 shall begin to apply to cases where an application for the payment of catastrophic health expenditure is filed after this Decree enters into force.