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STATUTES

THE REPUBLIC OF KOREA

Volume

NATIONAL HEALTH INSURANCE ACT

Wholly Amended by Act No. 11141, Dec. 31, 2011

Amended by Act No. 11787, May 22, 2013

Act No. 12176, Jan. 1, 2014

CHAPTER I GENERAL PROVISIONS

Article 1 (Purpose)

The purpose of this Act is to improve citizens' health and promote social security by providing citizens with insurance benefits for the prevention, medical examination, medical treatment of and rehabilitation from diseases and injury, for childbirth and death, and for improvement of health.

Article 2 (Charge)

The Minister of Health and Welfare shall administer the national health insurance program prescribed by this Act.

Article 3 (Definitions)

The definitions of the terms used in this Act shall be as follows:

1. The term "worker"

Article 1 ~ 3

means a person who, regardless of the type of his/her occupation, lives on remuneration received as compensation for his/her work (including a director or other executive of a corporation), except for a public official or a school employee;

2. The term "employer" means a person who falls under any of the following items:

(a) The owner of the workplace at which a worker is employed;

(b) The head of the organ at which a public official is employed, who is determined by Presidential Decree;

(c) The person who establishes and operates a private school (referring to a private school referred to in Article 3 of the Pension for Private School Teachers and Staff Act; hereafter the same shall apply in this Article) at which a school employee is employed;

3. The term "workplace" means a place of business or office;

4. The term "public official" means a person who is a regular employee of the State or a local government providing civil service;

5. The term "school

Article 3

employee" means a teacher at, or an employee of, a private school or an organization that manages the school.

Article 4 (Health Insurance Policy Deliberative Committee)

(1) The Health Insurance Policy Deliberative Committee (hereinafter referred to as the "Deliberative Committee") mandated to deliberate and vote on matters concerning health insurance policies, which fall under each of the following subparagraphs, shall be established under the Minister of Health and Welfare:

1. The standards for medical care benefits provided for in Article 41 (2);

2. Matters concerning medical care benefit costs provided for in Article 45 (3) and 46;

3. The insurance premium rates of employer-provided policyholders provided for in Article 73 (1);

4. The monetary value per contribution point of the locally provided policyholders provided for in Article 73 (3);

5. Other important matters prescribed by Presidential Decree concerning health insurance.

(2) The Deliberative Committee shall be comprised of 25 members, including one chairperson and one vice chairperson.

(3) The chairperson

Article 4

of the Deliberative Committee shall be the Vice Minister of Health and Welfare and the vice chairperson shall be nominated by the chairperson from among the members referred to in paragraph (4) 4.

(4) The following persons shall be appointed or commissioned by the Minister of and Welfare as members of the Deliberative Committee:

1. Two persons, each recommended respectively by workers' organizations and employers' organizations;

2. One person, each recommended respectively by civil organizations (referring to the non-profit civil organizations provided for in Article 2 of the Assistance for Non-Profit, Non-Governmental Organizations Act; hereinafter the same shall apply), consumers' organizations, organizations of farmers and fishermen, and organizations of self-employed persons;

3. Eight persons who are recommended by the organizations representing the medical profession and the organizations representing the medicine manufacturers;

4. Eight persons falling under each of the following items:

(a) Two public officials who belong to central administrative agencies prescribed by Presidential Decree;

(b) One

Article 4

person, each recommended respectively by the president of the National Health Insurance Corporation and the president of the Health Insurance and Assessment Service;

(5) The terms of office of the members of the Deliberative Committee shall be three years: Provided, That the term of office for any member newly appointed, filling a vacancy of a resigned member, etc. shall be the remainder of the term of office for his/her predecessor.

(6) Matters necessary for the operation, etc. of the Deliberative Committee shall be prescribed by Presidential Decree.

CHAPTER II POLICYHOLDERS

Article 5 (Eligible Persons, etc.)

(1) Korean nationals who reside within Korea shall become policyholders (hereinafter referred to as "policyholder") of the health insurance referred to in this Act (hereinafter referred to as "health insurance") or their dependents: Provided, That this shall not apply to any of the following persons:

1. Persons who receive medical benefits under the provisions of the Medical Care Assistance Act (hereinafter referred to as "persons eligible for medical care");

Article 5

2. Persons who receive medical care under the provisions of the Act on the Honorable Treatment of Persons of Distinguished Services to Independence and the Act on the Honorable Treatment and Support of Persons, etc. of Distinguished Services to the State (hereinafter referred to as "persons eligible for medical care for distinguished service"): Provided, That any of the following persons shall be a policyholder or a dependent:

(a) A person from among persons eligible for medical care for distinguished service, who requests the insurer to provide him/her with health insurance cover;

(b) A person who does not request the insurer that he/she be excluded from health insurance cover, despite of change of his/her status from a person under the coverage of the health insurance to a person eligible for medical care for distinguished service.

(2) Dependents of policyholders referred to in paragraph (1) refers to any of the following persons who are supported mainly by employer-provided policyholders and do not have other remuneration or income:

1. Spouses of employer-provided policyholders;

2. Lineal ascendants of employer-provided policyholders (including lineal ascendants of their spouses);

Article 5

3. Lineal descendants (including lineal descendants of their spouses) and their spouses of employer-provided policyholders;

4. Brothers/sisters of employer-provided policyholders.

(3) The standards for determination of the dependent eligibility referred to in paragraph (2), time of acquisition or loss of such eligibility, and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare.

Article 6 (Categories of Policyholders)

(1) Policyholders shall be divided into employer-provided policyholders and locally provided policyholders.

(2) Workers and employers of all workplaces and public officials and school employees shall become employer-provided policyholders: Provided, That any of the following persons shall be excluded herefrom:

1. Daily-paid workers who are employed for a period of less than one month;

2. Soldiers in active service under the Military Service Act (including staff sergeants appointed without volunteering), secondment personnel and candidates for military officers;

3. Public officials who assume office by winning an election, and who

Article 6

do not receive monthly remuneration or salary equivalent thereto;

4. Workers and employers of workplaces prescribed by Presidential Decree, in light of the characteristics of workplace, forms of employment and kinds of business, and public officials and school employees.

(3) Persons who are neither employer-provided policyholders nor their dependents shall be locally provided policyholders.

(4) Workers and employers under paragraph (2) 4 may either become employer-provided policyholders or withdraw from such status, according to the procedures prescribed by Presidential Decree.

Article 7 (Reporting on Workplace)

Where an employer of a workplace falls under any of the following subparagraphs, he/she shall report such fact to an insurer, as prescribed by Ordinance of the Ministry of Health and Welfare within 14 days thereafter. This shall also apply where any matter reported to the insurer is changed as he/she falls under subparagraph 1:

1. Where his/her workplace becomes a workplace using employees, public officials and school employees who become employer-provided policyholders pursuant to Article 6 (2) (hereinafter referred to as a "workplace of eligible persons");

2. Where a cause

Article 7

prescribed by Ordinance of the Ministry of Health and Welfare exists, such as suspension of business and closure of business.

Article 8 (Time, etc. of Acquisition of Eligibility)

(1) A policyholder shall become eligible as an employer-provided policyholder or a locally provided policyholder on the day he/she takes residence in the country: Provided, That a person who falls under any of the following subparagraphs shall become eligible for each on the applicable day:

1. For a former person eligible for medical care, on the day when he/she becomes excluded from such eligibility;

2. The day on which a former dependent of an employer-provided policyholder loses his/her eligibility;

3. For a former person eligible for medical care for distinguished service, on the day when he/she is excluded from such eligibility;

4. For a person eligible for medical care for distinguished service who requests the insurer for coverage under the health insurance under Article 5 (1) 2 (a), on the day when the request is made.

(2) If a person becomes eligible under paragraph (1), the employer of the employer-provided policyholder concerned or the head of the household of the locally provided policyholder concerned shall report the particulars to the insurer as prescribed by Ordinance

Article 8

of the Ministry of Health and Welfare within 14 days after the date of acquisition of the eligibility.

Article 9 (Time, etc. of Change in Eligibility)

(1) The eligibility of a policyholder shall change on the date when he/she falls under any of the following subparagraphs:

1. When a locally provided policyholder becomes an employer of a workplace of eligible persons or is employed as an employee, public official or school employee (hereinafter referred to as an "employee, etc.");

2. When an employer-provided policyholder becomes an employer of another workplace of eligible persons or is employed as an employee, etc.;

3. On the date immediately following the date of expiration of employment relationship of employer, etc. who is an employer-provided policyholder;

4. On the date immediately following the date on which any cause under subparagraph 2 of Article 7 occurs at the workplace of eligible persons;

5. On the date on which a locally provided policyholder moves into another household.

(2) Where the eligibility of a policyholder changes under paragraph (1), the employer of an employer-provided policyholder or a householder of an locally provided policyholder shall report the particulars

Article 9

to the insurer according to the following distinction as prescribed by Ordinance of the Ministry of and Welfare within fourteen days from the date on which the eligibility changes:

1. Where eligibility changes pursuant to subparagraphs 1 and 2 of paragraph (1): employer of the employer-provided policyholder;

2. Where there is a change in eligibility pursuant to subparagraphs 3 through 5 of paragraph (1): householder of a locally provided policyholder.

(3) Where an employer-provided policyholder or locally provided policyholder falls under subparagraph 3 or 4 of Article 54, the Minister of National Defense and the Minister of Justice shall notify the insurer as provided by Ordinance of the Ministry of Health and Welfare within one month from the date of such change.

Article 10 (Time, etc. of Loss of Eligibility)

(1) A policyholder shall lose his/her eligibility on the day he/she falls under any of the following subparagraphs:

1. Day after the day he/she dies;

2. Day after the day he/she loses his/her nationality;

3. Day after the day he/she ceases to reside within the country;

Article 10

4. The day he/she becomes a dependent of an employer-provided policyholder;

5. The day he/she becomes a person eligible for medical care;

6. The day a request for exclusion from coverage of the health insurance is made by a person formerly covered by health insurance but became a person eligible for medical care for distinguished service.

(2) If eligibility is lost under paragraph (1), the employer of the employer-provided policyholder concerned or the head of the household of the locally provided policyholder concerned shall report the particulars to the insurer as prescribed by Ordinance of the Ministry of Health and Welfare within 14 days after the date of loss of the entitlement.

Article 11 (Confirmation of Acquisition, etc. of Eligibility)

(1) Acquisition, change, or loss of the entitlement of a policyholder shall take effect retrospectively from the time of acquisition, change or loss of the eligibility under Articles 8 through 10. In such cases, the insurer may confirm the fact thereof.

(2) A policyholder or a former policyholder, or a dependent or a former dependent may request the confirmation referred to in paragraph (1).

Article 12 (Health Insurance Card)

Article 11 ~ 12

(1) The National Health Insurance Corporation shall issue health insurance cards to the policyholders.

(2) When a policyholder or his/her dependent receives a medical care benefit, he/she shall present the insurance card referred to in paragraph (1) to a medical care institution referred to in Article 42 (1) (hereinafter referred to as "medical care institution"): Provided, That this shall not apply if an unavoidable circumstance such as a natural disaster exists.

(3) Notwithstanding the main sentence of paragraph (2), a policyholder or a dependent may not, if it is possible for a health care institution to ascertain his/her eligibility using his/her resident registration certificate, driver's license, passport or other identification prescribed by Ordinance of the Ministry of Health and Welfare to confirm himself/herself, submit his/her health insurance card.

(4) Neither a policyholder nor his/her dependent may receive insurance benefits after losing his/her eligibility under Article 10 (1) by a document that had been used to certify his/her eligibility before. <Newly Inserted by Act No. 11787, May 22, 2013>

(5) No person is allowed to arrange another person to receive insurance benefits by transferring or lending his/her health insurance card or identification. <Newly Inserted by Act No. 11787, May 22, 2013>

Article 12

(6) No person is allowed to receive insurance benefits by taking over, borrowing, or fraudulently using, another person's health insurance card or identification. <Amended by Act No. 11787, May 22, 2013>

(7) Matters necessary with regard to the form of the health insurance card referred to in paragraph (1) and issuing and using it shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 11787, May 22, 2013>

CHAPTER III NATIONAL HEALTH INSURANCE CORPORATION

Article 13 (Insurer)

The insurer of national health insurance shall be the National Health Insurance Corporation (hereinafter referred to as the "Corporation").

Article 14 (Affairs, etc.)

(1) The Corporation shall administer the following affairs:

1. Supervision of the eligibility of policyholders and their dependents;

2. Imposition and collection of insurance premiums and other fees provided

Article 13 ~ 14

for in this Act;

3. Administration of insurance benefits;

4. Preventive programs necessary for maintenance and improvement of health of policyholders and their dependents;

5. Payment of insurance benefit costs;

6. Programs for managing, employing and increasing its assets;

7. Operation of medical facilities;

8. Educational training and publicity in connection with health insurance;

9. Investigative research and international cooperation in connection with health insurance;

10. Matters prescribed by this Act as the duties of the Corporation;

11. Operations delegated under the National Pension Act, the Act on the Collection of Insurance Premiums, etc. for Employment Insurance and Industrial Accident Compensation Insurance, the Wage Claim Guarantee Act, and the Asbestos Injury Relief Act (hereinafter referred to as "law applicable to the entrustment of collection");

12. Other operations

Article 14

delegated under this Act or other Acts and subordinate statutes;

13. Other operations determined by the Minister of Health and Welfare as being necessary in connection with health insurance.

(2) Programs for managing, employing, and increasing assets under paragraph (1) 6 shall be carried out in accordance with each of the following methods taking the stability and profitability into consideration:

1. Making deposits or setting up trust at offices of communication or banks established under the Banking Act;

2. Purchase of securities issued directly, or fulfillment of the obligation thereof is guaranteed, by the State, local governments, or banks established under the Banking Act;

3. Purchase of securities issued by a corporation established under any Special Act;

4. Purchase of securities issued by trust business entities established under the Financial Investment Services and Capital Markets Act or collective investment business entities established under the same Act;

5. Acquisition of real estates for use in operating the Corporation or partial lease thereof ;

Article 14

6. Other programs prescribed by Presidential Decree as necessary to increase the assets of the Corporation.

(3) If a service is provided, or the use of the facilities of the Corporation is allowed to, a specific person, the Corporation may collect a service charge or a use fee for the provision of the service or the use of the facilities, as prescribed by the Corporation's articles of incorporation.

(4) The Corporation shall disclose to the public, the information that it maintains and manages in connection with health insurance as prescribed by the Official Information Disclosure Act.

Article 15 (Legal Personality of Corporation)

(1) The Corporation shall be a juristic person.

(2) The Corporation shall come into existence upon registering its establishment at the seat of its principal office.

Article 16 (Office)

(1) Location of the principal office of the Corporation shall be determined by its articles of incorporation.

(2) If necessary, the Corporation may establish branch offices as prescribed by its articles of incorporation.

Article 17 (Articles of Incorporation)

Article 15 ~ 17

(1) The articles of incorporation of the Corporation shall state the following matters:

1. Objectives;

2. Its name;

3. Seat of office;

4. Matters concerning its executives and employees;

5. Management of board of directors;

6. Matters concerning its financial operation committee;

7. Matters concerning insurance premiums and insurance benefits;

8. Matters concerning its budget and settlement of accounts;

9. Matters concerning its assets and accounting;

10. Services and provision thereof;

11. Matters concerning amendment of the articles of incorporation;

12. Matters concerning public announcements.

Article 17

(2) When the Corporation intends to modify its articles of incorporation, it shall obtain authorization of the Minister of Health and Welfare.

Article 18 (Registration)

The registration of incorporation of the Corporation shall include the following matters:

1. Objectives;

2. Its name;

3. Seat of the principal office and branch offices;

4. Name, address and resident registration number of the president.

Article 19 (Dissolution)

Matters regarding the dissolution of the Corporation shall be prescribed by Acts.

Article 20 (Executives)

(1) The Corporation shall have, as its executives, one president, fourteen directors and one auditor. In such cases, the president, five directors and the auditor shall be standing.

(2) The president shall be appointed by the President of the Republic of Korea

Article 18 ~ 20

upon recommendation of the Minister of Health and Welfare from among several persons recommended by the executive recommendation committee established under Article 29 of the Act on the Management of Public Institutions (hereinafter referred to as "executive recommendation committee").

(3) Full-time directors shall be appointed by the president following the recommendation procedures prescribed by Ordinance of the Ministry of Health and Welfare.

(4) As part-time directors, following persons shall be appointed by the Minister of Health and Welfare:

1. Persons, each one of whom is recommended respectively by labor unions, an employer organization, a civil organization, a consumer organization, an agricultural and fisheries organization, and a senor citizens' organization;

2. Three relevant public officials recommended as prescribed by Presidential Decree.

(5) The auditor shall be appointed by the President of the Republic of Korea upon recommendation by the Minister of Strategy and Finance from among several persons recommended by the executive recommendation committee.

(6) Part-time directors prescribed in paragraph (4) may receive reimbursement for actual expenses, as prescribed by the articles of incorporation.

Article 20

(7) The term of the office of the president shall be three years, and that of directors (excluding directors who are public officials) and auditor shall be two years respectively.

Article 21 (Collection Director)

(1) Among standing directors, a director who has extensive knowledge and experience in management, economy and social insurance and who meets the qualification determined by Ordinance of the Ministry of Health and Welfare shall be appointed as a director in charge of the operations under Article 14 (1) 2 and 11.

(2) The Corporation shall have a committee for nominating collection directors (hereinafter referred to as "Nomination Committee") in order to nominate candidates for a collection director, having directors as its members. In such cases, a director nominated by the president shall be the chairperson of the Nomination Committee.

(3) The Nomination Committee shall publish recruitment advertisement for a collection director on major daily newspapers, and in addition, may verify a candidate who is regarded as qualified, or request a specialized organization to verify such candidate.

(4) The Nomination Committee shall screen persons recruited pursuant to paragraph (3) according to the candidate screen criteria for a collection director determined by Ordinance of the Ministry of Health and Welfare, and consult on the contract terms with

Article 21

te collection director nominee.

(5) The president shall conclude a contract with the candidate for a collection director in accordance with the result of screening and consultation conducted under paragraph (4), and in such a case, a standing director shall be deemed appointed under Article 20 (3).

(6) Matters necessary for the consultation on contract terms under paragraph (4), contract conclusion, etc. under paragraphs (5) shall be prescribed by Ordinance of the Ministry of Health and Welfare.

[This Article Newly Inserted by Act No. 9690, May. 21, 2009]

Article 22 (Duties of Executives)

(1) The president shall represent the Corporation, exercise overall control over its affairs, and take responsibility for the management performance of the Corporation.

(2) The standing directors shall conduct the affairs of the Corporation under the order of the president.

(3) Where the president is unable to perform his/her duties due to an unavoidable circumstance, a standing director determined by the articles of incorporation shall act on behalf of the president, and where no standing director exists or a standing director is unable to perform such duties, an executive determined by articles of incorporation shall act on behalf of the president.

Article 22

(4) The auditor shall audit the status of the Corporation, its accounting and assets status.

Article 23 (Disqualification of Executives)

No person who falls under any of the following subparagraphs may become an executive of the Corporation:

1. A person who is not a national of the Republic of Korea;

2. A person falling under any subparagraph of Article 34 (1) of the Act on the Management of Public Institutions.

Article 24 (Obligatory Retirement and Dismissal of Executives)

(1) If an executive falls under any of the subparagraphs of Article 23, or is confirmed to fall thereunder at the time of his/her appointment, he/she shall be obligated to retire.

(2) If an executive falls under any of the following subparagraphs, the person with the power to appoint him/her may dismiss him/her:

1. Where he/she is deemed unable to perform his/her duties due to a physical or mental disability;

2. Where he/she breaches an official duty;

3. Where he/she causes loss to the Corporation, either intentionally or through gross negligence;

Article 23 ~ 24

4. Where he/she commits an act that damages his/her dignity, regardless of whether while on duty or off duty;

5. Where he/she violates an order of the Minister of Health and Welfare issued under this Act.

Article 25 (Prohibition, etc. of Executive''s Holding Concurrent Offices)

(1) Standing executives and employees of the Corporation may not engage in another business having a commercial purpose, in addition to the duties assigned to them.

(2) Where a standing executive of the Corporation obtains permission from the person with the power to appoint or recommend him/her, or where an employee of the Corporation obtains permission from the president thereof, such executive or employee may concurrently perform the affairs for non-profit purpose.

Article 26 (Board of Directors)

(1) The Corporation shall have a board of directors in order to deliberate on and resolve important matters (referring to matters prescribed in Article 17 (1) of the Act on the Management of Public Institutions) of the Corporation.

(2) The board of directors shall be comprised of the president and directors.

Article 25 ~ 26

(3) The auditor may appear before the board of directors to speak.

(4) Matters necessary with regard to the issues to be resolved by the board of directors and the operation of the board of directors shall be prescribed by Presidential Decree.

Article 27 (Appointment and Dismissal of Employees)

The president shall appoint and dismiss employees as prescribed by the articles of incorporation.

Article 28 (Legal Fiction of Public Officials in Application of Penal Provisions)

The executives and the employees of the Corporation shall be deemed public officials for the purposes of Articles 129 through 132 of the Criminal Act.

Article 29 (Rules, etc.)

Rules relevant to the organization, human resource related affairs, remunerations, and accounting of the Corporation shall be determined with approval from the Minister of Health and Welfare after undergoing a resolution of the board of directors.

Article 30 (Selection and Appointment of Agent)

The president

Article 27 ~ 30

may select and appoint an agent from among the directors or employees of the Corporation in order to have the agent act on behalf of him/her in all judicial or extra-judicial acts relevant to the affairs of the Corporation.

Article 31 (Limitation on Representative Powers)

(1) In connection with the matters with regard to which the interests of the Corporation and the interests of the president are in conflict, the president is not allowed to represent the Corporation. In such cases, the auditor shall represent the Corporation.

(2) Paragraph (1) shall apply mutatis mutandis to any litigation between the Corporation and the president.

Article 32 (Delegation of Powers of Chairperson of Board of Directors)

From among the powers of the president referred to in this Act, those prescribed by Presidential Decree, such as restriction of benefits and notice to pay insurance premiums, may be delegated to the heads of the branch offices pursuant to the articles of incorporation.

Article 33 (Financial Operation Committee)

(1) The Corporation shall have a financial operation committee to deliberate and resolve on the matters related to insurance finance, such as contracts of medical care benefit costs provided for

Article 31 ~ 33

in Article 45 (1), the deficit disposal provided for in Article 84.

(2) The chairperson of the financial operation committee shall be elected by the committee from among the committee members referred to in Article 34 (1) 3.

Article 34 (Composition, etc. of Financial Operation Committee)

(1) The financial operation committee shall be comprised of the following members:

1. 10 members representing the employer-provided policyholders;

2. 10 members representing the locally provided policyholders;

3. 10 members representing the public interest.

(2) As the members referred to in paragraph (1), the Minister of Health and Welfare shall appoint or commission the following persons:

1. As the committee members referred to in paragraph (1) 1, five persons each recommended by the labor unions' organization and by the employers' organization;

2. As the committee members referred to in paragraph (1) 2, persons recommended by the agricultural and fishery organization, the urban self-employed persons' organization and the civil

Article 34

organization as prescribed by Presidential Decree;

3. As the committee members referred to in paragraph (1) 3, relevant public officials and persons with extensive knowledge on and experience in health insurance who are determined by Presidential Decree.

(3) The term of the office of the members of the financial operation committee (excluding the members who are public officials) shall be two years: Provided, That the term of the office of any member newly appointed to fill a vacancy of a resigned member, etc. shall be the remaining term of his/her predecessor.

(4) Matters necessary with regard to the operation, etc. of the financial operation committee shall be prescribed by Presidential Decree.

Article 35 (Accounting)

(1) The fiscal year of the Corporation shall be based on the fiscal year of the Government.

(2) The Corporation shall administer the financial affairs of employer-provided policyholders and locally provided policyholders in an integrated manner.

(3) The Corporation shall keep separate accounting for the health insurance program, and the national pension program, employment insurance program, industrial accident compensation insurance program,

Article 35

and wage claim guarantee program entrusted under the law applicable to the entrustment of collection.

Article 36 (Budget)

The Corporation shall compile a proposed budget for each fiscal year with separate contents thereof based on the nature thereof, and obtain approval from the Minister of Health and Welfare. This shall also apply where it intends to modify the budget.

Article 37 (Loans)

The Corporation may borrow funds where a shortage of cash exists in making disbursements: Provided, That approval from the Minister of Health and Welfare is necessary for any long-term loan with a term of at least one year.

Article 38 (Reserve Funds)

(1) Out of the funds remaining after the settlement of accounts for each fiscal year, the Corporation shall accumulate as its reserve funds an amount equivalent to at least 5/100 of the expenses required for payment of insurance benefits for that fiscal year until the funds reach 50/100 of the expenses required for that fiscal year.

(2) The reserve funds referred to in paragraph (1) may not be used except to meet shortages in the expenses incurred in paying insurance benefits or where a shortage of cash exists in making disbursements; where the shortage of cash in making disbursements

Article 36 ~ 38

i met out of the reerve fund, the amount hall be made up for within the fiscal year concerned.

(3) Matters necessary for the method of managing, operating, etc. the reserve funds referred to in paragraph (1) shall be prescribed by the Minister of Health and Welfare.

Article 39 (Settlement of Accounts)

(1) The Corporation shall prepare a statement of accounts and a report on business performance for each fiscal year and report to the Minister of Health and Welfare thereon by the end of February in the following year.

(2) When the Corporation reports to the Minister of Health and Welfare on it statement of accounts and business report under paragraph (1), it shall publicly announce the contents thereof as prescribed by Ordinance of the Ministry of Health and Welfare.

Article 40 (Mutatis Mutandis Application of Civil Act)

Unless otherwise prescribed by this Act and the Act on the Management of Public Institutions, the provisions of the Civil Act that are relevant to an incorporated foundation shall apply mutatis mutandis to the Corporation.

CHAPTER IV INSURANCE BENEFITS

Article 41 (Medical Care Benefits)

(1) Medical care

Article 39 ~ 41

bnfits rfrrd to in th following subparagraphs shall be provided for diseases, injuries, childbirths, etc. of the policyholders and their dependents:

1. Diagnosis, medical examinations;

2. Supply of medicines and materials for medical treatment;

3. Emergency aid, operation or other types of medical treatments;

4. Prevention, rehabilitation;

5. Hospitalization;

6. Nursing;

7. Transfers.

(2) Criteria for medical care benefits referred to in paragraph (1) (hereinafter referred to as "medical care benefits"), such as the method, procedure, scope, and upper limit on medical care benefits shall be prescribed by Ordinance of the Ministry of Health and Welfare.

(3) In prescribing the criteria for medical care benefits under paragraph (2), the Minister of Health and Welfare may exclude ailments that do not cause difficulties at work or in daily life and other items determined by Ordinance of the Ministry of Health and Welfare, from items eligible for medical care benefits.

Article 41

Article 41-2 (Exclusion, etc. of Medicines from Medical Care Benefits)

(1) The Minister of Health and Welfare may suspend the application of medical care benefits for medicines referred to in Article 41 (1) 2 and related to the violation of Article 47 (2) of the Pharmaceutical Affairs Act, for a fixed period within the limit of one year.

(2) Where a medicine suspended from the application of medical care benefits under paragraph (1) becomes the subject of suspension under paragraph (1) again, the Minister of Health and Welfare may exclude it from the application of medical care benefits, taking the total suspension period, severity of violation, etc. into consideration.

(3) Criteria and procedures for the suspension of, and exclusion from, the application of medical care benefits under paragraphs (1) and (2) and other necessary matters shall be prescribed by Presidential Decree.

[This Article Newly Inserted by Act No. 12176, Jan. 1, 2014] <<Enforcement Date: Jul. 2, 2014>>

Article 42 (Medical Care Institution)

(1) Medical care benefits (excluding nursing and transfers) shall be provided by the medical care institutions referred to in the following

Article 41-2 ~ 42

subparagraphs. In such cases, the Minister of Health and Welfare may exclude, medical facilities, etc. determined by Presidential Decree, such as those unfit as medical care institutions, in the public interest or for national policy reasons, from among medical care institutions:

1. Medical facilities established under the Medical Service Act;

2. Pharmacies registered under the Pharmaceutical Affairs Act;

3. The Korea Orphan Drug Center established under Article 91 of the Pharmaceutical Affairs Act;

4. Public health clinics, public health and medical care centers, and branches of public health clinics referred to in the Regional Public Health Act;

5. Public health clinics established under the Act on the Special Measures for Public Health and Medical Services in Agricultural and Fishing Villages, etc.

(2) If necessary for efficiently providing medical care benefits, the Minister of Health and Welfare may recognize medical care institutions meeting the standards prescribed by Ordinance of the Ministry of Health and Welfare, such as facilities, equipment, human resources, and areas of specialization, as specialized medical care institutions, as prescribed by Ordinance of the Ministry of Health and Welfare. In such cases, he/she shall

Article 42

issue a written recognition for each of the relevant specialized medical care institutions.

(3) If a medical care institution recognized under paragraph (2) falls under any of the following cases, the Minister of Health and Welfare shall revoke such recognition:

1. Where it fails to meet the standards for recognition referred to in the forepart of paragraph (2);

2. Where it returns the written recognition received under the latter part of paragraph (2).

(4) Medical care institutions recognized to be specialized medical care institutions under paragraph (2) or superior general hospitals under Article 3-4 of the Medical Service Act may set the medical care benefit procedure referred to in Article 41 (2) and medical care benefit costs referred to in Article 45 differently from other medical care institutions.

(5) Medical care institutions referred to in paragraphs (1), (2) and (4) may not refuse to provide medical care benefits without any justifiable ground.

Article 43 (Reports on Current Status of Medical Care Institutions)

(1) A medical care institution shall, at the time it claims reimbursement of its first medical care benefit costs under Article 47, report on the current status of its facilities, equipment, manpower,

Article 43

etc. to the Health Insurance and Assessment Service (hereinafter referred to as the "Review and Assessment Service") established under Article 62.

(2) Where any matter reported under paragraph (1) (limited to any matter related to the increase or reduction of medical care benefit costs under Article 45) is changed, the medical care institution shall report thereon to the Review and Assessment Service within 15 days from the date on which such change is made, as prescribed by Ordinance of the Ministry of Health and Welfare.

(3) Matters necessary for the scope of reporting, matters subject to reporting, methods and procedures, etc. for the reporting prescribed in paragraphs (1) and (2) shall be prescribed by Ordinance of the Ministry of Health and Welfare.

Article 44 (Partial Defrayment of Expenses)

A person who receives medical care benefits shall personally partially defray such expenses (hereinafter referred to as "individual co-payment") as prescribed by Presidential Decree.

Article 45 (Calculation, etc. of Medical Care Benefit Costs)

(1) The costs of medical care benefits shall be determined by contract between the president of the Corporation and persons determined by Presidential Decree who represent the medical and pharmaceutical communities. In such cases, the term of the contract shall be one year.

(2) If a contract

Article 44 ~ 45

is concluded under paragraph (1), it shall be deemed concluded between the Corporation and each individual medical care institution.

(3) A contract under paragraph (1) shall be concluded by May 31 of the year in which the expiration date of the term of the immediately preceding contract falls; if no contract is concluded within that period, the costs of medical care benefits shall be determined by the Minister of Health and Welfare by no later than June 30 of the year in which the expiration date of the term of the immediately preceding contract falls after reaching a resolution thereon by the Deliberative Committee. In such cases, the costs of medical care benefits determined by the Minister of Health and Welfare shall be deemed the medical care benefit costs determined by contract under paragraphs (1) and (2). <Amended by Act No. 11787, May 22, 2013>

(4) If the medical care benefit costs are determined under paragraph (1) or (3), the Minister of Health and Welfare shall publicly notify the particulars of the medical care benefit costs without delay.

(5) The president of the Corporation shall enter into a contract under paragraph (1), subject to the deliberation and resolution of the Financial Operation Committee under Article 33.

(6) When the president of the Corporation requests for materials necessary to conclude a contract under paragraph (1), the Review and Assessment Service shall sincerely comply therewith.

Article 45

(7) Details of a contract concluded under paragraph (1) and other necessary matters shall be prescribed by Presidential Decree.

Article 46 (Calculation, etc. Medical Care Benefit Costs for Medicines and Materials for Medical Treatment)

Notwithstanding Article 45, the medical care benefit costs for medicines and materials for medical treatment referred to in Article 41 (1) 2 (hereinafter referred to as "medicines and materials for medical treatment") may be calculated as prescribed by Presidential Decree, taking the purchase prices, etc. of the medicines and materials for medical treatment paid by the medical care institutions into consideration.

Article 47 (Claims for and Payment, etc. of Medical Care Benefit Costs)

(1) A medical care institution may claim the medical care benefit costs from the Corporation. In such cases, a request for review referred to in paragraph (2) shall be deemed a claim to the Corporation for the medical care benefit costs.

(2) A medical care institution which intends to claim the medical care benefit costs under paragraph (1) shall request the Review and Assessment Service for a review of the medical care benefit costs, and the Review and Assessment Service, in receipt of the

Article 46 ~ 47

request, shall review t matter and immediately notify the Corporation and the medical care institution of the details of its review.

(3) In receipt of the notification of the review details under paragraph (2), the Corporation shall immediately pay the medical care benefit costs to the medical care institution in accordance with such details. In such cases, where the individual co-payment already paid is in excess of the amount notified under paragraph (2), the difference of the excess payment shall be subtracted from the amount to be paid to the medical care institution and paid to the relevant policyholder.

(4) The Corporation may, for accounting purposes, offset the amount to be paid to a policyholder under paragraph (3) against the insurance premiums and other collections under this Act which the relevant policyholder should pay (hereinafter referred to as "insurance premiums, etc.").

(5) Where the Review and Assessment Service evaluates the reasonableness of a medical care benefit referred to in Article 63 and notifies it to the Corporation, the Corporation shall adjust the payment by increasing or reducing the medical care benefit costs in accordance with the results of the evaluation. In such cases, the standards for increased or reduced payment of medical care benefit costs shall be prescribed by Ordinance of the Ministry of Health and Welfare.

(6) A medical care institution may authorize any of the following organizations to claim for a review referred to in paragraph (2) on its

Article 47

behalf:

1. The association of medical doctors, the association of dentists, the association of oriental medical doctors and the association of midwives provided for in Article 28 (1) of the Medical Service Act or a branch office or a branch of each of those associations, each of which files a report pursuant to paragraph (6) of the same Article;

2. The organization of medical institutions provided for in Article 52 of the Medical Service Act;

3. The association of pharmacists provided for in Article 11 of the Pharmaceutical Affairs Act or a branch office or a branch of the association, which files a report pursuant to Article 14 of the same Act.

(7) Matters necessary for the method and procedure for making the claim, review, payment, etc. of the medical care benefits costs referred to in paragraphs (1) through (6) shall be prescribed by Ordinance of the Ministry of Health and Welfare.

Article 48 (Verification of Entitlement to Medical Care Benefits, etc.)

(1) Any policyholder or any dependent may request the Review and Assessment Service to verify whether part of the medical expenses he/she has borne, other than individual co-payment is excluded from his/her entitlement to medical care benefits in accordance with Article 41 (3).

Article 48

(2) The Health Insurance and Assessment Service in receipt of a request for verification under paragraph (1) shall notify the person who requested the verification of its result. In such cases, if part of the medical expenses for which the verification is requested is verified to be entitled to medical care benefits, the Review and Assessment Service shall notify the Corporation and the relevant medical care institution of such facts.

(3) A medical care institution in receipt of a notice under the latter part of paragraph (2) shall refund without delay, the amount it has collected in excess of the amount it should have received to the person who requested the verification (hereinafter referred to as "over-collected medical expenses"): Provided, That where the relevant medical care institution fails to refund the over-collected medical expenses, the Corporation may refund such over-collected medical expenses to the person who requested for verification after deducting them from the medical care benefits it is liable to pay such medical care institution.

Article 49 (Medical Care Costs)

(1) Where a policyholder or his/her dependent, due to emergency or other unavoidable circumstances determined by Ordinance of the Ministry of Health and Welfare, receives medical care for a disease, injury, childbirth, etc. at an institution determined by Ordinance of the Ministry of Health and Welfare and performs functions similar to those of a medical care institution (including a medical care institution placed under a period of

Article 49

suspension o operation under Article 98 (1)) or undergoes a childbirth at a place other than a medical care institution, the Corporation shall disburse an amount equivalent to the medical care benefit concerned to the policyholder or his/her dependent as the medical care costs, as prescribed by Ordinance of the Ministry of Health and Welfare.

(2) An institution that has provided medical care under paragraph (1) shall issue to the recipient of medical care a detailed medical care cost statement or a receipt stating the particulars of the medical care, as prescribed by the Minister of Health and Welfare, and the person who has received the medical care shall submit such statement or receipt to the Corporation.

Article 50 (Additional Benefits)

In addition to the medical care benefits prescribed in this Act, the Corporation may subsidize medical expenses for pregnancy and childbirth, funeral costs, sickness allowances, and other benefits, as prescribed by Presidential Decree. <Amended by Act No. 11787, May 22, 2013>

Article 51 (Special Case for Disabled Person)

(1) The Corporation may provide insurance benefits of supportive equipment for a disabled policyholder registered under the Welfare of Disabled Persons Act and his/her dependents.

(2) The scope, method, and procedure of the insurance benefits for supportive equipment referred to in paragraph (1) and other necessary

Article 50 ~ 51

matters shall be prescribed b Ordinance of the Ministr of Health and Welfare.

Article 52 (Health Checkups)

(1) The Corporation shall provide health checkups for policyholders and their dependents in order to facilitate early detection of diseases and subsequent medical care benefits.

(2) Candidates for, frequency of, and procedures for the health checkup referred to in paragraph (1) and other necessary matters shall be prescribed by Presidential Decree.

Article 53 (Restriction of Benefits)

(1) If a person who is eligible to receive insurance benefits falls under any of the following subparagraphs, the Corporation shall not provide any insurance benefit:

1. Where he/she has intentionally, or through gross negligence, caused criminal conduct or intentionally contributed to the occurrence of an accident;

2. Where he/she has intentionally or through gross negligence failed to follow medical care-related instructions of the Corporation or the medical care institution;

3. Where he/she has intentionally, or through gross negligence, refused to submit the documents referred to in Article 55 or other items or evaded questions or medical checkups;

Article 52 ~ 53

4. Where he/she receives or is eligible to receive insurance benefits or compensations under other Acts and subordinate statutes due to a disease, an injury or a disaster incurred relating to his/her business or in the line of duty.

(2) When a person who is eligible to receive a medical care benefit has received from the State or a local government a benefit equivalent to the medical care benefit or expenses equivalent to the medical care benefit costs under the provisions of other Acts and subordinate statutes, the Corporation shall withhold the insurance benefit up to the limit of such amount.

(3) The Corporation may withhold insurance benefits from a policyholder delinquent in paying the insurance premiums falling under any of the following subparagraphs for a period prescribed by Presidential Decree or his/her dependants until the delinquent insurance premium is paid in full: Provided, That this shall not apply where gross frequency of delinquency in paying monthly insurance premiums is below the number of times prescribed by Presidential Decree (delinquent insurance premiums which have already been paid shall be excluded in calculating the frequency of delinquency), regardless of the period of delinquency in paying insurance premiums:

1. Insurance premiums based on monthly income referred to in Article 69 (4) 2;

2. Per household

Article 53

insurance premiums referred to in Article 69 (5).

(4) Paragraph (3) shall apply to an employer liable to pay insurance premiums under Article 77 (1) 1 is delinquent in paying the insurance premiums based on the amount of monthly remuneration referred to in Article 69 (4) 1, only where such delinquency is attributable to the employer-provided policyholder himself/herself. In such cases, the dependants of the relevant employer-provided policyholder shall also be subject to paragraph (3).

(5) Notwithstanding the provisions of paragraphs (3) and (4), where the approved insurance premiums is provided on not less than one occasion after obtaining approval for the installment payment from the Corporation pursuant to the provisions of Article 82, the insurance benefits may be paid: Provided, That the same shall not apply where anyone who has obtained approval for the installment payment provided for in the provisions of Article 82 fails to pay the approved insurance premiums not less than two times without any justifiable grounds therefor.

(6) The insurance benefits received in the period during which no insurance benefits are to be provided pursuant to paragraphs (3) and (4) (hereafter referred to as "benefit suspension period" in this paragraph) shall be recognized as insurance benefits only in the following cases:

1. Where the insurance premiums in arrears are fully paid by the deadline

Article 53

for its payment in the month to which the date on which two months lapse from the date when the Corporation has served a notice that insurance benefits were received during the benefit suspension period belongs;

2. Where the insurance premium for which installment payment is approved pursuant to Article 82 is paid not less than once by the deadline for its payment in the month to which the date on which two months lapse from the date when the Corporation has served a notice that insurance benefits were paid during the benefit suspension period belongs: Provided, That where anyone who has obtained approval for the installment payment pursuant to Article 82 fails to pay the approved insurance premiums on at least two occasions without justifiable grounds therefor, his/her entitlement to insurance benefits shall be denied.

Article 54 (Suspension of Benefits)

When a person eligible to receive insurance benefits falls under any of the following subparagraphs, no insurance benefit shall be provided during that period: Provided, That in the cases of subparagraphs 3 and 4, the medical care benefits under the provisions of Article 60 shall be provided:

1. When he/she is travelling abroad;

2. When he/she is engaged in business abroad;

3. When he/she falls

Article 54

under Article 6 (2) 2;

4. When he/she is committed to a correctional institution or equivalent facilities.

Article 55 (Verification of Benefits)

If determined to be necessary when providing insurance benefits, the Corporation may demand a person who receives insurance benefits to submit documents and other items or be subject to questioning or diagnosis by relevant personnel.

Article 56 (Disbursement of Medical Care Costs, etc.)

When there is a claim for disbursement of medical care costs or for additional benefits the Corporation is obligated to provide under this Act, the Corporation shall pay or provide them without delay.

Article 57 (Collection of Unjust Gains)

(1) The Corporation shall collect all or part of an amount equivalent to the insurance benefits or the insurance benefit costs from a person who has received insurance benefits or a medical care institution that has received insurance benefit costs by deceit or other unjust means.

(2) Where a medical care institution that has received insurance benefit costs by deceit or other unjust means under paragraph (1) falls under any of the following subparagraphs, the Corporation may require the person who has established such medical care institution

Article 55 ~ 57

to pay the money collectable under paragraph (1), severally or jointly with such medical care institution: <Newly Inserted by Act No. 11787, May 22, 2013>

1. A medical care institution established and operated by a person who is not eligible to establish the institution due to the violation of Article 33 (2) of the Medical Service Act, by borrowing the license of a medical person or the name of a medical corporation, etc.;

2. A pharmacy established and operated by a person who is not eligible to establish the pharmacy due to the violation of Article 20 (1) of the Pharmaceutical Affairs Act, by borrowing the license of a pharmacist, etc.

(3) Where insurance benefits have been provided based on a false report or false testimony of the employer or the policyholder, or false diagnosis by a medical care institution, the Corporation may require payment of the money collectable under paragraph (1) from such person or institution jointly with the person who received the insurance benefits. <Amended by Act No. 11787, May 22, 2013>

(4) The Corporation may require payment of the money collectable under paragraph (1) from a policyholder who belongs to the same household as the person who has received insurance benefits by deceit or other unjust means (referring to an employer-provided policyholder if the person who has received the insurance benefits by deceit or other unjust means is a dependent) severally

Article 57

or jointly with the person who has received the insurance benefits by deceit or other unjust means. <Amended by Act No. 11787, May 22, 2013>

(5) Where a medical care institution has received medical care benefit costs from a policyholder or his/her dependent by deceit or other unjust means, the Corporation shall collect the amount thereof from the medical care institution concerned and disburse it to the policyholder or his/her dependent without delay. In such cases, the Corporation may offset the amount payable to the policyholder or his/her dependent against the insurance premiums, etc. to be paid by such policyholder or his/her dependent. <Amended by Act No. 11787, May 22, 2013>

Article 58 (Rights to Indemnity)

(1) When the Corporation has provided an insurance benefit to a policyholder or dependent because the grounds for the insurance benefit have arisen due to the act of a third party, the Corporation shall have the right to claim compensation from the third party up to the amount of the expenses incurred for the benefit concerned.

(2) Where the person who receives the insurance benefit has already received compensation for the loss from the third party under paragraph (1), the Corporation shall withhold the insurance benefit, up to the amount of such compensation.

Article 59 (Protection of Entitlement to Benefits)

Entitlement to receive

Article 58 ~ 59

insurance benefits shall be unalienable and unseizable.

Article 60 (Provision of Medical Care Benefit Costs to Soldiers, etc. in Active Service)

(1) Where any person who falls under subparagraphs 3 and 4 of Article 54 has received medical care, etc. prescribed by Presidential Decree (hereafter referred to as "medical care benefit" in this Article) at the medical care institution, the Corporation may pay the costs necessary therefor (hereafter referred to as the "medical care benefit costs" in this Article) to be borne by it, after receiving a deposition from the Minister of Justice, Minister of National Defense, Administrator of the National Emergency Management Agency, Commissioner General of the National Police Agency or Commissioner General of the Korea Coast Guard. In such cases, the Minister of Justice, Minister of National Defense, Administrator of the National Emergency Management Agency, Commissioner General of the National Police Agency or Commissioner General of the Korea Coast Guard shall, as prescribed by Presidential Decree, deposit in advance the annual medical care benefit costs anticipated, except for the inevitable cases in their budgets.

(2) Articles 41, 42, 44 through 48, 55 and 56 shall apply mutatis mutandis to the matters concerning the medical care benefits and medical care benefit costs.

Article 61 (Settlement of Medical Care Benefit Costs)

Article 60 ~ 61

Where the Korea Workers' Compensation and Welfare Service under Article 10 of the Industrial Accident Compensation Insurance Act claims medical care benefit costs for the medical care benefits already paid pursuant to Article 40 of the Industrial Accident Compensation Insurance Act to a person eligible to receive the medical care benefits pursuant to this Act because of the cancellation of the decision to pay the medical care benefits, the Corporation may pay an amount equivalent to the medical care benefits on the condition that the medical care benefits are accepted to be an amount equivalent to a medical care benefit providable pursuant to this Act.

CHAPTER V HEALTH INSURANCE REVIEW AND ASSESSMENT SERVICE

Article 62 (Establishment)

In order to review the costs of medical care benefits and evaluate the reasonableness of medical care benefits, the Health Insurance and Assessment Service shall be established.

Article 63 (Services, etc.)

(1) The Review and Assessment Service shall be in charge of the services referred to in the following subparagraphs:

1. Review of the costs of medical care benefits;

2. Evaluation

Article 62 ~ 63

of the reasonableness of medical care benefits;

3. Development of criteria for review and evaluation;

4. Investigative research and international cooperation related to the operations referred to in subparagraphs 1 through 3;

5. Services delegated to it in connection with review of the costs of benefits or evaluation of the reasonableness of medical care that are provided for under the provisions of other Acts;

6. Services determined by the Minister of Health and Welfare to be necessary in connection with the health insurance program;

7. Other services prescribed by Presidential Decree in connection with review of the costs of insurance benefits and evaluation of the reasonableness of insurance benefits.

(2) The criteria, procedures, methods, etc. relevant to the evaluation of the reasonableness of medical care benefits referred to in paragraph (1) 2 and 7, and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare.

Article 64 (Legal Personality, etc.)

(1) The Review

Article 64

and Assessment Service shall be a juristic person.

(2) The Review and Assessment Service shall come into existence with the registration of its establishment at the seat of its principal office.

Article 65 (Executives)

(1) The Review and Assessment Service shall have as its executives the president, 14 directors and one auditor. In this case, the president, three trustees, and the auditor shall be standing.

(2) The president shall be appointed by the President of the Republic of Korea from among the plural number of persons recommended by the Minister of Health and Welfare.

(3) Standing directors shall be appointed by the president following the recommendation procedures prescribed by Ordinance of the Ministry of Health and Welfare.

(4) As non-standing directors, 10 persons from among the persons falling under the following subparagraphs and one relevant public official recommended as prescribed by Presidential Decree shall be appointed by the Minister of Health and Welfare:

1. One person recommended by the Corporation;

2. Five persons recommended by a medicine related organization;

Article 65

3. Persons, each one of whom is recommended respectively by a labor unions' group, an employers' organization, a consumer organization, and an agricultural and fishing organization.

(5) The auditor shall be appointed by the President upon recommendation of the Minister of Strategy and Finance from among the plural number of persons recommended by executive recommendation committee.

(6) Non-standing directors prescribed in paragraph (4) may receive reimbursement for actual expenses, as prescribed by the articles of incorporation.

(7) The term of office of the president shall be three years, and that of directors (excluding the director who is a public official) and the auditor shall be two years, respectively.

Article 66 (Medical Treatment Review Committee)

(1) In order to efficiently conduct the operations of the Review and Assessment Service, a medical treatment review committee (hereinafter referred to as "review committee") shall be established under the Review and Assessment Service.

(2) The review committee shall be comprised of no more than 50 full-time review members, including the chairperson of the committee, and no more than 100 part-time review members, and it may establish a subcommittee for each area of medical specialization.

Article 66

(3) Full-time review members referred to in paragraph (2) shall be appointed by the president of the Review and Assessment Service from among the persons prescribed by Ordinance of the Ministry of Health and Welfare.

(4) Part-time review members referred to in paragraph (2) shall be commissioned by the president of the Review and Assessment Service from among the persons prescribed by Ordinance of the Ministry of Health and Welfare.

(5) If a review member falls under any of the following subparagraphs, the president of the Review and Assessment Service may dismiss or discommission him/her:

1. Where he/she is deemed incapable of performing his/her duties due to a physical or mental disability;

2. Where he/she breaches or neglects an official duty;

3. Where he/she causes loss to the Review and Assessment Service, either intentionally or through gross negligence;

4. Where he/she does an act that causes damage to his/her dignity, regardless of whether while on duty or off duty;

(6) Necessary matters concerning the qualifications and the term of office of the members of the review committee, the organization and operation of the committee, etc. other than those prescribed

Article 66

in paragraph (1) through (5) shall be prescribe by Orinance of the Ministry of Health and Welfare.

Article 67 (Raising, etc. of Funds)

(1) The Review and Assessment Service may collect contributions from the Corporation to conduct the operations referred to in Article 63 (1) (excluding the operations referred to in Article 63 (1) 5).

(2) Where affairs related to review of the costs of benefits or evaluation of the reasonableness of medical care are entrusted to the Review and Assessment Service under Article 63 (1) 5, the Review and Assessment Service may collect a fee from the delegator.

(3) The amount and collection method of the special assessment and fee referred to in paragraphs (1) and (2) and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare.

Article 68 (Provisions Applied Mutatis Mutandis)

Articles 14 (3) and (4), 16, 17 (excluding Article 17 (1) 6 and 7), 18, 19, 22 through 32, 35 (1), 36, 37, 39 and 40 shall apply mutatis mutandis in regard to the Review and Assessment Service. In this regard, the "Corporation" shall be deemed the "Review and Assessment Service" and the "president of the Corporation" shall be deemed the "president of the Review and Assessment Service," respectively. <Amended by Act No. 11787, May 22, 2013>

Article 67 ~ 68

CHAPTER VI INSURANCE PREMIUM

Article 69 (Insurance Premiums)

(1) To meet the expenses incurred for the health insurance program, the Corporation shall collect insurance premiums from the persons obligated to pay insurance premiums referred to in Article 77.

(2) The insurance premiums referred to in paragraph (1) shall be collected from the month following that in which the date on which the policyholder becomes eligible falls until the month in which the date before the date on which the policyholder loses his/her eligibility falls: Provided, That where the eligibility of the policyholder is obtained on the first day of any month, it shall be collected from the relevant month.

(3) In collecting insurance premiums under paragraphs (1) and (2), where the eligibility of a policyholder has been altered, the insurance premium of the month whereto belongs the altered day shall be collected on the basis of eligibility prior to such alteration: Provided, That where the eligibility of the policyholder is altered on the first day of any month, it shall be collected on the basis of the altered eligibility.

(4) The amount of the monthly insurance premium for an employer-provided policyholder shall be the amount calculated as follows:

Article 69

1. The amount of insurance premium based on monthly remuneration: The amount obtained by multiplying the amount of monthly remuneration calculated under Article 70 by the insurance premium rate under Article 73 (1) or (2);

2. The amount of insurance premium based on the monthly income: The amount obtained by multiplying the amount of monthly income calculated under Article 71 by 50/100 of the insurance premium rate under Article 73 (1) or (2).

(5) The amount of the monthly insurance premium per month for a locally provided policyholder shall be calculated per unit of household, but the insurance premium per month for the household to which a locally provided policyholder belongs shall be the amount obtained by multiplying the monetary value per contribution point under Article 73 (3) by the contribution points calculated under Article 72.

Article 70 (Amount of Monthly Remuneration)

(1) The amount of monthly remuneration of an employer-provided policyholder provided for in Article 69 (4) 1 shall be calculated on the basis of the amount of remuneration received by each of the employer-provided policyholders and the upper limit and the lowest limit thereof may be set according to the standards prescribed by Presidential Decree.

(2) Insurance premiums based on monthly remuneration for a policyholder to whom a part or all of his/her remuneration is not paid due to

Article 70

temprary retirement frm ffice r ther circumstances (hereinafter referred to as a "person temporarily retiring from office, etc.") shall be calculated on the basis of the monthly remuneration amount for the month before the occurrence of the circumstance in question.

(3) Remunerations referred to in paragraph (1) shall mean money and other valuables (excluding anything in the nature of reimbursement for expenses) that workers, etc. receive from employers, the State or local governments for providing their labor, which are determined by Presidential Decree. In this case, if it falls under the cases prescribed by Presidential Decree, such as there are no data relating to the remunerations or they are indistinct, the amount determined and publicly notified by the Minister of Health and Welfare shall be regarded as the remunerations.

(4) Matters necessary for the calculation, etc. of the amount of monthly remuneration referred to in paragraph (1) and the calculation, etc. of the amount of monthly remuneration for unremunerated employers shall be prescribed by Presidential Decree.

Article 71 (Amount of Monthly Income)

(1) Where the amount of income of an employer-provided policyholder excluding the amount of remuneration included in the calculation of the amount of monthly remuneration under Article 70 (hereinafter referred to as "extra income other than remuneration") exceeds the amount prescribed by Presidential Decree, the amount of monthly income shall be calculated on the basis of

Article 71

the amount of the extra income other than remuneration, and the upper limit thereof may be set according to the standards prescribed by Presidential Decree.

(2) Matters necessary for the calculation of the amount of monthly income, including the standards for and method of the calculation, shall be prescribed by Presidential Decree.

Article 72 (Contribution Point)

(1) The contribution point provided for in the provisions of Article 69 (5) shall be set taking into account the income, property, standard of living and the participation rate in economic activities, etc. of each of the locally provided policyholders and the upper limit and the lowest limit thereof may be set according to the standards prescribed by Presidential Decree.

(2) In determining the method and criteria for calculating the contribution point under the provisions of paragraph (1), assets in relation to which excercise of property rights is restricted under Acts and subordinate statutes may be treated differently from other assets.

(3) Methods and standards for calculating contribution points and other necessary matters shall be prescribed by Presidential Decree.

Article 73 (Insurance Premium Rate, etc.)

(1) Insurance premium rates for an employer-provided policyholder shall be

Article 72 ~ 73

determined by Presidential Decree, within the limit of 80/100 after undergoing a resolution of the Deliberative Committee.

(2) Insurance premium rate for an employer-provided policyholder who is engaged outside of Korea for business operations shall be 50/100 of the insurance premium rate determined under the provisions of paragraph (1).

(3) The monetary value per contribution point for each of the locally provided policyholders shall be determined by Presidential Decree after undergoing deliberation by the Deliberative Committee.

Article 74 (Exemption from Insurance Premium)

(1) Where an employer-provided policyholder falls under any of subparagraphs 2 through 4 of Article 54, the Corporation shall exempt him/her from payment of insurance premiums: Provided, That an employer-provided policyholder falling under subparagraph 2 of Article 54 shall be exempted from paying insurance premiums only if he/she does not have any dependent who resides within Korea.

(2) Where a locally provided policyholder falls under any of subparagraphs 2 through 4 of Article 54, contribution points referred to in Article 72 shall be excluded from calculation of the insurance premiums for the household to which such policyholder belongs:

(3) For the exemption of insurance premiums under paragraph (1) or the contribution

Article 74

point to be exempted from the computation of insurance premiums under paragraph (2), it shall apply from the month following the month whereto belongs the day on which the reasons for allowance suspension falling under any of subparagraphs 2 through 4 of Article 54 have occurred to the month whereto belongs the day on which the reasons have been settled: Provided, That where the reasons for allowance suspension have been resolved on the first day of each month, the insurance premiums of relevant month shall not be exempted, or the contribution point shall not be exempted from the computation of insurance premiums.

Article 75 (Reduction, etc. of Insurance Premiums)

(1) With respect to the policyholders prescribed by Ordinance of the Ministry of Health and Welfare from among the following policyholders, part of the insurance premiums of the policyholders or the households to which the policyholders belong may be reduced:

1. Persons who reside on islands, in remote areas and agricultural and fishery communities, etc. prescribed by Presidential Decree;

2. Persons who are at least 65 years old;

3. Disabled persons who are registered pursuant to the Welfare of Disabled Persons Act;

4. Persons who have rendered distinguished service for the State, provided for in Article 4 (1) 4, 6, 12, 15 or 17 of the Act

Article 75

on the Honorable Treatment and Support of Persons, etc. of Distinguished Services to the State;

5. Persons temporarily retiring from office;

6. Other persons designated and publicly announced by the Minister of Health and Welfare as the persons whose insurance premiums need to be reduced on the grounds of the difficult lifehood and natural disaster, etc.

(2) Where a person obligated to pay insurance premiums under Article 77 falls under any of the following, he/she may be granted such financial gains as reduction of insurance premiums, etc. as prescribed by Presidential Decree: <Newly Inserted by Act No. 11787, May 22, 2013>

1. Where he/she receives a notice to pay insurance premiums by means of an electronic document under Article 79 (2);

2. Where he/she pays insurance premiums by means of automatic account transfer.

(3) Methods and procedures for reducing insurance premiums under paragraph (1) and other necessary matters shall be determined and publicly notified by the Minister of Health and Welfare. <Amended by Act No. 11787, May 22, 2013>

Article 76 (Burden of Insurance Premiums)

(1) The insurance premiums for an employer-provided policyholder shall be borne,

Article 76

50/100 each, by the employer-provided policyholder and the person referred to in the following classifications: Provided, That where an employer-provided policyholder is a school employee working for a private school, 50/100, 30/100, and 20/100 of the amount of the insurance premium shall be borne by the said employer-provided policyholder, the person prescribed in subparagraph 2 (c) of Article 3, and the State, respectively: <Amended by Act No. 12176, Jan. 1, 2014>

1. Where the employer-provided policyholder is a worker: The employer prescribed in subparagraph 2 (a) of Article 3;

2. Where the employer-provided policyholder is a public official: The State or the local government to which that public official belongs;

3. Where the employer-provided policyholder is a school employee (excluding school employees working for private schools): The employer prescribed in subparagraph 2 (c) of Article 3.

(2) Insurance premiums based on monthly income of a employer-provided policyholder shall be borne by the employer-provided policyholder.

(3) The insurance premiums for a locally provided policyholder shall be borne jointly by all locally provided policyholders who reside in the same household as the said policyholder.

Article 76

(4) Where an employer-provided policyholder is a school employee, and if an employee prescribed in subparagraph 2 (c) of Article 3 is unable to bear the whole amount to be borne, the deficiency may be made to be borne from the account of the school. <Newly Inserted by Act No. 12176, Jan. 1, 2014>

Article 77 (Responsibility for Payment of Insurance Premiums)

(1) Insurance premiums of an employer-provided policyholder shall be paid by the person prescribed as follows pursuant to the following classifications:

1. Insurance premiums based on monthly remuneration: In such cases, where the workplace has more than two employers, the employers of the workplace shall jointly pay the insurance premiums of the relevant employer-provided policyholder;

2. Insurance premiums based on monthly income: Employer-provided policy holder.

(2) Insurance premiums of a locally provided policyholder shall be paid jointly by all locally provided policyholders of a household to which the policyholder belongs: Provided, That minors who meet the criteria prescribed by Presidential Decree in consideration of income, property, standard of living, the rate of participation in economic activities, etc. shall not be liable to pay insurance premiums.

(3) An employer shall

Article 77

pay the portion of the insurance premium for the month to be borne by an employer-provided policyholder out of the insurance premium based on monthly remuneration by deducting it from his/her remunerations. In such cases, the employer shall notify the employer-provided policyholder of the amount of deduction.

Article 78 (Deadline for Payment of Insurance Premiums)

(1) A person who is liable to pay insurance premiums under Article 77 (1) and (2) shall pay the policyholder's insurance premiums for the applicable month by the tenth day of the following month: Provided, That insurance premiums based on monthly income of employer-provided policyholders and insurance premiums of locally provided policyholders may be paid quarterly, as prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 11787, May 22, 2013>

(2) Where any cause or event prescribed by Ordinance of the Ministry of Health and Welfare, such as delay in the delivery of notice of payment, occurs, the Corporation may extend the payment deadline up to one month from the payment deadline provided under paragraph (1) at the request of the person obligated to make such payment, notwithstanding paragraph (1). In such cases, matters relating to the method and procedures for applying for the extension of payment deadline and other relevant matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Newly Inserted by Act No. 11787, May 22, 2013>

Article 79 (Notice to Pay Insurance Premium, etc.)

Article 78 ~ 79

(1) When the Corporation intends to collect insurance premiums, etc., it shall determine the amount thereof and make a payment notice to each person who is obligated pay it by means of a written notice wherein following matters are stated:

1. Types of insurance premium, etc. to be collected;

2. Amount subject to be paid;

3. Deadline for and place of payment.

(2) If requested by a person obligated to pay the insurance premium, the Corporation may, when a payment notice is to be issued under paragraph (1), notify it by means of an electronic document, such as exchange of electronic messages.

(3) Where the Corporation makes a payment notice by means of an electronic document under paragraph (2), it shall be deemed received by the person obligated to make payment at the time it is saved in the information and communications network prescribed by Ordinance of the Ministry of Health and Welfare or entered into the address of an electronic mail designated by the person obligated to make payment.

(4) Where the employers of an employer-provided policyholder are two or more persons or where a household of a locally provided policyholder consists of two or more persons, a notice made to any one of them shall be deemed to take its effect to all other employers of the relevant workplace or all other locally provided

Article 79

policyholders who are the relevant household members.

(5) A payment notice issued to a person temporarily retiring from office, etc. may be postponed until the time the reason for temporary retirement, etc. disappears, as prescribed by Ordinance of the Ministry of Health and Welfare.

(6) Matters necessary for the method, procedures, etc. for applying for notice by means of an electronic document under paragraph (2) shall be prescribed by Ordinance of the Ministry of Health and Welfare.

Article 80 (Arrears)

(1) If a person obligated to pay insurance premium, etc. fails to make payment of insurance premium, etc. by the payment deadline, the Corporation shall collect arrears equivalent to 3/100 of the insurance premium, etc. in arrears from the date payment thereof becomes an overdue.

(2) If a person obligated to pay insurance premium, etc. fails to pay an insurance premium, etc. in arrears, the Corporation shall collect another additional charge equivalent to 1/100 of the insurance premium, etc. in arrears in addition to the arrears under paragraph (1) at the end of each month from the date the payment thereof becomes overdue. In such cases, the arrears shall not exceed 9/100 of the insurance premium, etc. in arrears.

(3) If any natural disaster occurs or any other extenuating circumstances prescribed

Article 80

by Ordinance of Ministry of Health and Welfare exist, collection of arrears referred to paragraphs (1) and (2) may be forgone, notwithstanding paragraphs (1) and (2).

Article 81 (Demands for Insurance Premiums, etc. and Dispositions on Default)

(1) Where a person who is liable to pay insurance premiums as referred to in Articles 57 and 77 fails to pay the insurance premiums, etc., the Corporation may demand payment by the specified period. In such cases, where the number of employers of an employer-provided policyholder is at least two, or the household of a locally provided policyholder consists of two or more members, notice or demand to any of the employers or any of the household members shall be deemed effective regarding the other employers of the concerned workplace or the other locally provided policyholders who are the members of the household.

(2) Where a demand is being made under paragraph (1), a payment period of at least 10 days, but no more than 15 days shall be determined and a letter of demand issued.

(3) Where a person who receives a demand referred to in paragraph (1) fails to pay the insurance premiums, etc. by the payment deadline, the Corporation may collect it in the same manner as national taxes in arrears are collected, after obtaining approval from the Minister of Health and Welfare.

(4) Where the Corporation

Article 81

determines that an asset seized in the same manner as national taxes in arrears are collected under paragraph (3) is not appropriate to be auctioned directly by it because expert knowledge is necessary for the public auction or because of other special circumstances, the Corporation may have the Korea Asset Management Corporation established under the Act on the Efficient Disposal of Non-Performing Assets, etc. of Financial Institutions and the Establishment of Korea Asset Management Corporation (hereinafter referred to as the "Korea Asset Management Corporation") conduct the auction on behalf of the Corporation, and in which case the auction shall be deemed to have been conducted by the Corporation.

(5) Where the Korea Asset Management Corporation conducts an auction on behalf of the Corporation under paragraph (4), the Corporation may pay a fee, as prescribed by Ordinance of the Ministry of Health and Welfare.

Article 81-2 (Provision of Data concerning Default or Disposition on Deficits)

(1) Where any centralized credit information collection agency provided for in Article 25 (2) 1 of the Use and Protection of Credit Information Act requests data concerning the personal information, amount in arrears, or amount written off, of any of the following defaulters or persons whose amount in arrears is written off (hereafter referred to as "data concerning default, etc." in this Article), the Corporation may provide such data, if necessary for the collection of insurance premiums

Article 81-2

or for public interest: Provided, That this shall not apply where any administrative appeal or administrative litigation is pending in connection with the insurance premiums in arrears or any other amount collectable under this Act, or where any other cause or event prescribed by Presidential Decree occurs:

1. A person in whose case the total amount of insurance premiums remaining unpaid for a period exceeding one year from the following day of the time limit for payment under this Act, other amount to be paid, and the disposition fee for arrears under this Act is not less than five million won;

2. A person in whose case the total amount written off under Article 84 is not less than five million won.

(2) Matters relating to the procedures for the provision of data concerning default, etc. shall be prescribed by Presidential Decree.

(3) No person who is provided with data concerning default, etc. under paragraph (1) shall divulge or use them for any purpose other than for performing his/her official duties.

[This Article Newly Inserted by Act No. 11787, May 22, 2013]

Article 82 (Installment Payments of Insurance Premiums in Arrears)

(1) With respect

Article 82

o a person who has defauled in he paymen of insurance premiums not less than three occasions, the Corporation may grant approval for his/her payment of insurance premiums in installments, as prescribed by Ordinance of the Ministry of Health and Welfare.

(2) Where a person who is approved to pay insurance premiums in installments pursuant to paragraph (1) fails to pay the approved insurance premiums on at least two occasions without any justifiable grounds therefor, the Corporation shall revoke its approval for payment of his/her insurance premiums in installments.

(3) Necessary matters concerning procedures, methods and standards, etc. for approval and the revocation of approval to pay insurance premiums in installments shall be prescribed by Ordinance of the Ministry of Health and Welfare.

Article 83 (Disclosure of Personal Information of Persons who are Defaulters of Large Amount or who Habitually Falls into Arrears)

(1) Where a person who has defaulted in the payment of insurance premiums, arrears and expenses for disposition on default (including insurance premiums, arrears and expenses for disposition on default which has been written off under Article 84 but the extinctive prescription for which has not run out) which have been in arrears for more than two years from the day following the payment deadline under this Act in the amount of not less 10 million won in total despite the fact that he/she has the ability to pay them, the Corporation may disclose his/her

Article 83

personal information, amount in arrears, etc. (hereafter referred to as "personal information, etc." in this Article): Provided, That, this shall not apply where any administrative appeal or administrative litigation is pending or where any cause prescribed by Presidential Decree, such as partial payment of the amount in arrears, exists.

(2) The Deliberative Committee on Disclosure of Insurance Premium Information shall be established in the Corporation in order to deliberate on whether to disclose personal information, etc. under paragraph (1) of persons in default.

(3) The Deliberative Committee on Disclosure of Insurance Premium Information shall provide persons who are subject matter of disclosure of personal information, etc. an opportunity to defence themselves by notifying in writing that they shall be subject to the disclosure, and select the persons subject to the disclosure after six months lapse from the date of such notification taking into consideration the fulfillment, etc. of their obligation to pay the amount in arrears.

(4) Personal information, etc. of persons in default under paragraph (1) shall be disclosed by means of publication in the official gazette or posting on the Internet homepage of the Corporation.

(5) Matters necessary for the criteria for the ability to make payment, procedures for disclosure, organization and operation of the committee, etc. concerning the disclosure of personal information, etc. of persons in default under paragraphs (1) through (4)

Article 83

shall be prescribed by Presidential Decree.

Article 84 (Dispositions as Losses)

(1) Where any of the following grounds occur, the Corporation may write off insurance premiums, etc. as loss after obtaining a resolution of the financial operation committee:

1. Where the disposition on default is concluded and the portion to be appropriated for the amount in arrears is insufficient for meeting the amount in arrears;

2. Where the extinctive prescription for the claim concerned has run out;

3. Cases determined by Presidential Decree where the possibility of collection is recognized nonexistent.

(2) Where the Corporation discovers the existence of other seizable assets after the disposition on loss under paragraph (1) 3, it shall immediately cancel the disposition and effect a default disposition.

Article 85 (Precedence of Collection of Insurance Premium, etc.)

Insurance premiums, etc. shall be collected before other claims except for national taxes and local taxes: Provided, That this shall not apply to the claims secured by a lease on a deposit basis, the right of pledge or a mortgage where the insurance premium is assessed against the proceeds from the sale of an asset for which entering into a lease on a deposit basis, the right

Article 84 ~ 85

of pledge or a mortgage having been registered prior to the payment period for the insurance premiums, etc. is proved.

Article 86 (Appropriation for and Return of Insurance Premium, etc.)

(1) Where any payment of the insurance premiums, etc., arrears or expenses for disposition on default is erroneously made by a person liable to make such payment, the Corporation shall immediately determine the erroneous payment as a refund.

(2) The refund referred to in paragraph (1) shall be appropriated for any insurance premiums, etc., arrears or expenses for disposition on default yet to be paid as prescribed by Presidential Decree, and any balance remaining after the appropriation shall be disbursed to the payer within 30 days after the date of the determination referred to in paragraph (1). In such cases, when the Corporation appropriates or disburses a refund, it shall add interest prescribed by Presidential Decree to the refund.

CHAPTER VII FILING OF OBJECTIONS AND REQUESTS FOR TRIAL, ETC.

Article 87 (Filing of Objection)

(1) A person who has an objection to the decisions of the Corporation on the qualification, insurance premium, etc., insurance benefits,

Article 86 ~ 87

and insurance benefit costs for a policyholder or his/her dependents, may formally raise such objection to the Corporation.

(2) The Corporation, a medical care institution, or other entity that has an objection to the decisions of the Review and Assessment Service on evaluation, etc. of the reasonableness of the medical care benefit costs and medical care benefits may formally raise the objection to the Review and Assessment Service.

(3) Any objection referred to in paragraphs (1) and (2) (hereinafter referred to as "filing of objection") shall be filed in writing within 90 days after the date the person became aware of such decision and shall not be filed after 180 days from the date on which the decision is made: Provided, That this shall not apply where an explanation is made that the objection within the relevant period could not be raised due to a legitimate reason.

(4) Notwithstanding the main sentence of paragraph (3), where a medical care institution intends to file an objection to the verification of the Health Insurance Review and Assessment Service referred to in Article 48, it shall do so within 30 days from the date on which it receives notice referred to in paragraph (2) of the same Article.

(5) Matters necessary for the method of filing an objection and decision thereon, and notice of the decision, etc. other than those prescribed in paragraph (1) through (4) shall be prescribed by

Article 87

Presidential Decree.

Article 88 (Requests for Trial)

(1) A person who appeals against a decision on an objection filed may request the Health Insurance Dispute Mediation Committee for a trial pursuant to Article 89. In such cases, Article 87 (3) shall apply mutatis mutandis to a request for trial.

(2) A person who intends to request a trial pursuant to paragraph (1) shall submit a request for trial prescribed by Presidential Decree to the Corporation or the Review and Assessment Service, whichever of the two made a decision pursuant to Article 76 (1) or (2) or with the Health Insurance Dispute Mediation Committee under Article 89.

(3) Matters necessary for the procedure and method for filing a request for trial, decision, notification of such decision, etc. other than those prescribed in paragraphs (1) and (2) shall be prescribed by Presidential Decree.

Article 89 (Health Insurance Dispute Mediation Committee)

(1) The Health Insurance Dispute Mediation Committee (hereinafter referred to as the "Dispute Mediation Committee") shall be established under the Ministry of Health and Welfare to deliberate and resolve on requests for trial pursuant to Article 88.

(2) The Dispute Mediation Committee shall be comprised of 35 or fewer committee

Article 88 ~ 89

members including a chairperson, from which one committee member excluding the chairperson shall be an ex officio member.

(3) The meeting of the Dispute Mediation Committee shall have a total of nine members, being the chairperson, one ex officio member and seven committee members as designated by the chairperson each time a meeting is held.

(4) Resolutions of the Dispute Mediation Committee shall be passed by the attendance of the majority of committee members under paragraph (3) and affirmative voting of the majority of those present.

(5) Matters necessary for the organization, operation, etc. of the Dispute Mediation Committee, other than those prescribed in paragraphs (1) through (4), shall be prescribed by Presidential Decree.

#Article 89 (Health Insurance Dispute Mediation Committee)

(2) The Dispute Mediation Committee shall be comprised of 60 or fewer committee members, including a chairperson, and one committee member, excluding the chairperson, shall be an ex officio member. <Amended by Act No. 12176, Jan. 1, 2014>

Article 89

(3) The meetings of the Dispute Mediation Committee shall have a total of nine members, being the chairperson, one ex officio member and seven committee members as designated by the chairperson each time a meeting is held.

(4) Resolutions of the Dispute Mediation Committee shall be passed by the attendance of the majority of committee members under paragraph (3) and affirmative voting of the majority of those present.

(5) A secretariat shall be established under the Dispute Mediation Committee to provide assistance at working level. <Newly Inserted by Act No. 12176, Jan. 1, 2014>

(6) Matters necessary for the organization, operation, etc. of the Dispute Mediation Committee and the secretariat, other than those prescribed in paragraphs (1) through (5), shall be prescribed by Presidential Decree. <Amended by Act No. 12176, Jan. 1, 2014><<Enforcement Date: Jul. 2, 2014>>

Article 90 (Administrative Litigation)

A person who has an objection to a decision of the Corporation or the Review and Assessment Service or a person who protests against a decision on the objection filed under Article 87 or a request for trial made under Article 88 may institute an administrative action pursuant to the Administrative Litigation Act.

Article 90

CHAPTER VIII SUPPLEMENTARY PROVISIONS

Article 91 (Prescription)

(1) The following rights shall be barred by prescription if not exercised within three years:

1. Entitlement to collect insurance premiums and arrears;

2. Entitlement to be refunded any excessive or mistaken amount paid as an insurance premium and arrears;

3. Entitlement to receive an insurance benefit;

4. Entitlement to receive reimbursement of insurance benefit costs;

5. Entitlement to receive a refund of excess individual co-payment under the latter part of Article 47 (3);

6. A right of the Korea Workers' Compensation and Welfare Service under Article 61.

(2) The prescription referred to in paragraph (1) shall be interrupted by an occurrence of any of the following events:

1. A notice of or demand for insurance premiums;

2. A claim for insurance benefit or insurance benefit costs.

Article 91

(3) The extinctive prescription of the right to collect insurance premiums from a person temporarily retiring from office, etc. shall not, if notification is suspended pursuant to Article 79 (5), proceed until the reason for temporary retirement from office, etc. ceases to exist.

(4) Except for matters prescribed in this Act, the term of extinctive prescription pursuant to paragraph (1), interruption of prescription pursuant to paragraph (2) and suspension of prescription pursuant to paragraph (3) shall be in accordance with the Civil Act.

Article 92 (Calculation of Periods)

Except as otherwise provided for in this Act, the Civil Act that are relevant to periods shall apply mutatis mutandis to the calculation of the periods prescribed by this Act or by orders under this Act.

Article 93 (Protection of Rights and Interests of Workers)

An employer who employs the workers at all places of business who do not fall under any subparagraph of Article 6 (2) shall not prevent the workers he/she has employed from becoming employer-provided policyholders under this Act or take a measure that is injurious to the workers, such as denial of a worker's promotion or wage increase or the dismissal of a worker, for the purpose of evading an increase of the employer's share to be borne by the employer in question and without any justifiable

Article 92 ~ 93

ground therefor.

Article 94 (Reporting, etc.)

(1) The Corporation may require an employer, employer-provided policyholder or the head of a household to report the following matters or to submit relevant documents (including those recorded by an electronic method): <Amended by Act No. 11787, May 22, 2013>

1. A policyholder's change of residence;

2. A policyholder's remuneration and income;

3. Other matters necessary for the health insurance program.

(2) Where the Corporation recognizes a necessity for factual verification of the materials reported or submitted under paragraph (1), the Corporation may require employees under its charge to investigate the matters in question.

(3) The Corporation's employees who conduct an investigation under paragraph (2) shall carry documents indicating their authority and produce them to related persons.

Article 95 (Forwarding, etc. of Data on Reduction or Omission of Income)

(1) Where the Corporation recognizes that remuneration, income, etc. reported

Article 94 ~ 95

under Article 94 (1) is ruc or omitt, it may forward in writing the matters on income reduction or omission to the Commissioner of the National Tax Service through the Minister of Health and Welfare.

(2) Where the Commissioner of the National Tax Service conducts any tax investigation under related Acts, such as the Framework Act on National Taxes, on the matters forwarded under paragraph (1), he/she shall forward the matters on the remuneration or income from among the results of relevant investigation to the Corporation.

(3) Matters necessary for forwarding procedures under paragraphs (1) and (2) and other necessary matters shall be prescribed by Presidential Decree.

Article 96 (Furnishing of Materials)

(1) The Corporation and the Review and Assessment Service may request the State, local governments, medical care institutions, insurance companies and actuarial organizations under the Insurance Business Act, and other public organizations to furnish the materials necessary for the health insurance program.

(2) The Corporation may request the State, local governments, and other public institutions and public organizations to furnish the materials necessary to conduct services under Article 14 (1) 11.

(3) Those that have received request to furnish materials under paragraphs

Article 96

(1) and (2) shall sincerely comply therewith.

(4) Fees, commissions, etc. shall be exempted for the materials furnished to the Corporation or the Review and Assessment Service by the State, local governments, medical care institutions, insurance rate computing organizations under the Insurance Business Act and other public institutions and public organizations under paragraphs (1) and (2).

Article 96-2 (Preservation of Documents)

(1) Each medical care institution shall keep the documents related to any claim for medical care benefit costs under Article 47 for five years from the date of end of provision of such medical care benefit, as prescribed by Ordinance of the Ministry of Health and Welfare: Provided, That pharmacies and other medical care institutions prescribed by Ordinance of the Ministry of Health and Welfare shall keep prescriptions for three years from the day the relevant medical care benefit costs are claimed.

(2) Each employer shall keep documents related to health insurance including management of the eligibility requirements and calculation of insurance premiums for three years, as prescribed by Ordinance of the Ministry of Health and Welfare.

[This Article Newly Inserted by Act No. 11787, May 22, 2013]

Article 97 (Reports and Inspections)

(1) The Minister of Health and Welfare may order an employer, an employer-provided

Article 96-2 ~ 97

policyholder or the head of a household to report or submit materials on a policyholder's relocation, remuneration, income and other necessary matters or require public officials under his/her charge to question relevant persons or inspect relevant documents.

(2) The Minister of Health and Welfare may require a medical care institution (including any institution that has provided medical care under Article 49) to report on the matters relevant to insurance benefits, such as the provision of medical care and medicine, or submit relevant documents or require public officials under his/her charge to question relevant persons or inspect relevant documents.

(3) The Minister of Health and Welfare may require a person who has received an insurance benefit to report on the details of the insurance benefit concerned or require public officials under his/her charge to question the person.

(4) The Minister of Health and Welfare may order an organization that is assigned to vicariously file claims for examining medical care benefit costs pursuant to Article 47 (6) (hereinafter referred to as "vicarious claim organization") to submit necessary materials or require public officials under his/her charge to investigate and verify the materials, etc. pertaining to the vicarious claims.

(5) Public officials who conduct an investigation under any of paragraph (1) through (4) shall carry documents indicating their authority and produce them to related persons.

Article 97

Article 98 (Suspension of Operation)

(1) Where a medical care institution falls under any of the following subparagraphs, the Minister of Health and Welfare may order the medical care institution to suspend its operation by specifying a period of within one year:

1. Where it places the burden of medical care benefit costs on an insurer, policyholder, or dependent by deceit or other illegitimate means;

2. Where it violates the order referred to in Article 97 (2), files a false report, or rejects, interferes with or evades an inspection or questioning by a public official belonging to competent authorities.

(2) A person who has been ordered to suspend operation under the provisions of paragraph (1) shall not provide medical care benefits during the period of suspension of the operations in question.

(3) The effect of the disposition of suspension of operation under paragraph (1) shall be succeeded by a person who takes over the medical care institution for which such disposition has been made, a corporation which survives after a merger, or a corporation established by a merger, and in cases where any procedure of the disposition of suspension of operation is pending, it may proceed with respect to the transferee, the corporation which continues to exist after a merger or the corporation established by a merger: Provided, That the same shall

Article 98

not apply to a transferee or corporation surviving a merger in cases where he/she or it proves that he/she or it was unaware of such disposition or the fact of violation.

(4) A person who is subject to the disposition of the suspension of operation under paragraph (1) or a person for whom the procedure of the disposition of suspension of operation is under way shall notify, without delay, a transferee, a corporation surviving a merger or a corporation incorporated in the course of a merger of the fact that it is subject to an administrative disposition or the fact that the procedure of an administrative disposition is under way under the conditions as prescribed by Presidential Decree as prescribed by Ordinance of the Ministry of Health and Welfare.

(5) The standards of administrative disposition by the kind, degree, etc. of violating acts which are subject to the suspension of operation under paragraph (1) and other necessary matters shall be prescribed by Presidential Decree.

Article 99 (Penalty Surcharge)

(1) Where a medical care institution is subject to the disposition of suspension of operation by falling under Article 98 (1) 1, if such disposition causes a serious inconvenience to persons who use a medical care institution or if any special causes prescribed by the Minister of Health and Welfare are deemed to exist, the Minister of Health and Welfare may impose and collect a penalty surcharge in the amount not exceeding five times of the amount to be imposed on conducts by deceit or other

Article 99

illegitimate methods in lieu of the disposition of suspension of operation. In such cases, the Minister of Health and Welfare may permit such payment to be made in installments within 12 months.

(2) Where a person responsible for the payment of a penalty surcharge under paragraph (1) fails to make such payment by the deadline thereof, it shall be collected in accordance with the examples of disposition on national taxes in arrears.

(3) If necessary for collecting a penalty surcharge, the Minister of Health and Welfare may file a written request to furnish tax information with the head of the tax office or the head of the local government concerned wherein following matters are stated:

1. Personal information of a taxpayer;

2. Purpose of use;

3. Grounds and standards for imposition of penalty surcharge.

(4) The penalty surcharges collected pursuant to paragraph (1) shall not be used for any purposes other than the following:

1. Funds the Corporation provides as medical care benefit costs pursuant to Article 47 (3);

2. Support for the emergency medical service fund referred to in the Emergency

Article 99

Medical Service Act.

(5) The amount of penalty surcharge according to number of days for business suspension pursuant to paragraph (1), necessary matters for the payment thereof, the amount of support from penalty surcharges referred to in paragraph (4) by uses, procedure of use, and other necessary matters shall be prescribed by Presidential Decree.

#Article 99 (Penalty Surcharges)

(1) Where a medical care institution is subject to the disposition of suspension of operation by falling under Article 98 (1) 1, if such disposition causes a serious inconvenience to persons who use a medical care institution or if any special causes prescribed by the Minister of Health and Welfare are deemed to exist, the Minister of Health and Welfare may impose and collect a penalty surcharge in the amount not exceeding five times the amount to be imposed on conducts by deceit or other illegitimate methods in lieu of the disposition of suspension of operation. In such cases, the Minister of Health and Welfare may have it paid in installments within the limit of 12 months.

(2) Where the Minister of Health and Welfare deems there is a special ground on worries on that the suspension or exclusion of any medicine from medical care benefits under Article 41-2 (1) or (2) may cause serious hazard to national health, he/she may, in lieu of the suspension or exclusion thereof from the medical care benefits, impose and collect a penalty surcharge up to 40/100 of the total amount of medical care benefits for the

Article 99

relevant medicine, as prescribed by Presidential Decree. In such cases, the Minister of Health and Welfare may have it paid in installments within the limit of 12 months. <Newly Inserted by Act No. 12176, Jan. 1, 2014>

(3) The total amount of medical care benefit costs for the relevant medicine to be prescribed by Presidential Decree under paragraph (2) shall not exceed the total amount of medical care benefits paid for one year taking into consideration the record, etc. of medical care benefits for the relevant medicine paid in the past. <Newly Inserted by Act No. 12176, Jan. 1, 2014>

(4) Where a person liable to pay a penalty surcharge under paragraph (1) or (2) fails to make such payment by the deadline thereof, it shall be collected in the same manner as delinquent national taxes are collected. <Amended by Act No. 12176, Jan. 1, 2014>

(5) If necessary for collecting a penalty surcharge, the Minister of Health and Welfare may file a written request to furnish tax information with the head of the tax office or the head of the local government concerned wherein following matters are stated:

1. Personal information of a taxpayer;

2. Purpose of use;

3. Grounds and standards for imposition of the penalty surcharge.

Article 99

(6) No penalty surcharges collected under paragraphs (1) and (2) shall be used for any purpose, other than the followings: <Amended by Act No. 12176, Jan. 1, 2014>

1. Funds that the Corporation provides as medical care benefit costs pursuant to Article 47 (3);

2. Support for the emergency medical service fund referred to in the Emergency Medical Service Act.

(7) The amount of penalty surcharges under paragraphs (1) and (2), necessary matters for the payment thereof, the amount of support from penalty surcharges referred to in paragraph (6) by uses, procedure of use, and other necessary matters shall be prescribed by Presidential Decree. <Amended by Act No. 12176, Jan. 1, 2014><<Enforcement Date: Jul. 2, 2014>>

Article 100 (Publication of Fact of Violation)

(1) If a medical care institution which has received an administrative disposition under Article 98 or 99 because of claims for medical care benefit costs in falsehood by falsifying or forging relevant documents falls under any of the following subparagraphs, the Minister of Health and Welfare may publish the act of violation, details of disposition, the name, address and name of a representative of the relevant medical care institution, and other matters prescribed by Presidential Decree which are necessary to distinguish it from other medical care institutions.

Article 100

In such cases, the motive, degree, frequency, results, etc. of the violation shall be taken into consideration in deciding whether to make such publication:

1. Where the amount claimed in falsehood exceeds fifteen million won;

2. The rate of amount claimed in falsehood exceeds 20/100 of the total amount of medical care benefit costs.

(2) The Minister of Health and Welfare shall establish and operate the Health Insurance Publication Deliberation Committee (hereafter referred to as the "Publication Deliberation Committee" in this Article) to deliberate on whether to make a publication, etc. under paragraph (1).

(3) The Minister of Health and Welfare shall notify a medical care institution which becomes subject to publication, undergoing the deliberation by the Publication Deliberation Committee of the fact that it is subject to publication, in order to provide it with an opportunity to submit explanatory materials or appear to make a statement of opinion.

(4) The Minister of Health and Welfare shall select medical care institutions to become subject to publication after the Publication Deliberation Committee redeliberates medical care institutions to be subject to publication, taking into account explanatory materials or statements of opinion referred to in paragraph (3).

Article 100

(5) Matters necessary for the procedure for and method of publication, organization and operation, etc. of the Publication Deliberation Committee other than those prescribed in paragraphs (1) through (4) shall be prescribed by Presidential Decree.

Article 101 (Prohibited Acts of Manufacturers, etc.)

(1) No manufacturer, operator of a manufacture by entrustment and sale business, importer nor exporter of drugs under the Pharmaceutical Affairs Act nor a manufacturer, importer, repairer, distributor and lessor of medical devices under the Medical Devices Act (hereinafter referred to as "manufacturer, etc.") shall, in assessing the scope of medical care benefits under Article 41 (2) or in calculating the medical care benefit costs under Article 46 with respect to the medicines and materials for medical treatment, causes any loss to the financial standing of the health insurance by involving in an offense of a medical care institution referred to in Article 98 (1) 1 or by a deceit including the raise of the maximum prices or sale prices of medicines or materials for medical treatment by submitting false data, or by other unjust methods prescribed by Ordinance of the Ministry of Health and Welfare.

(2) In order to ascertain whether a manufacturer, etc. has committed any violation of paragraph (1), the Minister of Health and Welfare may conduct a necessary investigation, such as issuing an order to the relevant manufacturer, etc. to submit the documents concerned, or assigning public officials under his/her control

Article 101

to ask questions to the related persons or inspect the documents concerned. In such cases, the competent public officials shall carry documents indicating their authority and produce them to related persons.

Article 102 (Maintaining Confidentiality)

No person who has been or is engaged in the services of the Corporation or the Review and Assessment Service, the vicarious claim organization shall divulge any confidential information which he/she has learned in the course of carrying out his/her duties.

Article 103 (Supervision of Corporation, etc.)

(1) In order for the Corporation and the Review and Assessment Service to achieve their management goals, the Minister of Health and Welfare may supervise them, such as ordering them to report on the following programs or business or inspecting the conditions of their programs, affairs or property:

1. Services of the Corporation set forth in Article 14 (1) 1 through 13, and services of the Review and Assessment Service set forth in Article 63 (1) 1 through 7;

2. Business related to satisfying the guidelines for management prescribed in Article 50 of the Act on the Management of Public Institutions;

3. Services entrusted to the Corporation and the Review and Assessment Service under this Act or other Acts and subordinate statutes;

Article 102 ~ 103

4. Other business related to the matters prescribed by related Acts and subordinate statutes.

(2) The Minister of Health and Welfare may, where necessary for supervision under paragraph (1), order to amend the articles of incorporation or regulations, or order other necessary dispositions.

Article 104 (Payment of Monetary Rewards, etc.)

(1) The Corporation may pay a reward to a person who reports a medical care institution that has been paid medical care benefit costs by deceit or other unjust means.

(2) The Corporation may give an incentive to a medical care institution that has contributed to the efficient financial management of health insurance. <Newly Inserted by Act No. 11787, May 22, 2013>

(3) Matters necessary for the criteria for and scope of payment of a reward and incentive, procedure and method of payment, and other necessary matters pertaining to paragraphs (1) and (2) shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 11787, May 22, 2013>

Article 105 (Prohibition from Use of Similar Names)

(1) No person, other than the Corporation or the Review and Assessment Service,

Article 104 ~ 105

shall use such names as the National Health Insurance Corporation, Health Insurance Review and Assessment Service or other names similar thereto.

(2) A person, other than one who carries out a health insurance business prescribed by this Act, shall be prohibited from using the term, "national health insurance" in an insurance contract or in the name of an insurance contract.

Article 106 (Disposal of Small Sums)

Where an amount to be collected or returned is less than 2,000 won in one case (excluding any individual co-payment refund and any amount to be paid to a policyholder or his/her dependent, which may be disposed of by offsetting under Article 47 (4) and the latter part of Article 57 (5)), the Corporation shall not collect or return such amount. <Amended by Act No. 11787, May 22, 2013>

Article 107 (Disposal of Fractional Sum)

In calculating the expenses related to insurance premiums, etc. and insurance benefits, fractional sums under Article 47 of the Management of the National Funds Act shall be excluded from the calculation.

Article 108 (Government's Subsidies for Insurance Finance)

(1) The State shall subsidize an amount equivalent to 14/100 of the amount of anticipated revenues from insurance premiums for the relevant year to the Corporation from the National Treasury each year

Article 106 ~ 108

within budgetary limits.

(2) The National Health Promotion Fund under the National Health Promotion Act may provide funds to the Corporation, as prescribed by the same Act.

(3) The Corporation shall appropriate financial resources raised pursuant to paragraph (1) for the following purposes: <Amended by Act No. 11787, May 22, 2013>

1. Insurance benefits for policyholders and their dependents;

2. Operational expenses for the health insurance business;

3. Subsidies needed to reduce insurance premiums pursuant to Articles 75 and 110 (4).

(4) The Corporation shall use the funds provided pursuant to paragraph (2) for the following businesses:

1. Projects undertaken to enhance health, such as health checkup;

2. Insurance benefits paid to treat diseases suffered by policyholders and their dependents that are caused by smoking;

3. Insurance benefits paid to the aged who are at least 65 years old, from among policyholders and their dependents.

Article 108

<<By Article 2 of the Addenda No. 1114 on December 31, 2011, this Article shall remain effective until December 31, 2016>>

Article 109 (Special Cases for Foreigners, etc.)

(1) The Government may arrange for separate health insurance for the workers at a workplace where a foreign government is the employer, in consultation with the foreign government.

(2) Overseas Korean nationals or foreigners who live in the Republic of Korea and who are prescribed by Presidential Decree shall become policyholders or dependents under the application of this Act, notwithstanding Article 5.

Article 110 (Special Cases for Unemployed Persons)

(1) Any person prescribed by Ordinance of the Ministry of Health and Welfare, among the employer-provided policyholders whose employment relationship has expired, may file an application with the Corporation for retaining his/her qualification as an employer-provided policyholder by the date two months elapse after the deadline for the payment of the insurance premium stated in the first notice he/she receives as a locally provided policyholder under Article 79. <Amended by Act No. 11787, May 22, 2013>

(2) Notwithstanding Article 9, a policyholder who files an application with the Corporation under paragraph (1) (hereinafter referred to

Article 109 ~ 110

as "vluntarily and cntinuusly insured persn") shall retain his/her qualification during the period prescribed by Presidential Decree: Provided, That where he/she fails to pay the first insurance premium of an employer-provided policyholder to be paid after the filing of an application under paragraph (1) until two months elapse after the deadline therefor, his/her qualification shall be suspended. <Newly Inserted by Act No. 11787, May 22, 2013>

(3) A voluntarily and continuously insured person's amount of monthly wage shall be the average amount of his/her wages paid for immediately preceding three months with the exception of the month in which the date on which the employment relationship expires falls, notwithstanding Article 70. <Amended by Act No. 11787, May 22, 2013>

(4) Part of the insurance premiums of a voluntarily and continuously insured person may be reduced, as published by the Minister of Health and Welfare. <Amended by Act No. 11787, May 22, 2013>

(5) Total amount of the insurance premiums of voluntarily and continuously insured persons shall be borne and paid by them notwithstanding Articles 76 (1) and 77 (1) 1. <Amended by Act No. 11787, May 22, 2013>

(6) Where a voluntarily and continuously insured person fails to pay the insurance premium by a payment deadline, Article 53 (3), (5) and (6) of shall apply mutatis mutandis. In such cases, the terms, "per household insurance premiums referred to in Article

Article 110

69 (5)" shall be construed as "insurance premiums pursuant to Article 110 (5)". <Amended by Act No. 11787, May 22, 2013>

(7) Matters relating to the methods and procedures for filing applications to become a voluntarily and continuously insured person and other relevant matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 11787, May 22, 2013>

Article 111 (Assignment and Entrustment of Authority)

(1) The authority of the Minister of Health and Welfare under this Act may be partially delegated to the Special Metropolitan City Mayor, Metropolitan City Mayors, Do Governors, or the Governor of a Special Self-Governing Province as prescribed by Presidential Decree.

(2) The authority of the Minister of Health and Welfare under Article 97 (2) may be entrusted to the Corporation or the Review and Assessment Service, as prescribed by Presidential Decree.

Article 112 (Entrustment of Services)

(1) The Corporation may entrust each of the following services to postal service agencies, financial institutions or other persons prescribed by Presidential Decree:

1. Receipt of insurance premiums and verifying payment of insurance premiums;

Article 111 ~ 112

2. Payment of insurance benefit costs;

3. Receipt of pension insurance premiums, employment insurance premiums, employment insurance and industrial accident compensation insurance premiums, contributions and other charges (hereinafter referred to as "insurance premiums, etc. entrusted for collection") collected according to the entrustment of the law applicable to the entrustment of collection, or verification of payment of insurance premiums.

(2) The Corporation may entrust part of its services to state agencies, local governments, corporations that conduct social insurance affairs under other Acts and subordinate statutes, or other persons.

(3) The scope of the operations the Corporation may entrust under paragraph (2) and of the persons to whom they may be entrusted shall be prescribed by Ordinance of the Ministry of Health and Welfare.

Article 113 (Allocation, Payment, etc. of Insurance Premiums, etc. Entrusted for Collection)

(1) Where the amount of insurance premiums collected by the Corporation, subsequent fees or insurance premiums, etc. entrusted with collection is smaller than the amount the Corporation has to collect, it shall collect the payment in installments according to the criteria and means prescribed by Presidential Decree:

Article 113

Provided, That where a person liable to make such payment states otherwise, the Corporation shall comply therewith.

(2) Where the Corporation has collected insurance premiums, etc. entrusted for collection, it shall immediately pay such to the relevant funds by insurance.

Article 114 (Purpose, etc. of Contributions)

(1) For the expenses incurred in conducting services under Article 14 (1) 11, the Corporation shall use contributions received respectively from the National Pension Fund, Industrial Accident Compensation Insurance Fund, Employment Insurance Fund, and Wage Claim Guarantee Fund under the National Pension Act, Industrial Accident Compensation Insurance Act, and Employment Insurance Act.

(2) Matters necessary for management, operation, etc. of contributions received under paragraph (1) shall be prescribed by Presidential Decree.

CHAPTER IX PENAL PROVISIONS

Article 115 (Penal Provisions)

(1) A person who works for a claim processing agency and files a claim for medical care benefit costs by false or illegal means shall be punished by imprisonment with prison labor for not more than three years, or by a fine not exceeding 30 million won.

Article 114 ~ 115

(2) A person who falls under any of the following subparagraphs shall be punished by imprisonment with prison labor for not more than one year, or by a fine not exceeding 10 million won: <Amended by Act No. 11787, May 22, 2013>

1. A person who permits any other person who is not a claim processing agency to vicariously examine such claims, in violation of Article 47 (6);

2. An employer who violates Article 93;

3. A founder of any medical care institution, who violates Article 98 (2);

4. A person who violates Article 102;

5. A person who receives or arranges another person to receive insurance benefits by deceit or other unjust means.

Article 116 (Penal Provisions)

A person who fails to report or submit documents, a person who files a false report or submits false documents, or a person who refuses, interferes with or evades inspection or questioning in violation of Article 97 (2) shall be punished by a fine not exceeding 10 million won.

Article 117 (Penal Provisions)

A person who violates Article 40 (4) or a person who fails to issue a detailed

Article 116 ~ 117

statement of medical care costs or a receipt stating the particulars of the medical care in violation of Article 49 (2) shall be punished by a fine not exceeding five million won.

Article 118 (Joint Penal Provisions)

Where the representative of a corporation, or an agent, employee or any other person working for the corporation or an individual commits any act which violates Articles 115 through 117 in connection with the business of the corporation or the individual, not only shall such violator be punished accordingly, but the corporation or the individual shall be punished by a fine prescribed in the relevant provisions: Provided, That the same shall not apply to cases where the corporation or the individual has not been negligent in paying due attention and supervision to the relevant business in order to prevent such violation.

Article 119 (Fines for Negligence)

(1) Deleted. <by Act No. 11787, May 22, 2013>

(2) Deleted. <by Act No. 11787, May 22, 2013>

(3) A person who violates Article 98 (4) shall be punished by a fine for negligence not exceeding five million won.

(4) A person who falls under any of the following subparagraphs shall be punished by a fine for negligence not exceeding one million won: <Amended by Act No. 11787, May 22, 2013>

Article 118 ~ 119

1. A person who fails to make a report or makes a false report, in violation of Article 7;

2. A person who fails to make a report or makes a false report, in violation of Article 43 (1) or (2);

3. A person who fails to submit documents, to state his/her opinion or to make a report, a person who makes a false statement or false report, or a person who refuses, interferes with or evades investigation or inspection, in violation of Article 94 (1) or (2), 97 (1), (3) or (4), or 101 (2);

4. A person who fails to preserve documents in violation of Article 96-2;

5. A person who violates an order issued under Article 103;

6. A person who violates Article 105.

(5) Fines for negligence under paragraphs (3) and (4) shall be imposed and collected by the Minister of Health and Welfare, as prescribed by Presidential Decree. <Amended by Act No. 11787, May 22, 2013>

ADDENDA

Article 1 (Enforcement Date)

This Act shall enter

Addenda

into force on September 1, 2012: Provided, That the amended provisions of Article 98 (2), 108, and 115 (2) 3 shall enter into force on the date of its promulgation.

Article 2 (Term of Validity)

@Article 108 shall remain in force until December 31, 2016.

Article 3 (Succession of Rights by Universal Title, etc.)

The Corporation shall succeed, by universal title, to the rights and duties of the Medical Insurance Association and the Medical Insurance Federation referred to in the former Medical Insurance Act existing as of July 1, 2000 on which date the National Health Insurance Act (Act No. 5854) entered into force: Provided, That the Review and Assessment Service shall succeed, by universal title, to the rights and duties of the Medical Insurance Federation related with its review operations.

Article 4 (Application Example concerning Collection and Exemption of Insurance Premiums)

The amended provisions of Articles 69 (2) and 74 (3) shall apply from the case where a person obtains qualifications or becomes disqualified for a policyholder or where a ground for suspension of benefits occurs or ceases to exist for the first time on or after November 1, 2006, on which date the partially amended National Health Insurance Act (Act No. 8034) entered into

Addenda

force.

Article 5 (Application Example concerning Insurance Premiums)

The amended provisions of Article 69 (4) 1 and (5) shall apply from the first insurance premium notified on or after January 1, 2007, on which date the partially amended National Health Insurance Act (Act No. 8153) entered into force.

Article 6 (Applicable Example concerning Exemption of Minors from Obligation of Joint Payment of Locally Provided Policyholder's Insurance Premium and Collection of Additional Amount Added to Additional Dues)

(1) The amended provisions of the proviso to Article 77 (2) shall apply from the first insurance premium, etc. notified on or after September 29, 2008, on which date they entered into force under the proviso to Article 1 of the Addenda of the partially amended National Health Insurance Act (Act No. 9022).

(2) The amended provisions of Article 80 shall apply from the first insurance premium, etc. notified on or after July 1, 2008, the date on which they entered into force under the proviso to Article 1 of the Addenda of the partially amended National Health Insurance Act (Act No. 9022).

Article 7 (Applicable Example concerning Addition of Interests to Refunds)

Addenda

The amended provisions of the latter part of Article 86 (2) shall apply from the first refund made on or after September 29, 2008, the date on which they entered into force under the proviso to Article 1 of the Addenda of the partially amended National Health Insurance Act (Act No. 9022).

Article 8 (Applicable Example concerning Prescription)

The amended provisions of Article 91 (1) 6 shall also apply to the rights of the Korea Workers' Compensation and Welfare Service whose prescription is not completed as at the time this Act enters into force.

Article 9 (Applicable Example concerning Fact of Violation)

The amended provisions of Article 100 shall apply from the first violation that occurs on or after September 29, 2008, the date on which they entered into force under the proviso to Article 1 of the Addenda of the partially amended National Health Insurance Act (Act No. 9022).

Article 10 (Applicable Example concerning Government's Subsidies for Insurance Finance)

The amended provisions of Article 108 shall apply from the budget of fiscal year 2012.

Article 11 (Special Case concerning Retirement Age of Employees Consequential to Integrating Collection Services of Social Insurance

Addenda

Premiums)

The retirement age of an employee who was transferred from the National Pension Service or the Korea Workers' Compensation and Welfare Service to the Corporation on January 1, 2011, the date on which the partially amended National Health Insurance Act (Act No. 9690) entered into force shall conform to the retirement age of the relevant National Pension Service or Korea Workers' Compensation and Welfare Service at the time he/she was transferred to the Corporation: Provided, That this shall not apply where the retirement age of an employee of the Corporation is higher than that of the relevant Service.

Article 12 (Transitional Measures concerning Deliberative Committee and Financial Operation Committee)

(1) Members of the Deliberative Committee and the Financial Operation Committee appointed or commissioned under former provisions existing at the time this Act enters into force, shall be deemed appointed or commissioned under this Act, and the their term of office shall be the period remaining pursuant to former provisions.

(2) Matters which have undergone the deliberation and resolution of the Deliberative Committee and the Financial Operation Committee at the time this Act enters into force shall be deemed to have undergone the deliberation and resolution under this Act.

Addenda

Article 13 (Transitional Measures concerning the Corporation)

The National Health Insurance Management Corporation under the former National Medical Insurance Act existing as of July 1, 2000 on which date the National Health Insurance Act (Act No. 5854) entered into force shall be deemed the Corporation established under this Act.

Article 14 (Transitional Measures concerning Executives)

Notwithstanding the amended provisions of Articles 20 and 65, the term of office of executives of the Corporation and the Review and Assessment Service appointed under former provisions at the time this Act enters into force shall continue until the date of completion of their term of office fixed at the time they were appointed.

Article 15 (Transitional Measures concerning Permission for Executives, etc. of the Corporation for Holding Concurrent Offices)

In cases where an executive or an employee of the Corporation or the Review and Assessment Service has obtained permission from the person with the power to appoint him/her to hold concurrent office under Article 37 (2) of the Act on the Management of Public Institutions at the time this Act enters into force, he/she shall be deemed to have obtained permission for holding concurrent offices under the amended provisions of Article 25 (2) (including the cases of application mutatis mutandis under Article 68).

Addenda

Article 16 (Transitional Measures concerning Report on Current Status of Medical Care Institutions)

A medical care institution which has filed a report on the current status of its manpower, facilities, equipment, etc. to the Review and Assessment Service at the time this Act enters into force shall be deemed to have filed such report under the amended provisions of Article 43.

Article 17 (Transitional Measures concerning Collection of Insurance Premium, etc.)

Collection of insurance premium, etc. the payment deadline of which has passed under the former Medical Insurance Act and National Medical Insurance Act as of July 1, 2000 on which date the National Health Insurance Act (Act No. 5854) entered into force shall be governed by the former provisions.

Article 18 (Transitional Measures concerning Extinctive Prescription of Previous Insurance Premium, etc.)

The extinctive prescription of any of the rights to collect insurance premiums, to receive a refund, to receive a insurance benefit and to receive a refund of duplicated overpayment which has occurred on or before July 1, 2000, on which date the National Health Insurance Act (Act No. 5854) entered into force shall be governed by the former Medical Insurance Act and the former National Medical Insurance Act.

Addenda

Article 19 (General Transitional Measures concerning Disposition, etc.)

Any act of the Corporation, Review and Assessment Service, Minister of Health and Welfare (hereafter referred to as the "Corporation, etc." in this Article) or any act against the Corporation, etc. done under former provisions at the time this Act enters into force shall be deemed an act corresponding thereto committed by or against the Corporation, etc. under this Act.

Article 20 (Transitional Measures concerning Disposition against Previous Offense)

(1) The disposition against an act in violation of the former Medical Insurance Act or the former National Medical Insurance Act committed on or before July 1, 2000 on which date the National Health Insurance Act (Act No. 5854) entered into force shall be governed by the former Medical Insurance Act and the former National Medical Insurance Act.

(2) The application of penal provisions and fines for negligence against an act committed before this Act enters into force shall be governed by former provisions.

Article 21 Omitted.

Article 22 (Relationship with other Acts and Subordinate Statutes)

Addenda

Where any other Act or subordinate statute cites the former provisions of the National Medical Insurance Act at the time this Act enters into force, it shall be deemed to have cited the relevant provisions of this Act in lieu of the former provisions, if any provisions corresponding thereto exist in this Act.

ADDENDA <Act No. 11787, May 22, 2013>

Article 1 (Enforcement Date)

This Act shall enter into force on the date of its promulgation: Provided, That the amended provisions of Articles 78, 81-2 and 104 shall enter into force six months after the date of its promulgation.

Article 2 (Applicable Example concerning Collection of Unjust Gains Obtained by Medical Care Institutions)

The amended provisions of Article 57 (2) shall apply where unjust gains are collected on or after the date this Act enters into force.

Article 3 (Applicable Example concerning Extension, etc. of Period for Application for Special Cases for Unemployed Persons)

(1) The amended provisions of Article 110 (1) and (3) shall apply to persons notified of an insurance premium as a locally provided policyholder on or after the date this Act enters into force (including

Addenda

persons notified of an insurance premium as a locally provided policyholder before this Act enters into force and the payment deadline has not elapsed as of the date this Act enters into force).

(2) The amended provisions of Article 110 (2) shall also apply to voluntarily and continuously insured persons in whose case two months have not elapsed since the deadline for payment of the first insurance premium of employer-provided policyholders.

Article 4 (Transitional Measures concerning Penal Provisions or Fines for Negligence)

The application of penal provisions or fines for negligence against an act committed before this Act enters into force shall be governed by the former provisions.

ADDENDA <Act No. 12176, Jan. 1, 2014>

Article 1 (Enforcement Date)

This Act shall enter into force six months after the date of its promulgation: Provided, That the amended provisions of Article 76 shall enter into force on January 1, 2014.

Article 2 (Applicability concerning Insurance Premiums for Employees of Private Schools)

The amended provisions of Article 76 shall apply to insurance premiums notified

Addenda

on or after this Act enters into force.

Addenda

NATIONAL HEALTH INSURANCE ACT
- Articles
- Addenda

1. 국민건강보험법

2025-10-01 / 제21065호 / 시행 2026-01-02
NATIONAL HEALTH INSURANCE ACT

2. 국민건강보험법

2024-10-22 / 제20505호 / 시행 2025-04-23
NATIONAL HEALTH INSURANCE ACT

3. 국민건강보험법

2024-02-20 / 제20324호 / 시행 2024-08-21
NATIONAL HEALTH INSURANCE ACT

4. 국민건강보험법

2024-02-06 / 제20211호 / 시행 2024-05-07
NATIONAL HEALTH INSURANCE ACT

5. 국민건강보험법

2024-01-23 / 제20092호 / 시행 2024-01-23
NATIONAL HEALTH INSURANCE ACT

6. 국민건강보험법

2023-07-11 / 제19527호 / 시행 2024-01-12
NATIONAL HEALTH INSURANCE ACT

7. 국민건강보험법

2022-12-27 / 제19123호 / 시행 2023-06-28
NATIONAL HEALTH INSURANCE ACT

8. 국민건강보험법

2022-06-10 / 제18895호 / 시행 2022-12-11
NATIONAL HEALTH INSURANCE ACT

9. 국민건강보험법

2021-06-08 / 제18211호 / 시행 2021-12-09
NATIONAL HEALTH INSURANCE ACT

10. 국민건강보험법

2020-12-29 / 제17772호 / 시행 2021-06-30
NATIONAL HEALTH INSURANCE ACT

11. 국민건강보험법

2020-12-29 / 제17758호 / 시행 2021-01-01
NATIONAL HEALTH INSURANCE ACT

12. 국민건강보험법

2020-04-07 / 제17196호 / 시행 2020-07-08
NATIONAL HEALTH INSURANCE ACT

13. 국민건강보험법

2019-12-03 / 제16728호 / 시행 2020-06-04
NATIONAL HEALTH INSURANCE ACT

14. 국민건강보험법

2019-11-26 / 제16652호 / 시행 2019-11-26
NATIONAL HEALTH INSURANCE ACT

15. 국민건강보험법

2019-04-23 / 제16366호 / 시행 2019-04-23
NATIONAL HEALTH INSURANCE ACT

16. 국민건강보험법

2019-01-15 / 제16238호 / 시행 2019-04-16
NATIONAL HEALTH INSURANCE ACT

17. 국민건강보험법

2018-12-11 / 제15874호 / 시행 2018-12-11
NATIONAL HEALTH INSURANCE ACT

18. 국민건강보험법

2018-03-27 / 제15535호 / 시행 2018-03-27
NATIONAL HEALTH INSURANCE ACT

19. 국민건강보험법

2018-01-16 / 제15348호 / 시행 2018-01-16
NATIONAL HEALTH INSURANCE ACT

20. 국민건강보험법

2017-07-26 / 제14839호 / 시행 2017-07-26
NATIONAL HEALTH INSURANCE ACT

21. 국민건강보험법

2017-04-18 / 제14776호 / 시행 2017-04-18
NATIONAL HEALTH INSURANCE ACT

22. 국민건강보험법

2017-02-08 / 제14557호 / 시행 2017-02-08
NATIONAL HEALTH INSURANCE ACT

23. 국민건강보험법

2016-05-29 / 제14183호 / 시행 2016-11-30
NATIONAL HEALTH INSURANCE ACT

24. 국민건강보험법

2016-03-22 / 제14084호 / 시행 2016-09-23
NATIONAL HEALTH INSURANCE ACT

25. 국민건강보험법

2016-02-03 / 제13985호 / 시행 2016-08-04
NATIONAL HEALTH INSURANCE ACT

26. 국민건강보험법

2014-11-19 / 제12844호 / 시행 2014-11-19
NATIONAL HEALTH INSURANCE ACT

27. 국민건강보험법

2014-05-20 / 제12615호 / 시행 2014-09-25
NATIONAL HEALTH INSURANCE ACT

28. 국민건강보험법

2014-01-01 / 제12176호 / 시행 2014-02-21
NATIONAL HEALTH INSURANCE ACT

29. 국민건강보험법

2013-05-22 / 제11787호 / 시행 2013-06-25
NATIONAL HEALTH INSURANCE ACT

30. 국민건강보험법

2011-12-31 / 제11141호 / 시행 2012-09-01
NATIONAL HEALTH INSURANCE ACT

31. 국민건강보험법

2011-09-15 / 제11041호 / 시행 2012-07-01
NATIONAL HEALTH INSURANCE ACT

32. 국민건강보험법

2011-05-19 / 제10682호 / 시행 2011-05-19
NATIONAL HEALTH INSURANCE ACT

33. 국민건강보험법

2010-06-10 / 제10366호 / 시행 2012-06-11
NATIONAL HEALTH INSURANCE ACT

34. 국민건강보험법

2010-03-22 / 제10155호 / 시행 2011-01-01
NATIONAL HEALTH INSURANCE ACT

35. 국민건강보험법

2010-01-18 / 제9932호 / 시행 2011-01-01
NATIONAL HEALTH INSURANCE ACT

36. 국민건강보험법

2009-05-21 / 제9690호 / 시행 2011-01-01
NATIONAL HEALTH INSURANCE ACT

37. 국민건강보험법

2009-01-30 / 제9386호 / 시행 2010-01-31
NATIONAL HEALTH INSURANCE ACT

38. 국민건강보험법

2008-03-28 / 제9079호 / 시행 2008-06-29
NATIONAL HEALTH INSURANCE ACT

39. 국민건강보험법

2008-03-28 / 제9022호 / 시행 2008-03-28
NATIONAL HEALTH INSURANCE ACT

40. 국민건강보험법

2008-02-29 / 제8852호 / 시행 2008-02-29
NATIONAL HEALTH INSURANCE ACT

41. 국민건강보험법

2007-12-14 / 제8694호 / 시행 2008-07-01
NATIONAL HEALTH INSURANCE ACT

42. 국민건강보험법

2006-12-30 / 제8153호 / 시행 2007-01-01
NATIONAL HEALTH INSURANCE ACT

43. 국민건강보험법

2006-10-04 / 제8034호 / 시행 2006-11-01
NATIONAL HEALTH INSURANCE ACT

44. 국민건강보험법

2005-07-13 / 제7590호 / 시행 2006-01-01
NATIONAL HEALTH INSURANCE ACT

45. 국민건강보험법

2005-01-27 / 제7377호 / 시행 2005-07-28
NATIONAL HEALTH INSURANCE ACT

46. 국민건강보험법

2005-01-27 / 제7347호 / 시행 2005-07-01
NATIONAL HEALTH INSURANCE ACT

47. 국민건강보험법

2004-01-29 / 제7144호 / 시행 2004-01-29
NATIONAL HEALTH INSURANCE ACT

48. 국민건강보험법

2003-09-29 / 제6981호 / 시행 2004-03-30
NATIONAL HEALTH INSURANCE ACT

49. 국민건강보험법

2003-07-29 / 제6951호 / 시행 2003-07-29
NATIONAL HEALTH INSURANCE ACT

50. 국민건강보험법

2002-12-18 / 제6799호 / 시행 2002-12-18
NATIONAL HEALTH INSURANCE ACT

51. 국민건강보험법

2002-01-19 / 제6618호 / 시행 2002-01-19
NATIONAL HEALTH INSURANCE ACT

52. 국민건강보험법

2001-05-24 / 제6474호 / 시행 2001-10-01
NATIONAL HEALTH INSURANCE ACT

53. 국민건강보험법

2000-12-29 / 제6320호 / 시행 2001-07-01
NATIONAL HEALTH INSURANCE ACT

54. 국민건강보험법

2000-01-12 / 제6124호 / 시행 2000-01-12
NATIONAL HEALTH INSURANCE ACT

55. 국민건강보험법

1999-12-31 / 제6093호 / 시행 1999-12-31
NATIONAL HEALTH INSURANCE ACT

56. 국민건강보험법

1999-12-31 / 제6073호 / 시행 1999-12-31
NATIONAL HEALTH INSURANCE ACT

57. 국민건강보험법

1999-02-08 / 제5854호 / 시행 2000-07-01
NATIONAL HEALTH INSURANCE ACT