Korean health insurance covers the whole population living in the country. Insurance benefits are medical services provided for the insured in the case of injuries, childbirth, health promotions, rehabilitations, or preventions of diseases. NHIS gives service benefits or cash benefits. The Korean health insurance service imposes insurance contributions differently on the insured depend on his/her level of wealth, but it provides insurance benefits equally to all the insured.
Insurance Benefits
|
Insurance Benefits |
Benefits in kind |
- Health Care Benefits |
|
Benefits in cash |
- Compensation for Excessive Co-payment - Reimbursement of expenses exceeding one’s co-payment
ceiling
the disabled |
Co-Payment
| Co-Payment |
Co-Payment |
|
|
Inpatient |
|
20% of total treatment cost (Registered cancer patients 5%, Registered rare/incurable diseases patients 10%) |
|
Outpatient |
Higher level general hospital |
60% of total treatment cost and other expenses |
|
General Hospital |
50% (administrative district: Dong), 45% (administrative district: Eup, Myeon) of total care benefit expenses |
|
|
Pharmacy |
40% (administrative district: Dong). 35% (administrative district: Eup, Myeon) of total care benefit expenses |
|
|
Hospital |
30% of total care benefit expenses |
|
|
Clinic |
30% of total care benefit expenses |
Additional Benefits
NHIS can subsidize medical service expenses for pregnancy, childbirth and infants treatment
Eligible persons : a policy holder or his/her dependent whose pregnancy is verified by a doctor
Subsidized expenses : 600,000 KRW per one pregnancy & childbirth
Non-Benefits
- Medicine, medical material, or medical service that is provided or used for a disease that does not influence a patient’s daily life seriously.
- Medicine, medical material, or medical service that does not improve the essential bodily functions.
ex) Cosmetic surgery, freckle treatment, snoring treatment.
Exception: Case of reconstructive surgery for burned face)
- More detail : https://www.nhis.or.kr/english/wbheaa02600m01.do