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Medical Insurance

Life in korea/Medical Insurance

The health security system in Korea

The health security system of Korea pursues to promote people's health and improve the social security by providing necessary health care services for disease, injury, birth, and death, etc. In Korea, there are a National Health Insurance program for ordinary people and a Medical Aid program for low-income households as the health security system.



	The NHI program of Korea covers whole population as a compulsory social insurance system. Its main source of finance are contributions from the insured and government subsidies. The benefits package consists of benefits in-kind and benefits in-cash on the whole. According to types of health care institutions, there are complicated co-payment systems, which lead people to use medical services rationally. Patients are given almost unconstrained freedom in choosing providers and can choose both western and oriental medicine. The third-party payment system has been adopted for providing medical services and providers are paid by mainly fee-for-service. With regards to administration of the NHI program, NHIC, the unique insurer, is responsible for operating the program, Health Insurance Review Agency(HIRA) is in charge of reviewing claims of providers, Ministry of Health and Welfare supervises its operation as a whole.



	The Medical Aid program is a public assistance scheme to secure the minimum livelihood of low-income households and help their self-help through providing medical services. The government, facing social problems such as health inequality arising from the gulf between rich and poor, initiated this program to provide substantial medical services for low-income people in the year of 1979 after its promulgation of Medical Aid Act in 1977. The Medical Aid program is funded jointly by central and local governments, the insurer. Each local government selects the beneficiary who meet the conditions the Minister of Health and Welfare sets. According to their income level and other factors, the beneficiary fall under one of 2 categories. The Medical Aid program provides beneficiaries for the same benefit package as that of the insured in NHI program. NHIC, responsible for operating the program instead of the government, reimburses providers for medical services provided.

Korean Health Card System

[Quotation from SEC]

Frequent Questions(1)

1. Where can foreigners get the Status of Stay?

- They can get the Status of Stay at a branch office of the Immigration Bureau near their residential areas.

2. Who are subject to the employee insured under the NHI program?

- Those who are the employers or the employees of workplaces in Korea are covered compulsorily as the employee insured.

3. What should foreigners who want to be covered as an insuree in the category of the employee insured do for their enrollment?

- Foreign workers shall make an application for enrollment to the employer of their workplaces who is by law responsible for submitting the application to the National Health Insurance Corporation with the required documentations.

4. Who can be the dependants of the employee insured?

- Any family member(parents, spouse and children, etc)can be registered as a dependant under the NHI program, provided that he/she submits relevant documents to verify the family-relationship.

5. Are the insurance benefits for the dependant different from those for the employee insured?

- No, the dependants have the same insurance benefits as those for the employee insured.

6. When is the effective date of coverage for the employee insured?

- The enrollment is effective on the employee's first date at work. For the employees who hadn't been covered by the NHI program, their coverage has been compulsory since the first of January in 2006

7. When will the employee insured be disqualified from the NHI program?

- They lose eligibility from the next day when their employment contract is terminated.

8. Can foreigners drop out of the NHI program when they are doing job in their workplace?

- No, they can not voluntarily secede from the NHI program as long as they are the employees of workplaces.

9. Who can be the self-employed insured under the NHI program?

- Foreigners who have the Status of Stay D1 ~ D9, E1 ~ E5, E7 ~ E8, and F1 ~ F5 while not being the employee insured under the NHI program can be the self-employed insured on the voluntary basis.

10. What is the payment method for the contribution of the foreign self-employed insured?

- The sum of 3 month contributions should be prepaid every month(the contribution payment duty is retroactive to the day when they were registered for their residence in Korea) However, this payment method is not applied to the permanent foreign resident.

11. What percentage of the monthly contribution do the employee and the employer share?

- The monthly contribution is borne by employee and employer as follows:

Classification	Total	Employee Insured	Employer	Government
Employee	100%	50%	50%	-
Government Employee	100%	50%	-	50%
Private school Employee	100%	50%	30%	20%

12. What method is applied to calculate the amount of the monthly contribution of the employee insured?

- The amount of the monthly contribution of the employee insured is calculated as follows : - Monthly Contribution = Standard Monthly Wage ¡¿ Contribution Rate(currently 4.48%)

13. What is the Standard Monthly Wage?

- The Standard Monthly Wage is the average monthly wage of an employee in the Standard Monthly Wage Table which consists of 100 income brackets.

14. Who is in charge of paying the contribution of the employee to the NHIC?

- The employer has responsibility for paying the contribution. The contribution should be deducted from the salary of the employee and the employer should pay it to the NHIC.

15. What method is applied to calculate the contribution of foreigners?

- Foreigners whose income(wage) can be identified

- Status of Sojourn : D-3(industrial training), D-5(press coverage), D-6(religious workers), D-7(intra-company transfer), D-8(investment), D-9(trade and management), E-1(professor), E-2(foreign language teaching), E-3(research), E-4(technological guidance), E-5(professional employment), E-7(specially designated activities), E-8(training), E-9(non-professional employment)

- Contribution : calculated by multiplying monthly wage by the contribution rate of the employee insured

[However, if income(wage) is unidentified, or if the estimated contribution is below the average contribution of the self- employed for the previous year, the average contribution of Korean self-employed insured for the previous year shall be imposed. For D-6(religious workers), 30% of the contribution estimated is reduced.]

[Quotation from SEC]

Frequent Questions(2)

1. What types of benefits does the NHIC supply for the insured?

- Diverse services such as health care benefits including medical treatment and drug, health screening service, Refunding Allowance for Health Care, Funeral Allowance, Compensation for Excessive Co-payment, and Appliance Expenses for the Disabled, etc are provided. For more detail, please, visit our website(www.nhic.or.kr).

2. When are the insured restricted to getting the insurance benefits?

- The insured cannot get insurance benefits if they come under one of the following cases: when the injury was deliberately caused or due to criminal actions; when they intentionally violated the instructions or regulations of the NHIC or health care institutions; when they intentionally disregarded the inquiry or diagnosis of the NHIC or health care institutions; or when the insured person has already been compensated for the injuries or diseases that had happened at work or on public duty from other social security programs like Industrial Accidents Compensation Insurance.

3. What amount of co-payments are patients required to pay?

- Persons who receive health care treatments pay certain portion of the health care costs as co-payments. Co-payments are paid to health care institutions directly by patients. ¡？ In-patient Medical Services When a patient is admitted to a clinic, a hospital or a general hospital, the patient is required to pay 20% of the total medical charges for the in-patient care. ¡？ Outpatient Medical Services Co-payments for out-patient cares vary depending on the level of health care facilities or the total amount of service charges. For outpatient services provided at a clinic, the patient must pay 3,000 won when the total charges do not exceed 15,000 won (at a dental clinic; 3,500 won). An elderly patient, however, pays only 1,500 won when total charges do not exceed 15,000 won; the patient pays 30% of the total charges including the diagnosis fee when total charges exceed 15,000 won. For outpatient services provided at a hospital or a general hospital, 40% or 50 %, respectively, of the total charges is paid for co-payment. And, when a patient visits a hospital or a general hospital in remote and rural areas for outpatient services, the patient, if the total cost does not exceed 15,000 won, pays 4,100 won or 4,600 won, respectively, if exceeding 15,000 won, pays 35% or 45% of total costs, respectively. However, at a specialized general hospital the patient has to pay 50% of the total charges, excluding the diagnosis and consultation fee.

4. What kinds of medical services are not insured by the NHI?

- 1.Any medical services, drugs, or materials provided or used for diseases which do not cause serious problems in daily life or business 2. Any medical services, drugs, or materials provided or used for care, which is not for the improvement of physically essential functions 3. Any medical services, drugs, or materials provided or used for preventive care, which is not for the treatment of disease/injury 4.Medical services, drugs, or materials provided or used for the services that are incompatible with the principle of social insurance benefits or health insurance benefit policy 5.Medical services, drugs, or medical materials, which are temporarily excluded from insurance benefit coverage If you want to get more information in detail, please refer to the homepage for national health insurance program- non-insured benefits.

[Quotation from SEC]