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ENFORCEMENT DECREE OF THE NATIONAL HEALTH INSURANCE ACT — 법갈피

영문법령 / ENFORCEMENT DECREE OF THE NATIONAL HEALTH INSURANCE ACT

ENFORCEMENT DECREE OF THE NATIONAL HEALTH INSURANCE ACT

대통령령일부개정시행 2025-09-16보건복지부,보건복지부,보건복지부 · 제35751호 · 공포 2025-09-16

CHAPTER I GENERAL PROVISIONS

Article 1(Purpose) #

The purpose of this Decree is to prescribe matters mandated by the National Health Insurance Act and those necessary for the enforcement thereof.

Article 2(Head of organ who is employer) #

"Who is prescribed by Presidential Decree" in subparagraph 2 (b) of Article 3 of the National Health Insurance Act (hereinafter referred to as the "Act") means heads of organizations referred to in Appendix 1; provided, when deemed necessary for efficiently dealing with the health insurance service, the National Health Insurance Service referred to in Article 13 of the Act (hereinafter referred to as the "NHIS") may separately designate the head of an organ that belongs to the head of an institution set forth in Appendix 1 as the head of an organ who is an employer, in consideration of the location of the organization, the number of its personnel and other conditions.

Article 2-2(Formulation of comprehensive national health insurance plans) #

(1) Where the Minister of Health and Welfare formulates a comprehensive national health insurance plan under the former part of Article 3-2 (1) of the Act (hereinafter referred to as "comprehensive plan") and an annual implementation plan under paragraph (3) of that Article (hereinafter referred to as "implementation plan"), he or she shall do so by the time classified as follows:

1. Comprehensive plan: By September 30 of the year immediately preceding the enforcement year;

2. Implementation plan: By December 31 of the year immediately preceding the enforcement year.

(2) Where the Minister of Health and Welfare formulates or modifies a comprehensive plan or implementation plan, he or she shall publish it by either of the following methods, whichever is relevant:

1. Comprehensive plan: Providing public notice in the Official Gazette;

2. Implementation plan: Posting it on the official website of the Ministry of Health and Welfare.

(3) Where the Minister of Health and Welfare formulates or modifies a comprehensive plan or implementation plan, he or she shall notify the details thereof to the heads of related central administrative agencies, the president of the NHIS, and the president of the Health Insurance Review and Assessment Service referred to in Article 62 of the Act (hereinafter referred to as the "Review and Assessment Service").

Article 18(Medical facilities excluded from health care institution) #

(1) "Medical facilities, etc. prescribed by Presidential Decree" in the latter part, with the exception of the subparagraphs, of Article 42 (1) of the Act means the following medical institutions or drugstores: <Amended on Mar. 20, 2017>

1. Affiliated medical institutions established under Article 35 of the Medical Service Act;

2. Medical institutions established for the purpose of medical treatment for the inmates of social service facilities under Article 34 of the Social Welfare Services Act;

3. Medical institutions falling under any of the following items which have become subject to disposition to suspend business, etc. due to activities of inducing the insured or his or her dependent by means of not receiving the amount of co-payment under Article 19 (1) or receiving it in the reduced amount, or performing excessive medical treatments in connection therewith, or demanding exorbitant medical fees:

(a) Medical institutions which have been subject to business suspension under Article 98 of the Act or disposition of penalty surcharges under Article 99 of the Act twice or more for five years;

(b) Medical institutions established and operated by medical persons who have been subject to a disposition of license suspension under Article 66 of the Medical Service Act twice or more for five years;

4. Medical institutions or drugstores established by the founder of the health care institutions subject to a business suspension or under the process of the procedures for business suspension under Article 98 of the Act.

(2) Where the medical institutions stipulated under paragraph (1) 1 and 2 intend to be excluded from among health care institutions, they shall file an application for exclusion from among health care institutions determined by the Minister of Health and Welfare.

(3) The period for which a medical institution, etc. is excluded from among health care institutions shall not exceed one year in cases under paragraph (1) 3, and by not later than the end of the business suspension period in cases under paragraph (1) 4.

Article 18-2(Reduction of upper limit amount of costs of health care benefits for medicines and criteria for suspension of application of health care benefits) #

(1) Where the Minister of Health and Welfare reduces the upper limit amount of costs of health care benefits for medicines (referring to the amount set as the upper limit of health care benefits of each kind of medicine pursuant to Article 41 (3) of the Act; hereinafter referred to as "upper limit amount") or suspends any medicine from the application of health care benefits pursuant to Article 41-2 of the Act, he or she shall notify the NHIS and the Review and Assessment Service of such fact to record and manage the details of reduction of the upper limit amount and suspension of the application of health care benefits.

(2) "Period prescribed by Presidential Decree" in Article 41-2 (2) and (3) of the Act means five years, respectively. <Amended on Jun. 11, 2019>

(3) The Minister of Health and Welfare need not reduce the upper limit amount for any of the following medicines, among medicines subject to reduction of the upper limit amount prescribed in Article 41-2 (1) or (2) of the Act:

1. Shortage prevention drugs (referring to medicines designated and publicly notified by the Minister of Health and Welfare, which a manufacturer, contract manufacturing business entity, or importer under the Pharmaceutical Affairs Act avoids their production or import, because such medicines are essential for the treatment of patients but are not cost-effective; hereinafter the same shall apply);

2. Orphan drugs (referring to medicines determined by the Minister of Food and Drug Safety, which should be urgently produced or imported because no alternative drug exists; hereinafter the same shall apply);

3. Low-cost drugs (referring to medicines determined and publicly notified by the Minister of Health and Welfare, whose upper limit amount does not exceed the basic amount determined and publicly notified by the Minister of Health and Welfare).

(4) The criteria for reducing the upper limit amount for medicines and suspending the application of health care benefits under Article 41-2 (1) through (3) of the Act shall be as specified in Appendix 4-2.

[This Article Wholly Amended on Sep. 28, 2018]

Article 18-4(Selective benefits) #

(1) Selective benefits referred to in Article 41-4 (1) of the Act (hereinafter referred to as "selective benefits") may be provided for any of the following cases:

1. Where economic feasibility, medical treatment effects, etc. are uncertain and thus additional grounds are required to verify them;

2. Where potential advantages exist for the recovery of health of the insured or his or her dependents despite low economic feasibility;

3. Cases equivalent to subparagraph 1 or 2, where social demand for health care benefits exists or the Minister of Health and Welfare deems it particularly necessary to enhance national health.

(2) An assessment of the appropriateness of selective benefits referred to in Article 41-4 (2) of the Act (hereinafter referred to as "assessment of appropriateness") shall be conducted as follows:

1. Assessment period: An assessment of appropriateness shall be conducted every five years from the date selective benefits are provided; provided, the Minister of Health and Welfare may determine the assessment period differently, if he or she deems a prompt assessment necessary in the light of the contents, nature, effects, etc. of the relevant selective benefit;

2. Assessment items: An assessment of appropriateness shall be conducted for the following matters:

(a) Medical treatment effects and improvement of the treatment process;

(b) Cost effectiveness;

(d) Potential benefits for national health;

(e) Any other matters similar to those specified in items (a) through (d), which are deemed by the Minister of Health and Welfare particularly necessary for the assessment of appropriateness;

3. Assessment method: An assessment of appropriateness shall be conducted in writing; provided, where deemed necessary by the Minister of Health and Welfare, site investigations, literature review, surveys or other methods may be added to such written assessment.

(3) Where the Minister of Health and Welfare deems that a professional and in-depth review is necessary in connection with an assessment of appropriateness, he or she may request a health care-related research institute, organization, experts, etc. to conduct such assessment.

(4) Where deemed necessary for an assessment of appropriateness, the Minister of Health and Welfare may request relevant central administrative agencies, local governments, public institutions prescribed in the Act on the Management of Public Institutions, or health care-related corporations, organizations, experts, etc. to submit necessary data or their opinions.

(5) Except as provided in paragraphs (2) through (4), matters necessary for the procedures, methods, etc. for conducting an assessment of appropriateness, shall be determined and publicly notified by the Minister of Health and Welfare.

[This Article Added on Mar. 20, 2017]

Article 19(Expenses borne by beneficiaries) #

(1) The rate and amount of co-payment prescribed in Article 44 (1) of the Act (hereinafter referred to as "co-payment") shall be as set forth in Appendix 2.

(2) The amount of co-payment shall be paid by the persons who receive health care benefits to health care institutions upon claims from the health care institutions. In such cases, no health care institution shall claim expenses under pretexts other than health care benefit items or non-benefit items prescribed by Decree of the Ministry of Health and Welfare pursuant to Article 41 (3) or (4) of the Act, such as hospitalization deposits.

(3) The total amount of co-payment prescribed in Article 44 (2) 1 of the Act shall be an amount obtained by adding up the amounts of annual co-payment borne by a person who receives health care benefits; provided, none of the following amounts of co-payment shall be added: <Amended on Jun. 26, 2018; Apr. 2, 2019; Jun. 11, 2019; Oct. 22, 2019; Oct. 7, 2020; Jun. 29, 2021; Jun. 20, 2023; Nov. 7, 2023; Apr. 19, 2024; Aug. 20, 2024>

1. In cases of using two-bed or three-bed rooms of general inpatient units and two-bed or three-bed rooms of inpatient units of the departments of psychiatry, of tertiary care hospitals, general hospitals, hospitals, oriental medical clinics, and intermediate care hospitals (limited to long-term care hospitals that are medical institutions satisfying the requirements prescribed in Article 3-2 of the Medical Service Act among the medical rehabilitation facilities referred to in Article 58 (1) 4 of the Act on Welfare of Persons with Disabilities), and mental hospitals prescribed in subparagraph 1 (a) (i) of Appendix 2, an amount borne as hospitalization costs;

1-2. An amount borne in accordance with subparagraph 1 (b) or 3 (p) of Appendix 2 for outpatient treatment received at a tertiary hospital for a disease determined and publicly notified by the Minister of Health and Welfare as a main disease or injury pursuant to subparagraph 1 (c) (iii) of that Table; provided, the amount borne by any of the following persons shall be excluded herefrom:

(a) A pregnant woman;

(b) A person under six years of age;

(d) A person who receives infertility treatment determined and publicly notified by the Minister of Health and Welfare pursuant to subparagraph 3 (k) of Appendix 2;

(e) A person eligible for medical assistance who receives medical assistance under the following statutes:

(i) Article 33 of the Act on the Honorable Treatment of Persons of Distinguished Service to the May 18 Democratization Movement and Establishment of Related Organizations;

(ii) Article 6 (2) of the Act on Assistance to Patients Suffering from Actual or Potential Aftereffects of Defoliants and Establishment of Related Organizations;

(iii) Article 41 of the Act on the Honorable Treatment of and Support for Persons of Distinguished Service to the State;

(iv) Article 17 of the Act on the Honorable Treatment of Persons of Distinguished Service to Independence;

(v) Article 50 of the Act on Support for Persons Eligible for Veteran's Compensation;

(vi) Article 20 of the Support for Veterans Act;

(vii) Article 7 of the Act on Honorable Treatment of War Veterans and Establishment of Related Associations;

(viii) Article 32 of the Act on Honorable Treatment of Persons of Distinguished Service during Special Missions and Establishment of Related Organizations;

2. An amount borne as prescribed in subparagraph 3 (d) (v), (vi), (ix) and (x) of Appendix 2;

3. An amount borne as prescribed in subparagraph 3 (g) and (o) of Appendix 2;

4. An amount borne as prescribed in subparagraph 4 of Appendix 2;

4-2. An amount borne as prescribed in subparagraph 5-2 of Appendix 2;

5. An amount borne as prescribed in subparagraph 6 of Appendix 2.

(4) The co-payment ceiling referred to in the former part, with the exception of the subparagraphs, of Article 44 (2) of the Act (hereinafter referred to as "co-payment ceiling") means an amount computed by the calculation method specified in Appendix 3. <Amended on Nov. 7, 2023; Aug. 20, 2024>

(5) Where the NHIS pays an amount exceeding the co-payment ceiling pursuant to the latter part, with the exception of the subparagraphs, of Article 44 (2) of the Act, it shall pay the amount into a savings account designated by the relevant party (referring to savings accounts determined by the Minister of Health and Welfare, such as savings accounts opened at postal service agencies specified in the Postal Savings and Insurance Act or at banks specified in the Banking Act); provided, the NHIS may make such payment by the method determined by the Minister of Health and Welfare, where it is unable to pay the amount into the relevant savings account due to any unavoidable cause. <Amended on Jun. 11, 2019; Nov. 7, 2023; Aug. 20, 2024>

(6) Except as provided in paragraphs (2) and (5), the payment method for co-payment, the method for paying an amount exceeding the co-payment ceiling, and other necessary matters shall be determined and publicly notified by the Minister of Health and Welfare.

[This Article Wholly Amended on Mar. 20, 2017]

Article 20(Party to contract on costs of health care benefits) #

The person who represents the medical and pharmaceutical communities and is a party to the contract on the costs of health care benefits under Article 45 (1) of the Act shall be as follows: <Amended on Jun. 26, 2018; Jun. 29, 2021; Jun. 20, 2025>

1. For costs of health care benefits for medical clinics prescribed in Article 3 (2) 1 (a) of the Medical Service Act: The head of the association of doctors provided for in Article 28 (1) of that Act;

2. For costs of health care benefits for dental clinics and dental hospitals under Article 3 (2) 1 (b) and 3 (b) of the Medical Service Act: The head of the association of dentists under Article 28 (1) of that Act;

3. For costs of health care benefits for oriental medical clinics or oriental medical hospitals under Article 3 (2) 1 (c) and 3 (c) of the Medical Service Act: The head of the oriental medical doctors' association under Article 28 (1) of that Act;

4. For costs of health care benefits for midwifery clinics under Article 3 (2) 2 of the Medical Service Act: One person from among the head of the midwives' association under Article 28 (1) of that Act or the head of the Central Nurses Association under Article 18 of the Nursing Act;

5. For costs of health care benefits for hospitals, long-term care hospitals, mental hospitals, and general hospitals under Article 3 (2) 3 (a), (d), and (e) of the Medical Service Act: The head of an organization under Article 52 of the Medical Service Act;

6. For costs of health care benefits for drugstores under subparagraph 3 of Article 2 of the Pharmaceutical Affairs Act and the Korea Orphan and Essential Drug Center under Article 91 of that Act: The president of the Korean Pharmaceutical Association under Article 11 (1) of the Pharmaceutical Affairs Act;

7. For costs of health care benefits for public health clinics, public health and medical care centers, branches of public health clinics under the Regional Public Health Act and the public health and medical clinics established under the Act on Special Measures for Health and Medical Services in Agricultural and Fishing Villages: The person designated by the Minister of Health and Welfare.

Article 21(Terms and conditions of contracts) #

(1) Contracts provided for in Article 45 (1) of the Act shall be concluded between the president of the NHIS and persons provided for in each subparagraph of Article 20 who represent each type of health care institutions by determining a unit price per point of the relative value points of each health care benefit.

(2) The points of relative values of health care benefits referred to in paragraph (1) shall be those that have shown the values of health care benefits in the relative points between each item, computed in consideration of workload such as hours and efforts required for health care benefits, resource volumes such as human resources, facilities and equipment, the level of risk of health care benefits, social benefits in relation to health care benefits, etc.; and the Minister of Health and Welfare shall give public notice thereof after deliberation by the Deliberative Committee, as prescribed by Decree of the Ministry of Health and Welfare. <Amended on Mar. 20, 2017>

(3) Notwithstanding paragraph (2), in any of the following cases, the points of relative values of health care benefits may be computed as classified in the following: <Amended on Jun. 30, 2015; Nov. 18, 2015; Jul. 24, 2017; Jul. 2, 2019; Jun. 29, 2021>

1. Where the medical treatment is received by hospitalization in a long-term care hospital provided for in Article 3 (2) 3 (d) of the Medical Service Act (excluding long-term care hospitals that are medical institutions satisfying the requirements prescribed in Article 3-2 of the Medical Service Act among the medical rehabilitation facilities referred to in Article 58 (1) 4 of the Act on Welfare of Persons with Disabilities): To be calculated by the point of relative value per day which is obtained by classifying into the degree of seriousness of patients' conditions after aggregating the points of each item of health care benefits and costs of medicines and materials for the relevant medical treatment;

2. Where the medical treatment is received by hospitalization in a medical clinic provided for in Article 3 (2) 1 (a) of the Medical Service Act, a hospital provided for in Article 3 (2) 3 (a) of that Act, a long-term care hospital provided for in Article 3 (2) 3 (d) of that Act, a general hospital provided for in Article 3 (2) 3 (e) of that Act, a tertiary hospital provided for in Article 3-4 of that Act, or a health care center provided for in Article 12 of the Regional Public Health Act for a diagnosis-related group (referring to the group of patients categorized by the names of diagnosis, names of medical treatments, seriousness of patients' conditions, patient's ages, etc.) determined and publicly notified by the Minister of Health and Welfare: To be calculated as one and the same point of relative value per case of hospitalization, which includes all the points of items of health care benefits and the costs of the medicines and materials for the relevant medical treatments;

3. Where the hospice or palliative care is received under Article 28 of the Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life: To be calculated as the point of relative value per day, which is the total of all the points of items of health care benefits and the costs of the medicines and materials for the relevant medical treatments.

(4) In concluding a contract prescribed in paragraph (1), a contract on the expenses for new items of health care benefits for which the point of relative values is not publicly notified shall be deemed concluded on the date the point of relative values of that item is publicly notified by the Minister of Health and Welfare under paragraph (2). In such cases, the contract shall apply, beginning with the first the health care benefits for the relevant item executed on or after the date when a public notice is given.

Article 22-2(Withholding payment of costs of health care benefits) #

(1) Where the NHIS intends to withhold the payment of costs of health care benefits pursuant to the former part of Article 47-2 (1) of the Act, it shall first notify the relevant health care institution thereof in a document stating the following matters: <Amended on Jun. 29, 2021>

1. The name of the relevant health care institution, the representative, and the address thereof;

2. The fact that becomes a ground for withholding of payment, the costs of health care benefits subject to withholding of payment, and the legal grounds therefor;

3. The purport that the relevant health care institution may submit its opinion on matters referred to in subparagraph 2, and the processing method when it fails to submit its opinion.

(2) If any health care institution, in receipt of notification under paragraph (1), has an objection to the withholding of payment, it shall submit to the NHIS a written opinion on withholding of payment of the costs of health care benefits, stating the purport of and the reason for filing an objection, along with necessary documents.

(3) After examining a written opinion submitted by a health care institution under paragraph (2), the NHIS shall notify the outcomes thereof in writing to the health care institution.

(4) "Reasons prescribed by Presidential Decree, such as where a court's judgment of acquittal becomes final and conclusive" in the former part of Article 47-2 (4) of the Act means any of the following; provided, this shall not apply in the case of subparagraph 2 or 3 where a health institution is found guilty through the ruling of the court after it was reinvestigated and an indictment was brought, though non-transfer decision or non-prosecution disposition had been rendered: <Amended on Dec. 29, 2020; Aug. 20, 2024>

1. Final judgment of acquittal;

2. Non-transfer decision (limited to the disposition to be cleared of suspicion or to be innocent; hereinafter the same shall apply);

3. Non-prosecution disposition (limited to the disposition to be cleared of suspicion or to be innocent; hereinafter the same shall apply).

(5) Where a health care institution that has received a decision to withhold the payment of costs of health care benefits under the former part of Article 47-2 (1) of the Act receives a judgment of acquittal, non-transfer decision, or non-prosecution disposition, it shall notify the NHIS of such fact. <Amended on Dec. 29, 2020; Jun. 29, 2021>

(6) Upon being notified pursuant to paragraph (5), the NHIS shall pay without delay the withheld health care benefits costs and the interest accrued during the period in which the payment of health care benefits costs has been withheld. <Amended on Aug. 20, 2024>

(7) Except as provided in paragraphs (1) through (6), details such as the form of a written opinion to be notified to the relevant health care institutions necessary for withholding of payment of costs of health care benefits, etc., and the methods of handling the opinion when it is submitted, shall be determined by the NHIS.

[This Article Added on Nov. 20, 2014]

Article 23(Additional benefits) #

(1) Additional benefits prescribed in Article 50 of the Act mean medical expenses for pregnancy and delivery (including miscarriage and stillbirth; hereinafter the same shall apply). <Amended on Sep. 19, 2017>

(2) A person eligible for the medical expenses for pregnancy and delivery prescribed in paragraph (1) shall be as follows: <Amended on Dec. 24, 2018; Jun. 29, 2021>

1. An insured person who is pregnant or gave birth to a baby, or her dependents;

2. Legal representative (limited to where the insured person gave birth to a baby or her dependents died) of the insured or his or her dependents under two years of age (hereinafter referred to as "infants and young children under two years of age").

(3) The NHIS may issue a person falling under any subparagraph of paragraph (2) with treatment coupons for medical expenses for pregnancy and delivery which can be used to pay any of the following expenses: <Amended on Dec. 24, 2018; Jun. 2, 2021; Jun. 29, 2021>

1. Expenses incurred in relation to medical treatment related to an insured person who is pregnant or gave birth to a baby;

2. Expenses incurred in purchasing medicines or materials for medical treatment for an insured person who is pregnant or gave birth to a baby or her dependents;

3. Expenses incurred in relation to medical treatment for infants and young children under two years of age;

4. Expenses incurred in purchasing medicines or materials for medical treatment prescribed for infants and young children under two years of age.

(4) A person who intends to be issued with treatment coupons (hereafter in this Article referred to as "applicant") shall submit an application for issuance prescribed by Decree of the Ministry of Health and Welfare, along with a certificate verifying that the applicant falls under any subparagraph of paragraph (2). <Amended on Dec. 24, 2018>

(5) Upon receipt of an application for issuance of treatment coupons prescribed in paragraph (4), the NHIS shall issue the applicant with the coupons after verifying that he or she falls under any subparagraph of paragraph (2). <Amended on Dec. 24, 2018>

(6) The period of using treatment coupons shall be from the date of being issued with the treatment coupons pursuant to paragraph (5) until any of the following days: <Amended on Dec. 24, 2018; Jun. 29, 2021>

1. The insured who is pregnant or gave birth to a baby, or her dependents: A date when two years have elapsed from the date of childbirth (in cases of miscarriage and stillbirth, the relevant date);

2. Legal representative of infants and young children under two years of age: A date when two years have elapsed from the date of birth of infants and young children under two years of age.

(7) The upper limit of payable amount of a treatment coupon shall be as follows; provided, if deemed necessary and publicly notified by the Minister of Health and Welfare, the payable amount may exceed the following upper limits: <Amended on Dec. 24, 2018; Jun. 29, 2021>

1. In cases of being pregnant with or giving birth to a fetus: 1 million won;

2. In cases of being pregnant with or giving birth to at least two fetuses: 1.4 million won.

(8) Except as provided in paragraphs (2) through (7), matters necessary for the procedures for and methods of the payment of the medical expenses for pregnancy and delivery, the issuance and use of treatment coupons, and other relevant matters shall be prescribed by Decree of the Ministry of Health and Welfare. <Amended on Jun. 30, 2016>

Article 25(Health checkups) #

(1) Health checkups prescribed in Article 52 of the Act (hereinafter referred to as "health checkups") shall be conducted at least once every two years, and for the employees insured who do not work at a desk, health checkups shall be conducted once a year; provided, cancer checkups shall be conducted as prescribed by the Enforcement Decree of the Cancer Control Act, and infant and child health checkups may be conducted according to the checkup cycle and frequency determined and publicly notified by the Minister of Health and Welfare, in consideration of the ages, etc. of infants and young children.

(2) Health checkups shall be conducted by health examination institutions designated in accordance with Article 14 of the Framework Act on Health Examination (hereinafter referred to as "examination institutions").

(3) If the NHIS intends to conduct a health checkup, it shall notify the persons eligible for a health check of the matters concerning conducting their health checkups according to the following classifications:

1. General health checkups and cancer checkups: Where a health checkup is conducted for the employee insured, the relevant employers shall be notified of the health checkup, and where a health checkup is conducted for the dependents of the employee insured and the self-employed insured, persons who undergo health checkups shall be notified thereof;

2. Infant and child health checkups: Where a health checkup is conducted for infants and children who are the dependents of the employee insured, the relevant employee insured shall be notified thereof, and where a health checkup is conducted for infants and children who are the self-employed insured, the heads of their households shall be notified thereof.

(4) Examination institutions that have conducted health checkups shall notify the NHIS of the outcomes of health checkups, and the NHIS shall notify persons who have undergone health checkups, of the outcomes of such health checkups; provided, where any examination institution directly notifies anyone who has undergone a health checkup of the outcomes of his or her health checkup, the NHIS needs not notify him or her of such outcomes.

(5) The subject matters of health checkups, the methods for conducting health checkups, expenses incurred therein, procedures for notifying the outcomes of health checkups, and other necessary matters concerning health checkups shall be determined and publicly notified by the Minister of Health and Welfare.

[This Article Wholly Amended on Dec. 24, 2018]

Article 26-3(Disclosure of personal details on persons in arrears of payment of unjust enrichment or unjust profit collectable and causes for exclusion from disclosure thereof) #

(1) "Information prescribed by Presidential Decree" in the main clause of Article 57-2 (1) of the Act means the violation that has given rise to the money collectable, the name of the person in arrears (including the name of the representative of a corporation), his or her trade name (including the name of a corporation), age, address, and type of the amount in arrears (referring to the amount of collection in arrears, subsequent arrears, and delinquency disposition expenses; hereafter in this Article the same shall apply), payment due date, amounts, and summary of the arrears.

(2) "Where there is a compelling reason prescribed by Presidential Decree not to do so, such as partial payment of an amount in arrears" in the proviso of Article 57-2 (1) of the Act means any of the following cases:

1. Where at least 10/100 of the amount in arrears as at the time of notification under Article 57-2 (3) of the Act is paid within six months from the date of notification;

2. Where the defaulter is in the grace period of collection after the collection of the amount in arrears is deferred following a decision to grant authorization for a rehabilitation plan referred to in Article 243 of the Debtor Rehabilitation and Bankruptcy Act; or pays the amount in arrears according to the payment schedule specified in the rehabilitation plan;

3. Where an investigation is being conducted or a criminal trial is underway due to a violation giving rise to the money collectable;

4. Where gross damage is caused to property of a person in arrears or other similar cases due to a natural disaster, for which case the Deliberative Committee on Disclosure of Unjust Enrichment and Unjust Profit in Arrears established under Article 57-2 (2) of the Act (hereinafter referred to as the "Deliberative Committee on Disclosure of Unjust Enrichment and Unjust Profit in Arrears") recognizes the disclosure of personal details, etc. under paragraph (1) of that Article shall not be of any practical benefit.

(3) When the NHIS serves on a person in arrear a notice under Article 57-2 (3) of the Act, it shall demand him or her to pay the amount in arrears, and in cases falling within the proviso of paragraph (1) of that Article, it shall inform him or her to submit explanatory materials for the default.

[This Article Added on Jun. 2, 2020]

Article 32(Upper and lower limits of amount of monthly insurance contributions) #

The upper and lower limits of the amount of monthly insurance contributions under Article 69 (6) of the Act shall be as classified in the following subparagraphs: <Amended on Aug. 31, 2022; Dec. 27, 2022; Jan. 2, 2024; May 7, 2024>

1. The upper limit of the amount of monthly insurance contributions shall be as follows:

(a) Insurance contributions based on monthly remuneration of the employee insured: The amount determined and publicly notified by the Minister of Health and Welfare, taking into consideration the amount equivalent to 30 times the insurance contributions based on the average amount of monthly remuneration (hereafter in this Article referred to as "amount of insurance contributions based on the average monthly remuneration of the year before the preceding year") of such employee in the year before the year preceding that in which the insurance contributions are imposed;

(b) Insurance contributions based on extra monthly income other than remuneration for the employee insured and the amount of the monthly insurance contributions of the self-employed insured: The amount determined and publicly notified by the Minister of Health and Welfare, taking into consideration the amount equivalent to 15 times the insurance contributions based on the average amount of monthly remuneration of the year before the year preceding that in which the insurance contributions are imposed;

2. The lower limit of the amount of monthly insurance contributions shall be as follows:

(a) The amount of insurance contributions based on monthly remuneration of the employee insured: The amount determined and publicly notified by the Minister of Health and Welfare, of at least 50/1000 but less than 85/1000 of the amount of insurance contributions based on the average monthly remuneration of the year preceding that in which the insurance contributions are imposed;

(b) The amount of the monthly insurance contributions of the self-employed insured: The amount determined and publicly notified by the Minister of Health and Welfare, of at least 90/100 but less than 100/100 of the amount of insurance contributions based on monthly remuneration prescribed in item (a).

[This Article Wholly Amended on Mar. 6, 2018]

Article 35(Report of remuneration for computing monthly remuneration amount) #

(1) Each employer shall report to the NHIS by not later than March 10 each year of the matters required for the computation of the monthly remuneration amount under Article 70 (1) of the Act, such as the gross amount of remuneration paid in the preceding year to all the employee insured (referring to the gross amount of remuneration paid from January to December by the relevant employee insured, which is the amount computed under Article 70 of the Act and Article 33 of this Decree; hereinafter the same shall apply), and the period in which the employee insured have engaged in the relevant workplace, the State, local government, private school or its school management agency (hereinafter referred to as "workplace, etc."). In such cases, for the employee insured who are subject to the application of the latter part of Article 70 (3) of the Act, such reporting may be omitted. <Amended on Sep. 26, 2013>

(2) Each employer shall report to the NHIS the matters required for the computation of the monthly remuneration under Article 70 (1) of the Act, such as the gross amount of remuneration paid to all the employee insured who have been engaged, appointed, or employed until then (referring to the relevant employee insured, in cases under subparagraph 3), where the relevant workplace falls under any of the following cases:

1. Where the workplace is closed, or bankrupted, or circumstances corresponding thereto occur;

2. Where a private school is closed;

3. Where some of the employee insured retire.

(3) Notwithstanding the former part of paragraph (1), if an employer has already submitted a simplified statement of payment regarding the total amount of remuneration paid to the employee insured for the preceding year to the head of the tax office having jurisdiction over withholding taxes, the commissioner of a regional tax office, or the Commissioner of the National Tax Service pursuant to Article 164-3 (1) of the Income Tax Act, the reporting under the former part of paragraph (1) shall be deemed made; provided, this shall not apply where the NHS is unable to verify information necessary for calculating the amount of monthly remuneration due to omissions, errors, etc. in the relevant simplified statement of payment. <Added on Aug. 20, 2024>

Article 36(Confirmation on amount of monthly remuneration) #

(1) The NHIS shall confirm the amount obtained by dividing the gross amount of remuneration reported under Article 35 by the number of months for which the employee insured has engaged during the preceding year in the relevant workplace, etc., as the monthly remuneration; provided, where the employers have notified the NHIS of the average rate of increase or decrease of remunerations during the relevant business year in the relevant workplace, etc., the amount of monthly remuneration shall be determined every year by making the amount computed after reflecting the relevant average increase or decrease rate in the amount calculated as provided for in the main clause.

(2) Where remuneration to the relevant employee insured is increased or decreased, the employers may file an application with the NHIS for the change of the amount of monthly remuneration; provided, the employer of a workplace to which at least 100 full-time workers belong shall file an application for change of the amount of monthly remuneration as follows: <Amended on Dec. 22, 2015>

1. Where the remuneration of the relevant month is changed on or before the 14th day: By the 15th day of the relevant month;

2. Where the remuneration of the relevant month is changed on or after the 15th day: By the 15th day of the month following the relevant month.

(3) Where an employer fails to report under Article 35 or where the details of such report are incorrect, the NHIS may investigate the relevant facts and compute or change the monthly remuneration under Article 94 of the Act, and the NHIS in receipt of an application for changes of the amount of monthly remuneration under paragraph (2) may change the monthly remuneration from the month remuneration is increased or the month remuneration is decreased.

(4) Where an employee insured is being paid the remuneration by not less than two workplaces to which the health insurance is available, his or her monthly remuneration is confirmed respectively taking into account the remunerations that are paid by such workplaces to him or her.

(5) Where the monthly remuneration of the employee insured is difficult to compute under Articles 33 through 38 or where no data exists to enable verify the enumerations, as well as the required matters such as an application for changes of the monthly remuneration when increasing or decreasing remuneration, the methods of computation of monthly remuneration shall be prescribed by the articles of incorporation of the NHIS through a resolution by the Financial Operation Committee.

Article 38(Confirmation on amount of monthly remuneration for employers who receive no remuneration) #

(1) The monthly remuneration amount for an employer who receives no remuneration under Article 70 (4) of the Act shall be computed based on the following methods; in such cases, the relevant employer shall submit data verifying the amount of his or her income or notify the amount of his or her income to the NHIS by not later than May 31 each year (in cases of employers who have submitted a certificate of faithful return to the head of the competent tax office under Article 70-2 of the Income Tax Act (hereafter in this paragraph referred to as "faithfully-returned employers"), by not later than June 30], and the amount of monthly remuneration so calculated shall be applicable from June of each year to May of the following year (in cases of faithfully-returned employers, from July of each year to June of the following year): <Amended on Sep. 26, 2013>

1. Where the income is attributable to the relevant workplace during the relevant year and is prescribed by Decree of the Ministry of Health and Welfare, and the amount thereof is verified by objective data;

2. Where no objective data exists to enable verification of the income, the amount reported by the employer.

(2) Articles 34 (1), 35 (2), and 36 shall apply mutatis mutandis to the procedures, etc. for confirming or changing the amount of monthly remuneration of the employers who receive no remuneration. <Added on Sep. 26, 2013>

(3) Notwithstanding paragraphs (1) and (2), the amount of monthly remuneration of such employer shall be a relevant amount specified in the following subparagraphs: <Amended on Dec. 29, 2020>

1. Where the amount of monthly remuneration calculated based on the amount verified or the amount reported under paragraph (1) 1 or 2 is less than the amount of monthly remuneration of a worker who is paid the highest amount of monthly remuneration in the relevant workplace (excluding cases falling under subparagraph 2 (b)): The amount of monthly remuneration of the worker who is paid the highest amount of monthly remuneration in the relevant workplace;

2. Where it falls under any of the following categories: The amount obtained by averaging the monthly remuneration of workers in the relevant workplace:

(a) Where the employer has failed to submit data and notify the amount of his or her income under the latter part, with the exception of the subparagraphs, of paragraph (1) or he or she has no objective data to enable verification of his or her income under the subparagraph 1 of that paragraph;

(b) Where an amount verified under paragraph (1) 1 is 0 won or less.

[Title Amended on Dec. 29, 2020]

Article 39(Settlement of amount of insurance contributions based on monthly remuneration, and payment by installments) #

(1) Where the amount of insurance contributions based on monthly remuneration that is initially computed and collected exceeds the amount of insurance contributions recomputed pursuant to Articles 34 through 38, the NHIS shall refund such overpayment to the employer, and where it falls short thereof, collect, in addition, the difference from the employer.

(2) Where the relations of employment, appointment, and engagement of the employee insured are terminated, the employer shall undergo the procedure for settling accounts with the NHIS, after settling accounts with the worker by further re-computing the insurance contributions based on monthly remuneration already paid by the relevant employee insured; provided, as regards the employee insured to whom the amount publicly notified by the Minister of Health and Welfare under the latter part of Article 70 (3) of the Act is applied, the calculation of the contributions imposed during the period whereto the notified amount is applied, may be omitted.

(3) Regarding the amount to be refunded to or to be borne by the employee insured among the amount that has been refunded or paid in addition under paragraph (1), the employer shall settle accounts with the relevant employee insured.

(4) Where the amount to be borne by the employee insured, out of the amount to be additionally collected pursuant to paragraph (1) (hereinafter referred to as "amount to be additionally collected"), is greater than the amount of insurance contributions based on monthly remuneration (referring to the amount of insurance contributions based on monthly remuneration for the month which includes the date of notifying the amount to be additionally collected), the NHIS may, upon the request of an employer, allow such employee insured to make payments in up to 12 installments.<Amended on May 7, 2024>

(5) Except as provided in paragraphs (1) through (4), details necessary for the settlement of accounts of the amount of insurance contributions based on monthly remuneration, and the payment thereof in installments shall be prescribed by the articles of incorporation of the NHIS. <Added on Mar. 20, 2018>

Article 41(Amount of monthly income) #

(1) Income included in the calculation of the amount of monthly income (referring to the amount of extra monthly income other than remuneration under Article 71 (1) of the Act for the employee insured, and referring to the amount of monthly income under paragraph (2) of that Article for the self-employed insured; hereinafter the same shall apply) shall be as follows; in such cases, non-taxable income under the Income Tax Act shall be excluded: <Amended on Oct. 7, 2020; Jun. 30, 2022; May 7, 2024>

1. Interest income: Income prescribed in Article 16 of the Income Tax Act;

2. Dividend income: Income prescribed in Article 17 of the Income Tax Act;

3. Business income: Income prescribed in Article 19 of the Income Tax Act;

4. Earned income: Income prescribed in Article 20 of the Income Tax Act;

5. Pension income: Income prescribed in Article 20-3 of the Income Tax Act; provided, in cases of public pension incomes provided in paragraph (1) 1 of that Article, paragraph (2) of that Article shall not apply, and the entirety of pension incomes accrued during the relevant taxable period shall be deemed the pension income;

6. Other income: Income prescribed in Article 21 of the Income Tax Act.

(2) Detailed methods for calculating the income referred to in each subparagraph of paragraph (1) shall be prescribed by Decree of the Ministry of Health and Welfare. <Added on Oct. 7, 2020>

(3) The timing to reflect income data specified in the subparagraphs of paragraph (1) in calculating the amount of monthly income shall be classified as follows; provided, where any unavoidable reason exists such as a natural disaster, the timing to reflect the income data may be adjusted, as prescribed by the articles of incorporation of the NHIS: <Added on Aug. 31, 2022; May 7, 2024>

1. When calculating the amount of monthly income from January to October each year: Data for the year before the preceding year in which insurance contributions based on monthly income (referring to insurance contributions based on extra monthly income other than remuneration for the employee insured, and monthly insurance contributions for income for the self-employed insured; hereinafter the same shall apply) are imposed; provided, data on pension income under paragraph (1) 5 shall be data for the year before the year in which insurance contributions based on monthly income are imposed;

2. When calculating the amount of monthly income for November and December each year: Data for the year preceding the year when insurance contributions based on monthly income are imposed.

(4) "Amount prescribed by Presidential Decree" in the provisions, other than the calculation formula referred to in Article 71 (1) of the Act and in the calculation formula referred to in that paragraph means 20 million won per year. <Amended on Mar. 6, 2018; Oct. 7, 2020; Aug. 31, 2022>

(5) Except as provided in paragraphs (1) through (4), details necessary for the calculation of the amount of monthly income, such as the specific types of income data, shall be prescribed by the articles of incorporation of the NHIS. <Added on Aug. 31, 2022; May 7, 2024>

Article 41-2(Adjustment of amount of monthly income) #

(1) Where an insured witnesses an increase or decrease in income under any subparagraph of Article 41 (1) (hereafter in this Article, referred to as "business income, etc.") due to reasons prescribed by the NHIS's articles of incorporation, such as business closure and changes in business performance, he or she may file an application with the NHIS for the adjustment of the amount of monthly income accompanied by documents evidencing the cause of the income change, thus allowing the NHIS to reflect data regarding business income, etc. earned at the time of the imposition of the insurance contributions based on monthly income in calculating the amount of monthly income.

(2) Notwithstanding Article 41 (3), the NHIS, upon receipt of an application for adjustment under paragraph (1), may adjust the amount of monthly income by reflecting such data regarding business income, etc. earned at the time of imposing the insurance contributions based on monthly income in the calculation of the amount of monthly income, and the insurance contributions based on monthly income imposed subsequently in the relevant year shall be calculated based on the adjusted amount of monthly income.

(3) Where the business income, etc. for the relevant year accrues to the insured who has filed an application for the adjustment of the amount of monthly income under paragraph (1) after such adjustment is made pursuant to paragraph (2), he or she shall report the fact of accrual of business income, etc. and the amount thereof to the NHIS within one month from the first day of the month following the month in which such business income, etc. accrues, and thereafter the amount of insurance contributions based on the monthly income for the relevant year imposed by the NHIS shall be calculated based on the adjusted amount of monthly income reflecting the reported business income, etc. <Added on Jun. 20, 2023; May 7, 2024>

(4) Where the business income, etc. for the relevant year are verified following the adjustment of the amount of monthly income pursuant to paragraph (2) or (3), the NHIS may settle the insurance contributions based on monthly income by calculating again the amount of monthly income for the relevant year based on the verified business income, etc. <Amended on Jun. 20, 2023>

(5) Where the amount of insurance contributions based on monthly income calculated following the adjustment of the amount of monthly income pursuant to paragraph (2) or (3) is less than the amount of insurance contributions based on monthly income settled pursuant to paragraph (4), the NHIS shall additionally collect the shortfall from the insured. <Amended on Jun. 20, 2023; May 7, 2024; Sep. 16, 2025>

(6) The NHIS may allow insurance contributions based on monthly income which are additionally collected pursuant to paragraph (5) to be paid in up to 12 installments. <Amended on Jun. 20, 2023; May 7, 2024>

(7) Where the amount of insurance contributions based on monthly income recalculated after adjustment of the amount of monthly income pursuant to paragraph (2) or (3) exceeds the amount calculated pursuant to paragraph (4), the NHS shall pay the excess amount to the insured. In such cases, the NHS may offset the amount to be paid to the insured against the insurance contributions, etc. to be paid by the insured. <Added on Aug. 20, 2024; Sep. 16, 2025>

(8) Notwithstanding paragraph (1), if a simplified statement of payment has been submitted to the head of the tax office having jurisdiction over withholding taxes, the commissioner of a regional tax office, or the Commissioner of the National Tax Service pursuant to Article 164-3 of the Income Tax Act, it shall be deemed that the evidentiary documents under paragraph (1) are attached; provided, this shall not apply where the NHS is unable to verify the information necessary for calculating the amount of monthly income due to any omission, error, etc. in the relevant simplified statement of payment. <Added on Sep. 16, 2025>

(9) Except as provided in paragraphs (1) through (8), details necessary for the procedures for applying for adjustment of the amount of monthly income, the procedures for reporting the occurrence of business income, etc. after such adjustment, the calculation, settlement, and payment in installments of insurance contributions based on monthly income, and other relevant matters shall be prescribed by the articles of incorporation of the NHIS. <Amended on Jun. 20, 2023; Aug. 20, 2024; Sep. 16, 2025>

[This Article Added on Aug. 31, 2022]

Article 42-2(Exclusion from contribution points based on property of housing-related loan amounts) #

(1) "Self-employed insured prescribed by Presidential Decree" in the proviso of Article 72 (1) of the Act means any of the following self-employed insured: <Amended on Dec. 27, 2022; Nov. 7, 2023>

1. A self-employed insured who belongs to such household that owns one house per household as determined and publicly notified by the Minister of Health and Welfare, while meeting all the following requirements (hereinafter referred to as "member of a family owning one house per household"):

(a) The owner (including his or her spouse or lineal ascendant or descendant who constitutes the same household as the owner according to resident registration) of the house shall take out a loan determined and publicly notified by the Minister of Health and Welfare (hereafter in this Article referred to as "housing mortgage loan, etc."), including a loan secured by housing (where a new loan is taken out and secured against the relevant housing for the purpose of lowering the interest rate on the loan or extending the term of the loan, and with which the existing loan is paid off on the same day as the date when the new loan is taken out, including the new loan (hereafter in this Article referred to as "mortgage refinance loan"), from a financial company, etc. defined in the Act on Real Name Financial Transactions and Confidentiality (hereinafter referred to as "financial company, etc.");

(b) The relevant household shall take out a housing mortgage loan, etc. (excluding a mortgage refinance loan) for the first time within three months before or after the date of acquisition of ownership of a house;

2. A self-employed insured person who belongs to a household that has no housing ownership as determined and publicly notified by the Minister of Health and Welfare (hereinafter referred to as "member of a household without housing ownership"), while meeting all the following requirements:

(a) A lessee (including a spouse or lineal ascendant or descendant who constitutes the same household as the lessee according to resident registration) shall take out a loan determined and publicly notified by the Minister of Health and Welfare, (hereafter in this Article, referred to as "loan secured by security deposit, etc.") including a loan secured by housing deposit for leased housing (where a new loan is taken out and secured against the security deposit for the relevant leased housing for the purpose of lowering the interest rate on the loan or extending the term of the loan, and with which the existing loan is paid off on the same day as the date when the new loan is taken out, including the new loan (hereafter in this Article referred to as "security deposit refinance loan") from a financial company, etc. to live in the house leased by the relevant household;

(b) The relevant household shall take out a loan secured by a security deposit, etc. (excluding a mortgage refinance loan) for the first time within three months before or after (referring to three months before and after the date of modification, extension, or renewal of a lease contract, where the loan is taken out for such purposes) the earlier of the date of moving into the house or the move-in date specified in the lease contract documents under Article 3-2 (2) of the Housing Lease Protection Act (in the case of an alien, referring to the date of registering the place of stay as indicated in the alien registration card or the date of reporting changes therein under the Immigration Act, or the date of reporting the place of residence in the Republic of Korea or the date of reporting changes thereof under the Act on the Immigration and Legal Status of Overseas Koreans).

(2) "House that does not exceed the standards prescribed by Presidential Decree" in the proviso of Article 72 (1) of the Act means a house that meets the following requirements: <Amended on Aug. 31, 2022>

1. In cases of a member of a family owning one house per household: The tax base amount for property tax on a house purchased with a housing mortgage loan, etc. shall not exceed the amount obtained by multiplying the assessed value of the house under the main clause of Article 52 (5) of the Income Tax Act by the fair market price rates prescribed in Article 109 of the Enforcement Decree of the Local Tax Act;

2. In cases of a member of a household without housing ownership: The amount appraised by the standards prescribed by Decree of the Ministry of Health and Welfare, of the security deposit and monthly rents of the house leased with a loan secured by security deposit, etc., shall not exceed 30 percent of the assessed value of the house under the main clause of Article 52 (5) of the Income Tax Act.

(3) The assessed value of the amount of loan under the proviso of Article 72 (1) of the Act shall be the amount classified as follows; in such cases, where the amount of mortgage refinance loan or the amount of security deposit refinance loan is greater than the amount of existing loan, the difference shall be subtracted when assessing the amount of loan: <Amended on Aug. 31, 2022; Dec. 27, 2022>

1. In cases of a member of a family owning one house per household: An amount obtained by multiplying the aggregate amount of housing mortgage loans, etc. (excluding the amount paid off) by the fair market price rates prescribed in Article 109 of the Enforcement Decree of the Local Tax Act. In such cases, if the amount exceeds the tax base amount for the property tax of the relevant house, it shall be the amount of property tax base, and if such amount exceeds 50 million won, it shall be 50 million won;

2. In cases of a member of a household without housing ownership: 30 percent of the aggregate amount of the loans secured by security deposit, etc. (excluding the amount paid off). In such cases, if the amount is greater than the amount equivalent to 30 percent of the amount of security deposit, it shall be 30 percent of the security deposit.

(4) "Data or information prescribed by Presidential Decree, including those on the amount of loans" in Article 72 (3) of the Act means the following data or information: <Amended on May 7, 2024>

1. The name and resident registration number of a person who has obtained a housing mortgage loan, etc. or loan secured by security deposit, etc.;

2. Information on the current status of a housing mortgage loan, etc. or loan secured by security deposit, etc., including the kind, period, amount, and security;

3. Other data or information determined and publicly notified by the Minister of Health and Welfare as necessary for calculating contribution points based on property.

(5) Except as provide in paragraphs (1) through (4), details necessary for assessing the amount of loan under the proviso of Article 72 (1) of the Act shall be determined and publicly notified by the Minister of Health and Welfare.

[This Article Added on Jun. 30, 2022]

[Title Amended on May 7, 2024]

[(previous) Article 42-2 moved to Article 42-3 <Jun. 30, 2022>]

Article 47-3(Certification of payment of insurance contributions) #

(1) "Construction project, manufacture, purchase, service, or any other contract prescribed by Presidential Decree" in the main clause of Article 81-4 (1) of the Act means any of the following contracts: <Amended on Nov. 29, 2016; Jun. 20, 2023>

1. A contract referred to in Article 2 of the Act on Contracts to Which the State Is a Party; provided, any contract the price for which is paid with the operating expenses for government agencies referred to in Article 31 of the Enforcement Decree of the Management of the National Funds Act shall be excluded herefrom;

2. A contract referred to in Article 2 of the Act on Contracts to Which a Local Government Is a Party; provided, any contract the price for which is paid with the ordinary expenses referred to in Article 38 of the Enforcement Decree of the Local Accounting Act shall be excluded herefrom;

3. A contract concluded by a public institution under the Act on the Management of Public Institutions; provided, any contract the price for which is paid with the funds, which are prescribed and publicly notified by the Minister of Health and Welfare and considered to be ordinary expenses in their nature, shall be excluded herefrom.

(2) "Cases prescribed by Presidential Decree, including where a person obligated to make payment intends to pay all or some of the price for a contract with insurance contributions in arrears" in the proviso of Article 81-4 (1) of the Act means any of the following: <Amended on Jun. 20, 2023>

1. Where a person obligated to make payment intends to pay all of the price received with the insurance contributions, subsequent arrears and delinquency disposition expenses, or to pay some of such price with the total amount of the insurance contributions, subsequent arrears and delinquency disposition expenses;

2. Where the NHIS receives the price for the relevant contract in accordance with the delinquency disposition under Article 81 of the Act;

3. Where the competent court deems it impracticable to smoothly take bankruptcy procedures because a trustee in bankruptcy under the Debtor Rehabilitation and Bankruptcy Act is unable to certify the payment of insurance contributions, and the trustee in bankruptcy requests the NHIS for an exception to the certification of payment;

4. Where the relevant rehabilitation plan under the Debtor Rehabilitation and Bankruptcy Act provides that the collection of insurance contributions, subsequent arrears and delinquency disposition expenses or the realization of any property under a delinquency disposition is deferred. In such cases, the insurance contributions, subsequent arrears and delinquency disposition expenses the certification of payment of which is not required shall be limited to the amount the collection or realization of which is deferred.

(3) Where a person obligated to pay insurance contributions under Article 77 of the Act intends to receive certification for the payment of insurance contributions, subsequent arrears, and delinquency disposition expenses pursuant to the main clause of Article 81-4 (1) of the Act, he or she shall request the NHIS to certify the payment thereof, as determined and publicly notified by the Minister of Health and Welfare; provided, where a person who receives the price for a contract is not the original contractor, the following persons shall request the certification for the payment thereof: <Amended on Jun. 20, 2023>

1. Where the claims are transferred: Transferor and transferee;

2. Where the court's assignment order is complied with: Execution creditor;

3. Where the subcontract consideration for a construction project is directly received pursuant to Article 14 (1) 1 or 2 of the Fair Transactions in Subcontracting Act: Subcontractor.

[This Article Added on Aug. 2, 2016]

Article 48(Disclosure of personal details of persons in arrear with large amount or in habitual arrears and causes for exclusion from disclosure thereof) #

(1) "Where any cause prescribed by Presidential Decree, such as partial payment of the amount in arrears, exists" in the proviso of Article 83 (1) of the Act means any of the following cases: <Amended on Jun. 2, 2020>

1. Where not less than 30/100 of the amount of insurance contributions in arrear, arrears, and expenses for disposition on delinquency (hereafter in this Article referred to as "amount in arrears") which are in default at the time a notification is issued under Article 83 (3) of the Act is paid within six months after the date of such notification;

2. Where the collection of amount in arrears is postponed by the determination to grant authorization of the rehabilitation plan made under Article 243 of the Debtor Rehabilitation and Bankruptcy Act and the case is within the grace period or the amount in arrears is being paid in accordance with payment schedule of the rehabilitation plan;

3. Where gross damage is caused to property of a person in arrear or his or her business falls into a serious crisis due to a natural disaster, for which case the Deliberative Committee on Disclosure of Insurance Contribution Information established under Article 83 (2) of the Act (hereinafter referred to as the "Deliberative Committee on Disclosure of Insurance Contribution Information") recognizes the disclosure of personal information, amount in arrears, etc. (hereinafter referred to as "personal details, etc.") of the defaulter shall not be of any practical benefit.

(2) In selecting the persons subject to the disclosure of personal details, etc. under Article 83 (3) of the Act, the NHIS and the Deliberative Committee on Disclosure of Insurance Contribution Information shall make a judgment on whether they have the ability to make payment, taking into account their property conditions and income levels, whether or not they are minors, and other circumstances comprehensively.

(3) When the NHIS informs a person in arrear under Article 83 (3) of the Act that he or she is subject to the disclosure of personal details, etc., it shall demand him or her to pay the amount in arrears, and if a defaulter has any reason for exclusion from the disclosure of personal details, etc. under the proviso of Article 83 (1) of the Act, it shall inform him or her to submit explanatory materials for the default.

(4) When the NHIS makes a disclosure of personal details, etc. under Article 83 (4) of the Act, it shall also disclose the name of a person in arrears, his or her trade name (including the name of a corporation), age, type of business he or she engages in, occupation, address, type of the amount in arrears, payment due date, amount due, gist of the arrear, etc., and where a person in arrears is a corporation, the name of the representative of the corporation shall also be disclosed. <Amended on Jun. 20, 2023>

Article 52(Additional interest upon appropriation or refund of overpayment or erroneous payment) #

(1) When the NHIS intends to appropriate the overpayment or erroneous payment to the insurance contributions, etc., arrears, or delinquency disposition expenses under Article 86 (1) of the Act or to refund the balance after appropriation pursuant to paragraph (2), it shall notify the payer of the fact in writing. <Added on 2020. 6. 2>

(2) "Interest prescribed by Presidential Decree" in Article 86 (3) of the Act means the amount calculated by multiplying the overpayment or erroneous payment by the interest rate of additional payment on the refund of national tax under the main clause of Article 43-3 (2) of the Enforcement Decree of the Framework Act on National Taxes for the period from the date classified in the following subparagraphs until the date the overpayment or erroneous payment is appropriated to the insurance contributions, etc., arrears, or delinquency disposition expenses (or until the date a notice of refund is issued in cases of refund): <Amended on Sep. 26, 2013; Jun. 2, 2020; Sep. 16, 2025>

1. Where insurance contributions, etc., arrears, or delinquency disposition expenses (hereinafter referred to as "amount in arrears") have been paid in installments on at least two occasions, the day following the date payment in installments classified in the following items was made:

(a) Where the relevant refund does not exceed the amount paid in installments for the last time: Date of payment in installments for the last time;

(b) Where the relevant refund is more than the amount paid in installments for the last time: Date of payment in installments of each refund calculated retroactively in the order of date of recent payment in installments until the relevant refund becomes equivalent to the case under item (a);

2. Where the NHIS refunds overpayments to the employer under Article 39 (1), the day classified in the following items:

(a) The day on which 7 days have elapsed from the due date of notification where the employer has notified the NHIS by the due date of notification of the total amount, etc. of remuneration paid to the employee insured under Articles 35 and 38; provided, where it is notified after the due date of notification, the day on which 7 days have elapsed from the date of notification;

(b) The day on which 7 days have elapsed from the date of application where the employer applied for the change of monthly remuneration to the NHIS under Article 36 (2) (including cases applicable mutatis mutandis in Article 38 (2));

3. Where the NHIS refunds the insurance contributions after settling accounts with the employer due to any cause provided for in any subparagraph of Article 35 (2) as applicable mutatis mutandis under Article 38 (2) or where it refunds the insurance contributions after resettling accounts with the employer under Article 39 (2) as the relationship of employment, appointment or engagement of the employee insured came to an end, the day classified as follows:

(a) Where eligibility changes under Article 9 (1) of the Act: The day on which 7 days have elapsed from the day when a report of change in eligibility was made;

(b) Where entitlement is lost under Article 10 (1) of the Act: The day on which 7 days have elapsed from the day when a report of loss of eligibility was made;

4. Where the NHIS pays the excess amount to the insured pursuant to the former part of Article 41-2 (7): The day on which 7 days have elapsed from the date on which the insurance contributions based on monthly income were settled under paragraph (4) of that Article;

5. In cases other than those provided in subparagraphs 1 through 4: The day following the day on which an overpayment or erroneous payment was made.

[Title Amended on Jun. 2, 2020]

Article 59(Submission of request for judgment) #

(1) Those who intend to request for judgment under Article 88 (1) of the Act shall submit a request for judgment, stating the following matters to the NHIS, the Review and Assessment Service, or the Health Insurance Dispute Mediation Committee (hereinafter referred to as the "Dispute Mediation Committee") under Article 89 of the Act; in such cases, when a request for judgment has been submitted to a person without justifiable authority, the request for judgment shall be sent to a person with due authority:

1. Name, resident registration number, and address of the requester and of the person subject to the disposition (in cases of a corporation, referring to the name, registration number and location of the corporation; hereafter in subparagraph 1 of Article 60 the same shall apply);

2. Person who has made the original disposition (refers to the head of a relevant branch office where the head of the branch office has performed the original disposition on commission of the president of the NHIS or the president of the Review and Assessment Service; hereinafter the same shall apply);

3. Gist of disposition, and the date when he or she became aware that the original disposition was made;

4. Purport and grounds for request for judgment;

5. Where the requester is not a person subject to the disposition, relationship with him or her;

6. Indication of attached documents;

7. Whether public notice was issued on the request for judgment, and its details.

(2) Where the NHIS or the Review and Assessment Service has received a request for judgment under paragraph (1), it shall submit to the Dispute Mediation Committee the request for judgment accompanying a reply of the person who has taken the disposition and a copy of the decision on objection within 10 days from the date it received the request for judgment.

(3) Where the Dispute Mediation Committee has received a request for judgment under paragraph (1), it shall send a copy or duplicate thereof to the NHIS or the Review and Assessment Service and the person who has taken the original disposition without delay, and the NHIS or the Review and Assessment Service shall submit to the Dispute Mediation Committee, the reply of the person who has taken the disposition and a copy of the written determination on objection within 10 days from the date it received the copy or duplicate.

(4) When the request for judgment has been sent to a person with verifiable authority as referred to in the latter part of paragraph (1), the fact shall be notified to the requester without delay.

(5) In calculating the period of request for judgment under the latter part of Article 88 (1) of the Act, it shall be deemed that a request for judgment was raised at the time when a request for judgment was submitted to the NHIS, the Review and Assessment Service, the Dispute Mediation Committee or a person without verifiable authority under paragraph (1).

Article 68(Procedure for delivery of data on reduced or omitted income) #

(1) In any of the following cases, the NHIS shall present the relevant data to the Minister of Health and Welfare, and deliver such data to the Commissioner of the National Tax Service under Article 95 (1) of the Act, following an investigation of the Income Reduction and Omission Investigation Committee pursuant to paragraph (2):

1. Where the remuneration, income, etc. (hereinafter referred to as "income, etc.") that an employer, the employee insured, or householder has reported pursuant to Article 94 (1) of the Act falls under any of the following cases:

(a) Where it differs from the income, etc. reported to the National Tax Service;

(b) Where it is below the average income, etc. of the relevant industry or type of work;

2. Any of the following cases where the reduction or omission of income, etc. is deemed to exist:

(a) Where he or she fails to submit the data requested under Article 94 (1) of the Act or delays to submit them for not less than three months;

(b) Where he or she refuses, interferes with, or evades an investigation conducted under Article 94 (2) of the Act on three or more occasions.

(2) The Income Reduction and Omission Investigation Committee shall be established within the NHIS to investigate reduction or omission of income, etc. referred to in Article 95 (1) of the Act (hereinafter referred to as the "Income Reduction and Omission Investigation Committee").

(3) The Income Reduction and Omission Investigation Committee shall be comprised of five members, including one Chairperson.

(4) The Chairperson of the Income Reduction and Omission Investigation Committee shall be appointed by the president of the NHIS from among the executive officers and employees of the NHIS.

(5) Any of the following persons appointed or commissioned by the president of the NHIS shall be the members of the Income Reduction and Omission Investigation Committee:

1. One employee of the NHIS;

2. Two persons, each one of whom is respectively designated by the head of the agency where he or she belongs, from among the public officials of Grade V or higher who are under the control of the Ministry of Health and Welfare and the National Tax Service, or the public officials in general service belonging to the Senior Executive Service;

3. One certified tax accountant or one certified public accountant.

(6) Except as provided in paragraphs (3) through (5), matters necessary for operating the Income Reduction and Omission Investigation Committee shall be determined by the president of the NHIS.

Article 73(Composition and operation of Publication Deliberation Committee) #

(1) The Publication Deliberation Committee shall be comprised of 11 members, including 1 Chairperson. <Amended on Sep. 16, 2025>

(2) The Chairperson of the Publication Deliberation Committee shall be elected from among members under subparagraphs 1 through 4, and its members shall be appointed or commissioned by the Minister of Health and Welfare, from among the following persons: <Amended on Sep. 16, 2025>

1. One person recommended by consumers' organizations;

2. One journalist;

3. One legal expert, such as a lawyer;

4. Five persons recommended by organizations representing the medical and pharmaceutical industry, who have abundant knowledge of and experience in health insurance;

5. One public official in general service who belongs to the Senior Executive Service of the Ministry of Health and Welfare;

6. Two persons, each of whom is recommended by the president of the NHIS and the president of the Review and Assessment Service, respectively.

(3) The term of office of members of the Publication Deliberation Committee (excluding members in paragraph (2) 5) shall be two years.

(4) The Chairperson of the Publication Deliberation Committee shall represent the Publication Deliberation Committee, and shall manage overall affairs of the Publication Deliberation Committee.

(5) When the Chairperson of the Publication Deliberation Committee is unable to perform his or her duty due to any unavoidable reason, the member designated by the Chairperson shall perform the duty on his or her behalf.

(6) The Publication Deliberation Committee shall open its meetings with the attendance of a majority of all the incumbent members and shall pass resolutions with concurrent votes of a majority of the members present.

(7) Except as provided in paragraphs (1) through (6), matters necessary for organization, operation, etc., the Publication Deliberation Committee shall be determined by the Chairperson of the Publication Deliberation Committee after deliberation of the Publication Deliberation Committee.

Article 74(Procedure for and methods of announcement) #

(1) The Minister of Health and Welfare shall provide the health care institution which has been notified that it is subject to announcement under Article 100 (3) of the Act with an opportunity to submit evidence or to present itself and state opinions within 20 days from the date it received the notification.

(2) The Minister of Health and Welfare shall publicly announce the matters of publication under Article 100 (1) of the Act concerning the health care institutions selected as the objects of publication under Article 100 (4) of the Act for six months on the website of the Ministry of Health and Welfare, the NHIS, the Review and Assessment Service, the competent Special Metropolitan City, Metropolitan City, Special Self-Governing City, Do, Special Self-Governing Province, and Si/Gun/autonomous Gu and the relevant health center, and may publicly announce them additionally on a bulletin board, etc. of the relevant organizations. <Amended on Jun. 2, 2020>

(3) Where the Minister of Health and Welfare deems that an additional publication is necessary for such reason as a health care institution selected as the object of announcement under Article 100 (4) of the Act makes fraudulent claims falling under the subparagraphs of Article 100 (1) of the Act repeatedly or its fraudulent claims constitute a serious violation, etc., he or she may announce them in a newspaper under the Act on the Promotion of Newspapers or may broadcast them under the Broadcasting Act in addition to the public announcement in paragraph (2).

(4) When it is confirmed that the matters of publication under Article 100 (1) of the Act are changed during the period of public announcement under paragraph (2) because of permission for change, report of change, etc. granted or filed under Article 33 (5) of the Medical Service Act, the Special Metropolitan City Mayor, Metropolitan City Mayor, Special Self-Governing Province Mayor, Do Governor, Special Self-Governing Province Governor, head of the Si/Gun/Gu, or the head of the public health clinic having jurisdiction over the relevant health care institution subject to public announcement under paragraph (2) shall notify, without delay, the Minister of Health and Welfare of such fact. In such cases, the Minister of Health and Welfare shall take necessary measures so that the matters of change shall be immediately applied to the details of public announcement under paragraph (2). <Amended on Jun. 2, 2020>

(5) Except as provided in paragraphs (1) through (4), matters necessary for the procedure for and method of announcement, change in the matters of announcement, etc. shall be determined by the Minister of Health and Welfare.

Article 75-2(Payment of incentives) #

(1) The NHIS shall pay incentives under Article 104 (2) of the Act to a health care institution that has contributed to reducing the financial expenditure of the national health insurance in any of the following manners: <Amended on Aug. 29, 2014; Dec. 7, 2021>

1. Prescribing or preparing medicines of which costs of health care benefits are relatively low, among the medicines that can be used alternatively because their components or efficacy is the same;

2. Prescribing or preparing medicines the prices of which are low compared with other medicines and the effect of which is potent enough to replace other medicines due to the characteristics of the medicines, among medicines designated and publicly notified as shortage prevention drugs referred to in Article 70-2 (2) 1;

3. Purchasing medicines at a price lower than the upper price limit during a period prescribed and publicly notified by the Minister of Health and Welfare, or reducing the amount of use compared with the previous year.

(2) The amount of incentives shall not exceed 70/100 of the amount reduced from the financial expenditure of the national health insurance by the prescription and preparation referred to in paragraph (1).

(3) A health care institution that intends to receive incentives under paragraph (1) 1 or 2 shall request the payment of the incentives simultaneously with the filing of a request for the review of health care benefits with the Review and Assessment Service under Article 47 (2) of the Act. <Added on Aug. 29, 2014>

(4) The amount of incentives payable under paragraph (1) 3 shall be calculated by the Review and Assessment Service and notified to the NHIS after obtaining approval from the Minister of Health and Welfare. <Added on Aug. 29, 2014>

(5) Except as provided in paragraphs (1) through (4), matters necessary for the criteria, method, procedures for payment of an incentive and others shall be determined and publicly notified by the Minister of Health and Welfare. <Amended on Aug. 29, 2014>

[This Article Added on Sep. 26, 2013]

Article 76-2(Time to acquire eligibility as the insured for foreigners) #

(1) An overseas Korean national or a foreigner residing in the Republic of Korea (hereinafter referred to as "foreigner, etc. residing in Korea") shall become eligible as the insured on any of the following dates, whichever is relevant, pursuant to the proviso of Article 109 (6) of the Act: <Amended on Jul. 16, 2019>

1. Where the relevant person falls under Article 109 (3) 2 of the Act and resides in Korea during the period referred to in subparagraph 1 of that paragraph: The date the period expires;

2. Where the relevant person falls under Article 109 (3) 2 of the Act and constitutes the grounds on which he or she is expected to reside in Korea continuously pursuant to subparagraph 1 of that paragraph: The date the person enters Korea;

3. Other cases where the Minister of Health and Welfare deems it necessary to determine the timing for acquiring the eligibility as the insured for foreigners, etc. differently from that for Korean nationals residing in Korea, based on the status, period, circumstances, etc. of stay, and publicly notifies such timing: The date prescribed in the relevant public notice.

(2) A foreigner, etc. residing in Korea shall lose the eligibility as the insured on the relevant date specified in Article 10 (1) 1, 4, or 5 of the Act, pursuant to Article 10 of the Act which is applicable mutatis mutandis under the main clause of Article 109 (6) of the Act; provided, a foreigner, etc. residing in Korea shall also lose the eligibility on any of the following dates, whichever is relevant, pursuant to the proviso of Article 109 (6) of the Act: <Amended on Jun. 11, 2019; Jul. 16, 2019>

1. The employee insured: Any of the following dates:

(a) The date following the date the period of stay expires under Article 10-2 (1) 2 of the Immigration Act or Article 10 (1) of the Act on the Immigration and Legal Status of Overseas Koreans;

(b) The date following the date a written order of deportation is issued under Article 59 (3) of the Immigration Act;

(c) The date the employer requests the exclusion of the relevant person from the employee insured pursuant to Article 109 (5) 2 of the Act; Provided, That where such request is made within 14 days from the date a report on eligibility acquisition as the employee insured is made under Article 8 (2) of the Act, the relevant person shall lose the eligibility on the date of eligibility acquisition;

(d) Other cases where the Minister of Health and Welfare deems it necessary to determine the timing for losing the eligibility as the insured for foreigners, etc. differently from that for Korean nationals residing in Korea, based on the status, period, circumstances, etc. of stay, and publicly notifies such timing: The date prescribed in the relevant public notice.

2. The self-employed insured: Any of the following dates:

(a) The date referred to in subparagraph 1 (a) or (b);

(b) Where one month has elapsed since an overseas Korean national or a foreigner whose period of stay has not expired departed from Korea: The date following the date of departure;

(c) The date the self-employed insured requests the exclusion of him or her from the insured pursuant to Article 109 (5) 2 of the Act; provided, where the self-employed insured who has failed to pay insurance contributions or the self-employed insured for whom 14 days have not passed since the first payment of insurance contributions requests the exclusion of him or her from the insured after meeting the requirements determined and publicly notified by the Minister of Health and Welfare, it shall be the date of acquisition of the eligibility;

[This Article Added on Sep. 22, 2016]

Article 76-3(Timing to acquire eligibility as dependents for foreigners) #

(1) A foreigner, etc. residing in Korea shall acquire the eligibility as a dependent on any of the following dates, whichever is relevant, pursuant to the proviso of Article 109 (6) of the Act: <Amended on Apr. 19, 2024>

1. In cases of a newborn baby defined in subparagraph 4 of Article 2 of the Mother and Child Health Act, who is a child of the employee insured (including the child of his or her spouse): The date of birth;

2. Where the relevant person files an application for the eligibility acquisition as a dependent within 90 days from the date of resident registration, reporting on his or her place of residence in Korea, or alien registration under any subparagraph of Article 109 (2) of the Act (hereafter in this Article referred to as "resident registration, etc."):

(a) Where he or she meets all the requirements prescribed in the subparagraphs of Article 109 (4) of the Act as of the date of filing an application for eligibility acquisition as a dependent: The date of the relevant resident registration, etc.; provided, where he or she becomes the employee insured after the resident registration, etc., the date on which he or she becomes the employee insured;

(b) Where he or she fails to meet only the requirements prescribed in Article 109 (4) 3 of the Act as of the date of filing an application for eligibility acquisition as a dependent: The date on which he or she meets the requirements prescribed in Article 109 (4) 3 of the Act;

3. Where he or she files an application for eligibility acquisition as a dependent after 90 days have elapsed from the date of resident registration, etc.;

(a) Where he or she meets all the requirements prescribed in the subparagraphs of Article 109 (4) of the Act as at the date of filing an application for eligibility acquisition as a dependent: The date of filing an application for eligibility acquisition; provided, where he or she becomes the employee insured after resident registration, etc. and files an application for eligibility acquisition as a dependent within 90 days from the date he or she becomes the employee insured, the date he or she becomes the employee insured;

4. Other cases where the Minister of Health and Welfare deems it necessary to determine the time to acquire the eligibility as dependents for foreigners, etc. differently from that for Korean nationals residing in Korea in consideration of the status, period, circumstances, etc. of stay, and publicly notifies such time: The date prescribed in the relevant public notice.

(2) A foreigner, etc. residing in Korea shall lose the eligibility as a dependent on the date specified in Article 5 (3) of the Act (limited to where he or she is deceased; where his or her supporter loses the eligibility as the employee insured; or where he or she receives medical benefits), pursuant to Article 5 of the Act which is applicable mutatis mutandis under the main clause of Article 109 (6) of the Act; provided, the relevant person shall also lose the eligibility as a dependent on any of the following dates pursuant to the proviso of Article 109 (6) of the Act: <Amended on Jun. 11, 2019>

1. The date following the date the period of stay expires under Article 10-2 (1) 2 of the Immigration Act or Article 10 (1) of the Act on the Immigration and Legal Status of Overseas Koreans;

2. The date following the date a written order of deportation is issued under Article 59 (3) of the Immigration Act;

3. Other cases where the Minister of Health and Welfare deems it necessary to determine the time to lose the eligibility as dependents for foreigners, etc. differently from that for Korean nationals residing in Korea in consideration of the status, period, circumstances, etc. of stay, and publicly notifies such time: The date prescribed in the relevant public notice.

[This Article Added on Sep. 22, 2016]

Article 81(Processing of sensitive information and personally identifiable information) #

(1) Where unavoidable to perform the following business affairs, the NHIS (including those entrusted with the business affairs of the NHIS under Article 112 of the Act) may process information on health under Article 23 of the Personal Information Protection Act, data that constitutes a criminal history under subparagraph 2 of Article 18 of the Enforcement Decree of that Act, and data containing resident registration numbers, passport numbers, driver's license numbers, or alien registration numbers under the subparagraphs of Article 19 of that Decree: <Amended on Sep. 26, 2013; Nov. 20, 2014; Jun. 30, 2022; Jun. 20, 2023>

1. Affairs related to reporting on a workplace under Article 7 of the Act;

2. Affairs related to the services set forth in Article 14 (1) of the Act;

3. Affairs related to the payment of costs of health care benefits to soldiers, etc. in active service under Article 60 of the Act;

4. Affairs related to the settlement of costs of health care benefits under Article 61 of the Act;

4-2. Affairs related to the provision of financial information, etc. under Articles 72 and 96-2 of the Act;

4-3. Affairs related to the provision of data under Article 81-3 of the Act;

5. Affairs related to the disclosure of personal details, etc. of persons in arrears under Article 83 of the Act;

6. Affairs related to the filing of objections and administrative proceedings under Articles 87 and 90 of the Act;

7. Affairs related to reporting, etc. under Article 94 of the Act;

8. Affairs related to the forwarding of data on the reduction or omission of incomes under Article 95 of the Act;

8-2. Affairs related to a request for provision of data under Article 96 of the Act;

9. Affairs related to the payment of monetary awards under Article 104 of the Act;

10. Affairs related to the entrustment of services under Article 112 of the Act.

(2) Where unavoidable to perform the following business affairs, the Review and Assessment Service may process information on health under Article 23 of the Personal Information Protection Act and data containing resident registration numbers, passport numbers, driver's license numbers, or alien registration numbers under Article 19 of the Enforcement Decree of that Act: <Amended on Sep. 26, 2013; Nov. 20, 2014; Mar. 27, 2017>

1. Affairs related to reporting on the current status of facilities, equipment, human resources, etc. of health care institutions under Article 43 of the Act;

1-2. Affairs related to the verification of entitlement to health care benefits, etc. under Article 48 of the Act;

2. Affairs related to the services set forth in Article 63 (1) of the Act;

3. Affairs related to the filing of objections and administrative litigations under Articles 87 and 90 of the Act;

4. Affairs related to a request for provision of data under Article 96 of the Act.

(3) Where unavoidable to perform the following business affairs, health care institutions (including organizations authorized by health care institutions to act on their behalf pursuant to Article 47 (7) of the Act, in the case of subparagraph 2) may process information on health under Article 23 of the Personal Information Protection Act and data containing resident registration numbers, passport numbers, driver's license numbers, or alien registration numbers under Article 19 of the Enforcement Decree of that Act: <Added on Mar. 27, 2017; Jun. 20, 2023>

1. Affairs related to the provision of health care benefits referred to in Article 41 (1) of the Act;

2. Affairs related to claims for costs of health care benefits referred to in Article 47 (1) or (2) of the Act.

(4) Where unavoidable to perform business affairs regarding claims for the payment of health care costs under Article 49 (3) of the Act, a quasi-health care institution under Article 49 (1) of the Act (hereinafter referred to as "quasi-health care institution") may process information on health under Article 23 of the Personal Information Protection Act or data containing resident registration numbers, passport numbers, driver's license numbers, or alien registration numbers under Article 19 of the Enforcement Decree of that Act. <Added on Jun. 29, 2021; Jun. 20, 2023>

(5) Where unavoidable to perform business affairs regarding claims for the payment of insurance benefits under the former part of Article 51 (2) of the Act, a person who sells assistive devices under Article 51 (2) of the Act (hereinafter referred to as "assistive device seller") may process information on health under Article 23 of the Personal Information Protection Act or data containing resident registration numbers, passport numbers, driver's license numbers, or alien registration numbers under Article 19 of the Enforcement Decree of that Act. <Added on Jun. 29, 2021; Jun. 20, 2023>

(6) The Minister of Health and Welfare (including those delegated or entrusted with the authority of the Minister of Health and Welfare under Article 111 of the Act) may process data referred to in paragraph (1) where unavoidable to perform the following: <Amended on Mar. 27, 2017; Jun. 29, 2021>

1. Affairs related to approval for delinquency disposition under Article 81 (3) of the Act;

2. Affairs related to a request for a trial under Article 88 of the Act;

3. Affairs related to reports and inspections, etc. under Article 97 of the Act;

4. Affairs related to the disposition of suspension of operation under Article 98 of the Act;

5. Affairs related to the imposition and collection of penalty surcharges under Article 99 of the Act;

6. Affairs related to the publication of the fact of violation under Article 100 of the Act.

ENFORCEMENT DECREE OF THE NATIONAL HEALTH INSURANCE ACT

Article 1(Purpose) #

Article 2(Head of organ who is employer) #

Article 2-2(Formulation of comprehensive national health insurance plans) #

Article 2-3(Matters to be included into comprehensive plans) #

Article 3(Matters subject to deliberation and resolution by Deliberative Committee) #

Article 4(Members who are public officials) #

Article 4-2(Discharge or dismissal of Deliberative Committee members) #

Article 5(Chairperson of Deliberative Committee) #

Article 6(Meetings of Deliberative Committee) #

Article 7(Administrative secretary of Deliberative Committee) #

Article 8(Allowances of members of Deliberative Committee) #

Article 9(Persons excluded from the employee insured) #

Article 9-2(Services of the NHIS) #

Article 10(Executive officer who is public official) #

Article 11(Matters to be deliberated and resolved at meetings of board of directors) #

Article 12(Meetings of board of directors) #

Article 13(Delegation of authority of president) #

Article 14(Composition of Financial Operation Committee) #

Article 15(Operation of Financial Operation Committee) #

Article 16(Administrative secretary of Financial Operation Committee) #

Article 17(Minutes of Financial Operation Committee) #

Article 17-2(Upper limit on contributions to catastrophic health expenditure support programs) #

Article 18(Medical facilities excluded from health care institution) #

Article 18-2(Reduction of upper limit amount of costs of health care benefits for medicines and criteria for suspension of application of health care benefits) #

Article 18-3 #

Article 18-4(Selective benefits) #

Article 19(Expenses borne by beneficiaries) #

Article 20(Party to contract on costs of health care benefits) #

Article 21(Terms and conditions of contracts) #

Article 22(Costs of health care benefits for medicines and materials for medical treatment) #

Article 22-2(Withholding payment of costs of health care benefits) #

Article 23(Additional benefits) #

Article 24 #

Article 25(Health checkups) #

Article 26(Restrictions on benefits) #

Article 26-2(Methods of and procedures for filing application for accounts for receipt of health care costs) #

Article 26-3(Disclosure of personal details on persons in arrears of payment of unjust enrichment or unjust profit collectable and causes for exclusion from disclosure thereof) #

Article 26-4(Establishment and operation of Deliberative Committee on disclosure of information on unjust enrichment and unjust profit in arrears) #

Article 27(Payment of costs of health care benefits to soldiers in active service) #

Article 28(Services) #

Article 29(Executive officers who are public officials) #

Article 29-2(Dual office holding by members of Medical Treatment Review Committee) #

Article 30(Delegation of the President's authority) #

Article 31(Provisions applied mutatis mutandis) #

Article 32(Upper and lower limits of amount of monthly insurance contributions) #

Article 33(Money and valuables to be included in remunerations) #

Article 34(Principle of imposing insurance contributions on the employee insured) #

Article 35(Report of remuneration for computing monthly remuneration amount) #

Article 36(Confirmation on amount of monthly remuneration) #

Article 37(Confirmation of monthly remuneration when acquiring or changing eligibility as the employee insured) #

Article 38(Confirmation on amount of monthly remuneration for employers who receive no remuneration) #

Article 39(Settlement of amount of insurance contributions based on monthly remuneration, and payment by installments) #

Article 40(Payment of insurance contributions when public officials are transferred) #

Article 41(Amount of monthly income) #

Article 41-2(Adjustment of amount of monthly income) #

Article 42(Criteria for calculating contribution points based on property) #

Article 42-2(Exclusion from contribution points based on property of housing-related loan amounts) #

Article 42-3 #

Article 42-4 #

Article 42-5 #

Article 42-6 #

Article 42-7(Evaluation of appropriateness of insurance contribution imposition system) #

Article 43(Separation of household of the self-employed insured) #

Article 44(Insurance contribution rates and monetary value per contribution point based on property) #

Article 44-2(Period of stay abroad to be excluded from payment of insurance contributions) #

Article 45(Areas subject to reduction of insurance contributions) #

Article 45-2(Reduction of insurance contributions for account transferors) #

Article 46(Minors subject to exemption from joint liability of the self-employed insured from payment of insurance contributions) #

Article 46-2(Secondary payment responsibility following transfer, or acquisition by transfer, of business) #

Article 46-3(Additional charges) #

Article 46-4(Payment of insurance contributions by credit card) #

Article 46-5(Exception to notification before making delinquency disposition on insurance contributions) #

Article 46-6(Seizure of unjust enrichment or unjust profit collectible) #

Article 47(Causes for exclusion from provision of data concerning delinquency or write-off of deficits) #

Article 47-2(Procedures for provision of data concerning delinquency or write-off of deficits) #

Article 47-3(Certification of payment of insurance contributions) #

Article 47-4(Service by mail) #

Article 48(Disclosure of personal details of persons in arrear with large amount or in habitual arrears and causes for exclusion from disclosure thereof) #

Article 49(Composition and operation of Deliberative Committee on disclosure of insurance contribution information) #