NATIONAL HEALTH INSURANCE ACT [See entire ACT]
CHAPTER I GENERAL PROVISIONS
- Article 1 (Purpose)
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The purpose of this Act is to improve citizens' health and promote social security by providing citizens with insurance benefits for the prevention, medical examination, medical treatment of and rehabilitation from diseases and injury, for childbirth and death, and for improvement of health.
- Article 2 (Charge)
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The Minister of Health and Welfare shall administer the national health insurance program prescribed by this Act.
- Article 3 (Definitions)
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The definitions of the terms used in this Act shall be as follows:
1. The term "worker" means a person who, regardless of the type of his/her occupation, lives on remuneration received as compensation for his/her work (including a director or other executive of a corporation), except for a public official or a school employee;
2. The term "employer" means a person who falls under any of the following items:
(a) The owner of the workplace at which a worker is employed;
(b) The head of the organ at which a public official is employed, who is determined by Presidential Decree;
(c) The person who establishes and operates a private school (referring to a private school referred to in Article 3 of the Pension for Private School Teachers and Staff Act; hereafter the same shall apply in this Article) at which a school employee is employed;
3. The term "workplace" means a place of business or office;
4. The term "public official" means a person who is a regular employee of the State or a local government providing civil service;
5. The term "school employee" means a teacher at, or an employee of, a private school or an organization that manages the school.
Enforcement Ordinance
- Article 2 (Head of Organ Who is Employer)
"Person determined by Presidential Decree" in subparagraph 2 (b) of Article 3 of the National Health Insurance Act (hereinafter referred to as the "Act") refers to heads of organizations designated in attached Table 1: Provided, That when deemed necessary for efficiently dealing with the affairs of health insurance, 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 attached Table 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.
Enforcement Ordinance
- Article 4 (Health Insurance Policy Deliberative Committee)
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(1) The Health Insurance Policy Deliberative Committee (hereinafter referred to as the "Deliberative Committee") mandated to deliberate and vote on matters concerning health insurance policies, which fall under each of the following subparagraphs, shall be established under the Minister of Health and Welfare:
1. The standards for medical care benefits provided for in Article 41 (2);
2. Matters concerning medical care benefit costs provided for in Article 45 (3) and 46;
3. The insurance premium rates of employer-provided policyholders provided for in Article 73 (1);
4. The monetary value per contribution point of the locally provided policyholders provided for in Article 73 (3);
5. Other important matters prescribed by Presidential Decree concerning health insurance.
(2) The Deliberative Committee shall be comprised of 25 members, including one chairperson and one vice chairperson.
(3) The chairperson of the Deliberative Committee shall be the Vice Minister of Health and Welfare and the vice chairperson shall be nominated by the chairperson from among the members referred to in paragraph (4) 4.
(4) The following persons shall be appointed or commissioned by the Minister of and Welfare as members of the Deliberative Committee:
1. Two persons, each recommended respectively by workers' organizations and employers' organizations;
2. One person, each recommended respectively by civil organizations (referring to the non-profit civil organizations provided for in Article 2 of the Assistance for Non-Profit, Non-Governmental Organizations Act; hereinafter the same shall apply), consumers' organizations, organizations of farmers and fishermen, and organizations of self-employed persons;
3. Eight persons who are recommended by the organizations representing the medical profession and the organizations representing the medicine manufacturers;
4. Eight persons falling under each of the following items:
(a) Two public officials who belong to central administrative agencies prescribed by Presidential Decree;
(b) One person, each recommended respectively by the president of the National Health Insurance Corporation and the president of the Health Insurance and Assessment Service;
(c) Four persons of profound learning and experience in health insurance.
(5) The terms of office of the members of the Deliberative Committee shall be three years: Provided, That the term of office for any member newly appointed, filling a vacancy of a resigned member, etc. shall be the remainder of the term of office for his/her predecessor.
(6) Matters necessary for the operation, etc. of the Deliberative Committee shall be prescribed by Presidential Decree.
Enforcement Ordinance
- Article 3 (Matters Subject to Deliberation and Resolution by Deliberative Committee)
"Matters prescribed by Presidential Decree" in Article 4 (1) 5 of the Act refers to matters falling under each of the following subparagraphs:
1. The relative point value of each benefit in kind provided for in Article 21 (2);
2. The upper-limit on the costs of the benefit in kind of each medicine and materials for medical treatment provided for in Article 22;
3. Other important matters concerning health insurance under Article 5 (1) of the Act including the matters concerning additional benefits under Article 23, which are placed on the agenda of the meetings of the Health Insurance Policy Deliberative Committee provided for in Article 4 of the Act (hereinafter referred to as the "Deliberative Committee") by its chairperson (hereinafter referred to as the "chairperson").
Enforcement Ordinance
- Article 4 (Members Who are Public Officials)
"Public officials who belong to central administrative agencies prescribed by Presidential Decree" in Article 4 (4) 4 (a) of the Act refers to public officials, each one of whom is nominated by the head of an administrative agency for which he/she works from among the public officials of Grade III who belong to the Ministry of Strategy and Finance and the Ministry of Health and Welfare or the public officials in general service who belong to the Senior Civil Service Corps, each of whom is nominated by the head of an agency to which he/she belongs.
Enforcement Ordinance
- Article 6 (Meetings of Deliberative Committee)
(1) The chairperson shall convene and preside over meetings of the Deliberative Committee.
(2) Meetings of the Deliberative Committee shall be convened upon a request from at least one third of the total registered members, or where the chairperson deems it necessary.
(3) Meetings of the Deliberative Committee shall open with the attendance of a majority of the total members and pass resolutions with the concurrent vote of a majority of those present.
(4) The chairperson shall not participate in resolutions under paragraph (3): Provided, That when the numbers of votes of approval and disapproval are equal, the chairperson shall determine thereon.
(5) The Deliberative Committee may, where it is deemed necessary to ensure its efficient deliberation, set up subcommittees by field.
(6) Necessary matters concerning the operation of the Deliberative Committee and the subcommittees, other than those prescribed in paragraphs (1) through (5), shall be determined by the chairperson after undergoing the resolution thereon by the Deliberative Committee.
Enforcement Ordinance
- Article 7 (Secretary of Deliberative Committee)
(1) The Deliberative Committee shall have one secretary to administer the offices of the Deliberative Committee.
(2) The secretary shall be nominated by the chairperson, from among the public officials of Grade IV or higher in rank who work for the Ministry of Health and Welfare, or from among public officials in general service who belong to the Senior Civil Service Corps.
Enforcement Ordinance
- Article 8 (Allowances, etc. of Members of Deliberative Committee)
Allowances, travel expenses and other necessary expenses may be reimbursed to the members who have attended the meeting of the Deliberative Committee within budget limits: Provided, That this shall not apply where any member who is a public official attends in direct connection with his/her duties.
