Article 5 (Eligible Persons, etc.)

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

1. Persons who receive medical aid under the Medical Care Assistance Act (hereinafter referred to as "eligible recipient");

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

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

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

(2) Dependents of the insured referred to in paragraph (1) refers to any of the following persons who are supported mainly by the employee insured and whose income or property falls below the standards prescribed by Ordinance of the Ministry of Health and Welfare:

1. Spouses of the employee insured;

2. Lineal ascendants of the employee insured (including lineal ascendants of their spouses);

3. Lineal descendants (including lineal descendants of their spouses) and their spouses of the employee insured;

4. Siblings of the employee insured.

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

Article 6 (Categories of Policyholders)

(1) The insured shall be divided into the employee insured and the self-employed insured.

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

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

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

3. Public officials who assume office by winning an election, and who do not receive monthly remuneration or salary equivalent thereto;

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

(3) Persons who are neither the employee insured nor their dependents shall be the self-employed insured.

(4) Deleted.

Enforcement Ordinance

Article 7 (Reporting on Workplace)

Where an employer of a workplace falls under any of the following subparagraphs, he/she shall report such fact to an insurer, as prescribed by Ordinance of the Ministry of Health and Welfare within 14 days thereafter. This shall also apply where any matter reported to the insurer is changed as he/she falls under subparagraph 1:
1. Where his/her workplace becomes a workplace using employees, public officials and school employees who become employer-provided policyholders pursuant to Article 6 (2) (hereinafter referred to as a "workplace of eligible persons");
2. Where a cause prescribed by Ordinance of the Ministry of Health and Welfare exists, such as suspension of business and closure of business.

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

(1) A policyholder shall become eligible as an employer-provided policyholder or a locally provided policyholder on the day he/she takes residence in the country: Provided, That a person who falls under any of the following subparagraphs shall become eligible for each on the applicable day:
1. For a former person eligible for medical care, on the day when he/she becomes excluded from such eligibility;
2. The day on which a former dependent of an employer-provided policyholder loses his/her eligibility;
3. For a former person eligible for medical care for distinguished service, on the day when he/she is excluded from such eligibility;
4. For a person eligible for medical care for distinguished service who requests the insurer for coverage under the health insurance under Article 5 (1) 2 (a), on the day when the request is made.
(2) If a person becomes eligible under paragraph (1), the employer of the employer-provided policyholder concerned or the head of the household of the locally provided policyholder concerned shall report the particulars to the insurer as prescribed by Ordinance of the Ministry of Health and Welfare within 14 days after the date of acquisition of the eligibility.

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

(1) The eligibility of a policyholder shall change on the date when he/she falls under any of the following subparagraphs:
1. When a locally provided policyholder becomes an employer of a workplace of eligible persons or is employed as an employee, public official or school employee (hereinafter referred to as an "employee, etc.");
2. When an employer-provided policyholder becomes an employer of another workplace of eligible persons or is employed as an employee, etc.;
3. On the date immediately following the date of expiration of employment relationship of employer, etc. who is an employer-provided policyholder;
4. On the date immediately following the date on which any cause under subparagraph 2 of Article 7 occurs at the workplace of eligible persons;
5. On the date on which a locally provided policyholder moves into another household.
(2) Where the eligibility of a policyholder changes under paragraph (1), the employer of an employer-provided policyholder or a householder of an locally provided policyholder shall report the particulars to the insurer according to the following distinction as prescribed by Ordinance of the Ministry of and Welfare within fourteen days from the date on which the eligibility changes:
1. Where eligibility changes pursuant to subparagraphs 1 and 2 of paragraph (1): employer of the employer-provided policyholder;
2. Where there is a change in eligibility pursuant to subparagraphs 3 through 5 of paragraph (1): householder of a locally provided policyholder.
(3) Where an employer-provided policyholder or locally provided policyholder falls under subparagraph 3 or 4 of Article 54, the Minister of National Defense and the Minister of Justice shall notify the insurer as provided by Ordinance of the Ministry of Health and Welfare within one month from the date of such change.

Article 9-2 (Notice of Acquisition and Change of Eligibility)

Upon confirmation of the acquisition or change of eligibility of the insured through the data received pursuant to Article 96 (1), the NHIS shall give notice of the acquisition or change of the eligibility, as prescribed by Ordinance of the Ministry of Health and Welfare, when the billing of contribution is made to the person obligated to pay it under Article 79 for the first time after the acquisition or change of the eligibility.

[This Article Newly Inserted on Jan. 15, 2019]

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

(1) A policyholder shall lose his/her eligibility on the day he/she falls under any of the following subparagraphs:
1. Day after the day he/she dies;
2. Day after the day he/she loses his/her nationality;
3. Day after the day he/she ceases to reside within the country;
4. The day he/she becomes a dependent of an employer-provided policyholder;
5. The day he/she becomes a person eligible for medical care;
6. The day a request for exclusion from coverage of the health insurance is made by a person formerly covered by health insurance but became a person eligible for medical care for distinguished service.
(2) If eligibility is lost under paragraph (1), the employer of the employer-provided policyholder concerned or the head of the household of the locally provided policyholder concerned shall report the particulars to the insurer as prescribed by Ordinance of the Ministry of Health and Welfare within 14 days after the date of loss of the entitlement.

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

(1) Acquisition, change, or loss of the entitlement of a policyholder shall take effect retrospectively from the time of acquisition, change or loss of the eligibility under Articles 8 through 10. In such cases, the insurer may confirm the fact thereof.
(2) A policyholder or a former policyholder, or a dependent or a former dependent may request the confirmation referred to in paragraph (1).

Article 12 (Health Insurance Card)

(1) The National Health Insurance Service shall issue a health insurance card upon application by the insured or his or her dependent.

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

(3) Notwithstanding the main clause of paragraph (2), if it is possible for a health care institution to ascertain his or her eligibility using his or her resident registration certificate, driver's license, passport, or other identification cards prescribed by Ordinance of the Ministry of Health and Welfare (hereinafter referred to as "identification cards") to verify his or her identity, the insured or a dependent need not submit his or her health insurance card.

(4) Neither the insured nor his or her dependent may receive insurance benefits after losing his or her eligibility under Article 10 (1) using a document that had been used to certify his or her eligibility before.

(5) No person is allowed to arrange another person to receive insurance benefits by transferring or lending his or her health insurance card or identification card.

(6) No person is allowed to receive insurance benefits by transferring, borrowing, or fraudulently using another person's health insurance card or identification card.

(7) Matters necessary for the procedures and methods for application and the form for the health insurance card referred to in paragraph (1) and issuing and using it shall be prescribed by Ordinance of the Ministry of Health and Welfare.