Article 41 (Medical Care Benefits)

(1) Medical care benefits referred to in the following subparagraphs shall be provided for diseases, injuries, childbirths, etc. of the policyholders and their dependents:
1. Diagnosis, medical examinations;
2. Supply of medicines and materials for medical treatment;
3. Emergency aid, operation or other types of medical treatments;
4. Prevention, rehabilitation;
5. Hospitalization;
6. Nursing;
7. Transfers.
(2) Criteria for medical care benefits referred to in paragraph (1) (hereinafter referred to as "medical care benefits"), such as the method, procedure, scope, and upper limit on medical care benefits shall be prescribed by Ordinance of the Ministry of Health and Welfare.
(3) In prescribing the criteria for medical care benefits under paragraph (2), the Minister of Health and Welfare may exclude ailments that do not cause difficulties at work or in daily life and other items determined by Ordinance of the Ministry of Health and Welfare, from items eligible for medical care benefits.

Article 41-2 (Reduction of Upper Limit Amount of Costs of Health Care Benefits for Medicines)

(1) The Minister of Health and Welfare may reduce the upper limit amount (referring to the amount set as the upper limit of each kind of medicine pursuant to Article 41 (3); hereinafter the same shall apply) of costs of health care benefits for the medicines referred to in Article 41 (1) 2 as are involved in a violation of Article 47 (2) of the Pharmaceutical Affairs Act within the extent not exceeding 20/100 of such amount.

(2) Where any medicine for which the upper limit amount of costs of health care benefits is reduced pursuant to paragraph (1) again becomes subject to the reduction of amount under paragraph (1) within the period determined by Presidential Decree within the extent of five years from the date when the upper limit amount of such medicine was reduced, the Minister of Health and Welfare may partially reduce the upper limit amount of costs of health care benefits for such medicine within the extent not exceeding 40/100 of such upper limit amount.

(3) Where any medicine for which the upper limit amount of costs of health care benefits is reduced pursuant to paragraph (2) is again involved in a violation of Article 47 (2) of the Pharmaceutical Affairs Act within the period determined by Presidential Decree within the scope of five years from the date when the upper limit amount of costs of health care benefits for such medicine is reduced, the Minister of Health and Welfare may suspend the application of health care benefits for a fixed period not exceeding one year.

(4) Standards and procedures for reducing the upper limit amount of costs of health care benefits and suspending the application of health care benefits pursuant to paragraphs (1) through (3), and other matters therefor shall be prescribed by Presidential Decree.

[This Article Newly Inserted on Jan. 1, 2014]

[Title Amended on Mar. 27, 2018]

Enforcement Ordinance

Enforcement Ordinance

Article 42 (Medical Care Institution)

(1) Health care benefits (excluding nursing and transfers) shall be provided by the health care institutions referred to in the following subparagraphs. In such cases, the Minister of Health and Welfare may exclude medical facilities, etc. determined by Presidential Decree, which are unfit as health care institutions for the public interest or for national policy reasons, from among health care institutions:

1. Medical institutions established under the Medical Service Act;

2. Pharmacies registered under the Pharmaceutical Affairs Act;

3. The Korea Orphan and Essential Drug Center established under Article 91 of the Pharmaceutical Affairs Act;

4. Public health clinics, public health and health care centers, and branches of public health clinics referred to in the Regional Public Health Act;

5. Public health clinics established under the Act on Special Measures for Health and Medical Services in Agricultural and Fishing Villages.

(2) If necessary for efficiently providing health care benefits, the Minister of Health and Welfare may recognize health care institutions meeting the standards prescribed by Ordinance of the Ministry of Health and Welfare, such as facilities, equipment, human resources, and medical departments, as specialized health care institutions, as prescribed by Ordinance of the Ministry of Health and Welfare. In such cases, he or she shall issue a written recognition for each of the relevant specialized health care institutions.

(3) If a health care institution recognized under paragraph (2) falls under any of the following cases, the Minister of Health and Welfare shall revoke such recognition:

1. Where it fails to meet the standards for recognition referred to in the former part of paragraph (2);

2. Where it returns the written recognition received under the latter part of paragraph (2).

(4) Health care institutions recognized to be specialized health care institutions under paragraph (2) or tertiary hospitals under Article 3-4 of the Medical Service Act may set the procedure for health care benefits referred to in Article 41 (3) and the costs of health care benefits referred to in Article 45 differently from other health care institutions.

(5) Health care institutions referred to in paragraphs (1), (2), and (4) may not refuse to provide health care benefits without any justifiable ground.

Enforcement Ordinance

Article 43 (Reports on Current Status of Medical Care Institutions)

(1) A medical care institution shall, at the time it claims reimbursement of its first medical care benefit costs under Article 47, report on the current status of its facilities, equipment, manpower, etc. to the Health Insurance and Assessment Service (hereinafter referred to as the "Review and Assessment Service") established under Article 62.
(2) Where any matter reported under paragraph (1) (limited to any matter related to the increase or reduction of medical care benefit costs under Article 45) is changed, the medical care institution shall report thereon to the Review and Assessment Service within 15 days from the date on which such change is made, as prescribed by Ordinance of the Ministry of Health and Welfare.
(3) Matters necessary for the scope of reporting, matters subject to reporting, methods and procedures, etc. for the reporting prescribed in paragraphs (1) and (2) shall be prescribed by Ordinance of the Ministry of Health and Welfare.

Article 44 (Partial Defrayment of Expenses)

A person who receives medical care benefits shall personally partially defray such expenses (hereinafter referred to as "individual co-payment") as prescribed by Presidential Decree.

Enforcement Ordinance

Article 44 (Partial Defrayment of Expenses)

A person who receives medical care benefits shall personally partially defray such expenses (hereinafter referred to as "individual co-payment") as prescribed by Presidential Decree.

Article 45 (Calculation, etc. of Medical Care Benefit Costs)

(1) The costs of medical care benefits shall be determined by contract between the president of the Corporation and persons determined by Presidential Decree who represent the medical and pharmaceutical communities. In such cases, the term of the contract shall be one year.
(2) If a contract is concluded under paragraph (1), it shall be deemed concluded between the Corporation and each individual medical care institution.
(3) A contract under paragraph (1) shall be concluded by May 31 of the year in which the expiration date of the term of the immediately preceding contract falls; if no contract is concluded within that period, the costs of medical care benefits shall be determined by the Minister of Health and Welfare by no later than June 30 of the year in which the expiration date of the term of the immediately preceding contract falls after reaching a resolution thereon by the Deliberative Committee. In such cases, the costs of medical care benefits determined by the Minister of Health and Welfare shall be deemed the medical care benefit costs determined by contract under paragraphs (1) and (2).
(4) If the medical care benefit costs are determined under paragraph (1) or (3), the Minister of Health and Welfare shall publicly notify the particulars of the medical care benefit costs without delay.
(5) The president of the Corporation shall enter into a contract under paragraph (1), subject to the deliberation and resolution of the Financial Operation Committee under Article 33.
(6) When the president of the Corporation requests for materials necessary to conclude a contract under paragraph (1), the Review and Assessment Service shall sincerely comply therewith.
(7) Details of a contract concluded under paragraph (1) and other necessary matters shall be prescribed by Presidential Decree.

Enforcement Ordinance

Enforcement Ordinance

Article 46 (Calculation, etc. Medical Care Benefit Costs for Medicines and Materials for Medical Treatment)

Notwithstanding Article 45, the medical care benefit costs for medicines and materials for medical treatment referred to in Article 41 (1) 2 (hereinafter referred to as "medicines and materials for medical treatment") may be calculated as prescribed by Presidential Decree, taking the purchase prices, etc. of the medicines and materials for medical treatment paid by the medical care institutions into consideration.

Enforcement Ordinance

Article 47 (Claims for and Payment, etc. of Medical Care Benefit Costs)

(1) A medical care institution may claim the medical care benefit costs from the Corporation. In such cases, a request for review referred to in paragraph (2) shall be deemed a claim to the Corporation for the medical care benefit costs.
(2) A medical care institution which intends to claim the medical care benefit costs under paragraph (1) shall request the Review and Assessment Service for a review of the medical care benefit costs, and the Review and Assessment Service, in receipt of the request, shall review the matter and immediately notify the Corporation and the medical care institution of the details of its review.
(3) In receipt of the notification of the review details under paragraph (2), the Corporation shall immediately pay the medical care benefit costs to the medical care institution in accordance with such details. In such cases, where the individual co-payment already paid is in excess of the amount notified under paragraph (2), the difference of the excess payment shall be subtracted from the amount to be paid to the medical care institution and paid to the relevant policyholder.
(4) The Corporation may, for accounting purposes, offset the amount to be paid to a policyholder under paragraph (3) against the insurance premiums and other collections under this Act which the relevant policyholder should pay (hereinafter referred to as "insurance premiums, etc.").
(5) Where the Review and Assessment Service evaluates the reasonableness of a medical care benefit referred to in Article 63 and notifies it to the Corporation, the Corporation shall adjust the payment by increasing or reducing the medical care benefit costs in accordance with the results of the evaluation. In such cases, the standards for increased or reduced payment of medical care benefit costs shall be prescribed by Ordinance of the Ministry of Health and Welfare.
(6) A medical care institution may authorize any of the following organizations to claim for a review referred to in paragraph (2) on its behalf:
1. The association of medical doctors, the association of dentists, the association of oriental medical doctors and the association of midwives provided for in Article 28 (1) of the Medical Service Act or a branch office or a branch of each of those associations, each of which files a report pursuant to paragraph (6) of the same Article;
2. The organization of medical institutions provided for in Article 52 of the Medical Service Act;
3. The association of pharmacists provided for in Article 11 of the Pharmaceutical Affairs Act or a branch office or a branch of the association, which files a report pursuant to Article 14 of the same Act.
(7) Matters necessary for the method and procedure for making the claim, review, payment, etc. of the medical care benefits costs referred to in paragraphs (1) through (6) shall be prescribed by Ordinance of the Ministry of Health and Welfare.

Article 47-2 (Withholding of Payment of Medical Care Benefit Costs)

(1) Notwithstanding Article 47 (3), where the NHIS verifies, as a result of an investigation by an investigative agency, that a health care institution which has filed a claim for the payment of costs of health care benefits violates Article 4 (2) or 33 (2) or (8) of the Medical Service Act or Article 20 (1) or 21 (1) of the Pharmaceutical Affairs Act, it shall withhold the payment of the relevant health care institution. In such cases, the amount of payment of medical care benefit costs shall also extend to the health care benefit costs claimed after the disposition taken by the relevant institution.

(2) Before withholding the payment of the costs of health care benefits under paragraph (1), the NHIS shall provide the relevant health care institution with an opportunity to submit its opinion.

(3) Where the suspicion that a health care institution under paragraph (1) has violated Article 4 (2), 33 (2) or (8)of the Medical Service Act or Article 20 (1) or 21 (1) of the Pharmaceutical Affairs Act is not substantiated, due to grounds prescribed by Presidential Decree such as final verdict of acquittal, the NHIS shall pay the relevant health care institution the interest for the period the payment of the costs of health care benefits is withheld in addition to the amount of health care benefit cost of which the payment is withheld.

(4) Matters necessary for the procedure for withholding the payment, the procedure for submission of opinions, etc. under paragraphs (1) and (2), and matters necessary for the payment procedure of the health care benefit cost of which the payment is withheld and its interest, the calculation of interest, etc. under paragraph (3), shall be prescribed by Presidential Decree.

[This Article Newly Inserted on May 20, 2014]

Enforcement Ordinance

Article 48 (Verification of Entitlement to Medical Care Benefits, etc.)

(1) Any policyholder or any dependent may request the Review and Assessment Service to verify whether part of the medical expenses he/she has borne, other than individual co-payment is excluded from his/her entitlement to medical care benefits in accordance with Article 41 (3).
(2) The Health Insurance and Assessment Service in receipt of a request for verification under paragraph (1) shall notify the person who requested the verification of its result. In such cases, if part of the medical expenses for which the verification is requested is verified to be entitled to medical care benefits, the Review and Assessment Service shall notify the Corporation and the relevant medical care institution of such facts.
(3) A medical care institution in receipt of a notice under the latter part of paragraph (2) shall refund without delay, the amount it has collected in excess of the amount it should have received to the person who requested the verification (hereinafter referred to as "over-collected medical expenses"): Provided, That where the relevant medical care institution fails to refund the over-collected medical expenses, the Corporation may refund such over-collected medical expenses to the person who requested for verification after deducting them from the medical care benefits it is liable to pay such medical care institution.

Article 49 (Medical Care Costs)

(1) Where the insured or dependent, due to emergency or other unavoidable reasons determined by Ordinance of the Ministry of Health and Welfare, receives health care for a disease, injury, childbirth, etc. at an institution determined by Ordinance of the Ministry of Health and Welfare and performs functions similar to those of a health care institution (including a health care institution placed under a period of suspension of operation under Article 98 (1); hereinafter referred to as “quasi-health care institution”) or undergoes a childbirth at a place other than a health care institution, the NHIS shall disburse an amount equivalent to the health care benefits concerned to the insured or dependent as the health care costs, as prescribed by Ordinance of the Ministry of Health and Welfare.

(2) A quasi-health care institution shall issue to the recipient of health care a detailed health care cost statement or a receipt stating the particulars of the health care, as prescribed by the Minister of Health and Welfare, and the person who has received the health care shall submit such statement or receipt to the NHIS.

(3) Notwithstanding paragraphs (1) and (2), a quasi-health care institution may directly claim the payment of the health care expenses to the NHIS, if a policyholder or his or her dependent has been delegated thereto. In such cases, the NHIS may pay the health care expenses to the quasi-medical care institution after examining the appropriateness of the particulars that the benefits have been requested."

(4) Matters necessary for the request for the payment of health care expenses by quasi-health care institutions under paragraph (3), the review of the NHIS' appropriateness, etc. shall be prescribed by Ordinance of the Ministry of Health and Welfare.

Article 50 (Additional Benefits)

In addition to the medical care benefits prescribed in this Act, the Corporation may subsidize medical expenses for pregnancy and childbirth, funeral costs, sickness allowances, and other benefits, as prescribed by Presidential Decree.

Enforcement Ordinance

Enforcement Ordinance

Article 51 (Special Case for Disabled Person)

(1)The NHIS may provide insurance benefits for assistive devices pursuant to subparagraph 2 of Article 3 of the Act on the Support for Assistive Devices for Persons with Disabilities, Senior Citizens, Etc. and Promotion of Use Thereof (hereafter referred to as “assistive devices” in this Article) for the disabled insured and dependents registered under the Act on Welfare of Persons with Disabilities.

(2) A person who sells assistive devices to a policyholder or his or her dependent who is a person with disabilities, may claim insurance benefits directly to the NHIS where a policyholder or his or her dependent is delegated. In such cases, the NHIS may pay insurance benefits on assistive devices to a person who sells assistive devices after examining the appropriateness of the terms of a claim for payment.

(3) The scope and methods of, and procedures for, insurance benefits for assistive devices referred to in paragraph (1), a business entity selling assistive devices requests insurance benefits referred to in paragraph (2), the review of the NHIS's propriety, and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare.

Article 52 (Health Checkups)

(1) The NHIS shall provide health checkups for the insured and their dependents in order to facilitate early detection of diseases and provide subsequent health care benefits.

(2) The types of and candidates for health checkups under paragraph (1) are as follows:

1. General health checkups: The employee insured, the self-employed insured who is the head of a household, the self-employed insured of 20 years of age and over, and a dependent of 20 years of age and over;

2. Cancer checkups: A person who meets a checkup cycle, age standard, etc. by type of cancer under Article 11 (2) of the Cancer Control Act;

3. Infant health checkups: The insured and a dependent under the age of six.

(3) The items of health checkups under paragraph (1) shall be designed based on personal characteristics, such as gender and age, and life cycle.

(4) Frequency of and procedures for the health checkup referred to in paragraph (1), and other necessary matters shall be prescribed by Presidential Decree.

Enforcement Ordinance

Article 53 (Restriction of Benefits)

(1) If a person eligible to receive insurance benefits falls under any of the following subparagraphs, the NHIS shall not provide any insurance benefit:

1. Where he or she has caused criminal conduct by intention or gross negligence or caused an accident by intention;

2. Where he or she has failed to follow health care-related instructions of the NHIS or the health care institution by intention or gross negligence;

3. Where he or she has refused to submit the documents referred to in Article 55 or other items or evaded questions or medical checkups by intention or gross negligence;

4. Where he or she receives or is eligible to receive insurance benefits or compensations under other statutes due to a disease, injury, or disaster incurred relating to his or her business or in the line of duty.

(2) When a person eligible for health care benefits has received, from the State or a local government, benefits equivalent to the health care benefits or expenses equivalent to the costs of health care benefits under the provisions of other statutes, the NHIS shall not provide insurance benefits up to the limit of such amount.

(3) Where the insured fails to pay any of the following insurance contributions for a period prescribed by Presidential Decree, the NHIS may not provide insurance benefits to the insured or his or her dependents until the delinquent insurance contributions are paid in full: Provided, That this shall not apply where the total number of failure to pay monthly insurance contributions (delinquent insurance contributions which have already been paid shall be excluded in calculating the total number of failure, and the period of delinquency in paying insurance contributions shall not be taken into consideration) is below the number prescribed by Presidential Decree, or the income and property of the insured and his or her dependents are below the standard prescribed by Presidential Decree:

1. Insurance contributions based on monthly income referred to in Article 69 (4) 2;

2. Insurance contributions per household referred to in Article 69 (5).

(4) Where an employer liable to pay insurance contributions under Article 77 (1) 1 is delinquent in paying the insurance contributions based on monthly remuneration referred to in Article 69 (4) 1, paragraph (3) shall apply only if such delinquency is attributable to the employee insured himself/herself. In such cases, the dependents of the relevant employee insured shall also be subject to paragraph (3).

(5) Notwithstanding the provisions of paragraphs (3) and (4), where approval for the installment payment from the NHIS pursuant to the provisions of Article 82 is obtained and the approved insurance contributions are paid at least once, the insurance benefits may be provided: Provided, That the same shall not apply where anyone who has obtained approval for the installment payment pursuant to the provisions of Article 82 fails to pay the approved insurance contributions at least five times (if the number of installments approved under paragraph (1) of the same Article is less than five times, it means the number of installments; hereafter the same shall apply in this Article) without any justifiable grounds therefor.

(6) The insurance benefits received in the period during which no insurance benefits are to be provided pursuant to paragraphs (3) and (4) (hereafter referred to as "benefit suspension period" in this paragraph) shall be recognized as insurance benefits only in the following cases:

1. Where the insurance contributions in arrears are fully paid by the due date for its payment in the month to which the date two months lapse from the date when the NHIS has served notice that insurance benefits were received during the benefit suspension period belongs;

2. Where the insurance contributions for which installment payment is approved pursuant to Article 82 are paid at least once by the due date for its payment in the month to which the date two months lapse from the date when the NHIS has served notice that insurance benefits were paid during the benefit suspension period belongs: Provided, That where anyone who has obtained approval for the installment payment pursuant to Article 82 fails to pay the approved insurance contributions on at least five times without justifiable grounds therefor, his or her eligibility for insurance benefits shall be denied.

Enforcement Ordinance

Article 54 (Suspension of Benefits)

When a person eligible to receive insurance benefits falls under any of the following subparagraphs, no insurance benefit shall be provided during that period: Provided, That in cases of subparagraphs 3 and 4, the health care benefits under the provisions of Article 60 shall be provided:

1. Deleted;

2. When he or she is staying abroad;

3. When he or she falls under Article 6 (2) 2;

4. When he or she is committed to a correctional institution or equivalent facilities.

Article 55 (Verification of Benefits)

If determined to be necessary when providing insurance benefits, the Corporation may demand a person who receives insurance benefits to submit documents and other items or be subject to questioning or diagnosis by relevant personnel.

Article 56 (Disbursement of Medical Care Costs, etc.)

When there is a claim for disbursement of medical care costs or for additional benefits the Corporation is obligated to provide under this Act, the Corporation shall pay or provide them without delay.

Article 56-2 (Accounts for Receipt of Medical Care Costs, etc.)

(1) Where a recipient of medical care costs who is paid in cash for insurance benefits under this Act (hereinafter referred to as "medical care costs, etc.") files an application, the Corporation shall pay the medical care costs, etc. into an account opened in the name of the person eligible for medical care (hereinafter referred to as "account for receipt of medical care costs, etc."): Provided, That where an account transfer is impossible due to an information communication problem or any other inevitable cause prescribed by Presidential Decree, it may pay the medical care costs, etc., as prescribed by Presidential Decree, such as direct cash payment.
(2) A financial institute at which an account for receipt of medical care costs is opened shall ensure that only the medical care costs, etc. are deposited into such account, and shall manage it.
(3) Matters necessary for the methods and procedures for application for, and the management of, an account for receipt of medical care costs, etc. under paragraphs (1) and (2) shall be prescribed by Presidential Decree.
[This Article Newly Inserted by Act No. 12615, May 20, 2014]

Enforcement Ordinance

Article 57 (Collection of Unjust Gains)

(1) The NHIS shall collect all or part of an amount equivalent to the insurance benefits or the insurance benefit costs from a person who has received insurance benefits, a quasi-health care institution, a business entity selling assistive devices, or a health care institution that has received insurance benefit costs by fraud or other improper means.

(2) Where a health care institution that has received insurance benefit costs by fraud or other improper means under paragraph (1) falls under any of the following subparagraphs, the NHIS may require the person who has established such health care institution to pay the money collectable under paragraph (1), severally or jointly with such health care institution:

1. A medical institution established and operated by a person prohibited from establishing a medical institution because he or she violated Article 33 (2) of the Medical Service Act, by borrowing a health care provider's license or the name of a medical corporation;

2. A pharmacy established and operated by a person prohibited from establishing a pharmacy because he or she violated Article 20 (1) of the Pharmaceutical Affairs Act, by borrowing a pharmacist's license;

3. A medical institution established and operated in violation of Article 4 (2)or 33 (8) of the Medical Service Act;

4. A pharmacy opened and operated in violation of Article 21 (1) of the Pharmaceutical Affairs Act.

(3) Where insurance benefits have been provided based on a false report or false testimony (including arranging another person to receive insurance benefits by transferring or lending one’s own health insurance card or identification card in violation of Article 12 (5)) of the employer or the insured, or false diagnosis by a health care institution, the NHIS may require payment of the money collectable under paragraph (1) from such person or institution jointly with the person who received the insurance benefits.

(4) The NHIS may require payment of the money collectable under paragraph (1) from the insured who belongs to the same household as the person who has received insurance benefits by fraud or other improper means (referring to the employee insured if the person who has received the insurance benefits by fraud or other improper means is a dependent) severally or jointly with the person who has received the insurance benefits by fraud or other improper means.

(5) Where a health care institution has received the costs of health care benefits from the insured or his or her dependent by fraud or other improper means, the NHIS shall collect the amount thereof from the health care institution concerned and disburse it to the insured or his or her dependent without delay. In such cases, the NHIS may offset the amount payable to the insured or his or her dependent against the insurance contributions, etc. to be paid by such insured or his or her dependent.

Article 57-2 (Disclosure of Personal Details on Defaulters Who are in Arrears with Unjust Enrichment or Unjust Profit Collectable)

(1) Where a health care institution liable to pay the money collectable under Article 57 (1) or (2), falling under any of the subparagraphs of paragraph (2) of the same Article, or a person who has established such health care institution, fails to pay at least 100 million won in the money collectable for one year from the date immediately following its payment deadline specified in the billing under Article 79 (1), the NHIS may disclose the violation that has given rise to the money collectable, personal details on the defaulter, the amount in arrears, and other information prescribed by Presidential Decree (hereafter in this Article referred to as “personal details, etc.”): Provided, That this shall not apply if an objection under Article 87 or a request for trial under Article 88 is filed, or an administrative litigation is pending, with respect to the amount in arrears, or if there is a compelling reason prescribed by Presidential Decree not to do so, such as partial payment of the amount in arrears.

(2) A Deliberative Committee on Disclosure of Information on Unjust Enrichment and Unjust Profit in Arrears shall be established under the jurisdiction of the NHIS to deliberate on whether to disclose personal details, etc. under paragraph (1).

(3) The Deliberative Committee on Disclosure of Information on Unjust Enrichment and Unjust Profit in Arrears shall provide persons who are subject to disclosure of personal details, etc. an opportunity to defend themselves by notifying in writing that they shall be subject to the disclosure, and select the persons subject to the disclosure after six months lapse from the date of such notification taking into consideration the fulfillment, etc. of their obligation to pay the amount in arrears.

(4) Disclosure of personal details, etc. under paragraph (1) shall be made by publishing or posting it in the Official Gazette or on the website of the NHIS.

(5) Except as provided in paragraphs (1) through (4), matters necessary for the procedures for disclosure of personal details, etc., and for the organization and operation of the Deliberative Committee on Disclosure of Information on Unjust Enrichment and Unjust Profit in Arrears, shall be prescribed by Presidential Decree.

[This Article Newly Inserted on Dec. 3, 2019]

Article 58 (Rights to Indemnity)

(1) When the Corporation has provided an insurance benefit to a policyholder or dependent because the grounds for the insurance benefit have arisen due to the act of a third party, the Corporation shall have the right to claim compensation from the third party up to the amount of the expenses incurred for the benefit concerned.
(2) Where the person who receives the insurance benefit has already received compensation for the loss from the third party under paragraph (1), the Corporation shall withhold the insurance benefit, up to the amount of such compensation.

Article 59 (Protection of Entitlement to Benefits)

(1) Entitlement to receive insurance benefits shall be unalienable and unseizable.
(2) Medical care costs, etc. paid into an account for receipt of medical care costs under Article 56-2 (1) shall not be seized.

Article 60 (Payment of Costs of Health Care Benefits to Soldiers in Active Service)

(1) Where any person who falls under subparagraphs 3 and 4 of Article 54 has received medical care, etc. prescribed by Presidential Decree (hereafter referred to as "health care benefits" in this Article) at an health care institution, the NHIS may pay the costs necessary therefor (hereafter referred to as "costs of health care benefits" in this Article) and the health care costs pursuant to Article 49 to be borne by it, after receiving a deposition from the Minister of Justice, the Minister of National Defense, the Commissioner of the National Police Agency, the Administrator of the National Fire Agency, or the Commissioner of the Korea Coast Guard. In such cases, as prescribed by Presidential Decree, the Minister of Justice, the Minister of National Defense, the Commissioner of the National Police Agency, the Administrator of the National Fire Agency, or the Commissioner of the Korea Coast Guard shall pre-deposit the annual costs of health care benefits and health care costs anticipated, except for the inevitable cases in their budgets.

(2) Articles 41, 41-4, 42, 42-2, 44 through 47, 47-2, 48, 49, 55, 56, 56-2, and 59 (2) shall apply mutatis mutandis to the matters concerning the health care benefits, costs of health care benefits, and health care costs.

[Title Amended on Dec. 11, 2018]

Enforcement Ordinance

Article 61 (Settlement of Medical Care Benefit Costs)

Where the Korea Workers' Compensation and Welfare Service under Article 10 of the Industrial Accident Compensation Insurance Act claims medical care benefit costs for the medical care benefits already paid pursuant to Article 40 of the Industrial Accident Compensation Insurance Act to a person eligible to receive the medical care benefits pursuant to this Act because of the cancellation of the decision to pay the medical care benefits, the Corporation may pay an amount equivalent to the medical care benefits on the condition that the medical care benefits are accepted to be an amount equivalent to a medical care benefit providable pursuant to this Act.

Enforcement Ordinance

Enforcement Ordinance