NATIONAL HEALTH INSURANCE ACT [See entire ACT]

CHAPTER VII FILING OF OBJECTIONS AND REQUESTS FOR TRIAL, ETC.

Article 87 (Filing of Objection)

(1) A person who has an objection to the decisions of the Corporation on the qualification, insurance premium, etc., insurance benefits, and insurance benefit costs for a policyholder or his/her dependents, may formally raise such objection to the Corporation.
(2) The Corporation, a medical care institution, or other entity that has an objection to the decisions of the Review and Assessment Service on evaluation, etc. of the reasonableness of the medical care benefit costs and medical care benefits may formally raise the objection to the Review and Assessment Service.
(3) Any objection referred to in paragraphs (1) and (2) (hereinafter referred to as "filing of objection") shall be filed in writing within 90 days after the date the person became aware of such decision and shall not be filed after 180 days from the date on which the decision is made: Provided, That this shall not apply where an explanation is made that the objection within the relevant period could not be raised due to a legitimate reason.
(4) Notwithstanding the main sentence of paragraph (3), where a medical care institution intends to file an objection to the verification of the Health Insurance Review and Assessment Service referred to in Article 48, it shall do so within 30 days from the date on which it receives notice referred to in paragraph (2) of the same Article.
(5) Matters necessary for the method of filing an objection and decision thereon, and notice of the decision, etc. other than those prescribed in paragraph (1) through (4) shall be prescribed by Presidential Decree.

Enforcement Ordinance

Article 53 (Objection Committees)

An objection committee shall be established in the NHIS and the Review and Assessment Service, respectively, in order to efficiently perform the affairs concerned with filing of objections under Article 87 (1) and (2) of the Act.

Enforcement Ordinance

Article 54 (Composition, etc. of Objection Committees)

(1) Each objection committee (hereinafter referred to as "objection committee") established under Article 53 shall consist of 25 members including one chairperson.
(2) A standing director of the NHIS designated by the president of the NHIS shall be the chairperson of the objection committee to be established in the NHIS, and its members shall be appointed or commissioned by the president of the NHIS from among any of the following:
1. One person from among the executives or employees of the NHIS;
2. Eight persons, namely four persons recommended by an employers' organization and four persons recommended by a workers' organization, respectively;
3. Eight persons, namely two persons recommended by civil organizations, two persons recommended by consumers' organizations, two persons recommended by organizations of farmers or fishermen and two persons recommended by organizations of the self-employed;
4. Seven persons, namely lawyers and persons of profound learning and experience in social insurance and medical services.
(3) A standing director of the Review and Assessment Service designated by the president of the Review and Assessment Service shall be the chairperson of the objection committee to be established in the Review and Assessment Service, and its members shall be appointed or commissioned by the president of the Review and Assessment Service from among any of the following:
1. One person from among executives or employees of the Review and Assessment Service;
2. Five persons recommended by organizations representing the insured (including the civil organizations);
3. Four attorneys-at-law and persons of learning and experience in social insurance;
4. Fourteen persons recommended by medical organizations.
(4) The term of office of the members commissioned pursuant to paragraphs (2) and (3) shall be three years.

Enforcement Ordinance

Article 55 (Operation of Objection Committees)

(1) The chairperson of an objection committee shall convene every meeting of the objection committee and preside over such meetings. In such cases, if the chairperson is unable to perform any of his/her duties due to any extenuating circumstance, any member who is nominated by the chairperson shall act on behalf of the chairperson in performing the latter's duty.
(2) Meetings of an objection committee shall be attended by the chairperson and six members who are designated by the chairperson whenever such meetings are held.
(3) Meetings of an objection committee shall commence with the attendance of a majority of the members referred to in paragraph (2) and pass resolutions with the concurrent vote of a majority of those present.
(4) Members present at the meetings of an objection committee, other than the chairperson and officers and employees working for the committee, shall be paid allowances, travel expenses and other necessary expenses within limits of budget.
(5) The scope of items put on the agenda items of an objection committee and other necessary matters concerning the operation of the committee shall be determined by the chairperson after going through the resolution thereof of the committee.

Enforcement Ordinance

Article 56 (Methods of Filing Objections, etc.)

The filing of objections and decisions on it under Article 87 (1) and (2) of the Act shall be based on the forms determined by Ordinance of the Ministry of Health and Welfare.

Enforcement Ordinance

Article 57 (Notification of Decisions on Objection Filed)

Where the NHIS or the Review and Assessment Service has made a decision on any objection filed, it shall, without delay, notify the applicant with the original of such decision, and the interested parties with copies thereof.

Enforcement Ordinance

Article 58 (Period for Decisions on Objection Filed)

(1) The NHIS and the Review and Assessment Service shall make a decision within 60 days from the receipt of written objection: Provided, That where any extenuating circumstances exist, it may extend the relevant period within the limit of 30 days.
(2) Where the NHIS and the Review and Assessment Service intends to extend the period for decision under the proviso to paragraph (1), a notice thereof shall be served to the applicant by not later than seven days prior to the expiration of such period for determination.

Article 88 (Requests for Trial)

(1) A person who appeals against a decision on an objection filed may request the Health Insurance Dispute Mediation Committee for a trial pursuant to Article 89. In such cases, Article 87 (3) shall apply mutatis mutandis to a request for trial.
(2) A person who intends to request a trial pursuant to paragraph (1) shall submit a request for trial prescribed by Presidential Decree to the Corporation or the Review and Assessment Service, whichever of the two made a decision pursuant to Article 76 (1) or (2) or with the Health Insurance Dispute Mediation Committee under Article 89.
(3) Matters necessary for the procedure and method for filing a request for trial, decision, notification of such decision, etc. other than those prescribed in paragraphs (1) and (2) shall be prescribed by Presidential Decree.

Enforcement Ordinance

Article 59 (Submission, etc. 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 "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; hereinafter the same shall apply);
2. Person who has performed 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/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/her;
6. Indication of attached documents;
7. Whether a 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, without delay, send a copy or duplicate thereof to the NHIS or the Review and Assessment Service and the person who has taken the original disposition, 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.

Article 89 (Health Insurance Dispute Mediation Committee)

(1) The Health Insurance Dispute Mediation Committee (hereinafter referred to as the "Dispute Mediation Committee") shall be established under the Ministry of Health and Welfare to deliberate on and resolve requests for trial pursuant to Article 88.

(2) The Dispute Mediation Committee shall be comprised of up to 60 members, including one chairperson, and one member, excluding the chairperson, shall be an ex officio member. In such cases, members who are not public officials shall comprise a majority of the total members of the Committee.

(3) The meetings of the Dispute Mediation Committee shall have a total of nine members, including the chairperson, one ex officio member, and seven members as designated by the chairperson each time a meeting is held, whose majority shall be those who are not public officials.

(4) Resolutions of the Dispute Mediation Committee shall be passed by the attendance of a majority of the members under paragraph (3) and the concurring vote of at least a majority of those present.

(5) A secretariat shall be established under the Dispute Mediation Committee to provide assistance at working level.

(6) Except as provided in paragraphs (1) through (5), matters necessary for the composition and operation, etc. of the Dispute Mediation Committee and the secretariat shall be prescribed by Presidential Decree.

(7) In applying Articles 129 through 132 of the Criminal Act, a member of the Dispute Mediation Committee who is not a public official shall be deemed a public official.

Enforcement Ordinance

Article 62 (Organization, etc. of Dispute Mediation Committee)

(1) The chairperson of the Dispute Mediation Committee shall be appointed by the President upon the recommendation of the Minister of Health and Welfare, and its members shall be appointed or commissioned by the Minister of Health and Welfare from among the following persons:
1. A current or former public official of Grade IV or higher or public official in general service belonging to the Senior Civil Service;
2. A person qualified as a judge, public prosecutor or lawyer;
3. An associate professor or a person holding a higher position in a field related to social insurances or medical treatment at a school listed in subparagraphs 1 through 3 of Article 2 of the Higher Education Act;
4. A person with extensive knowledge on and experience in social insurance or medical treatment.
(2) A public official in charge of the duty regarding requests for trials under Article 88 of the Act shall become the ex officio member prescribed in Article 89 (2) of the Act among the members referred to in paragraph (1) 1.

Enforcement Ordinance

Enforcement Ordinance

Article 63 (Duty of Chairperson of Dispute Mediation Committee)

(1) The chairperson of the Dispute Mediation Committee shall represent the Dispute Mediation Committee and control overall duties of the Dispute Mediation Committee.
(2) Where the chairperson is unable to perform any of his/her duties due to any extenuating circumstance, the member designated by the chairperson shall act on his/her behalf.

Article 64 (Term of Office for Members of Dispute Mediation Committee)

The term of office for members of the Dispute Mediation Committee shall be three years: Provided, That the term of office for public officials from among the members set forth in Article 62 (1) 1 shall be the period of service at the relevant post.

Article 65 (Meetings of Dispute Mediation Committee)

(1) The chairperson of the Dispute Mediation Committee shall convene and preside over meetings of the Dispute Mediation Committee.
(2) Except as otherwise prescribed by this Decree, matters necessary for the operation of meetings of the Dispute Mediation Committee shall be determined by the chairperson via resolution of the Dispute Mediation Committee.

Enforcement Ordinance

Article 65-2 (Exclusion, Challenge and Withdrawal of Dispute Mediation Committee Members)

(1) Any member of the Dispute Mediation Committee (hereafter referred to as "member" in this Article) who falls under any of the following cases shall be excluded from the deliberation and resolutions of the Dispute Mediation Committee:
1. Where he/she, or his/her current or former spouse, becomes a party to the relevant agenda or holds any right or duty jointly with the party to such agenda;
2. Where he/she is a current or former relative of a party to the relevant agenda;
3. Where he/she has given any testimony, statement or advice, or conducted any research or provided service with respect to the relevant agenda;
4. Where he/she or any corporation to which he/she belongs is a current or former agent of a party to the relevant agenda;
5. Where he/she is or has been involved in a disposition or nonfeasance which became the cause of the relevant agenda.
(2) If the circumstances indicate that it would be impracticable to expect fair deliberation and resolution of a member, a party to the relevant agenda may file a request for challenge to him/her with the Dispute Mediation Committee, and the Dispute Mediation Committee shall make a decision on such request by its resolution. In such cases, the member subjected to such request for challenge shall not participate in the resolution.
(3) If a member falls under any ground for exclusion stipulated in the subparagraphs of paragraph (1), he/she shall voluntarily withdraw himself/herself from the deliberation and resolution of the relevant agenda.
[This Article Newly Inserted by Presidential Decree No. 25429, Jun. 30, 2014]

Enforcement Ordinance

Article 66 (Secretary of Dispute Mediation Committee)

(1) The Dispute Mediation Committee shall have one secretary to administer offices of the Dispute Mediation Committee.
(2) The executive secretary shall be appointed by the Minister of Health and Welfare from among the public officials belonging to the Ministry of Health and Welfare.

Enforcement Ordinance

Article 67 (Allowances for Members of Dispute Mediation Committee)

Allowances, travel expenses and other necessary expenses may be reimbursed to the members who attend the Dispute Mediation Committee within budget limits: Provided, That this shall not apply where members who are public officials attend in direct connection with their competent duties.

Article 90 (Administrative Litigation)

A person who has an objection to a decision of the Corporation or the Review and Assessment Service or a person who protests against a decision on the objection filed under Article 87 or a request for trial made under Article 88 may institute an administrative action pursuant to the Administrative Litigation Act.

For further questions, please
call (+82) 2-539-0098 or email bongsoo@k-labor.com

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