NATIONAL HEALTH INSURANCE ACT [See entire ACT]
CHAPTER VIII SUPPLEMENTARY PROVISIONS
- Article 91 (Prescription)
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(1) The following rights shall be barred by prescription if not exercised within three years:
1. Entitlement to collect insurance premiums and arrears;
2. Entitlement to be refunded any excessive or mistaken amount paid as an insurance premium and arrears;
3. Entitlement to receive an insurance benefit;
4. Entitlement to receive reimbursement of insurance benefit costs;
5. Entitlement to receive a refund of excess individual co-payment under the latter part of Article 47 (3);
6. A right of the Korea Workers' Compensation and Welfare Service under Article 61.
(2) The prescription referred to in paragraph (1) shall be interrupted by an occurrence of any of the following events:
1. A notice of or demand for insurance premiums;
2. A claim for insurance benefit or insurance benefit costs.
(3) The extinctive prescription of the right to collect insurance premiums from a person temporarily retiring from office, etc. shall not, if notification is suspended pursuant to Article 79 (5), proceed until the reason for temporary retirement from office, etc. ceases to exist.
(4) Except for matters prescribed in this Act, the term of extinctive prescription pursuant to paragraph (1), interruption of prescription pursuant to paragraph (2) and suspension of prescription pursuant to paragraph (3) shall be in accordance with the Civil Act.
- Article 92 (Calculation of Periods)
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Except as otherwise provided for in this Act, the Civil Act that are relevant to periods shall apply mutatis mutandis to the calculation of the periods prescribed by this Act or by orders under this Act.
- Article 93 (Protection of Rights and Interests of Workers)
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An employer who employs the workers at all places of business who do not fall under any subparagraph of Article 6 (2) shall not prevent the workers he/she has employed from becoming employer-provided policyholders under this Act or take a measure that is injurious to the workers, such as denial of a worker's promotion or wage increase or the dismissal of a worker, for the purpose of evading an increase of the employer's share to be borne by the employer in question and without any justifiable ground therefor.
- Article 94 (Reporting, etc.)
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(1) The Corporation may require an employer, employer-provided policyholder or the head of a household to report the following matters or to submit relevant documents (including those recorded by an electronic method):
1. A policyholder's change of residence;
2. A policyholder's remuneration and income;
3. Other matters necessary for the health insurance program.
(2) Where the Corporation recognizes a necessity for factual verification of the materials reported or submitted under paragraph (1), the Corporation may require employees under its charge to investigate the matters in question.
(3) The Corporation's employees who conduct an investigation under paragraph (2) shall carry documents indicating their authority and produce them to related persons.
- Article 95 (Forwarding, etc. of Data on Reduction or Omission of Income)
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(1) Where the Corporation recognizes that remuneration, income, etc. reported under Article 94 (1) is reduced or omitted, it may forward in writing the matters on income reduction or omission to the Commissioner of the National Tax Service through the Minister of Health and Welfare.
(2) Where the Commissioner of the National Tax Service conducts any tax investigation under related Acts, such as the Framework Act on National Taxes, on the matters forwarded under paragraph (1), he/she shall forward the matters on the remuneration or income from among the results of relevant investigation to the Corporation.
(3) Matters necessary for forwarding procedures under paragraphs (1) and (2) and other necessary matters shall be prescribed by Presidential Decree.
Enforcement Ordinance
- 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;
(c) Where it differs from the content of remuneration ledger, or other income-related papers, documents, etc.;
2. Any of the following cases where the reduction or omission of income, etc. is deemed exist:
(a) Where he/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/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 "income reduction and omission investigation committee").
(3) The income reduction and omission investigation committee shall be comprised of five members, including a chairperson.
(4) The chairperson of the income reduction and omission investigation committee shall be appointed by the president of the NHIS from among the executives 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/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 Civil Service;
3. One certified tax accountant or one certified public accountant.
(6) Matters necessary for the operation of the income reduction and omission investigation committee other than those prescribed in paragraphs (3) through (5) shall be prescribed by the president of the NHIS.
Enforcement Ordinance
- Article 69 (Reflection of Data Furnished by National Tax Service)
Upon receipt of the matters regarding remuneration or income sent by the Commissioner of the National Tax Service pursuant to Article 95 (2) of the Act, the NHIS shall apply the results to the remuneration or income of the relevant insured.
- Article 96 (Furnishing of Materials)
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(1) The NHIS may request the State, local governments, health care institutions, insurance companies, and actuarial organizations under the Insurance Business Act, public institutions under the Act on the Management of Public Institutions, other public organizations, etc. to furnish the data prescribed by Presidential Decree on resident registration, family relation registration, national taxes, local taxes, land, buildings, immigration control, etc. to perform the following:
1. Implementation of health insurance programs, such as supervision of eligibility of the insured and their dependents, imposition and collection of insurance contributions, and administration of insurance benefits;
2. Services referred to in Article 14 (1) 11.
(2) The Review and Assessment Service may request the State, local governments, health care institutions, insurance companies, and actuarial organizations under the Insurance Business Act, public institutions under the Act on the Management of Public Institutions, other public organizations, etc. to furnish the data prescribed by Presidential Decree on resident registration, immigration control, medical records, supply of medicine and medical supplies, etc. to examine the costs of health care benefits and to assess the appropriateness of health care benefits.
(3) The Minister of Health and Welfare may request the head of the relevant administrative agency to submit data necessary for reducing the upper limit amount of costs of health care benefits for medicines and suspending the application of health care benefits pursuant to Article 41-2.
(4) Those in receipt of a request to submit materials under paragraphs (1) and (3) shall sincerely comply therewith.
(5) Where the NHIS or the Review and Assessment Service requests health care institutions, insurance companies or actuarial organizations under the Insurance Business Act to furnish the data referred to in paragraph (1) or (2), it shall forward a written request for the furnishing of data which states the grounds and reasons for the request for the data, persons and period subject to the furnishing of the data, time limit for furnishing the data, data to be furnished, etc.
(6) Fees, commissions, etc. shall be exempted for the materials furnished to the NHIS or the Review and Assessment Service by the State, local governments, health care institutions, insurance contribution rate computing organizations under the Insurance Business Act and other public institutions and public organizations under paragraphs (1) and (2).
Enforcement Ordinance
- Article 69-2 (Data, etc. Requested to be Furnished)
(1) "Data prescribed by Presidential Decree" in Article 96 (1) of the Act means the data shown in subparagraph 1 of attached Table 4-3.
(2) "Data prescribed by Presidential Decree" in Article 96 (2) of the Act means the data shown in subparagraph 2 of attached Table 4-3.
(3) Where the data referred to in paragraph (1) or (2) is stored by using a computer data recording device or computer program, such as a diskette, magnetic tape, microfilm, optical disc, etc., the State, local governments, health care institutions, insurance companies under the Insurance Business Act or contribution rate calculating institutions, public institutions under the Act on the Management of Public Institutions, other public institutions, etc. in receipt of a request for provision of data under Article 96 (1) or (2) of the Act, may provide data in the relevant form.
[This Article Newly Inserted by Presidential Decree No. 25760, Nov. 20, 2014]
- Article 96-2 (Preservation of Documents)
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(1) If necessary for calculating the contribution point of the self-employed insured under the proviso of Article 72 (1), the NHIS may request, with a written consent, converted to an electronic form, submitted by the self-employed insured pursuant to Article 72 (3), that the head of the relevant financial company, etc. provide financial information, notwithstanding Article 4 (1) of the Act on Real Name Financial Transactions and Confidentiality.
(2) Notwithstanding Article 4 of the Act on Real Name Financial Transactions and Confidentiality, the head of a financial company, etc. requested to provide financial information pursuant to paragraph (1) shall provide financial information on the holder of a title deed.
(3) The head of a financial company, etc. who provides financial information pursuant to paragraph (2) shall notify the holder of a title deed of such provision of financial information: Provided, That he or she need not notify the relevant fact upon consent of the holder of the title deed, notwithstanding Article 4-2 (1) of the Act on Real Name Financial Transactions and Confidentiality.
(4) Except as provided in paragraphs (1) through (3), matters necessary for requests and procedures for the provision of financial information shall be prescribed by Presidential Decree.
[This Article Newly Inserted on Dec. 3, 2019]
[Previous Article 96-2 moved to Article 96-3]
[Enforcement Date: Jul. 1, 2022] Article 96-2
- Article 96-4 (Preservation of Documents)
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(1) A health care institution shall store the documents related to any claim for costs of health care benefits under Article 47 for five years from the date of the end of provision of such health care benefits, as prescribed by Ordinance of the Ministry of Health and Welfare: Provided, That pharmacies and other health care institutions prescribed by Ordinance of the Ministry of Health and Welfare shall store prescriptions for three years from the date the relevant costs of health care benefits are claimed.
(2) An employer shall store documents related to health insurance including management of the eligibility requirements and calculation of insurance contributions for three years, as prescribed by Ordinance of the Ministry of Health and Welfare.
(3) A quasi-health care institution that has filed a claim for health care costs pursuant to Article 49 (3) shall retain the documents related to the claim for health care costs, as prescribed by Ordinance of the Ministry of Health and Welfare for three years from the date the health care costs are paid.
(4) A person who has filed a claim for insurance benefits for any assistive device pursuant to Article 51 (2) shall retain documents concerning claims for insurance benefits for three years from the date he or she receives insurance benefits, as prescribed by Ordinance of the Ministry of Health and Welfare.
[This Article Newly Inserted on May 22, 2013]
[Moved from Article 96-3]
[Enforcement Date: Jul. 1, 2022] Article 96-4
- Article 97 (Reports and Inspections)
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(1) The Minister of Health and Welfare may order an employer, the employee insured, or the head of a household to report or submit materials on the relocation, remuneration, income, and other necessary matters of the insured or require public officials under his or her charge to question relevant persons or inspect relevant documents.
(2) The Minister of Health and Welfare may require a health care institution (including any institution that has provided health care under Article 49) to report on the matters relevant to insurance benefits, such as the provision of health care and medicine, or submit relevant documents or require public officials under his or her charge to question relevant persons or inspect relevant documents.
(3) The Minister of Health and Welfare may require a person who has received an insurance benefit to report on the details of the relevant insurance benefit or require public officials under his or her charge to question the person.
(4) The Minister of Health and Welfare may order an organization that is assigned to vicariously file claims for examining costs of health care benefits pursuant to Article 47 (6) (hereinafter referred to as "vicarious claim organization") to submit necessary materials or require public officials under his or her charge to investigate and verify the materials, etc. pertaining to the vicarious claims.
(5) If necessary for reducing the upper limit amount of costs of health care benefits for medicines and suspending the application of health care benefits pursuant to Article 41-2, the Minister of Health and Welfare may order a drug provider under Article 47 (2) of the Pharmaceutical Affairs Act to make a report of, or submit materials concerning, any such violation of the sale order of drugs as is caused by providing cash, goods, convenience, labor, entertainment or other economic benefits, or may direct a public official of the Ministry of Health and Welfare to inquire of the related person or inspect the related documents.
(6) Public officials who conduct an investigation under paragraphs (1) through (5) shall carry documents indicating their authority and produce them to related persons.
- Article 98 (Suspension of Operation)
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(1) Where a medical care institution falls under any of the following subparagraphs, the Minister of Health and Welfare may order the medical care institution to suspend its operation by specifying a period of within one year:
1. Where it places the burden of medical care benefit costs on an insurer, policyholder, or dependent by deceit or other illegitimate means;
2. Where it violates the order referred to in Article 97 (2), files a false report, or rejects, interferes with or evades an inspection or questioning by a public official belonging to competent authorities.
(2) A person who has been ordered to suspend operation under the provisions of paragraph (1) shall not provide medical care benefits during the period of suspension of the operations in question.
(3) The effect of the disposition of suspension of operation under paragraph (1) shall be succeeded by a person who takes over the medical care institution for which such disposition has been made, a corporation which survives after a merger, or a corporation established by a merger, and in cases where any procedure of the disposition of suspension of operation is pending, it may proceed with respect to the transferee, the corporation which continues to exist after a merger or the corporation established by a merger: Provided, That the same shall not apply to a transferee or corporation surviving a merger in cases where he/she or it proves that he/she or it was unaware of such disposition or the fact of violation.
(4) A person who is subject to the disposition of the suspension of operation under paragraph (1) or a person for whom the procedure of the disposition of suspension of operation is under way shall notify, without delay, a transferee, a corporation surviving a merger or a corporation incorporated in the course of a merger of the fact that it is subject to an administrative disposition or the fact that the procedure of an administrative disposition is under way under the conditions as prescribed by Presidential Decree as prescribed by Ordinance of the Ministry of Health and Welfare.
(5) The standards of administrative disposition by the kind, degree, etc. of violating acts which are subject to the suspension of operation under paragraph (1) and other necessary matters shall be prescribed by Presidential Decree.
Enforcement Ordinance
- Article 70 (Criteria for Administrative Dispositions)
(1) The criteria for the business suspension of health care institutions and for the imposition of penalty surcharges under Articles 98 (1) and 99 (1) of the Act shall be as shown in attached Table 5.
(2) The procedure for collection of penalty surcharges under paragraph (1) shall be determined by Ordinance of the Ministry of Health and Welfare.
- Article 99 (Penalty Surcharges)
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(1) Where a health care institution is subject to the disposition of suspension of operation by falling under Article 98 (1) 1 or 3, if such disposition causes a serious inconvenience to persons who use a health care institution or if any special causes prescribed by the Minister of Health and Welfare are deemed to exist, the Minister of Health and Welfare may impose and collect a penalty surcharge of the amount not exceeding five times the amount to be imposed on conducts by fraud or other improper means in lieu of the disposition of suspension of operation. In such cases, the Minister of Health and Welfare may have it paid in installments within 12 months.
(2) Where the Minister of Health and Welfare suspends any medicine from health care benefits under Article 41-2 (3), the Minister may impose and collect a penalty surcharge in any of the following cases within the scope of each of the following subparagraphs, as prescribed by Presidential Decree, in lieu of the suspension thereof from the health care benefits. In such cases, the Minister of Health and Welfare may have it paid in installments within 12 months:
1. When it is expected to interfere with public welfare, such as causing inconvenience to patient care: The scope shall not exceed 200/100 of the total costs of health care benefits for the relevant medicine;
2. When it is recognized that there are special reasons, such as it is expected to pose a serious risk to public health: The scope shall not exceed 60/100 of the total costs of health care benefits for the relevant medicine.
(3) Where any medicine subject to the imposition of a penalty surcharge pursuant to the former part of paragraph (2) becomes again subject to the imposition of a penalty surcharge pursuant to the former part of paragraph (2) within the period determined by Presidential Decree to the extent of five years from the date when a penalty surcharge is imposed, the Minister of Health and Welfare may impose and collect a penalty surcharge according to the following classifications, as prescribed by Presidential Decree.
1. In the case that a penalty surcharge is imposed for the reasons specified in paragraph (2) 1: The extent not exceeding 350/100 of the total amount of costs of health care benefits for the relevant medicine;
2. In the case that a penalty surcharge is imposed for the reasons specified in paragraph (2) 2: The extent not exceeding 100/100 of the total amount of costs of health care benefits for the relevant medicine.
(4) The total amount of costs of health care benefits for the relevant medicine to be prescribed by Presidential Decree under paragraphs (2) and (3) shall not exceed the total amount of health care benefits paid for one year taking into consideration the record, etc. of health care benefits for the relevant medicine paid in the past.
(5) Where a person liable to pay a penalty surcharge under paragraph (1) fails to pay it by the time-limit, the Minister of Health and Welfare shall revoke the disposition of imposing the penalty surcharge in accordance with the procedures prescribed by Presidential Decree, and then shall take a disposition of suspending operation under Article 98 (1) or collect the penalty surcharge in the same manner as delinquent national taxes are collected: Provided, That if it is impossible to take a disposition of suspending operation under Article 98 (1), due to discontinuance, etc. of business of the relevant health care institution, the penalty surcharge shall be collected in the same manner as delinquent national taxes are collected.
(6) Where a person liable to pay a penalty surcharge under paragraph (2) or (3) fails to make such payment by a due date thereof, the Minister of Health and Welfare shall collect it in the same manner as delinquent national taxes are collected.
(7) If necessary for collecting a penalty surcharge, the Minister of Health and Welfare may file a written request to furnish tax information with the head of the tax office or the head of the relevant local government wherein following matters are stated:
1. Taxpayer's personal information;
2. Purpose of use;
3. Grounds and standards for imposition of the penalty surcharge.
(8) The penalty surcharge collected pursuant to paragraphs (1) through (3) shall not be used for purposes other than the following. In such cases, the penalty surcharge collected pursuant to paragraphs (2) 1 and (3) 1 shall be used for the purpose of subparagraph 3:
1. Funds that the NHIS provides as costs of health care benefits pursuant to Article 47 (3);
2. Support for the emergency medical service fund referred to in the Emergency Medical Service Act;
3. Support for projects for supporting disastrous medical expenses under the Act on Support of Disastrous Medical Expenses.
(9) Necessary matters concerning the amount of penalty surcharges under paragraphs (1) through (3) and the payment thereof, and necessary matters concerning the scales of, and procedures for, support by purpose granted from penalty surcharges referred to in paragraph (8) shall be prescribed by Presidential Decree.
Enforcement Ordinance
- Article 70-2 (Criteria for Imposition of Penalty Surcharges)
(1) Where any of the following applies to a medicine subject to suspension of the application of health care benefits prescribed in Article 41-2 (3) of the Act, the Minister of Health and Welfare may impose a penalty surcharge in lieu of suspension of the application of health care benefits prescribed in Article 99 (2) or (3) of the Act:
1. Shortage prevention drugs;
2. Orphan drugs;
3. A medicine publicly notified as eligible for health care benefits prescribed in Article 41 (3) of the Act which is a single item, for which the same medication does not exist (referring to a product which has the same administration route, ingredients, content and dosage form);
4. Any other medicine deemed by the Minister of Health and Welfare to have any special ground.
(2) “Period determined by Presidential Decree” in Article 99 (3) of the Act means five years.
(3) Criteria for imposition of penalty surcharges prescribed in paragraph (1) shall be as specified in attached Table 4-2.
[This Article Newly Inserted by Presidential Decree No. 25429, Jun. 30, 2014]
Enforcement Ordinance
- Article 70-3 (Imposition and Payment of Penalty Surcharges)
(1) When the Minister of Health and Welfare intends to impose a penalty surcharge under Article 99 (1) or (2), he/she shall give a written notice stating the violation subject to the imposition of the penalty surcharge, the amount, payment due date, receiving agencies of the penalty surcharge and other matters.
(2) A person in receipt of the notice given under paragraph (1) shall pay the penalty surcharge by a payment due date specified on the payment notice of a penalty surcharge to the receiving agency: Provided, That where it is impossible to pay the penalty surcharge within the given period due to a natural disaster or any other extenuating circumstances, he/she shall pay it within seven days from the date on which such cause is settled.
(3) Upon receiving a penalty surcharge, a receiving agency referred to in paragraph (2) shall issue the receipt to the relevant payer, and notify the Minister of Health and Welfare of the receipt without delay.
[This Article Newly Inserted by Presidential Decree No. 25429, Jun. 30, 2014]
Enforcement Ordinance
Enforcement Ordinance
- Article 71 (Amounts of Support from Penalty Surcharges)
(1) Amounts of support by usage of penalty surcharges prescribed in Article 99 (8) of the Act shall be as follows:
1. Support for the funds for costs of health care benefits paid by the NHIS prescribed in Article 47 (3) of the Act: 50/100 of revenues of penalty surcharges;
2. Support for the funds for emergency medical services prescribed in the Emergency Medical Service Act: 35/100 of revenues of penalty surcharges;
3. Support for catastrophic health expenditure support programs prescribed in the Act on the Support for Catastrophic Health Expenditure: 15/100 of revenues of penalty surcharges.
(2) The president of the NHIS and a person entrusted with the management and operation of the emergency medical service funds prescribed in Article 19 (2) of the Emergency Medical Service Act shall submit to the Minister of Health and Welfare plans on operation of the penalty surcharges supported under paragraph (1) for the following year and the actual results of use during the preceding year by no later than April 30 each year.
(3) The Minister of Health and Welfare shall determine the amount of support from penalty surcharges for the following year in view of the plans for operations of penalty surcharges and the actual results of use of the penalty surcharge which he/she has received under paragraph (2), and put such amount in the budget under conditions as determined by national financial Acts.
- Article 100 (Publication of Fact of Violation)
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(1) If a medical care institution which has received an administrative disposition under Article 98 or 99 because of claims for medical care benefit costs in falsehood by falsifying or forging relevant documents falls under any of the following subparagraphs, the Minister of Health and Welfare may publish the act of violation, details of disposition, the name, address and name of a representative of the relevant medical care institution, and other matters prescribed by Presidential Decree which are necessary to distinguish it from other medical care institutions. In such cases, the motive, degree, frequency, results, etc. of the violation shall be taken into consideration in deciding whether to make such publication:
1. Where the amount claimed in falsehood exceeds fifteen million won;
2. The rate of amount claimed in falsehood exceeds 20/100 of the total amount of medical care benefit costs.
(2) The Minister of Health and Welfare shall establish and operate the Health Insurance Publication Deliberation Committee (hereafter referred to as the "Publication Deliberation Committee" in this Article) to deliberate on whether to make a publication, etc. under paragraph (1).
(3) The Minister of Health and Welfare shall notify a medical care institution which becomes subject to publication, undergoing the deliberation by the Publication Deliberation Committee of the fact that it is subject to publication, in order to provide it with an opportunity to submit explanatory materials or appear to make a statement of opinion.
(4) The Minister of Health and Welfare shall select medical care institutions to become subject to publication after the Publication Deliberation Committee redeliberates medical care institutions to be subject to publication, taking into account explanatory materials or statements of opinion referred to in paragraph (3).
(5) Matters necessary for the procedure for and method of publication, organization and operation, etc. of the Publication Deliberation Committee other than those prescribed in paragraphs (1) through (4) shall be prescribed by Presidential Decree.
Enforcement Ordinance
- Article 72 (Matters of Announcement)
"Matters prescribed by Presidential Decree" in the forepart of the part other than subparagraphs of Article 100 (1) of the Act means the matters falling under any of the following subparagraphs:
1. Kind of the relevant health care institution and license number and gender of the representative of such health care institution;
2. Name of the head of the relevant medical institution where the founder of which is a juristic person;
3. Other matters the Health Insurance Publication Deliberation Committee established under Article 100 (2) of the Act (hereinafter referred to as the "Publication Deliberation Committee") deems necessary for the distinction from other health care institutions.
Enforcement Ordinance
- Article 73 (Composition, Operation, etc. of Publication Deliberation Committee)
(1) The Publication Deliberation Committee shall consist of nine members, including one chairperson.
(2) The chairperson of the Publication Deliberation Committee shall be elected from among members set forth in subparagraphs 1 through 4, and its members shall be appointed or commissioned by the Minister of Health and Welfare from among persons in the following subparagraphs:
1. One person recommended by consumers' organizations;
2. One journalist;
3. One legal expert, such as a lawyer;
4. Three persons recommended by organizations representing the medical and pharmaceutical industry, who have abundant knowledge and experience in health insurance;
5. One public official in general service who belongs to the Senior Civil 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/her duty due to any extenuating circumstance, the member designated by the chairperson shall perform the duty on his/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) Matters necessary for the composition, operation, etc. of the Publication Deliberation Committee other than those prescribed in paragraphs (1) through (6) shall be determined by the chairperson of the Publication Deliberation Committee after deliberation of the Publication Deliberation Committee.
Enforcement Ordinance
Enforcement Ordinance
- Article 74 (Procedure for, Methods, etc. 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 publily 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, 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.
(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/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, Do governor, Special Self-Governing Province Governor, head of Si/Gun/Gu, or the head of 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).
(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 prescribed by the Minister of Health and Welfare.
- Article 101 (Prohibited Acts of Manufacturers, etc.)
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(1) No manufacturer, operator of a manufacture by entrustment and sale business, importer nor exporter of drugs under the Pharmaceutical Affairs Act nor a manufacturer, importer, repairer, distributor and lessor of medical devices under the Medical Devices Act (hereinafter referred to as "manufacturer, etc.") shall, in assessing the scope of medical care benefits under Article 41 (2) or in calculating the medical care benefit costs under Article 46 with respect to the medicines and materials for medical treatment, causes any loss to the financial standing of the health insurance by involving in an offense of a medical care institution referred to in Article 98 (1) 1 or by a deceit including the raise of the maximum prices or sale prices of medicines or materials for medical treatment by submitting false data, or by other unjust methods prescribed by Ordinance of the Ministry of Health and Welfare.
(2) In order to ascertain whether a manufacturer, etc. has committed any violation of paragraph (1), the Minister of Health and Welfare may conduct a necessary investigation, such as issuing an order to the relevant manufacturer, etc. to submit the documents concerned, or assigning public officials under his/her control to ask questions to the related persons or inspect the documents concerned. In such cases, the competent public officials shall carry documents indicating their authority and produce them to related persons.
Enforcement Ordinance
- Article 102 (Maintaining Confidentiality)
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No person who has been or is engaged in the services of the NHIS, the Review and Assessment Service, or a vicarious claim organization shall do any of the following acts:
1. Divulging personal information (referring to personal information defined in subparagraph 1 of Article 2 of the Personal Information Protection Act; hereinafter referred to as "personal information") of the insured or their dependents, using such information for any purpose other than performing his or her duties, or providing such information to a third party without any justifiable grounds;
2. Divulging any information learned in the course of performing his or her duties (excluding personal information referred to in subparagraph 1), using such information for any purpose other than performing his or her duties, or providing such information to a third party.
[Title Amended on Mar. 22, 2016]
- Article 103 (Supervision of Corporation, etc.)
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(1) In order for the Corporation and the Review and Assessment Service to achieve their management goals, the Minister of Health and Welfare may supervise them, such as ordering them to report on the following programs or business or inspecting the conditions of their programs, affairs or property:
1. Services of the Corporation set forth in Article 14 (1) 1 through 13, and services of the Review and Assessment Service set forth in Article 63 (1) 1 through 7;
2. Business related to satisfying the guidelines for management prescribed in Article 50 of the Act on the Management of Public Institutions;
3. Services entrusted to the Corporation and the Review and Assessment Service under this Act or other Acts and subordinate statutes;
4. Other business related to the matters prescribed by related Acts and subordinate statutes.
(2) The Minister of Health and Welfare may, where necessary for supervision under paragraph (1), order to amend the articles of incorporation or regulations, or order other necessary dispositions.
- Article 104 (Payment of Monetary Rewards)
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(1) The NHIS may pay a reward to a person who reports any of the following persons:
1. A person who has received insurance benefits by fraud or other improper means;
2. A person who arranges another person to receive insurance benefits by fraud or other improper means;
3. Health care institutions that receive insurance benefit costs or quasi-health care institutions or assistive device sellers who receive insurance benefit by fraud or other improper means.
(2) The NHIS may provide an incentive to a health care institution that has contributed to the efficient financial management of health insurance.
(3) Matters necessary for the criteria for and scope of payment of a reward and incentive, procedure and method of payment, and other necessary matters pertaining to paragraphs (1) and (2) shall be prescribed by Ordinance of the Ministry of Health and Welfare.
[Title Amended on May 22, 2013]
Enforcement Ordinance
- Article 75 (Standards for Payment of Rewards)
(1) A person who intends to report an individual who has received insurance benefits or a health care institution which has been paid insurance benefits by fraud or other improper means shall file a report thereon to the NHIS under Article 104 (1) of the Act as determined by the NHIS. In such cases, where at least two persons file a report jointly, they shall designate a representative.
(2) Upon receiving the report under paragraph (1), after confirming the reported matter, the NHIS shall determine whether to pay a reward and notify the result thereof to the reporter (referring to the representative referred to in the latter part of paragraph (1), where the report is filed by at least two persons jointly; hereafter the same shall apply in this Article).
(3) The reporter who is notified of the decision to pay a reward under paragraph (2) shall apply for the payment of the reward to the NHIS, as determined by the NHIS.
(4) The NHIS shall pay the reporter a reward in accordance with the standards for payment of rewards stipulated in attached Table 6 within one month from the date the application for payment of the reward is received under paragraph (3).
(5) No reward shall be paid to a person who makes a report, the details of which is the same with those already reported under paragraph (1).
(6) Except as provided in paragraphs (1) through (5), matters necessary for the standards for payment of rewards, method thereof, procedure therefor shall be determined by the NHIS.
Enforcement Ordinance
- Article 75-2 (Payment of Incentives, etc.)
(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:
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 efficacy of which is replaceable for that of 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 (1) 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.
(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.
(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.
[This Article Newly Inserted by Presidential Decree No. 24776, Sep. 26, 2013]
- Article 105 (Prohibition from Use of Similar Names)
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(1) No person, other than the Corporation or the Review and Assessment Service, shall use such names as the National Health Insurance Corporation, Health Insurance Review and Assessment Service or other names similar thereto.
(2) A person, other than one who carries out a health insurance business prescribed by this Act, shall be prohibited from using the term, "national health insurance" in an insurance contract or in the name of an insurance contract.
- Article 106 (Disposal of Small Sums)
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Where an amount to be collected or returned is less than 2,000 won in one case (excluding any individual co-payment refund and any amount to be paid to a policyholder or his/her dependent, which may be disposed of by offsetting under Article 47 (4) and the latter part of Article 57 (5)), the Corporation shall not collect or return such amount.
- Article 107 (Disposal of Fractional Sum)
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In calculating the expenses related to insurance premiums, etc. and insurance benefits, fractional sums under Article 47 of the Management of the National Funds Act shall be excluded from the calculation.
- Article 108 (Government's Subsidies for Insurance Finance)
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(1) The State shall subsidize an amount equivalent to 14/100 of the amount of anticipated revenues from insurance premiums for the relevant year to the Corporation from the National Treasury each year within budgetary limits.
(2) The National Health Promotion Fund under the National Health Promotion Act may provide funds to the Corporation, as prescribed by the same Act.
(3) The Corporation shall appropriate financial resources raised pursuant to paragraph (1) for the following purposes:
1. Insurance benefits for policyholders and their dependents;
2. Operational expenses for the health insurance business;
3. Subsidies needed to reduce insurance premiums pursuant to Articles 75 and 110 (4).
(4) The Corporation shall use the funds provided pursuant to paragraph (2) for the following businesses:
1. Projects undertaken to enhance health, such as health checkup;
2. Insurance benefits paid to treat diseases suffered by policyholders and their dependents that are caused by smoking;
3. Insurance benefits paid to the aged who are at least 65 years old, from among policyholders and their dependents.
- Article 109 (Special Cases for Foreigners, etc.)
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(1) The Government may arrange for separate health insurance for the workers at a workplace where a foreign government is the employer, in consultation with the foreign government.
(2) An overseas Korean national or a foreigner residing in the Republic of Korea (hereinafter referred to as "foreigner, etc. residing in Korea") who is an employee, public official, or school employee of a workplace of eligible persons shall become the employee insured, notwithstanding Article 5, if he or she does not fall under any subparagraph of Article 6 (2) but falls under any of the following:
1. A person who is registered pursuant to Article 6 (1) 3 of the Resident Registration Act;
2. A person who has reported on his or her place of residence in Korea pursuant to Article 6 of the Act on the Immigration and Legal Status of Overseas Koreans;
3. A person who has filed for alien registration pursuant to Article 31 of the Immigration Act.
(3) Where a foreigner, etc. residing in Korea who does not fall under the employee insured referred to in paragraph (2) satisfies all the following requirements, he or she shall become the self-employed insured, notwithstanding Article 5:
1. The relevant person shall fall under the ground prescribed by Ordinance of the Ministry of Health and Welfare that he or she resided in Korea during the period prescribed by Ordinance of the Ministry of Health and Welfare or is expected to reside therein continuously during the relevant period;
2. The relevant person shall fall under any of the following:
(a) A person specified in paragraph (2) 1 or 2;
(b) A person who has filed for alien registration pursuant to Article 31 of the Immigration Act and holds the status of sojourn prescribed by Ordinance of the Ministry of Health and Welfare.
(4) Where a foreigner, etc. residing in Korea who falls under any subparagraph of paragraph (2) satisfies all the following requirements, he or she may become a dependent, notwithstanding Article 5, if he or she files an application with the NHIS:
1. The relevant person's relationship with the employee insured shall fall under any subparagraph of Article 5 (2);
2. The relevant person shall meet the standards for determination of the dependent eligibility referred to in Article 5 (3).
(5) Notwithstanding paragraphs (2) through (4), no foreigner, etc. residing in Korea shall become the insured or a dependent if he or she falls under any of the following cases:
1. Where the relevant person's stay in Korea violates any Act and any ground prescribed by Presidential Decree exists;
2. Where a foreigner, etc. residing in Korea is eligible for medical guarantee equivalent to health care benefits referred to in Article 41 in accordance with foreign statutes, a foreign insurance or a contract concluded with his or her employer, and thus the employer or insured requests the exclusion of him or her from the insured, as prescribed by Ordinance of the Ministry of Health and Welfare.
(6) Articles 5 through 11 shall apply mutatis mutandis to matters necessary for the timing, procedures, etc. for acquisition and loss of the eligibility of the insured or dependents by foreigners, etc. residing in Korea, except as otherwise expressly provided for in paragraphs (2) through (5): Provided, That matters to be expressly provided for in consideration of the nature of foreigners, etc. residing in Korea may be otherwise prescribed by Presidential Decree.
(7) Where a foreigner, etc. residing in Korea who is the insured acquires the eligibility of the self-employed insured after the second day of any month and loses the eligibility in the month in which the date he or she acquired the eligibility falls, due to any ground publicly notified by the Minister of Health and Welfare, the insurance contributions for the month in which the date the eligibility was acquired falls shall be imposed and collected, notwithstanding the main clause of Article 69 (2).
(8) The insurance contributions for the self-employed insured who fall under foreigners, etc. residing in Korea (limited to those subject to the proviso of paragraph (9)) shall be paid by the 25th day of the immediately preceding month, notwithstanding the main clause of Article 78 (1): Provided, That in any of the following cases, the insurance contributions shall be paid as determined by the NHIS:
1. Where the insurance contributions for the month in which the date the eligibility is acquired falls are collected;
2. Where the eligibility is acquired during the period from the 26th day to the end of any month.
(9) Except as provided in paragraphs (7) and (8), Articles 69 through 86 shall apply mutatis mutandis to matters on the imposition and collection of insurance contributions for foreigners, etc. residing in Korea who are the insured: Provided, That matters on the imposition and collection of insurance contributions for foreigners, etc. residing in Korea prescribed by Presidential Decree may be otherwise determined and publicly notified by the Minister of Health and Welfare, taking into account their nature.
(10) Where a foreigner, etc. residing in Korea (limited to those subject to the proviso of paragraph (9)) who is the self-employed insured fails to pay insurance contributions, the NHIS shall not provide insurance benefits until the delinquent insurance contributions are paid in full, beginning with the date the foreigner, etc. falls into arrears, notwithstanding Article 53 (3). In such cases, the proviso of Article 53 (3), with the exception of its subparagraphs, and paragraphs (5) and (6) of the same Article shall not apply.
Enforcement Ordinance
- Article 76 (The insured who are Foreigners. etc. and their Dependents)
(1) An overseas Korean national or a foreigner who is a worker, public official, teacher or school staff member, falling under any of the following, shall be eligible for the employee insured under Article 109 (2) of the Act: Provided, That anyone who falls under any subparagraph of Article 6 (2) of the Act shall be excluded herefrom:
1. A person who is registered under Article 6 (1) 3 of the Resident Registration Act;
2. A person who has reported on his/her place of residence in the Republic of Korea under Article 6 of the Act on the Immigration and Legal Status of Overseas Koreans;
3. A person who has filed an alien registration under Article 31 of the Immigration Control Act.
(2) An overseas Korean national or a foreigner who meets each of the following requirements and files an application for entitlement as the self-employed insured with the NHIS shall be eligible for the self-employed insured under Article 109 (2) of the Act:
1. That he/she is not an overseas Korean national or a foreigner who will become the employee insured under paragraph (1);
2. That he/she has lived in the Republic of Korea for at least three months, or actually plans to live in the Republic of Korea for at least three months by reason of study or such; < >
3. That he/she falls under any of the following items:
(a) A person falling under paragraph (1) 1 or 2;
(b) A person who has filed an alien registration under Article 31 of the Immigration Control Act and holds his/her sojourn status prescribed by Ordinance of the Ministry of Health and Welfare.
(3) An overseas Korean national or a foreigner who meets all of the following requirements and files an application for the entitlement as a dependent with the NHIS shall be eligible for a dependent under Article 109 (2) of the Act:
1. That he/she shall be a person falling under any subparagraph of paragraph (1);
2. That his/her relationship with the employee insured falls under any subparagraph of Article 5 (2) of the Act;
3. That he/she is recognized to have no remuneration or income and depends on the employee insured to support his/her livelihood as specified in the standards determined and publicly notified by the Minister of Health and Welfare.
(4) Notwithstanding paragraphs (1) through (3), none of the following persons shall be eligible for the employee insured, the self-employed insured or dependent:
1. A person who resides in the Republic of Korea without obtaining permission for extension of the period of sojourn under Article 25 of the Immigration Control Act or Article 10 (2) of the Act on the Immigration and Legal Status of Overseas Koreans;
2. A person against whom a deportation order is issued under Article 59 (3) of the Immigration Control Act.
(5) Notwithstanding paragraph (1), where any overseas Korean national or any foreigner is eligible for medical guarantee equivalent to the benefit in kind provided for in Article 41 of the Act based on foreign Acts and subordinate statutes, a foreign insurance or a contract concluded with the employer, etc. while working in the Republic of Korea, he/she may be exempted from purchasing insurance under conditions as prescribed by Ordinance of the Ministry of Health and Welfare.
(6) An overseas Korean national or a foreigner who is a dependent or a relevant the employee insured may, if he/she so wishes, apply for the relinquishment of entitlement as a dependent, as prescribed by Ordinance of the Ministry of Health and Welfare.
(7) Matters necessary for obtaining the entitlement as the insured or dependent by an overseas Korean national and a foreigner, applying for the relinquishment of entitlement as a dependent, exemption from subscribing for the insurance, etc., other than those prescribed in paragraphs (1) through (6), shall be prescribed by Ordinance of the Ministry of Health and Welfare.
Enforcement Ordinance
- 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:
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 the same 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/she is expected to reside in Korea continuously pursuant to subparagraph 1 of the same 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 sojourn, 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 sentence of Article 109 (6) of the Act: Provided, That a foreigner, etc. residing in Korea shall also lose the eligibility on any of the following dates, whichever is relevant, pursuant to the proviso to Article 109 (6) of the Act:
1. The employee insured: Any of the following dates:
(a) The date following the date the period of sojourn 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 sojourn, 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 sojourn 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/her from the insured pursuant to Article 109 (5) 2 of the Act: Provided, That 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/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;
(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 sojourn, and publicly notifies such timing: The date prescribed in the relevant public notice.
[This Article Newly Inserted by Presidential Decree No. 27508, Sep. 22, 2016]
Enforcement Ordinance
Enforcement Ordinance
- Article 110 (Special Cases for Unemployed Persons)
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(1) From among the persons whose employment relationship has expired, those whose total period of having retained eligibility for the employee insured is not less than one year during the period determined by Ordinance of the Ministry of Health and Welfare may file an application with the NHIS for retaining his or her eligibility as the employee insured by the date two months elapse after the due date for the payment of the insurance contributions stated in the first notice he or she receives as the self-employed insured under Article 79.
(2) Notwithstanding Article 9, the insured who files an application with the NHIS under paragraph (1) (hereinafter referred to as "voluntarily continuous insured person") shall retain his or her eligibility during the period prescribed by Presidential Decree: Provided, That where he or she fails to pay the first insurance contributions of the employee insured to be paid after the filing of an application under paragraph (1) until two months elapse after the due date therefor, his or her eligibility shall be suspended.
(3) The amount of monthly remuneration of a voluntarily continuous insured person shall be the average amount of his or her monthly remuneration in recent 12 months during which the amounts of insurance contributions based on monthly remuneration have been calculated
(4) Part of the insurance contributions of a voluntarily continuous insured person may be reduced, as publicly notified by the Minister of Health and Welfare.
(5) Total amount of the insurance contributions of voluntarily continuous insured persons shall be borne and paid by them notwithstanding Articles 76 (1) and 77 (1) 1.
(6) Where a voluntarily continuos insured person fails to pay the insurance contributions by a payment due date, Article 53 (3), (5) and (6) of shall apply mutatis mutandis. In such cases, the terms, "per household insurance contributions referred to in Article 69 (5)" shall be construed as "insurance contributions pursuant to Article 110 (5)".
(7) Matters relating to the methods of and procedures for filing applications to become a voluntarily continuous insured person and other relevant matters shall be prescribed by Ordinance of the Ministry of Health and Welfare.
Enforcement Ordinance
- Article 77 (Applicable Period for Voluntarily and Continuously Insured Persons)
"Period prescribed by Presidential Decree" in the main sentence of Article 110 (2) of the Act is a period of up to 24 months reckoned from the day following the date on which employment relationship comes to an end.
- Article 111 (Assignment and Entrustment of Authority)
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(1) The authority of the Minister of Health and Welfare under this Act may be partially delegated to the Special Metropolitan City Mayor, Metropolitan City Mayors, Do Governors, or the Governor of a Special Self-Governing Province as prescribed by Presidential Decree.
(2) The authority of the Minister of Health and Welfare under Article 97 (2) may be entrusted to the Corporation or the Review and Assessment Service, as prescribed by Presidential Decree.
Enforcement Ordinance
- Article 81 (Management of Sensitive Information and Personally Identifiable Information)
(1) Where it is inevitable to perform the following affairs, the NHIS (including those entrusted with the services of the NHIS under Article 112 of the Act) may manage information on health under Article 23 of the Personal Information Protection Act, information falling under criminal records under subparagraph 2 of Article 18 of the Enforcement Decree of the same Act, and data containing resident registration numbers, passport numbers, driver's license numbers, or alien registration numbers under the subparagraphs of Article 19 of the same Decree:
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 data under Article 81-2 of the Act;
5. Affairs related to the disclosure of personal details, etc. of persons in arrear 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 rewards under Article 104 of the Act;
10. Affairs related to the entrustment of services under Article 112 of the Act.
(2) Where performing the following affairs is inevitable, the Review and Assessment Service may deal with 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 the same Act:
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 performing the following affairs is inevitable, health care institutions (including organizations authorized by health care institutions pursuant to Article 47 (6) of the Act, in the case of subparagraph 2) may deal with 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 the same Act:
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 performing the following affairs is inevitable, 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 manage information referred to in paragraph (1):
1. Affairs related to approval for disposition on default 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 Ordinance
- Article 81-2 (Re-Examination of Regulation)
The Minister of Health and Welfare shall examine the appropriateness of attached Table 4-2 every five years from July 2, 2014 (referring to the period that ends on the day before the base date of every fifth year) and take measures for improvement, etc.
[This Article Newly Inserted by Presidential Decree No. 25429, Jun. 30, 2014]
- Article 112 (Entrustment of Services)
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(1) The Corporation may entrust each of the following services to postal service agencies, financial institutions or other persons prescribed by Presidential Decree:
1. Receipt of insurance premiums and verifying payment of insurance premiums;
2. Payment of insurance benefit costs;
3. Receipt of pension insurance premiums, employment insurance premiums, employment insurance and industrial accident compensation insurance premiums, contributions and other charges (hereinafter referred to as "insurance premiums, etc. entrusted for collection") collected according to the entrustment of the law applicable to the entrustment of collection, or verification of payment of insurance premiums.
(2) The Corporation may entrust part of its services to state agencies, local governments, corporations that conduct social insurance affairs under other Acts and subordinate statutes, or other persons.
(3) The scope of the operations the Corporation may entrust under paragraph (2) and of the persons to whom they may be entrusted shall be prescribed by Ordinance of the Ministry of Health and Welfare.
Enforcement Ordinance
- Article 78 (Entrustment of Duties)
Where the NHIS intends to entrust duties under each subparagraph of Article 112 (1) of the Act to postal service agencies, financial institutions or other persons pursuant to Article 112 (1) of the Act, it shall obtain a resolution by the board of directors of the NHIS with respect to the selection of agencies to be entrusted and the details of entrustment contract.
- Article 113 (Allocation, Payment, etc. of Insurance Premiums, etc. Entrusted for Collection)
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(1) Where the amount of insurance premiums collected by the Corporation, subsequent fees or insurance premiums, etc. entrusted with collection is smaller than the amount the Corporation has to collect, it shall collect the payment in installments according to the criteria and means prescribed by Presidential Decree: Provided, That where a person liable to make such payment states otherwise, the Corporation shall comply therewith.
(2) Where the Corporation has collected insurance premiums, etc. entrusted for collection, it shall immediately pay such to the relevant funds by insurance.
Enforcement Ordinance
- Article 79 (Allocation, etc. of Insurance Contributions and Insurance Contributions, etc. Entrusted with Collection)
Where the NHIS collects insurance contributions and insurance contributions entrusted with collection through one integrated written notification for payment upon request from a person liable for payment (excluding where the NHIS collects such contributions by the means of delinquent dispositions according to Article 81 of the Act and applicable law to entrustment with collection), if the amount of insurance contributions collected, and subsequent fees or insurance contributions entrusted to the NHIS for collection is smaller than the amount the NHIS has to collect, it shall collect the payment in installments in the proportion of the amount by insurance (referring to the amount excluding arrears and additional charges under the Act and applicable law to the entrustment with collection) that the NHIS intends to collect pursuant to the main sentence of Article 113 (1) of the Act, unless the person liable for payment states otherwise by the payment date.
- Article 114 (Purpose, etc. of Contributions)
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(1) For the expenses incurred in conducting services under Article 14 (1) 11, the Corporation shall use contributions received respectively from the National Pension Fund, Industrial Accident Compensation Insurance Fund, Employment Insurance Fund, and Wage Claim Guarantee Fund under the National Pension Act, Industrial Accident Compensation Insurance Act, and Employment Insurance Act.
(2) Matters necessary for management, operation, etc. of contributions received under paragraph (1) shall be prescribed by Presidential Decree.
Enforcement Ordinance
- Article 80 (Management of Contributions)
The NHIS shall keep and manage separate accounts for contributions received from each respective Fund under Article 93-4 (1) of the Act.
- Article 114-2 (Legal Fiction as Public Officials in Application of Penalty Provisions)
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Non-public official members of the Deliberative Committee under Article 4 (1) and of the Health Insurance Publication Deliberation Committee under Article 100 (2) shall be deemed to be public officials in applying Articles 127 and 129 through 132 of the Criminal Act.
[This Article Newly Inserted on Jan. 15, 2019]
