Article 1 (Purpose)

The purpose of this Act is to improve citizens' health and promote social security by providing citizens with insurance benefits for the prevention, medical examination, medical treatment of and rehabilitation from diseases and injury, for childbirth and death, and for improvement of health.

Article 2 (Charge)

The Minister of Health and Welfare shall administer the national health insurance program prescribed by this Act.

Article 3 (Definitions)

The definitions of the terms used in this Act shall be as follows:
1. The term "worker" means a person who, regardless of the type of his/her occupation, lives on remuneration received as compensation for his/her work (including a director or other executive of a corporation), except for a public official or a school employee;
2. The term "employer" means a person who falls under any of the following items:
(a) The owner of the workplace at which a worker is employed;
(b) The head of the organ at which a public official is employed, who is determined by Presidential Decree;
(c) The person who establishes and operates a private school (referring to a private school referred to in Article 3 of the Pension for Private School Teachers and Staff Act; hereafter the same shall apply in this Article) at which a school employee is employed;
3. The term "workplace" means a place of business or office;
4. The term "public official" means a person who is a regular employee of the State or a local government providing civil service;
5. The term "school employee" means a teacher at, or an employee of, a private school or an organization that manages the school.

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Article 4 (Health Insurance Policy Deliberative Committee)

(1) The Health Insurance Policy Deliberative Committee (hereinafter referred to as the "Deliberative Committee") mandated to deliberate and vote on matters concerning health insurance policies, which fall under each of the following subparagraphs, shall be established under the Minister of Health and Welfare:
1. The standards for medical care benefits provided for in Article 41 (2);
2. Matters concerning medical care benefit costs provided for in Article 45 (3) and 46;
3. The insurance premium rates of employer-provided policyholders provided for in Article 73 (1);
4. The monetary value per contribution point of the locally provided policyholders provided for in Article 73 (3);
5. Other important matters prescribed by Presidential Decree concerning health insurance.
(2) The Deliberative Committee shall be comprised of 25 members, including one chairperson and one vice chairperson.
(3) The chairperson of the Deliberative Committee shall be the Vice Minister of Health and Welfare and the vice chairperson shall be nominated by the chairperson from among the members referred to in paragraph (4) 4.
(4) The following persons shall be appointed or commissioned by the Minister of and Welfare as members of the Deliberative Committee:
1. Two persons, each recommended respectively by workers' organizations and employers' organizations;
2. One person, each recommended respectively by civil organizations (referring to the non-profit civil organizations provided for in Article 2 of the Assistance for Non-Profit, Non-Governmental Organizations Act; hereinafter the same shall apply), consumers' organizations, organizations of farmers and fishermen, and organizations of self-employed persons;
3. Eight persons who are recommended by the organizations representing the medical profession and the organizations representing the medicine manufacturers;
4. Eight persons falling under each of the following items:
(a) Two public officials who belong to central administrative agencies prescribed by Presidential Decree;
(b) One person, each recommended respectively by the president of the National Health Insurance Corporation and the president of the Health Insurance and Assessment Service;
(c) Four persons of profound learning and experience in health insurance.
(5) The terms of office of the members of the Deliberative Committee shall be three years: Provided, That the term of office for any member newly appointed, filling a vacancy of a resigned member, etc. shall be the remainder of the term of office for his/her predecessor.
(6) Matters necessary for the operation, etc. of the Deliberative Committee shall be prescribed by Presidential Decree.

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Article 5 (Eligible Persons, etc.)

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

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

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

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

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

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

1. Spouses of the employee insured;

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

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

4. Siblings of the employee insured.

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

Article 6 (Categories of Policyholders)

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

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

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

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

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

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

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

(4) Deleted.

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Article 7 (Reporting on Workplace)

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

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

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

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

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

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

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

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

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

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

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

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

Article 12 (Health Insurance Card)

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

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

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

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

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

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

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

Article 13 (Insurer)

The insurer of national health insurance shall be the National Health Insurance Corporation (hereinafter referred to as the "Corporation").

Article 14 (Services)

(1) The NHIS shall administer the following affairs:

1. Supervision of the eligibility of the insured and their dependents;

2. Imposition and collection of insurance contributions and other fees provided for in this Act;

3. Administration of insurance benefits;

4. Preventive programs prescribed by Presidential Decree, which are conducted by utilizing information on the current state of providing health care benefits and the results of medical examination for the purpose of early detection and prevention of diseases and health management of the insured and their dependents;

5. Payment of insurance benefit costs;

6. Programs for managing, operating, and increasing its assets;

7. Operation of medical facilities;

8. Education and training and public relation in connection with health insurance;

9. Investigative research and international cooperation in connection with health insurance;

10. Matters prescribed by this Act as the service of the NHIS;

11. Operations entrusted under the National Pension Act, the Act on the Collection of Insurance Premiums for Employment Insurance and Industrial Accident Compensation Insurance, the Wage Claim Guarantee Act, and the Asbestos Injury Relief Act (hereinafter referred to as "applicable Acts to the entrustment of collection");

12. Other services entrusted under this Act or other statutes and regulations;

13. Others determined by the Minister of Health and Welfare as being necessary in connection with health insurance.

(2) Programs for managing, operating, and increasing assets under paragraph (1) 6 shall be conducted in accordance with each of the following methods, taking the stability and profitability into consideration:

1. Making deposits or setting up trust at postal service offices or banks established under the Banking Act;

2. Purchase of securities issued directly, or of which fulfillment of the obligation is guaranteed, by the State, local governments, or banks established under the Banking Act;

3. Purchase of securities issued by a corporation established under any Special Act;

4. Purchase of securities issued by trust business entities established under the Financial Investment Services and Capital Markets Act or collective investment business entities established under the same Act;

5. Acquisition of real estates for use in operating the NHIS or partial lease thereof;

6. Other programs prescribed by Presidential Decree as necessary to increase the assets of the NHIS.

(3) If a service is provided, or the use of the facilities of the NHIS is allowed to, a specific person, the NHIS may collect a service charge or a use fee for the provision of the service or the use of the facilities, as prescribed by the NHIS' articles of incorporation.

(4) The NHIS shall disclose to the public the information that it maintains and manages in connection with health insurance as prescribed by the Official Information Disclosure Act.

Article 15 (Legal Personality of Corporation)

(1) The Corporation shall be a juristic person.
(2) The Corporation shall come into existence upon registering its establishment at the seat of its principal office.
Article 16 (Office)(1) Location of the principal office of the Corporation shall be determined by its articles of incorporation.
(2) If necessary, the Corporation may establish branch offices as prescribed by its articles of incorporation.

Article 16 (Office)

)(1) Location of the principal office of the Corporation shall be determined by its articles of incorporation.
(2) If necessary, the Corporation may establish branch offices as prescribed by its articles of incorporation.

Article 17 (Articles of Incorporation)

(1) The articles of incorporation of the Corporation shall state the following matters:
1. Objectives;
2. Its name;
3. Seat of office;
4. Matters concerning its executives and employees;
5. Management of board of directors;
6. Matters concerning its financial operation committee;
7. Matters concerning insurance premiums and insurance benefits;
8. Matters concerning its budget and settlement of accounts;
9. Matters concerning its assets and accounting;
10. Services and provision thereof;
11. Matters concerning amendment of the articles of incorporation;
12. Matters concerning public announcements.
(2) When the Corporation intends to modify its articles of incorporation, it shall obtain authorization of the Minister of Health and Welfare.

Article 18 (Registration)

The registration of incorporation of the Corporation shall include the following matters:
1. Objectives;
2. Its name;
3. Seat of the principal office and branch offices;
4. Name, address and resident registration number of the president.

Article 19 (Dissolution)

Matters regarding the dissolution of the Corporation shall be prescribed by Acts.

Article 20 (Executives)

(1) The Corporation shall have, as its executives, one president, fourteen directors and one auditor. In such cases, the president, five directors and the auditor shall be standing.
(2) The president shall be appointed by the President of the Republic of Korea upon recommendation of the Minister of Health and Welfare from among several persons recommended by the executive recommendation committee established under Article 29 of the Act on the Management of Public Institutions (hereinafter referred to as "executive recommendation committee").
(3) Full-time directors shall be appointed by the president following the recommendation procedures prescribed by Ordinance of the Ministry of Health and Welfare.
(4) As part-time directors, following persons shall be appointed by the Minister of Health and Welfare:
1. Persons, each one of whom is recommended respectively by labor unions, an employer organization, a civil organization, a consumer organization, an agricultural and fisheries organization, and a senor citizens' organization;
2. Three relevant public officials recommended as prescribed by Presidential Decree.
(5) The auditor shall be appointed by the President of the Republic of Korea upon recommendation by the Minister of Strategy and Finance from among several persons recommended by the executive recommendation committee.
(6) Part-time directors prescribed in paragraph (4) may receive reimbursement for actual expenses, as prescribed by the articles of incorporation.
(7) The term of the office of the president shall be three years, and that of directors (excluding directors who are public officials) and auditor shall be two years respectively.

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Article 21 (Collection Director)

(1) Among standing directors, a director who has extensive knowledge and experience in management, economy and social insurance and who meets the qualification determined by Ordinance of the Ministry of Health and Welfare shall be appointed as a director in charge of the operations under Article 14 (1) 2 and 11.
(2) The Corporation shall have a committee for nominating collection directors (hereinafter referred to as "Nomination Committee") in order to nominate candidates for a collection director, having directors as its members. In such cases, a director nominated by the president shall be the chairperson of the Nomination Committee.
(3) The Nomination Committee shall publish recruitment advertisement for a collection director on major daily newspapers, and in addition, may verify a candidate who is regarded as qualified, or request a specialized organization to verify such candidate.
(4) The Nomination Committee shall screen persons recruited pursuant to paragraph (3) according to the candidate screen criteria for a collection director determined by Ordinance of the Ministry of Health and Welfare, and consult on the contract terms with the collection director nominee.
(5) The president shall conclude a contract with the candidate for a collection director in accordance with the result of screening and consultation conducted under paragraph (4), and in such a case, a standing director shall be deemed appointed under Article 20 (3).
(6) Matters necessary for the consultation on contract terms under paragraph (4), contract conclusion, etc. under paragraphs (5) shall be prescribed by Ordinance of the Ministry of Health and Welfare.
[This Article Newly Inserted by Act No. 9690, May 21, 2009]

Article 22 (Duties of Executives)

(1) The president shall represent the Corporation, exercise overall control over its affairs, and take responsibility for the management performance of the Corporation.
(2) The standing directors shall conduct the affairs of the Corporation under the order of the president.
(3) Where the president is unable to perform his/her duties due to an unavoidable circumstance, a standing director determined by the articles of incorporation shall act on behalf of the president, and where no standing director exists or a standing director is unable to perform such duties, an executive determined by articles of incorporation shall act on behalf of the president.
(4) The auditor shall audit the status of the Corporation, its accounting and assets status.

Article 23 (Disqualification of Executives)

No person who falls under any of the following subparagraphs may become an executive of the Corporation:
1. A person who is not a national of the Republic of Korea;
2. A person falling under any subparagraph of Article 34 (1) of the Act on the Management of Public Institutions.

Article 24 (Obligatory Retirement and Dismissal of Executives)

(1) If an executive falls under any of the subparagraphs of Article 23, or is confirmed to fall thereunder at the time of his/her appointment, he/she shall be obligated to retire.
(2) If an executive falls under any of the following subparagraphs, the person with the power to appoint him/her may dismiss him/her:
1. Where he/she is deemed unable to perform his/her duties due to a physical or mental disability;
2. Where he/she breaches an official duty;
3. Where he/she causes loss to the Corporation, either intentionally or through gross negligence;
4. Where he/she commits an act that damages his/her dignity, regardless of whether while on duty or off duty;
5. Where he/she violates an order of the Minister of Health and Welfare issued under this Act.

Article 25 (Prohibition, etc. of Executive's Holding Concurrent Offices)

(1) Standing executives and employees of the Corporation may not engage in another business having a commercial purpose, in addition to the duties assigned to them.
(2) Where a standing executive of the Corporation obtains permission from the person with the power to appoint or recommend him/her, or where an employee of the Corporation obtains permission from the president thereof, such executive or employee may concurrently perform the affairs for non-profit purpose.

Article 26 (Board of Directors)

(1) The Corporation shall have a board of directors in order to deliberate on and resolve important matters (referring to matters prescribed in Article 17 (1) of the Act on the Management of Public Institutions) of the Corporation.
(2) The board of directors shall be comprised of the president and directors.
(3) The auditor may appear before the board of directors to speak.
(4) Matters necessary with regard to the issues to be resolved by the board of directors and the operation of the board of directors shall be prescribed by Presidential Decree.

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Article 27 (Appointment and Dismissal of Employees)

The president shall appoint and dismiss employees as prescribed by the articles of incorporation.

Article 28 (Legal Fiction of Public Officials in Application of Penal Provisions)

The executives and the employees of the Corporation shall be deemed public officials for the purposes of Articles 129 through 132 of the Criminal Act.

Article 29 (Rules, etc.)

Rules relevant to the organization, human resource related affairs, remunerations, and accounting of the Corporation shall be determined with approval from the Minister of Health and Welfare after undergoing a resolution of the board of directors.

Article 30 (Selection and Appointment of Agent)

The president may select and appoint an agent from among the directors or employees of the Corporation in order to have the agent act on behalf of him/her in all judicial or extra-judicial acts relevant to the affairs of the Corporation.

Article 31 (Limitation on Representative Powers)

(1) In connection with the matters with regard to which the interests of the Corporation and the interests of the president are in conflict, the president is not allowed to represent the Corporation. In such cases, the auditor shall represent the Corporation.
(2) Paragraph (1) shall apply mutatis mutandis to any litigation between the Corporation and the president.

Article 32 (Delegation of Powers of Chairperson of Board of Directors)

From among the powers of the president referred to in this Act, those prescribed by Presidential Decree, such as restriction of benefits and notice to pay insurance premiums, may be delegated to the heads of the branch offices pursuant to the articles of incorporation.

Enforcement Ordinance

Article 33 (Financial Operation Committee)

(1) The Corporation shall have a financial operation committee to deliberate and resolve on the matters related to insurance finance, such as contracts of medical care benefit costs provided for in Article 45 (1), the deficit disposal provided for in Article 84.
(2) The chairperson of the financial operation committee shall be elected by the committee from among the committee members referred to in Article 34 (1) 3.

Article 34 (Composition, etc. of Financial Operation Committee)

(1) The financial operation committee shall be comprised of the following members:
1. 10 members representing the employer-provided policyholders;
2. 10 members representing the locally provided policyholders;
3. 10 members representing the public interest.
(2) As the members referred to in paragraph (1), the Minister of Health and Welfare shall appoint or commission the following persons:
1. As the committee members referred to in paragraph (1) 1, five persons each recommended by the labor unions' organization and by the employers' organization;
2. As the committee members referred to in paragraph (1) 2, persons recommended by the agricultural and fishery organization, the urban self-employed persons' organization and the civil organization as prescribed by Presidential Decree;
3. As the committee members referred to in paragraph (1) 3, relevant public officials and persons with extensive knowledge on and experience in health insurance who are determined by Presidential Decree.
(3) The term of the office of the members of the financial operation committee (excluding the members who are public officials) shall be two years: Provided, That the term of the office of any member newly appointed to fill a vacancy of a resigned member, etc. shall be the remaining term of his/her predecessor.
(4) Matters necessary with regard to the operation, etc. of the financial operation committee shall be prescribed by Presidential Decree.

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Article 35 (Accounting)

(1) The fiscal year of the NHIS shall be based on the fiscal year of the Government.

(2) The NHIS shall administer the finance of the employee insured and the self-employed insured in an integrated manner.

(3) The NHIS shall, separately from its other accounting, make accounting treatment for the health insurance program, as well as for the national pension program, employment insurance program, industrial accident compensation insurance program, and wage claim guarantee program entrusted pursuant to Acts authorizing the entrustment of collection, independently from one another.

Article 36 (Budget)

The Corporation shall compile a proposed budget for each fiscal year with separate contents thereof based on the nature thereof, and obtain approval from the Minister of Health and Welfare. This shall also apply where it intends to modify the budget.

Article 37 (Loans)

The Corporation may borrow funds where a shortage of cash exists in making disbursements: Provided, That approval from the Minister of Health and Welfare is necessary for any long-term loan with a term of at least one year.

Article 38 (Reserve Funds)

(1) Out of the funds remaining after the settlement of accounts for each fiscal year, the Corporation shall accumulate as its reserve funds an amount equivalent to at least 5/100 of the expenses required for payment of insurance benefits for that fiscal year until the funds reach 50/100 of the expenses required for that fiscal year.
(2) The reserve funds referred to in paragraph (1) may not be used except to meet shortages in the expenses incurred in paying insurance benefits or where a shortage of cash exists in making disbursements; where the shortage of cash in making disbursements is met out of the reserve funds, the amount shall be made up for within the fiscal year concerned.
(3) Matters necessary for the method of managing, operating, etc. the reserve funds referred to in paragraph (1) shall be prescribed by the Minister of Health and Welfare.

Article 39 (Settlement of Accounts)

(1) The Corporation shall prepare a statement of accounts and a report on business performance for each fiscal year and report to the Minister of Health and Welfare thereon by the end of February in the following year.
(2) When the Corporation reports to the Minister of Health and Welfare on it statement of accounts and business report under paragraph (1), it shall publicly announce the contents thereof as prescribed by Ordinance of the Ministry of Health and Welfare.

Article 40 (Mutatis Mutandis Application of Civil Act)

Unless otherwise prescribed by this Act and the Act on the Management of Public Institutions, the provisions of the Civil Act that are relevant to an incorporated foundation shall apply mutatis mutandis to the Corporation.

Article 39-2 (Contribution to Projects for Supporting Disastrous Medical Expenses)

The NHIS may contribute fund within its budgetary limits every year to be appropriated for the expenses used for the project for supporting disastrous medical expenses under the Act on Support of Disastrous Medical Expenses. In such case, matters necessary for the upper limit amount of such contribution shall be prescribed by Presidential Decree.

[This Article Newly Inserted on Jan. 16, 2018]

Enforcement Ordinance

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]

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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

Article 62 (Establishment)

In order to review the costs of medical care benefits and evaluate the reasonableness of medical care benefits, the Health Insurance and Assessment Service shall be established.

Article 63 (Services, etc.)

(1) The Review and Assessment Service shall be in charge of the services referred to in the following subparagraphs:
1. Review of the costs of medical care benefits;
2. Evaluation of the reasonableness of medical care benefits;
3. Development of criteria for review and evaluation;
4. Investigative research and international cooperation related to the operations referred to in subparagraphs 1 through 3;
5. Services delegated to it in connection with review of the costs of benefits or evaluation of the reasonableness of medical care that are provided for under the provisions of other Acts;
6. Services determined by the Minister of Health and Welfare to be necessary in connection with the health insurance program;
7. Other services prescribed by Presidential Decree in connection with review of the costs of insurance benefits and evaluation of the reasonableness of insurance benefits.
(2) The criteria, procedures, methods, etc. relevant to the evaluation of the reasonableness of medical care benefits referred to in paragraph (1) 2 and 7, and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare.

Enforcement Ordinance

Article 64 (Legal Personality, etc.)

(1) The Review and Assessment Service shall be a juristic person.
(2) The Review and Assessment Service shall come into existence with the registration of its establishment at the seat of its principal office.

Article 65 (Executives)

(1) The Review and Assessment Service shall have as its executives the president, 14 directors and one auditor. In this case, the president, three trustees, and the auditor shall be standing.
(2) The president shall be appointed by the President of the Republic of Korea from among the plural number of persons recommended by the Minister of Health and Welfare.
(3) Standing directors shall be appointed by the president following the recommendation procedures prescribed by Ordinance of the Ministry of Health and Welfare.
(4) As non-standing directors, 10 persons from among the persons falling under the following subparagraphs and one relevant public official recommended as prescribed by Presidential Decree shall be appointed by the Minister of Health and Welfare:
1. One person recommended by the Corporation;
2. Five persons recommended by a medicine related organization;
3. Persons, each one of whom is recommended respectively by a labor unions' group, an employers' organization, a consumer organization, and an agricultural and fishing organization.
(5) The auditor shall be appointed by the President upon recommendation of the Minister of Strategy and Finance from among the plural number of persons recommended by executive recommendation committee.
(6) Non-standing directors prescribed in paragraph (4) may receive reimbursement for actual expenses, as prescribed by the articles of incorporation.
(7) The term of office of the president shall be three years, and that of directors (excluding the director who is a public official) and the auditor shall be two years, respectively.

Enforcement Ordinance

Article 66 (Medical Treatment Review Committee)

(1) In order to efficiently conduct the operations of the Review and Assessment Service, a medical treatment review committee (hereinafter referred to as "review committee") shall be established under the Review and Assessment Service.
(2) The review committee shall be comprised of no more than 50 full-time review members, including the chairperson of the committee, and no more than 100 part-time review members, and it may establish a subcommittee for each area of medical specialization.
(3) Full-time review members referred to in paragraph (2) shall be appointed by the president of the Review and Assessment Service from among the persons prescribed by Ordinance of the Ministry of Health and Welfare.
(4) Part-time review members referred to in paragraph (2) shall be commissioned by the president of the Review and Assessment Service from among the persons prescribed by Ordinance of the Ministry of Health and Welfare.
(5) If a review member falls under any of the following subparagraphs, the president of the Review and Assessment Service may dismiss or remove him/her:
1. Where he/she is deemed incapable of performing his/her duties due to a physical or mental disability;
2. Where he/she breaches or neglects an official duty;
3. Where he/she causes loss to the Review and Assessment Service, either intentionally or through gross negligence;
4. Where he/she does an act that causes damage to his/her dignity, regardless of whether while on duty or off duty;
(6) Necessary matters concerning the qualifications and the term of office of the members of the review committee, the organization and operation of the committee, etc. other than those prescribed in paragraph (1) through (5) shall be prescribed by Ordinance of the Ministry of Health and Welfare.

Article 67 (Raising, etc. of Funds)

(1) The Review and Assessment Service may collect contributions from the Corporation to conduct the operations referred to in Article 63 (1) (excluding the operations referred to in Article 63 (1) 5).
(2) Where affairs related to review of the costs of benefits or evaluation of the reasonableness of medical care are entrusted to the Review and Assessment Service under Article 63 (1) 5, the Review and Assessment Service may collect a fee from the delegator.
(3) The amount and collection method of the special assessment and fee referred to in paragraphs (1) and (2) and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare.

Article 68 (Provisions Applied Mutatis Mutandis)

@Articles 14 (3) and (4), 16, 17 (excluding Article 17 (1) 6 and 7), 18, 19, 22 through 32, 35 (1), 36, 37, 39 and 40 shall apply mutatis mutandis in regard to the Review and Assessment Service. In this regard, the "Corporation" shall be deemed the "Review and Assessment Service" and the "president of the Corporation" shall be deemed the "president of the Review and Assessment Service," respectively.

Article 69 (Insurance Premiums)

(1) To meet the expenses incurred in relation to the health insurance program, the NHIS shall collect insurance contributions from the persons obligated to pay insurance contributions under in Article 77.

(2) The insurance contributions referred to in paragraph (1) shall be collected from the month following that in which the date the insured becomes eligible falls until the month in which the date before the date the insured loses his or her eligibility falls: Provided, That where the eligibility of the insured is obtained on the first day of any month or upon his or her request for health insurance cover under Article 5 (1) 2 (a), the insurance contributions shall be collected from the relevant month.

(3) In collecting insurance contributions under paragraphs (1) and (2), where the eligibility of the insured has been altered, the insurance contributions of the month whereto belongs the altered day shall be collected on the basis of eligibility prior to such alteration: Provided, That where the eligibility of the insured is altered on the first day of any month, it shall be collected on the basis of the altered eligibility.

(4) The amount of the monthly insurance contributions for the employee insured shall be the amount calculated as follows:

1. The amount of insurance contributions based on monthly remuneration: The amount obtained by multiplying the amount of monthly remuneration calculated under Article 70 by the insurance contribution rate under Article 73 (1) or (2);

2. The amount of insurance contributions based on the monthly income: The amount obtained by multiplying the amount of monthly income calculated under Article 71 by the insurance contribution rate under Article 73 (1) or (2).

(5) The amount of the monthly insurance contributions for the self-employed insured shall be calculated per unit of household, but the insurance contributions per month for the household to which the self-employed insured belongs shall be the amount obtained by multiplying the monetary value per contribution point under Article 73 (3) by the contribution points calculated under Article 72.

(6) The upper limit and lower limit of the amount of the monthly insurance contributions under paragraphs (4) and (5) shall be set in accordance with the standards prescribed by Presidential Decree, in consideration of the amount equivalent to a specified ratio of the average insurance contribution of the insured.

Article 70 (Amount of Monthly Remuneration)

(1) The amount of monthly remuneration of the employee insured provided for in Article 69 (4) 1 shall be calculated on the basis of the amount of remuneration received by each of the employee insured.

(2) Insurance contributions based on monthly remuneration for the insured to whom a part or all of his or her remuneration is not paid due to a leave of absence from office or other circumstances (hereinafter referred to as "person temporarily retiring from office, etc.") shall be calculated on the basis of the monthly remuneration amount for the month before the occurrence of the circumstance in question.

(3) Remunerations referred to in paragraph (1) shall mean money and other valuables (excluding anything in the nature of reimbursement for expenses) that workers, etc. receive from employers, the State or local governments for providing their labor, which are determined by Presidential Decree. In such cases, if it falls under the cases prescribed by Presidential Decree, such as there are no data relating to the remunerations or they are indistinct, the amount determined and publicly notified by the Minister of Health and Welfare shall be regarded as the remunerations.

(4) Matters necessary for calculation, etc., of the amount of monthly remuneration referred to in paragraph (1) and calculation, etc., of the amount of monthly remuneration for unremunerated employers, shall be prescribed by Presidential Decree.

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Article 71 (Amount of Monthly Income)

(1) Where the amount of income of the employee insured excluding the amount of remuneration included in the calculation of the amount of monthly remuneration under Article 70 (hereinafter referred to as "extra income other than remuneration") exceeds the amount prescribed by Presidential Decree, the amount of monthly income shall be calculated according to the following formula:

(2) Matters necessary for calculating the amount of monthly income, including the standards for and method of the calculation, shall be prescribed by Presidential Decree.

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Article 72 (Contribution Point)

(1) The contribution point provided for in Article 69 (5) shall be calculated based on the income and property of each of the self-employed insured.

(2) In determining the method and criteria for calculating the contribution point under paragraph (1), assets in relation to which exercise of property rights is restricted under statutes may be treated differently from other assets.

(3) Methods and criteria for calculating contribution points and other necessary matters shall be prescribed by Presidential Decree.

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Article 72-2 (Committee on Improvement of Insurance Contribution Imposition System)

(1) To improve a system related to the imposition of insurance contributions, a Committee on Improvement of the Insurance Contribution Imposition System (hereinafter referred to as the "System Improvement Committee"), consisting of public officials of relevant central administrative agencies and private experts, shall be established under the jurisdiction of the Minister of Health and Welfare.

(2) The System Improvement Committee shall deliberate on the following matters:

1. Surveys and research on the actual conditions of income of the insured ascertained;

2. Improvement plans to ascertain income of the insured and to strengthen the imposition of insurance contributions on such income;

3. Any other matters brought to the System Improvement Committee by the Chairperson, in connection with the improvement of a system related to the imposition of insurance contributions.

(3) The Minister of Health and Welfare shall report results of the operation of the System Improvement Committee established under paragraph (1), to the National Assembly.

(4) Matters necessary for the organization, operation, etc. of the System Improvement Committee, shall be prescribed by Presidential Decree.

[This Article Newly Inserted on Apr. 18, 2017]

Article 72-3 (Evaluating Appropriateness of Insurance Contribution Imposition System)

(1) The Minister of Health and Welfare shall evaluate the appropriateness of the standards for determination of the dependent eligibility referred to in Article 5 (hereafter referred to as "determination standards" in this Article) and that of the criteria, method, etc. for calculating the insurance contributions, amount of monthly remuneration of the employee insured, amount of income of the employee insured, and contribution point under Articles 69 through 72 (hereafter referred to as "calculation criteria" in this Article); and adjust them four years after this Act enters into force.

(2) Where the Minister of Health and Welfare evaluates the appropriateness under paragraph (1), he or she shall comprehensively take account of the following matters:

1. Status of income of the insured ascertained and improvement plans therefor, which have undergone deliberation by the System Improvement Committee pursuant to Article 72-2 (2) 2;

2. Status of income-related data owned by the NHIS;

3. Taxation status of global income referred to in Article 4 of the Income Tax Act (including global income subject to global taxation and global income subject to separate taxation);

4. Balance between insurance contributions imposed on the employee insured and those imposed on the self-employed insured;

5. Changes in insurance contributions caused by adjustment of the determination standards and calculation criteria referred to in paragraph (1);

6. Other matters prescribed by the Minister of Health and Welfare, which may be subject to the evaluation of the appropriateness.

(3) The procedures and method for evaluating the appropriateness under paragraph (1) and other necessary matters shall be prescribed by Presidential Decree.

[This Article Newly Inserted on Apr. 18, 2017]

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Article 73 (Insurance Premium Rate, etc.)

(1) Insurance premium rates for an employer-provided policyholder shall be determined by Presidential Decree, within the limit of 80/100 after undergoing a resolution of the Deliberative Committee.
(2) Insurance premium rate for an employer-provided policyholder who is engaged outside of Korea for business operations shall be 50/100 of the insurance premium rate determined under the provisions of paragraph (1).
(3) The monetary value per contribution point for each of the locally provided policyholders shall be determined by Presidential Decree after undergoing deliberation by the Deliberative Committee.

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Article 74 (Exemption from Insurance Premium)

(1) Where the employee insured falls under any of subparagraphs 2 through 4 of Article 54 (in the case of subparagraph 2 of the same Article, limited to cases where he or she is staying abroad for a period of at least one month prescribed by Presidential Decree: hereafter in this Article the same shall apply), the NHIS shall exempt him or her from payment of insurance contributions: Provided, That the employee insured falling under subparagraph 2 of Article 54 shall be exempted from paying insurance contributions only if he or she does not have any dependent who resides within Korea.

(2) Where the self-employed insured falls under any of subparagraphs 2 through 4 of Article 54, contribution points referred to in Article 72 shall be excluded from calculation of the insurance contributions for the household to which such insured belongs.

(3) For the exemption of insurance contributions under paragraph (1) or the contribution point to be excluded from the computation of insurance contributions under paragraph (2), it shall apply from the month following the month whereto belongs the day on which the reasons for allowance suspension falling under any of subparagraphs 2 through 4 of Article 54 occurs to the month whereto belongs the day on which the reasons cease to exist: Provided, That where any of the following subparagraphs applies, the insurance contributions of relevant month shall not be exempted, or the contribution point shall not be exempted from the computation of insurance contributions:

1. Where the reasons for allowance suspension cease to exist on the first day of each month;

2. Where the insured or his or her dependent falling under subparagraph 2 of Article 54 enters Korea and receives insurance benefits in the month whereto belongs the date of entry, and then leaves Korea in the month.

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Article 75 (Reduction, etc. of Insurance Premiums)

(1) Regarding the insured prescribed by Ordinance of the Ministry of Health and Welfare from among the following insured, part of the insurance contributions of the insured or the households to which the insured belongs may be reduced:

1. Persons who reside on islands, in remote areas or agricultural and fishery communities, etc. prescribed by Presidential Decree;

2. Persons who are at least 65 years old;

3. Persons with disabilities who are registered pursuant to the Act on Welfare of Persons with Disabilities;

4. Persons who have rendered distinguished service for the State, provided for in Article 4 (1) 4, 6, 12, 15, or 17 of the Act on the Honorable Treatment of and Support for Persons of Distinguished Service to the State;

5. Persons who take a leave of absence from office;

6. Other persons determined and publicly notified by the Minister of Health and Welfare as the persons whose insurance contributions need to be reduced on the grounds of the economic hardship and natural disaster, etc.

(2) Where a person obligated to pay insurance contributions under Article 77 falls under any of the following, he or she may be granted such financial benefits as reduction of insurance contributions, as prescribed by Presidential Decree:

1. Where he or she receives a billing of insurance contributions by means of an electronic document under Article 79 (2);

2. Where he or she pays insurance contributions by means of automatic transfer from bank account or credit card.

(3) Methods of and procedures for reducing insurance contributions under paragraph (1) and other necessary matters shall be determined and publicly notified by the Minister of Health and Welfare.

[Title Amended on May 22, 2013]

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Article 76 (Burden of Insurance Premiums)

(1) The insurance premiums for an employer-provided policyholder shall be borne, 50/100 each, by the employer-provided policyholder and the person referred to in the following classifications: Provided, That where an employer-provided policyholder is a school employee working for a private school, 50/100, 30/100, and 20/100 of the amount of the insurance premium shall be borne by the said employer-provided policyholder, the person prescribed in subparagraph 2 (c) of Article 3, and the State, respectively:
1. Where the employer-provided policyholder is a worker: The employer prescribed in subparagraph 2 (a) of Article 3;
2. Where the employer-provided policyholder is a public official: The State or the local government to which that public official belongs;
3. Where the employer-provided policyholder is a school employee (excluding school employees working for private schools): The employer prescribed in subparagraph 2 (c) of Article 3.
(2) Insurance premiums based on monthly income of a employer-provided policyholder shall be borne by the employer-provided policyholder.
(3) The insurance premiums for a locally provided policyholder shall be borne jointly by all locally provided policyholders who reside in the same household as the said policyholder.
(4) Where an employer-provided policyholder is a school employee, and if an employee prescribed in subparagraph 2 (c) of Article 3 is unable to bear the whole amount to be borne, the deficiency may be made to be borne from the account of the school.

Article 77 (Responsibility for Payment of Insurance Premiums)

(1) Insurance contributions of the employee insured shall be paid by the person as follows pursuant to the following classifications:

1. Insurance contributions based on monthly remuneration: In such cases, where the workplace has more than two employers, the employers of the workplace shall jointly pay the insurance contributions of the relevant employee insured;

2. Insurance contributions based on monthly income: The employee insured.

(2) Insurance contributions of the self-employed insured shall be paid jointly by all the self-employed insured of a household to which the insured belong: Provided, That minors who have no income or property and minors who meet the criteria prescribed by Presidential Decree in consideration of income, property, etc., shall not be liable to pay insurance contributions.

(3) An employer shall pay the portion of the insurance contributions for the month to be borne by the employee insured out of the insurance contributions based on monthly remuneration by deducting it from his or her remunerations. In such cases, the employer shall inform the employee insured of the amount of deduction.

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Article 78 (Deadline for Payment of Insurance Premiums)

(1) A person who is liable to pay insurance premiums under Article 77 (1) and (2) shall pay the policyholder's insurance premiums for the applicable month by the tenth day of the following month: Provided, That insurance premiums based on monthly income of employer-provided policyholders and insurance premiums of locally provided policyholders may be paid quarterly, as prescribed by Ordinance of the Ministry of Health and Welfare.
(2) Where any cause or event prescribed by Ordinance of the Ministry of Health and Welfare, such as delay in the delivery of notice of payment, occurs, the Corporation may extend the payment deadline up to one month from the payment deadline provided under paragraph (1) at the request of the person obligated to make such payment, notwithstanding paragraph (1). In such cases, matters relating to the method and procedures for applying for the extension of payment deadline and other relevant matters shall be prescribed by Ordinance of the Ministry of Health and Welfare.

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Article 79 (Notice to Pay Insurance Premium, etc.)

(1) When the Corporation intends to collect insurance premiums, etc., it shall determine the amount thereof and make a payment notice to each person who is obligated pay it by means of a written notice wherein following matters are stated:
1. Types of insurance premium, etc. to be collected;
2. Amount subject to be paid;
3. Deadline for and place of payment.
(2) If requested by a person obligated to pay the insurance premium, the Corporation may, when a payment notice is to be issued under paragraph (1), notify it by means of an electronic document, such as exchange of electronic messages.
(3) Where the Corporation makes a payment notice by means of an electronic document under paragraph (2), it shall be deemed received by the person obligated to make payment at the time it is saved in the information and communications network prescribed by Ordinance of the Ministry of Health and Welfare or entered into the address of an electronic mail designated by the person obligated to make payment.
(4) Where the employers of an employer-provided policyholder are two or more persons or where a household of a locally provided policyholder consists of two or more persons, a notice made to any one of them shall be deemed to take its effect to all other employers of the relevant workplace or all other locally provided policyholders who are the relevant household members.
(5) A payment notice issued to a person temporarily retiring from office, etc. may be postponed until the time the reason for temporary retirement, etc. disappears, as prescribed by Ordinance of the Ministry of Health and Welfare.
(6) Matters necessary for the method, procedures, etc. for applying for notice by means of an electronic document under paragraph (2) shall be prescribed by Ordinance of the Ministry of Health and Welfare.

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Article 79-2 (Payment of Insurance Premiums, etc. by Credit Cards, etc.)

(1) The person who pays insurance contributions, etc., the billing of which is made by the NHIS may pay them by credit card, debit card, etc. (hereafter referred to as "credit card, etc." in this Article) through an institution, etc. prescribed by Presidential Decree for vicarious payment of insurance contributions, etc. (hereafter referred to as "institution for vicarious payment of insurance contributions, etc." in this Article).

(2) Where payment is made by credit card, etc. pursuant to paragraph (1), the date the institution for vicarious payment of insurance contributions, etc. approves it shall be deemed the date of payment.

(3) An institution for vicarious payment of insurance contributions, etc. may collect fees from payers of insurance contributions, etc. in return for its vicarious payment of insurance contributions, etc.

(4) Matters necessary for designating and operating institutions for vicarious payment of insurance contributions, etc., fees, etc., shall be prescribed by Presidential Decree.

[This Article Newly Inserted on May 20, 2014]

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Article 80 (Arrears)

(1) If a person obligated to pay insurance contributions, etc. fails to pay insurance contributions, etc. by the payment due date, the NHIS shall collect the following arrears each day from the date payment thereof becomes overdue:

1. Where he or she fails to pay insurance contributions pursuant to Article 69 or collections related to insurance benefits received during the period of insurance benefit suspension pursuant to Article 53 (3): An amount equivalent to 1/1,500 of the amount in arrears. In such cases, the arrears shall not exceed 20/1,000 of the amount in arrears;

2. Where he or she fails to pay collections pursuant to this Act, other than those referred to in subparagraph 1: An amount equivalent to 1/1,000 of the amount in arrears. In such cases, the arrears shall not exceed 30/1,000 of the amount in arrears.

(2) If a person obligated to pay insurance contributions, etc. fails to pay insurance contributions, etc. in arrears, the NHIS shall collect another additional charge falling under any of the following subparagraphs in addition to the arrears under paragraph (1) each day from the date 30 days elapse after the payment due date:

1. Where he or she fails to pay insurance contributions pursuant to Article 69 or collections related to insurance benefits received during the period of insurance benefit suspension pursuant to Article 53 (3): An amount equivalent to 1/6,000 of the amount in arrears. In such cases, the arrears shall not exceed 50/1,000 of the amount in arrears;

2. Where he or she fails to pay collections pursuant to this Act, other than those referred to in subparagraph 1: An amount equivalent to 1/3,000 of the amount in arrears. In such cases, the arrears shall not exceed 90/1,000 of the amount in arrears.

(3) If any natural disaster occurs or any other extenuating circumstance prescribed by Ordinance of Ministry of Health and Welfare exists, collection of arrears referred to paragraphs (1) and (2) may be forgone, notwithstanding paragraphs (1) and (2).

Article 81 (Overdue Notice of Insurance Contributions and Disposition on Default)

(1) Where a person who is liable to pay insurance contributions, etc. pursuant to Articles 57, 77, 77-2, 78-2, and 101 fails to pay the insurance contributions, etc., the NHIS may make overdue notice by the specified period. In such cases, where the number of employers of the employee insured is at least two, or the household of the self-employed insured consists of two or more members, overdue notice made to any of the employers or any of the household members shall be deemed effective regarding the other employers of the relevant workplace or the other self-employed insured who are the members of the household.

(2) Where overdue notice is being made under paragraph (1), a payment period of at least ten days, but not more than 15 days shall be determined and a letter of overdue notice shall be issued.

(3) Where a person who receives overdue notice referred to in paragraph (1) fails to pay the insurance contributions, etc. by the payment due date, the NHIS may collect it in the same manner as national taxes in arrears are collected, after obtaining approval from the Minister of Health and Welfare.

(4) The NHIS shall, before taking a disposition on delinquency pursuant to paragraph (3), send a written notice containing the details of payment in arrears of the insurance contributions, etc., the kinds of seizable property, the fact of planned seizure, and the fact of prohibition of the seizure of small financial property under subparagraph 18 of Article 41 of the National Tax Collection Act: Provided, That this shall not apply in cases determined by Presidential Decree where it is necessary to urgently take a disposition on delinquency, such as in case of dissolution of a corporation.

(5) Where the NHIS determines that an asset seized in the same manner as national taxes in arrears are collected under paragraph (3) is not appropriate to be auctioned directly by it because expert knowledge is necessary for the public auction or because of other special circumstances, the NHIS may have the Korea Asset Management Corporation established under the Act on the Establishment of Korea Asset Management Corporation (hereinafter referred to as the "Korea Asset Management Corporation") conduct the auction on behalf of the NHIS, and in which case the auction shall be deemed to have been conducted by the NHIS.

(6) Where the Korea Asset Management Corporation conducts an auction on behalf of the NHIS under paragraph (5), the NHIS may pay a fee, as prescribed by Ordinance of the Ministry of Health and Welfare.

Article 81-2 (Provision of Data concerning Default or Disposition on Deficits)

(1) Where any centralized credit information collection agency provided for in Article 25 (2) 1 of the Use and Protection of Credit Information Act requests data concerning the personal information, amount in arrears, or amount written off, of any of the following defaulters or persons whose amount in arrears is written off (hereafter referred to as "data concerning default, etc." in this Article), the Corporation may provide such data, if necessary for the collection of insurance premiums or for public interest: Provided, That this shall not apply where any administrative appeal or administrative litigation is pending in connection with the insurance premiums in arrears or any other amount collectable under this Act, or where any other cause or event prescribed by Presidential Decree occurs:
1. A person in whose case the total amount of insurance premiums remaining unpaid for a period exceeding one year from the following day of the time limit for payment under this Act, other amount to be paid, and the disposition fee for arrears under this Act is not less than five million won;
2. A person in whose case the total amount written off under Article 84 is not less than five million won.
(2) Matters relating to the procedures for the provision of data concerning default, etc. shall be prescribed by Presidential Decree.
(3) No person who is provided with data concerning default, etc. under paragraph (1) shall divulge or use them for any purpose other than for performing his/her official duties.
[This Article Newly Inserted by Act No. 11787, May 22, 2013]

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Article 82 (Installment Payments of Insurance Premiums in Arrears)

(1) Where a person who has been in arrear with insurance contributions at least three times applies for the payment of insurance contributions in installments, the NHIS may grant approval therefor, as prescribed by Ordinance of the Ministry of Health and Welfare.

(2) Before taking a disposition on delinquency under Article 81 (3) against a person who has been in arrear with insurance contributions three times or more, the NHIS shall inform such person that he or she can apply for payment of insurance contributions in installments under paragraph (1), and guide the matters concerning procedures and methods for applying for payment of insurance contributions in installments, as prescribed by Ordinance of the Ministry of Health and Welfare.

(3) Where a person who obtains approval for the payment of insurance contributions in installments pursuant to paragraph (1) fails to pay the approved insurance contributions at least five times (if the number of installments approved under paragraph (1) is less than five times, it means the number of installments) without any justifiable grounds therefor, the NHIS shall revoke its approval for payment of his or her insurance contributions in installments.

(4) Necessary matters concerning procedures for, methods of and standards for, etc. approval, and the revocation of approval to pay insurance contributions in installments shall be prescribed by Ordinance of the Ministry of Health and Welfare.

Article 83 (Disclosure of Personal Information of Persons who are Defaulters of Large Amount or who Habitually Falls into Arrears)

(1) Where a person who has defaulted in the payment of insurance contributions, arrears, and expenses for disposition on default (including insurance contributions, arrears and expenses for disposition on default which have been written off under Article 84 but the extinctive prescription for which has not run out) which have been in arrears for more than one year from the day following the payment due date under this Act in the amount of not less 10 million won in total despite the fact that he or she has the ability to pay them, the NHIS may disclose his or her personal details, amount in arrears, etc. (hereafter referred to as "personal details, etc." in this Article): Provided, That this shall not apply where an objection pursuant to Article 87 or a request for trial pursuant to Article 88 is filed, or an administrative litigation is pending, in regard to insurance contributions in arrears, arrears, or expenses for disposition on default or where any cause prescribed by Presidential Decree, such as partial payment of the amount in arrears, exists.

(2) The Deliberative Committee on Disclosure of Insurance Contribution Information shall be established in the NHIS in order to deliberate on whether to disclose personal details, etc. under paragraph (1) of persons in arrear.

(3) The Deliberative Committee on Disclosure of Insurance Contribution Information 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) Personal details, etc. of persons in arrear under paragraph (1) shall be disclosed by means of publication in the Official Gazette or posting on the website of the NHIS.

(5) Matters necessary for the criteria for the ability to make payment, procedures for disclosure, organization, and operation of the Committee, etc. concerning the disclosure of personal details, etc. of persons in arrear under paragraphs (1) through (4) shall be prescribed by Presidential Decree.

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Article 84 (Dispositions as Losses)

(1) Where any of the following grounds occur, the Corporation may write off insurance premiums, etc. as loss after obtaining a resolution of the financial operation committee:
1. Where the disposition on default is concluded and the portion to be appropriated for the amount in arrears is insufficient for meeting the amount in arrears;
2. Where the extinctive prescription for the claim concerned has run out;
3. Cases determined by Presidential Decree where the possibility of collection is recognized nonexistent.
(2) Where the Corporation discovers the existence of other seizable assets after the disposition on loss under paragraph (1) 3, it shall immediately cancel the disposition and effect a default disposition.

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Article 85 (Precedence of Collection of Insurance Premium, etc.)

Insurance premiums, etc. shall be collected before other claims except for national taxes and local taxes: Provided, That this shall not apply to the claims secured by a lease on a deposit basis, the right of pledge or a mortgage where the insurance premium is assessed against the proceeds from the sale of an asset for which entering into a lease on a deposit basis, the right of pledge or a mortgage having been registered prior to the payment period for the insurance premiums, etc. is proved.

Article 86 (Appropriation for and Return of Insurance Premium, etc.)

(1) Where any payment of the insurance contributions, etc., arrears, or expenses for disposition on default is overpaid or erroneously paid by a person liable to make such payment, the NHIS shall appropriate the overpayment or erroneous payment first for the insurance contributions, etc., arrears, or expenses for disposition on default, as prescribed by Presidential Decree.

(2) The NHIS shall refund any balance remaining after the appropriation pursuant to paragraph (1) to the person liable to make payment, as prescribed by Presidential Decree.

(3) In the cases of paragraphs (1) and (2), interest prescribed by Presidential Decree shall be added to the overpayment or erroneous payment.

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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.

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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.

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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.

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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.

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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.

Article 91 (Prescription)

(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)

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)

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.)

(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)

(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

Enforcement Ordinance

Article 96 (Furnishing of Materials)

(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 96-2 (Preservation of Documents)

(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)

(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)

(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)

(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 99 (Penalty Surcharges)

(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

Enforcement Ordinance

Enforcement Ordinance

Enforcement Ordinance

Article 100 (Publication of Fact of Violation)

(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

Enforcement Ordinance

Enforcement Ordinance

Enforcement Ordinance

Article 101 (Prohibited Acts of Manufacturers, etc.)

(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)

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.)

(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)

(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

Enforcement Ordinance

Article 105 (Prohibition from Use of Similar Names)

(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)

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)

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)

(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.)

(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

Enforcement Ordinance

Enforcement Ordinance

Enforcement Ordinance

Article 110 (Special Cases for Unemployed Persons)

(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 111 (Assignment and Entrustment of Authority)

(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

Enforcement Ordinance

Article 112 (Entrustment of Services)

(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 113 (Allocation, Payment, etc. of Insurance Premiums, etc. Entrusted for Collection)

(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 114 (Purpose, etc. of Contributions)

(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 114-2 (Legal Fiction as Public Officials in Application of Penalty Provisions)

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]

Article 115 (Penalty Provisions)

(1) A person who divulges personal information of the insured or their dependents, uses such information for any purpose other than to perform his or her duties or provides such information to a third party without any justifiable grounds in violation of subparagraph 1 of Article 102 shall be punished by imprisonment with labor for not more than five years, or by a fine not exceeding 50 million won.

(2) Any of the following persons shall be punished by imprisonment with labor for not more than three years or by a fine not exceeding 30 million won:

1. A person who works for a claim processing agency and files a claim for costs of health care benefits by fraud or other improper means;

2. A person who divulges any information learned in the course of performing his or her duties, uses such information for any purpose other than to perform his or her duties or provides such information to a third party, in violation of subparagraph 2 of Article 102.

(3) Any person who uses or utilizes computerized information data shared in violation of 96-2 (3) for purposes other than those under paragraph (1) of the same Article shall be punished by imprisonment with labor for not more than three years or by a fine not exceeding 10 million won.

(4) A person who receives or arranges another person to receive insurance benefits by fraud or other improper means shall be punished by imprisonment with labor for not more than two years, or by a fine not exceeding 20 million won.

(5) Any of the following persons shall be punished by imprisonment with labor for at least one year or by a fine not exceeding 10 million won:

1. The founder of a health care institution who provides selective benefit, in violation of Article 42-2 (1) or (3);

2. A person who permits any other person who is not a claim processing agency to vicariously examine such claims, in violation of Article 47 (6);

3. An employer who violates Article 93;

4. The founder of a health care institution, who violates Article 98 (2);

5. Deleted.

Article 116 (Penal Provisions)

A person who fails to report or submit documents, a person who files a false report or submits false documents, or a person who refuses, interferes with or evades inspection or questioning in violation of Article 97 (2) shall be punished by a fine not exceeding 10 million won.

Article 117 (Penal Provisions)

A person who violates Article 40 (4) or a person who fails to issue a detailed statement of medical care costs or a receipt stating the particulars of the medical care in violation of Article 49 (2) shall be punished by a fine not exceeding five million won.

Article 118 (Joint Penal Provisions)

Where the representative of a corporation, or an agent, employee or any other person working for the corporation or an individual commits any act which violates Articles 115 through 117 in connection with the business of the corporation or the individual, not only shall such violator be punished accordingly, but the corporation or the individual shall be punished by a fine prescribed in the relevant provisions: Provided, That the same shall not apply to cases where the corporation or the individual has not been negligent in paying due attention and supervision to the relevant business in order to prevent such violation.

Article 119 (Administrative Fines)

(1) Deleted.

(2) Deleted.

(3) A person who falls under any of the following subparagraphs shall be subject to an administrative fine not exceeding five million won:

1. An employer who fails to make a report or makes a false report, in violation of Article 7;

2. A person who fails to file a report or to submit documents without any justifiable grounds, or files a false report or submits false documents, in violation of Article 94 (1);

3. A person who fails to make a report or to submit documents without any justifiable grounds, or makes a false report or submits false documents, in violation of Article 97 (1), (3), (4), or (5);

4. A person who fails to notify, without delay, the fact that he or she is subject to an administrative disposition or the fact that the procedure of an administrative disposition is under way, in violation of Article 98 (4);

5. A person who fails to submit documents or submits false documents without any justifiable grounds, in violation of Article 101 (2).

(4) Any of the following persons shall be punished by an administrative fine not exceeding one million won:

1. Deleted;

2. Deleted;

3. Deleted;

4. A person who fails to preserve documents in violation of Article 96-3;

5. A person who violates an order issued under Article 103;

6. Any person who violates Article 105.

(5) Administrative fines under paragraphs (3) and (4) shall be imposed and collected by the Minister of Health and Welfare, as prescribed by Presidential Decree.

Enforcement Ordinance